David S. Goldstein

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David S. Goldstein
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NationalityAmerican
OccupationInternist

David S. Goldstein is an American internist who has researched biomarkers and pathophysiologic mechanisms of autonomic and catecholamine-related disorders including pure autonomic failure, Parkinson's disease, and multiple system atrophy at the NIH. He currently serves as Chief of the Autonomic Medicine Section (AMS), in the Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke (NINDS). Goldstein has worked at the NIH for 45 years, including more than 30 years at the NINDS, acting sequentially as Chief of the Clinical Neurochemistry Section, Clinical Neurocardiology Section, and AMS.[1]

Research

The autonomic nervous system is the portion of the nervous system that is especially involved with automatic, unconscious, involuntary processes that are required for maintaining organismic integrity.[2] Dysautonomias are conditions in which altered activity of one or more components of the autonomic nervous system adversely affect health.[3] The catecholamines dopamine, norepinephrine, and epinephrine (adrenaline) are major chemical messengers of the autonomic nervous system.[4]

Goldstein has contributed work in 5 areas related to autonomic and catecholaminergic systems of the body: (a) clinical catecholamine neurochemistry,[5] (b) clinical sympathetic neuroimaging,[6] (c) cardiac autonomic physiology and pathophysiology,[7] (d) mechanisms of catecholaminergic neurodegeneration,[8] and (e) stress and homeostasis.[9] His publications have been widely cited, with an h-index of 125 according to Google Scholar.[10]

Clinical catecholamine neurochemistry

Goldstein and colleagues were the first to validate liquid chromatography with electrochemical detection for measuring plasma levels of the catecholamines norepinephrine and epinephrine in humans.[11] The methodology was expanded to plasma levels of 3,4-dihydroxy compounds (catechols), which includes the catecholamines, 3,4-dihydroxyphenylglycol (DHPG), 3,4-dihydroxyphenylacetic acid (DOPAC), and 3,4-dihydroxyphenylalanine (DOPA).[12] Applying this methodology, Goldstein showed that plasma levels of DHPG provide information on the fate of the sympathetic neurotransmitter norepinephrine in sympathetic nerves.[13] With Irwin J. Kopin he elucidated the sources and meanings of plasma levels of catechols and showed that particular abnormal plasma catechol patterns characterize Menkes disease, L-aromatic-amino-acid decarboxylase deficiency, dopamine-beta-hydroxylase deficiency, and familial dysautonomia.[14] With Graeme Eisenhofer, he estimated the rates of all the intra-neuronal processes in the synthesis, storage, release, reuptake, and metabolism in the human heart and discovered the bases for norepinephrine depletion despite increased norepinephrine release in congestive heart failure.[15] Expanding the assay methodology to post-mortem brain tissue, Goldstein reported evidence for a vesicular storage defect in residual putamen catecholaminergic neurons.[16] Post-mortem assays of myocardial tissue revealed a similar abnormality in cardiac sympathetic nerves in Lewy body diseases.[17] The autotoxic catecholaldehyde, 3,4-dihydroxyphenylacetaldehyde (DOPAL), an obligate intermediate in neuronal dopamine metabolism, is a catechol, and Goldstein discovered DOPAL buildup with respect to dopamine in post-mortem putamen from patients with Parkinson's disease.[18] He also reported the mechanisms of DOPAL buildup, including a shift from vesicular uptake to oxidative deamination of cytoplasmic dopamine.[19] Application of the catechols assay to cerebrospinal fluid (CSF) revealed that low DOPAC levels predict the later development of PD in individuals at risk for the disease.[20]

Clinical sympathetic neuroimaging

Goldstein and colleagues pioneered clinical sympathetic neuroimaging by 18F-dopamine positron emission tomography (PET) beginning in the late 1980s.[21] Applying this technology the group described cardiac sympathetic denervation in Parkinson's disease (PD) and pure autonomic failure (PAF), in contrast with intact innervation in most patients with multiple system atrophy (MSA).[22] These findings subsequently were confirmed by post-mortem immunohistochemistry[23] and neurochemistry. This was early evidence that PD is not only a brain disease and movement disorder but a generalized disease that involves a lesion of the autonomic nervous system in the heart. Goldstein and colleagues went on to validate cardiac 18F-dopamine PET as an in vivo biomarker of myocardial norepinephrine stores.[24] Computational modeling based on 18F-dopamine PET and catecholamine neurochemistry identified multiple functional abnormalities in cardiac sympathetic nerves in Lewy body diseases (LBDs).[25] In the intramural NINDS PDRisk study, Goldstein et al. reported in 2024 that low cardiac 18F-dopamine-derived radioactivity predicts the later development of central LBDs in at-risk individuals.[26] These and many other studies have demonstrated the remarkable power of 18F-dopamine PET for elucidating pathophysiological mechanisms and enhancing the diagnosis and informing the prognosis of diseases involving catecholaminergic neurodegeneration.

Autonomic circulatory physiology and pathophysiology

Goldstein has developed, validated, and applied several clinical laboratory physiological tests to assess different aspects of autonomic circulatory physiology and pathophysiology. A relatively early study compared techniques for assessing baroreflex function in humans.[27] With a co-worker he validated non-invasive methods for evaluating blood pressure continuously using finger cuff or radial tonometric devices. Applying this methodology he reported a non-invasive means to detect sympathetic neurocirculatory failure.[28] He noted that tracking the blood pressure continuously after premature heartbeats provided a "one-beat Valsalva maneuver" for identifying baroreflex-sympathoneural dysfunction.[29] His team developed, validated, and applied the baroreflex areas method for quantifying baroreflex-sympathoneural function.[30] Subsequently Goldstein and Sharabi found that baroreflex-sympathoneural dysfunction predicts central Lewy body diseases in at-risk individuals.[31]

Mechanisms of catecholaminergic neurodegeneration

Goldstein has advanced the "catecholaldehyde hypothesis," according to which the obligate intra-neuronal dopamine metabolite 3,4-dihydroxyphenylacetaldehyde (DOPAL) causes or contributes to catecholaminergic neurodegeneration.[32] His group discovered that putamen catecholamine depletion in Parkinson's disease and multiple system atrophy (MSA) is related to DOPAL buildup,[33] and they identified a "double hit" determining intra-neuronal DOPAL accumulation—decreased vesicular sequestration of cytoplasmic dopamine and decreased DOPAL detoxification by aldehyde dehydrogenase.[34] Consistent with pathogenic toxic interactions between DOPAL and the protein alpha-synuclein, they discovered that DOPAL potently oligomerizes, aggregates, and forms quinoprotein adducts with alpha-synuclein.[35] Reducing DOPAL production and inhibiting harmful DOPAL-alpha-synuclein interactions could be the basis for a disease-modification strategy to delay the onset or slow the progression of catecholaminergic neurodegeneration. Using a novel computational approach his group identified multiple functional abnormalities in cardiac sympathetic nerves in LBDs and modeled the progression of LBDs and effects of genetic predispositions and treatments on that progression.[36] The modeling identified tri-phasic progression of catecholamine depletion in LBDs, confirmed by analysis of prospective longitudinal data from the intramural NINDS PDRisk study.[37]

Stress and homeostasis

In several essays and books Goldstein has conveyed the "homeostat theory," a cohesive concept that refines stress and distress as medical scientific ideas.[38] Walter B. Cannon's views about homeostasis and a unitary sympathoadrenal system maintaining homeostasis during emergencies and Hans Selye's notion of non-specificity of the stress response have required revision. Goldstein's team provided early evidence for increased sympathetic noradrenergic outflow even during non-emergency activities such as mental challenge[39] and for differential adrenomedullary and sympathoneural responses in neurocardiogenic syncope.[40] Based on simultaneous measurements of norepinephrine, epinephrine, and corticotropin responses to various stressors, Goldstein's team tested Selye's doctrine of non-specificity for the first time, and the results refuted the notion of a unitary stress response regardless of the stressor.[41] Meta-analysis of the literature showed that across a variety of stressors plasma epinephrine responses are more closely tied to corticotropin than to norepinephrine responses, disconfirming Cannon's notion of a unitary sympathoadrenal response to stress. He has contrasted integrative physiology with systems biology and predicted rapprochement between these two epistemologies in a way that avoids teleological purposiveness, transcends pure mechanism, and incorporates adaptiveness in evolution.[42] Recently Goldstein introduced the concept of the extended autonomic system (EAS), which contains John Newport Langley's autonomic nervous system, neuroendocrine systems (including the sympathetic adrenergic system), the inflammatory/immune system, and the central autonomic network (within which is embedded the central stress system).[43] The EAS concept provides a systems-based framework for understanding multi-system disorders of regulation such as myalgic encephalomyelitis/chronic fatigue syndrome, postural tachycardia syndrome, Gulf War Illness, and acute and post-acute SARS-CoV2 (PASC).[44]

References

  1. "David S. Goldstein, M.D., Ph.D." irp.nih.gov. NIH Intramural Research Program. Retrieved August 5, 2024.
  2. Goldstein, David (2006). Adrenaline and the Inner World: An Introduction to Scientific Ingegrative Medicine. Baltimore, MD: The Johns Hopkins University Press. p. 309. ISBN 0-8018-8289-3.
  3. Goldstein, David (2001). The Autonomic Nervous System in Health and Disease. New York: Marcel Dekker, Inc. p. 618. ISBN 0-8247-0408-8.
  4. Goldstein, David S.; Eisenhofer, Graeme; McCarty, Richard (1998). Catecholamines: Bridging Basic Science with Clinical Medicine. New York: Academic Press. p. 1084. ISBN 0-12-032943-3.
  5. Goldstein, David (2018). "Roles of catechol neurochemistry in autonomic function testing". Clin Auton Res. 28 (3): 273–288. doi:10.1007/s10286-018-0528-9. PMC 8895275. PMID 29705971.
  6. Goldstein, David (2018). "Roles of cardiac sympathetic neuroimaging in autonomic medicine". Clin Auton Res. 28 (4): 397–410. doi:10.1007/s10286-018-0547-6. PMC 8917443. PMID 30062642.
  7. Goldstein, David (2017). "Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver". Clin Auton Res. 27 (6): 361–367. doi:10.1007/s10286-017-0474-y. PMC 8897824. PMID 29052077.
  8. Goldstein, David (2021). "The Catecholaldehyde Hypothesis for the Pathogenesis of Catecholaminergic Neurodegeneration: What We Know and What We Do Not Know". Int J Mol Sci. 22 (11): 5999. doi:10.3390/ijms22115999. PMC 8199574. PMID 34206133.
  9. Goldstein, David (2019). "How does homeostasis happen? Integrative physiological, systems biological, and evolutionary perspectives". Am J Physiol Regul Integr Comp Physiol. 316 (4): R301–R317. doi:10.1152/ajpregu.00396.2018. PMC 6483214. PMID 30649893.
  10. "Google Scholar | David S. Goldstein". scholar.google.com. Google Scholar. Retrieved August 5, 2024.
  11. Goldstein, David (1981). "Validity and reliability of liquid chromatography with electrochemical detection for measuring plasma levels of norepinephrine and epinephrine in man". Life Sci. 28 (5): 467–475. doi:10.1016/0024-3205(81)90139-9. PMID 7207028. Retrieved 4 August 2024.
  12. Holmes, Courtney (1994). "Improved assay for plasma dihydroxyphenylacetic acid and other catechols using high-performance liquid chromatography with electrochemical detection". J Chromatogr B Biomed Appl. 653 (2): 131–138. doi:10.1016/0378-4347(93)e0430-x. PMID 8205240. Retrieved 4 August 2024.
  13. Goldstein, David (1988). "Plasma dihydroxyphenylglycol and the intraneuronal disposition of norepinephrine in humans". J Clin Invest. 81 (1): 213–220. doi:10.1172/JCI113298. PMC 442496. PMID 3335637.
  14. Goldstein, David (1996). "Catecholamine phenotyping: clues to the diagnosis, treatment, and pathophysiology of neurogenetic disorders". J Neurochem. 67 (5): 1781–1790. doi:10.1046/j.1471-4159.1996.67051781.x. PMID 8863481. Retrieved 4 August 2024.
  15. Eisenhofer, Graeme (1996). "Cardiac sympathetic nerve function in congestive heart failure". Circulation. 93 (9): 1667–1676. doi:10.1161/01.cir.93.9.1667. PMID 8653872. Retrieved 4 August 2024.
  16. Goldstein, David (2015). "Deficient vesicular storage: A common theme in catecholaminergic neurodegeneration". Arkinsonism Relat Disord. 21 (9): 1013–1022. doi:10.1016/j.parkreldis.2015.07.009. PMC 4554767. PMID 26255205.
  17. Goldstein, David (2019). "The heart of PD: Lewy body diseases as neurocardiologic disorders". Brain Res. 1702: 74–84. doi:10.1016/j.brainres.2017.09.033. PMID 29030055.
  18. Goldstein, David (2011). "Catechols in post-mortem brain of patients with Parkinson disease". Eur J Neurol. 18 (5): 703–710. doi:10.1111/j.1468-1331.2010.03246.x. PMC 4580229. PMID 21073636.
  19. Goldstein, David (2013). "Determinants of buildup of the toxic dopamine metabolite DOPAL in Parkinson's disease". J Neurochem. 126 (5): 591–603. doi:10.1111/jnc.12345. PMC 4096629. PMID 23786406.
  20. Goldstein, David (2018). "Cerebrospinal fluid biomarkers of central dopamine deficiency predict Parkinson's disease". Parkinsonism Relat Disord. 50: 108–112. doi:10.1016/j.parkreldis.2018.02.023. PMC 6319386. PMID 29475591.
  21. Eisenhofer, Graeme (1989). "Neuronal uptake and metabolism of 2- and 6-fluorodopamine: false neurotransmitters for positron emission tomographic imaging of sympathetically innervated tissues". J Pharmacol Exp Ther. 248 (1): 419–427. PMID 2563292. Retrieved 4 August 2024.
  22. Goldstein, David (1997). "Sympathetic cardioneuropathy in dysautonomias". N Engl J Med. 336 (10): 696–702. doi:10.1056/NEJM199703063361004. PMID 9041100. Retrieved 4 August 2024.
  23. Amino, Takeshi (2005). "Profound cardiac sympathetic denervation occurs in Parkinson disease". Brain Pathol. 15 (1): 29–34. doi:10.1111/j.1750-3639.2005.tb00097.x. PMC 8095848. PMID 15779234.
  24. Lamotte, Guillaume (2020). "Cardioselective peripheral noradrenergic deficiency in Lewy body synucleinopathies". Ann Clin Transl Neurol. 7 (12): 2450–2460. doi:10.1002/acn3.51243.
  25. Goldstein, David (2019). "Computational modeling reveals multiple abnormalities of myocardial noradrenergic function in Lewy body diseases". JCI Insight. 5 (16): e130441. doi:10.1172/jci.insight.130441. PMID 31335324.
  26. Goldstein, David (2024). "Cardiac noradrenergic deficiency revealed by 18F-dopamine positron emission tomography identifies preclinical central Lewy body diseases". J Clin Invest. 134 (1): e172460. doi:10.1172/JCI172460.
  27. Goldstein, David (1982). "Comparison of techniques for measuring baroreflex sensitivity in man". Circulation. 66 (2): 432–439. doi:10.1161/01.cir.66.2.432. PMID 7094250. Retrieved 4 August 2024.
  28. Goldstein, David (2000). "Noninvasive detection of sympathetic neurocirculatory failure". Clin Auton Res. 10 (5): 285–291. doi:10.1007/BF02281111. PMID 11198484. Retrieved 4 August 2024.
  29. Goldstein, David (2000). "A new sign of sympathetic neurocirculatory failure: premature ventricular contraction as a "one-beat Valsalva maneuver"". Clin Auton Res. 10 (2): 63–67. doi:10.1007/BF02279893. PMID 10823337. Retrieved 4 August 2024.
  30. Rahman, Faisal (2014). "Quantitative indices of baroreflex-sympathoneural function: application to patients with chronic autonomic failure". Clin Auton Res. 24 (3): 103–110. doi:10.1007/s10286-014-0234-1. PMID 24706176. Retrieved 4 August 2024.
  31. Goldstein, David (2023). "Baroreflex-sympathoneural dysfunction characterizes at-risk individuals with preclinical central Lewy body diseases". Clin Auton Res. 33 (1): 41–49. doi:10.1007/s10286-022-00912-y. PMID 36507976. Retrieved 4 August 2024.
  32. Goldstein, David (2014). "Catecholamine autotoxicity. Implications for pharmacology and therapeutics of Parkinson disease and related disorders". Pharmacol Ther. 144 (3): 268–282. doi:10.1016/j.pharmthera.2014.06.006. PMC 4591072. PMID 24945828.
  33. Goldstein, David (2011). "Catechols in post-mortem brain of patients with Parkinson disease". Eur J Neurol. 18 (5): 703–710. doi:10.1111/j.1468-1331.2010.03246.x. PMC 4580229. PMID 21073636.
  34. Goldstein, David (2013). "Determinants of buildup of the toxic dopamine metabolite DOPAL in Parkinson's disease". J Neurochem. 126 (5): 591–603. doi:10.1111/jnc.12345. PMC 4096629. PMID 23786406.
  35. Jinsmaa, Yunden (2018). "3,4-Dihydroxyphenylacetaldehyde-Induced Protein Modifications and Their Mitigation by N-Acetylcysteine". J Pharmacol Exp Ther. 366 (1): 113–124. doi:10.1124/jpet.118.248492. PMC 5988001. PMID 29700232.
  36. Goldstein, David (2022). "Modeling the Progression of Cardiac Catecholamine Deficiency in Lewy Body Diseases". J Am Heart Assoc . 11 (11): e024411. doi:10.1161/JAHA.121.024411. PMC 9238705. PMID 35621196.
  37. Goldstein, David (2024). "Cardiac noradrenergic deficiency revealed by 18F-dopamine positron emission tomography identifies preclinical central Lewy body diseases". J Clin Invest. 134 (1): e172460. doi:10.1172/JCI172460.
  38. Goldstein, David (2013). "Concepts of scientific integrative medicine applied to the physiology and pathophysiology of catecholamine systems". Compr Physiol. 3 (4): 1569–1610. doi:10.1002/cphy.c130006. ISBN 978-0-470-65071-4. PMC 4902023. PMID 24265239.
  39. Goldstein, David (1987). "Plasma norepinephrine pharmacokinetics during mental challenge". Psychosom Med. 49 (6): 591–605. doi:10.1097/00006842-198711000-00004. PMID 2827219. Retrieved 4 August 2024.
  40. Goldstein, David (2003). "Sympathoadrenal imbalance before neurocardiogenic syncope". Am J Cardiol. 91 (1): 53–58. doi:10.1016/s0002-9149(02)02997-1. PMID 12505571. Retrieved 4 August 2024.
  41. Pacak, Karel (1998). "Heterogeneous neurochemical responses to different stressors: a test of Selye's doctrine of nonspecificity". Am J Physiol. 275 (4): R1247–R1255. doi:10.1152/ajpregu.1998.275.4.R1247. PMID 9756557. Retrieved 4 August 2024.
  42. {{cite journal |last1=Goldstein |first1=David |title=How does homeostasis happen? Integrative physiological, systems biological, and evolutionary perspectives |journal=Am J Physiol Regul Integr Comp Physiol |date=2019 |volume=316 |issue=4 |pages=R301–R317 |doi=10.1152/ajpregu.00396.2018}
  43. Goldstein, David (2021). "Stress and the "extended" autonomic system". Auton Neurosci. 236: 102889. doi:10.1016/j.autneu.2021.102889.
  44. Goldstein, David (2020). "The extended autonomic system, dyshomeostasis, and COVID-19". Clin Auton Res. 30 (4): 299–315. doi:10.1007/s10286-020-00714-0. PMC 7374073. PMID 32700055.

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