Several lines of evidence indicate that the propagation of misfolded α‐synuclein (α‐syn) plays a central role in the progression and manifestation of Parkinson's disease. Pathogenic α‐syn species can be present in the extracellular space. Thus, the identification and modulation of the key enzymes implicated in extracellular α‐syn turnover becomes vital. Kallikrein peptidase 6 has been identified as one of the major α‐syn degrading enzymes and has been implicated in the clearance of extracellular α‐syn. However, the physiological role of this enzyme in regulating α‐syn, in vivo, still remains elusive. Here, by utilizing Klk6 knock‐out (Klk6−/−) mice as our experimental model, we provide insight into the physiologic relevance of endogenous KLK6 expression on α‐syn processing. Behavioral phenotyping showed that Klk6−/− mice display no gross behavioral abnormalities. Further in vivo characterization of this mouse model, in the context of α‐syn accumulation, showed that KLK6 deletion had no impact on the protein levels of intracellular or extracellular α‐syn. Upon in vivo administration of α‐syn pre‐formed fibrils (PFF), α‐syn pathologic accumulations were evident both in the brains of Klk6−/−mice and wt mice without significant differences. Intrastriatal delivery of active KLK6, did not affect secreted α‐syn levels observed in the A53T α‐syn over‐expressing mice. These findings suggest that in the in vivo setting of PFF pathology induction, KLK6 alone is not able to modulate pathology transmission. Our study raises implications for the use of recombinant α‐syn fibrils in α‐syn turnover studies.

Background Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.

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