Unusual electrophysiological findings in a Chinese ALS 4 family with SETX-L389S mutation: a three-year follow-up

Unveiling ten novel SETX mutations: implications for ALS pathogenesis and clinical diversity

OBJECTIVE

To investigate the relationship between newly identified senataxin (SETX) gene mutations and the clinical manifestation of Amyotrophic Lateral Sclerosis (ALS), enhancing understanding of the genetic underpinnings associated with this disorder.

METHODS

A cohort study was conducted at Nanfang Hospital, involving comprehensive genetic sequencing of ALS patients to identify novel SETX mutations. Homology modelling and structural analysis were employed to predict the functional impacts of these mutations on the senataxin protein. Clinical assessments, including symptom evaluation, age of onset, and progression rate, were integrated with electrophysiological studies to establish correlations between genetic variants and clinical outcomes.

RESULTS

Ten novel SETX mutations were identified, expanding the genetic landscape of ALS. These mutations exhibited diverse impacts on clinical presentations, with patients showing variability in onset age, symptom severity, and progression rates. Computational modelling suggested that certain mutations cause significant structural changes in senataxin, potentially affecting its RNA/DNA helicase function. Electrophysiological findings consistently revealed nerve conduction abnormalities, indicating that these mutations may influence neuronal excitability and contribute to ALS pathogenesis.

CONCLUSION

The discovery of novel SETX mutations provides valuable insights into the genetic and clinical complexity of ALS. This study underscores the importance of genetic screening for SETX mutations and suggests potential personalised therapeutic approaches targeting senataxin dysfunction. By elucidating genotype-phenotype correlations, these findings contribute to the broader understanding of ALS and offer pathways for developing targeted interventions to address the challenges posed by this disabling disease.

De novo pathogenic variant in SETX causes a rapidly progressive neurodegenerative disorder of early childhood-onset with severe axonal polyneuropathy

Pathogenic variants in SETX cause two distinct neurological diseases, a loss-of-function recessive disorder, ataxia with oculomotor apraxia type 2 (AOA2), and a dominant gain-of-function motor neuron disorder, amyotrophic lateral sclerosis type 4 (ALS4). We identified two unrelated patients with the same de novo c.23C > T (p.Thr8Met) variant in SETX presenting with an early-onset, severe polyneuropathy. As rare private gene variation is often difficult to link to genetic neurological disease by DNA sequence alone, we used transcriptional network analysis to functionally validate these patients with severe de novo SETX-related neurodegenerative disorder. Weighted gene co-expression network analysis (WGCNA) was used to identify disease-associated modules from two different ALS4 mouse models and compared to confirmed ALS4 patient data to derive an ALS4-specific transcriptional signature. WGCNA of whole blood RNA-sequencing data from a patient with the p.Thr8Met SETX variant was compared to ALS4 and control patients to determine if this signature could be used to identify affected patients. WGCNA identified overlapping disease-associated modules in ALS4 mouse model data and ALS4 patient data. Mouse ALS4 disease-associated modules were not associated with AOA2 disease modules, confirming distinct disease-specific signatures. The expression profile of a patient carrying the c.23C > T (p.Thr8Met) variant was significantly associated with the human and mouse ALS4 signature, confirming the relationship between this SETX variant and disease. The similar clinical presentations of the two unrelated patients with the same de novo p.Thr8Met variant and the functional data provide strong evidence that the p.Thr8Met variant is pathogenic. The distinct phenotype expands the clinical spectrum of SETX-related disorders.

Update on benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D.