Enfermedad de Kennedy y resistencia parcial androgénica. Descripción de 4 casos y revisión de la literatura

Kennedy's disease from India: An Indian Cohort with multisystemic manifestations

BackgroundKennedy's disease (KD) is a rare, insidiously progressive lower motor neuron syndrome characterised by amyotrophy involving the appendicular or bulbar musculature of adult males in their fourth to fifth decade. There are no large series from the Indian subcontinent describing the clinical-genetic and laboratory spectrum of KD.AimTo describe the clinical, electrophysiologic, metabolic and genetic profile of patients with KD.MethodsWe conducted a retrospective review of ten genetically confirmed KD patients.ResultsThe mean age of the cohort was 47 years, with a mean age of onset of illness at 41.3 ± 9.9 years. The median duration of symptoms before presentation was 5 (3-12) years. The most common referral diagnosis was ALS. The majority presented with symmetric proximal limb weakness with bulbar symptoms and were found to have gynecomastia, lower motor neuron (LMN) facial weakness, and facial and lingual fasciculations. Electrophysiology revealed sensory neuropathy in five patients and chronic neurogenic changes consistent with anterior horn cell disease in all. Metabolic profile showed impaired glycemia, hyperlipidemia and evidence of non-alcoholic fatty liver disease in the majority. All had elevated serum creatine kinase. Genetic testing revealed a median of 46 CAG repeats. The phenotypes of our patients aligned with global data that is predominantly derived from participants of European ancestry.ConclusionWe describe a series of patients with KD from India with significant multisystemic involvement.

Kennedy Disease in Latin America: Two New Mexican Cases and a Systematic Review of Regional Reports

Spinal and bulbar muscular atrophy (SBMA), or Kennedy disease (KD), is a rare X-linked trinucleotide repeat disorder caused by cytosine, adenine, and guanine (CAG) expansions in the androgen receptor (AR) gene. KD affects lower motor neurons, leading to progressive muscle weakness, bulbar dysfunction, and endocrine symptoms such as gynecomastia. Diagnosis is challenging due to phenotypic overlap with other neurodegenerative diseases. This report aimed to describe two new Mexican cases of KD and to summarize all published cases of KD in Latin America through a systematic review (SR). The SR search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method in the Scielo, Lilacs, and Scopus databases, including cohort studies, case series, and case reports with molecular confirmation of SBMA. Clinical and molecular data were analyzed. The review identified 23 Latin American SBMA cases. The median age of onset was 43 years (range: 21-66). The most common manifestations were weakness (95.7%; n = 22), tremor (65.2%; n = 15), and bulbar symptoms such as dysarthria (95.6%; n = 22) and dysphagia (91.3%; n = 21). Endocrine manifestations such as gynecomastia (73.9%; n = 17) and sexual dysfunction (56.5%; n = 13) were common. Electrophysiological findings confirmed lower motor neuron involvement, and molecular analysis revealed a median of 46.5 CAG repeats. Despite its low frequency, SBMA remains underdiagnosed in Latin America, which may be due to limited awareness and clinical overlap with other pathologies. Molecular testing is crucial for diagnostic certainty. The review also highlights the need to evaluate multisystem involvement. Improved diagnostic protocols, genetic counseling, and increased awareness are needed for the timely detection and management of SBMA in Latin America.

Extranuclear partners of androgen receptor: at the crossroads of proliferation, migration, and neuritogenesis

In this review, we focus on the role played by the protein partners of ligand-activated extranuclear androgen receptor (AR) in the final effects of hormone action, such as proliferation, migration, and neuritogenesis. The choice of AR partner, at least in part, depends on cell type. Androgen-activated receptor directly associates with cytoplasmic Src tyrosine kinase in epithelial cells, whereas in mesenchymal and neuronal cells, it prevalently interacts with filamin A. In the former, proliferation represents the final hormonal outcome, whereas in the latter, either migration or neuritogenesis, respectively, occurs. Furthermore, AR partner filamin A is replaced with Src when mesenchymal cells are stimulated with very low androgen concentrations. Consequently, the migratory effect is replaced by mitogenesis. Use of peptides that prevent receptor/partner assembly abolishes the effects that are dependent on their association and offers new therapeutic approaches to AR-related diseases. Perturbation of migration is often associated with metastatic spreading in cancer. In turn, cell cycle aberration causes tumors to grow faster, whereas toxic signaling triggers neurodegenerative events in the CNS. Here, we provide examples of new tools that interfere in rapid androgen effects, including migration, proliferation, and neuronal differentiation, together with their potential therapeutic applications in AR-dependent diseases-mainly prostate cancer and neurodegenerative disorders.-Castoria, G., Auricchio, F., Migliaccio, A. Extranuclear partners of androgen receptor: at the crossroads of proliferation, migration, and neuritogenesis.