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O'Brien EM, Neiswinter N, Lin KY, Lynch D, Baldwin K, Profeta V, Flynn JM, Muhly WT. Perioperative management and outcomes for posterior spinal fusion in patients with Friedreich ataxia: A single-center, retrospective study. Paediatr Anaesth 2024; 34:654-661. [PMID: 38655751 DOI: 10.1111/pan.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Friedreich ataxia is a rare genetic disorder associated with progressive mitochondrial dysfunction leading to widespread sequelae including ataxia, muscle weakness, hypertrophic cardiomyopathy, diabetes mellitus, and neuromuscular scoliosis. Children with Friedreich ataxia are at high risk for periprocedural complications during posterior spinal fusion due to their comorbidities. AIM To describe our single-center perioperative management of patients with Friedreich ataxia undergoing posterior spinal fusion. METHODS Adolescent patients with Friedreich ataxia presenting for spinal deformity surgery between 2007 and 2023 were included in this retrospective case series performed at the Children's Hospital of Philadelphia. Perioperative outcomes were reviewed along with preoperative characteristics, intraoperative anesthetic management, and postoperative medical management. RESULTS Seventeen patients were included in the final analysis. The mean age was 15 ± 2 years old and 47% were female. Preoperatively, 35% were wheelchair dependent, 100% had mild-to-moderate hypertrophic cardiomyopathy with preserved systolic function and no left ventricular outflow tract obstruction, 29% were on cardiac medications, and 29% were on pain medications. Intraoperatively, 53% had transesophageal echocardiography monitoring; 12% had changes in volume status on echo but no changes in function. Numerous combinations of total intravenous anesthetic agents were used, most commonly propofol, remifentanil, and ketamine. Baseline neuromonitoring signals were poor in four patients and one patient lost signals, resulting in 4 (24%) wake-up tests. The majority (75%) were extubated in the operating room. Postoperative complications were high (88%) and ranged from minor complications like nausea/vomiting (18%) to major complications like hypotension/tachycardia (29%) and need for extracorporeal membrane oxygenation support in one patient (6%). CONCLUSIONS Patients with Friedreich ataxia are at high risk for perioperative complications when undergoing posterior spinal fusion and coordinated multidisciplinary care is required at each stage. Future research should focus on the utility of intraoperative echocardiography, optimal anesthetic agent selection, and targeted fluid management to reduce postoperative cardiac complications.
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Affiliation(s)
- Elizabeth M O'Brien
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natalie Neiswinter
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania, USA
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kimberly Y Lin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Lynch
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Keith Baldwin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Victoria Profeta
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John M Flynn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhang Y, Adamo M, Zou C, Porcari A, Tomasoni D, Rossi M, Merlo M, Liu H, Wang J, Zhou P, Metra M, Sinagra G, Zhang J. Management of hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2024; 25:399-419. [PMID: 38625835 PMCID: PMC11142653 DOI: 10.2459/jcm.0000000000001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
Hypertrophic cardiomyopathy is an important cause of heart failure and arrhythmias, including sudden death, with a major impact on the healthcare system. Genetic causes and different phenotypes are now increasingly being identified for this condition. In addition, specific medications, such as myosin inhibitors, have been recently shown as potentially able to modify its symptoms, hemodynamic abnormalities and clinical course. Our article aims to provide a comprehensive outline of the epidemiology, diagnosis and treatment of hypertrophic cardiomyopathy in the current era.
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Affiliation(s)
- Yuhui Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Changhong Zou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aldostefano Porcari
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Maddalena Rossi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Huihui Liu
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jinxi Wang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ping Zhou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Jian Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
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Vancheri C, Quatrana A, Morini E, Mariotti C, Mongelli A, Fichera M, Rufini A, Condò I, Testi R, Novelli G, Malisan F, Amati F. An RNA-seq study in Friedreich ataxia patients identified hsa-miR-148a-3p as a putative prognostic biomarker of the disease. Hum Genomics 2024; 18:50. [PMID: 38778374 PMCID: PMC11110315 DOI: 10.1186/s40246-024-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/26/2024] [Indexed: 05/25/2024] Open
Abstract
Friedreich ataxia (FRDA) is a life-threatening hereditary ataxia; its incidence is 1:50,000 individuals in the Caucasian population. A unique therapeutic drug for FRDA, the antioxidant Omaveloxolone, has been recently approved by the US Food and Drug Administration (FDA). FRDA is a multi-systemic neurodegenerative disease; in addition to a progressive neurodegeneration, FRDA is characterized by hypertrophic cardiomyopathy, diabetes mellitus and musculoskeletal deformities. Cardiomyopathy is the predominant cause of premature death. The onset of FRDA typically occurs between the ages of 5 and 15. Given the complexity and heterogeneity of clinical features and the variability of their onset, the identification of biomarkers capable of assessing disease progression and monitoring the efficacy of treatments is essential to facilitate decision making in clinical practice. We conducted an RNA-seq analysis in peripheral blood mononuclear cells from FRDA patients and healthy donors, identifying a signature of small non-coding RNAs (sncRNAs) capable of distinguishing healthy individuals from the majority of FRDA patients. Among the differentially expressed sncRNAs, microRNAs are a class of small non-coding endogenous RNAs that regulate posttranscriptional silencing of target genes. In FRDA plasma samples, hsa-miR-148a-3p resulted significantly upregulated. The analysis of the Receiver Operating Characteristic (ROC) curve, combining the circulating expression levels of hsa-miR-148a-3p and hsa-miR-223-3p (previously identified by our group), revealed an Area Under the Curve (AUC) of 0.86 (95%, Confidence Interval 0.77-0.95; p-value < 0.0001). An in silico prediction analysis indicated that the IL6ST gene, an interesting marker of neuroinflammation in FRDA, is a common target gene of both miRNAs. Our findings support the evaluation of combined expression levels of different circulating miRNAs as potent epi-biomarkers in FRDA. Moreover, we found hsa-miR-148a-3p significantly over-expressed in Intermediate and Late-Onset Friedreich Ataxia patients' group (IOG and LOG, respectively) compared to healthy individuals, indicating it as a putative prognostic biomarker in this pathology.
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Affiliation(s)
- Chiara Vancheri
- Department of Biomedicine and Prevention, Genetics Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Andrea Quatrana
- Department of Biomedicine and Prevention, Laboratory of Signal Transduction, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
- Muscular and Neurodegenerative Diseases Laboratory, Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy
| | - Elena Morini
- Department of Biomedicine and Prevention, Genetics Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Alessia Mongelli
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Mario Fichera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Alessandra Rufini
- Department of Biomedicine and Prevention, Laboratory of Signal Transduction, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, 00131, Italy
| | - Ivano Condò
- Department of Biomedicine and Prevention, Laboratory of Signal Transduction, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Roberto Testi
- Department of Biomedicine and Prevention, Laboratory of Signal Transduction, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Genetics Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
- Neuromed Institute, IRCCS, Pozzilli, 86077, Italy
- Department of Pharmacology, School of Medicine, University of Nevada, Reno, NV, 89557, USA
| | - Florence Malisan
- Department of Biomedicine and Prevention, Laboratory of Signal Transduction, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy.
| | - Francesca Amati
- Department of Biomedicine and Prevention, Genetics Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy.
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Lynch DR, Sharma S, Hearle P, Greeley N, Gunther K, Keita M, Strawser C, Hauser L, Park C, Schadt K, Lin KY. Characterization of clinical serum cardiac biomarker levels in individuals with Friedreich ataxia. J Neurol Sci 2024; 461:123053. [PMID: 38759249 DOI: 10.1016/j.jns.2024.123053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
Friedreich ataxia is a progressive autosomal recessive neurodegenerative disorder characterized by ataxia, dyscoordination, and cardiomyopathy. A subset of patients with Friedreich ataxia have elevated levels of serum cardiac troponin I, but associations with disease outcomes and features of cardiomyopathy remain unclear. In this study, we characterized clinically obtained serum cardiac biomarker levels including troponin I, troponin T, and B-type natriuretic peptide in subjects with Friedreich ataxia and evaluated their association with markers of disease. While unprovoked troponin I levels were elevated in 36% of the cohort, cTnI levels associated with a cardiac event (provoked) were higher than unprovoked levels. In multivariate linear regression models, younger age predicted increased troponin I values, and in logistic regression models younger age, female sex, and marginally longer GAA repeat length predicted abnormal troponin I levels. In subjects with multiple assessments, mean unprovoked troponin I levels decreased slightly over time. The presence of abnormal troponin I values and their levels were predicted by echocardiographic measures of hypertrophy. In addition, troponin I levels predicted long-term markers of clinical cardiac dysfunction over time to a modest degree. Consequently, troponin I values provide a marker of hypertrophy but only a minimally predictive biomarker for later cardiac manifestations of disease such as systolic dysfunction or arrhythmia.
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Affiliation(s)
- David R Lynch
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America.
| | - Sonal Sharma
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Patrick Hearle
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Nathaniel Greeley
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Katherine Gunther
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Medina Keita
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Cassandra Strawser
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Lauren Hauser
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Courtney Park
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Kimberly Schadt
- Divisions of Neurology Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
| | - Kimberly Y Lin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America; Divisions of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America
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Motamed-Gorji N, Khalil Y, Gonzalez-Robles C, Khan S, Mills P, Garcia-Moreno H, Ging H, Tariq A, Clayton PT, Giunti P. Elevated Bile Acid 3β,5α,6β-Trihydroxycholanoyl Glycine in a Subset of Adult Ataxias Including Niemann-Pick Type C. Antioxidants (Basel) 2024; 13:561. [PMID: 38790666 PMCID: PMC11117656 DOI: 10.3390/antiox13050561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Ataxia is a common neurological feature of Niemann-Pick disease type C (NPC). In this disease, unesterified cholesterol accumulates in lysosomes of the central nervous system and hepatic cells. Oxidation by reactive oxygen species produces oxysterols that can be metabolised to specific bile acids. These bile acids have been suggested as useful biomarkers to detect NPC. Concentrations of 3β,5α,6β-trihydroxycholanyl glycine (3β,5α,6β-triOH-Gly) and 3β,7β-dihydroxy-5-cholenyl glycine (3β,7β-diOH-Δ5-Gly) were measured in plasma of 184 adults with idiopathic ataxia. All patients were tested with whole genome sequencing containing hereditary ataxia panels, which include NPC1 and NPC2 mutations and other genetic causes of ataxia. Plasma 3β,5α,6β-triOH-Gly above normal (>90 nM) was found in 8 out of 184 patients. One patient was homozygous for the p.(Val1165Met) mutation in the NPC1 gene. The remaining seven included one patient with Friedreich's ataxia and three patients with autoimmune diseases. Oxidative stress is known to be increased in Friedreich's ataxia and in autoimmune diseases. Therefore, this subset of patients possibly shares a common mechanism that determines the increase of this bile acid. In a large cohort of adults with ataxia, plasma 3β,5α,6β-triOH-Gly was able to detect the one patient in the cohort with NPC1 disease, but also detected oxidation of cholesterol by ROS in other disorders. Plasma 3β,7β-diOH-Δ5-Gly is not a potential biomarker for NPC1.
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Affiliation(s)
- Nazgol Motamed-Gorji
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Youssef Khalil
- Inborn Errors of Metabolism, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK (P.M.)
| | - Cristina Gonzalez-Robles
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Shamsher Khan
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Philippa Mills
- Inborn Errors of Metabolism, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK (P.M.)
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Heather Ging
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Ambreen Tariq
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
| | - Peter T. Clayton
- Inborn Errors of Metabolism, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK (P.M.)
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK (H.G.-M.)
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Velikova T, Vasilev G, Shumnalieva R, Chervenkov L, Miteva DG, Gulinac M, Priftis S, Lazova S. Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy. World J Clin Cases 2024; 12:2031-2039. [PMID: 38680259 PMCID: PMC11045506 DOI: 10.12998/wjcc.v12.i12.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies. In this narrative review, we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease, immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following. We focused on the anti-gliadin antibodies, antibodies to different isoforms of tissue transglutaminase (TG) (anti-TG2, 3, and 6 antibodies), anti-glycine receptor antibodies, anti-glutamine acid decarboxylase antibodies, anti-deamidated gliadin peptides antibodies, etc. Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction, presented as different neurological disorders. We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
| | - Georgi Vasilev
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Clinic of Neurology and Department of Emergency Medicine, UMHAT "Sv. Georgi", Plovdiv 4000, Bulgaria
| | - Russka Shumnalieva
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia 1612, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Dimitrina Georgieva Miteva
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Genetics, Faculty of Biology, Sofia University "St. Kliment Ohridski", Sofia 1164, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Stamatios Priftis
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Sofia 1407, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Sofia 1407, Bulgaria
- Department of Pediatric, University Hospital "N. I. Pirogov", Sofia 1606, Bulgaria
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Mantle D, Hargreaves IP. Efficacy and Safety of Coenzyme Q10 Supplementation in Neonates, Infants and Children: An Overview. Antioxidants (Basel) 2024; 13:530. [PMID: 38790635 PMCID: PMC11117623 DOI: 10.3390/antiox13050530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
To date, there have been no review articles specifically relating to the general efficacy and safety of coenzyme Q10 (CoQ10) supplementation in younger subjects. In this article, we therefore reviewed the efficacy and safety of CoQ10 supplementation in neonates (less than 1 month of age), infants (up to 1 year of age) and children (up to 12 years of age). As there is no rationale for the supplementation of CoQ10 in normal younger subjects (as there is in otherwise healthy older subjects), all of the articles in the medical literature reviewed in the present article therefore refer to the supplementation of CoQ10 in younger subjects with a variety of clinical disorders; these include primary CoQ10 deficiency, acyl CoA dehydrogenase deficiency, Duchenne muscular dystrophy, migraine, Down syndrome, ADHD, idiopathic cardiomyopathy and Friedreich's ataxia.
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Affiliation(s)
- David Mantle
- Pharma Nord (UK) Ltd., Morpeth, Northumberland NE61 2DB, UK
| | - Iain Parry Hargreaves
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Merseyside L3 5UX, UK;
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Rojsajjakul T, Selvan N, De B, Rosenberg JB, Kaminsky SM, Sondhi D, Janki P, Crystal RG, Mesaros C, Khanna R, Blair IA. Expression and processing of mature human frataxin after gene therapy in mice. Sci Rep 2024; 14:8391. [PMID: 38600238 PMCID: PMC11006666 DOI: 10.1038/s41598-024-59060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/06/2024] [Indexed: 04/12/2024] Open
Abstract
Friedreich's ataxia is a degenerative and progressive multisystem disorder caused by mutations in the highly conserved frataxin (FXN) gene that results in FXN protein deficiency and mitochondrial dysfunction. While gene therapy approaches are promising, consistent induction of therapeutic FXN protein expression that is sub-toxic has proven challenging, and numerous therapeutic approaches are being tested in animal models. FXN (hFXN in humans, mFXN in mice) is proteolytically modified in mitochondria to produce mature FXN. However, unlike endogenous hFXN, endogenous mFXN is further processed into N-terminally truncated, extra-mitochondrial mFXN forms of unknown function. This study assessed mature exogenous hFXN expression levels in the heart and liver of C57Bl/6 mice 7-10 months after intravenous administration of a recombinant adeno-associated virus encoding hFXN (AAVrh.10hFXN) and examined the potential for hFXN truncation in mice. AAVrh.10hFXN induced dose-dependent expression of hFXN in the heart and liver. Interestingly, hFXN was processed into truncated forms, but found at lower levels than mature hFXN. However, the truncations were at different positions than mFXN. AAVrh.10hFXN induced mature hFXN expression in mouse heart and liver at levels that approximated endogenous mFXN levels. These results suggest that AAVrh.10hFXN can likely induce expression of therapeutic levels of mature hFXN in mice.
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Affiliation(s)
- Teerapat Rojsajjakul
- Department of Systems Pharmacology and Translational Therapeutics Perelman School of Medicine, Penn/CHOP Friedreich's Ataxia Center of Excellence, Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bishnu De
- Department of Genetic Medicine, Weill Cornell College of Medicine, New York, NY, USA
| | - Jonathan B Rosenberg
- Department of Genetic Medicine, Weill Cornell College of Medicine, New York, NY, USA
| | - Stephen M Kaminsky
- Department of Genetic Medicine, Weill Cornell College of Medicine, New York, NY, USA
| | - Dolan Sondhi
- Department of Genetic Medicine, Weill Cornell College of Medicine, New York, NY, USA
| | | | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell College of Medicine, New York, NY, USA
| | - Clementina Mesaros
- Department of Systems Pharmacology and Translational Therapeutics Perelman School of Medicine, Penn/CHOP Friedreich's Ataxia Center of Excellence, Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ian A Blair
- Department of Systems Pharmacology and Translational Therapeutics Perelman School of Medicine, Penn/CHOP Friedreich's Ataxia Center of Excellence, Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA.
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9
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Tamaš O, Mijajlović M, Švabić T, Kostić M, Marić G, Milovanović A, Jeremić M, Dragašević-Mišković N. Transcranial Sonography Characteristics of Cerebellar Neurodegenerative Ataxias. Brain Sci 2024; 14:340. [PMID: 38671992 PMCID: PMC11048096 DOI: 10.3390/brainsci14040340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Cerebellar neurodegenerative ataxias are a group of disorders affecting the cerebellum and its pathways with different neurological structures. Transcranial sonography (TCS) has been used for the evaluation of brain parenchymal structures in various diseases because of its fast and safe utilization, especially in neuropsychiatric and neurodegenerative diseases. The aim of our study was to investigate TCS characteristics of patients with neurodegenerative cerebellar ataxias. In our study, we included 74 patients with cerebellar degenerative ataxia; 36.5% had autosomal dominant onset, while 33.8% had sporadic onset. Standardized ultrasonographic planes were used for the identification of brain structures of interest. The SARA, INAS, neuropsychological and psychiatric scales were used for the further clinical evaluation of our study participants. The brainstem raphe was discontinued in 33.8% of the patients. The substantia nigra (SN) hyperechogenicity was identified in 79.7%. The third and fourth ventricle enlargement had 79.7% and 45.9% of patients, respectively. A positive and statistically significant correlation was found between SN hyperechogenicity with dystonia (p < 0.01), rigidity and dyskinesia (p < 0.05). The higher SARA total score is statistically significantly correlated with the larger diameter of the III (r = 0.373; p = 0.001) and IV ventricles (r = 0.324; p = 0.005). In such patients, the echogenicity of substantia nigra has been linked to extrapyramidal signs, and raphe discontinuity to depression. Furthermore, ataxia and its clinical subtypes have positively correlated with the IV ventricle diameter, indicating brain atrophy and brain mass reduction.
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Affiliation(s)
- Olivera Tamaš
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
| | - Milija Mijajlović
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
| | - Tamara Švabić
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
| | - Milutin Kostić
- Institute of Mental Health, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gorica Marić
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Andona Milovanović
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
| | - Marta Jeremić
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
| | - Nataša Dragašević-Mišković
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (T.Š.); (A.M.); (M.J.); (N.D.-M.)
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10
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Machado DS, Viana CF, Pedroso JL, Barsottini OGP, Tomaselli PJ, Marques W, Rezende TJR, Martinez ARM, França MC. Prevalence and Diagnostic Journey of Friedreich's Ataxia in the State of São Paulo, Brazil. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01687-w. [PMID: 38520642 DOI: 10.1007/s12311-024-01687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Friedreich's Ataxia (FRDA) is the leading cause of ataxia worldwide, but data on epidemiology and diagnostic journey are scarce, particularly in Latin America. Herein we estimated the prevalence of FRDA in the most populous Brazilian state and characterized the diagnostic odyssey of the disease. We received anonymized data of patients with FRDA from advocacy groups and physicians. Prevalence was estimated dividing the number of patients by the population of the state as reported in the last census. Patients were invited to answer an online survey to describe clinical data and diagnostic journey of the disease. FRDA estimated prevalence was 0.367:100,000, with a slight predominance of women (58.2% vs 41.7%). One hundred and four patients answered the survey (mean age of 37.3 ± 13.8 years; 75.9% classical and 24.0% late onset). On average, 6.2 ± 4.1 physicians were visited before reaching the diagnosis. Mean diagnostic delay was 7.8 ± 6.7 years; no difference between classical and LOFA groups was found. Most of the patients reported unsteadiness and gait abnormalities as the first symptom. Neurologists and orthopedical surgeons were the main specialties first sought by patients. We found a prevalence of 0.36:100,000 for FRDA in the state of São Paulo, Brazil. The disease is characterized by remarkable diagnostic delay, with no relevant differences between classical and LOFA patients.
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Affiliation(s)
- Daiana Suelen Machado
- Department of Neurology, School of Medical Sciences - University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Celiana Figueiredo Viana
- Ataxia Unit, Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Pedro José Tomaselli
- Department of Neuroscience and Behavioural Sciences, School of Medicine - University of São Paulo (USP) of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Wilson Marques
- Department of Neuroscience and Behavioural Sciences, School of Medicine - University of São Paulo (USP) of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Thiago J R Rezende
- Department of Neurology, School of Medical Sciences - University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences - University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Marcondes Cavalcante França
- Department of Neurology, School of Medical Sciences - University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-887, Brazil.
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Casey HL, Shah VV, Muzyka D, McNames J, El-Gohary M, Sowalsky K, Safarpour D, Carlson-Kuhta P, Schmahmann JD, Rosenthal LS, Perlman S, Rummey C, Horak FB, Gomez CM. Standing Balance Conditions and Digital Sway Measures for Clinical Trials of Friedreich's Ataxia. Mov Disord 2024. [PMID: 38469957 DOI: 10.1002/mds.29777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Progressive loss of standing balance is a feature of Friedreich's ataxia (FRDA). OBJECTIVES This study aimed to identify standing balance conditions and digital postural sway measures that best discriminate between FRDA and healthy controls (HC). We assessed test-retest reliability and correlations between sway measures and clinical scores. METHODS Twenty-eight subjects with FRDA and 20 HC completed six standing conditions: feet apart, feet together, and feet tandem, both with eyes opened (EO) and eyes closed. Sway was measured using a wearable sensor on the lumbar spine for 30 seconds. Test completion rate, test-retest reliability with intraclass correlation coefficients, and areas under the receiver operating characteristic curves (AUCs) for each measure were compared to identify distinguishable FRDA sway characteristics from HC. Pearson correlations were used to evaluate the relationships between discriminative measures and clinical scores. RESULTS Three of the six standing conditions had completion rates over 70%. Of these three conditions, natural stance and feet together with EO showed the greatest completion rates. All six of the sway measures' mean values were significantly different between FRDA and HC. Four of these six measures discriminated between groups with >0.9 AUC in all three conditions. The Friedreich Ataxia Rating Scale Upright Stability and Total scores correlated with sway measures with P-values <0.05 and r-values (0.63-0.86) and (0.65-0.81), respectively. CONCLUSION Digital postural sway measures using wearable sensors are discriminative and reliable for assessing standing balance in individuals with FRDA. Natural stance and feet together stance with EO conditions suggest use in clinical trials for FRDA. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hannah L Casey
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Vrutangkumar V Shah
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel Muzyka
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
| | - James McNames
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Mahmoud El-Gohary
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
| | - Kristen Sowalsky
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
| | - Delaram Safarpour
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | | | - Fay B Horak
- Precision Motion, APDM Wearable Technologies - a Clario company, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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12
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Mahale R, Purushottam M, Singh R, Yelamanchi R, Kamble N, Holla V, Pal PK, Jain S, Yadav R. Revisiting Friedreich's Ataxia: Phenotypic and Imaging Characteristics. Ann Indian Acad Neurol 2024; 27:152-157. [PMID: 38751907 PMCID: PMC11093178 DOI: 10.4103/aian.aian_1001_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background and Aim Friedreich's ataxia (FRDA) is a common cause of autosomal recessive cerebellar ataxia. The phenotype is dependent on the repeat size and duration of the disease. We aimed to study the clinical, electrophysiologic, and radiologic profiles in a large Indian cohort of genetically proven FRDA patients. Subjects and Methods A retrospective cross-sectional, descriptive analysis of genetically proven FRDA patients was performed. A detailed review of all the hospital case records was done to analyze the clinical, radiologic, and electrophysiologic details. Results A total of 100 FRDA patients were selected for the analysis. Eighty-six patients had an age at onset between 5 and 25 years. Eight patients (8%) were classified as late-onset FRDA and six patients (6%) as early-onset FRDA. The median age at presentation was 19 years. The median age at onset was 14 years, and the median duration of illness was 4 years. All patients had gait ataxia as the initial symptom. Gait ataxia, loss of proprioception, and areflexia were seen in all patients. Dysarthria, nystagmus, amyotrophy, spasticity, extensor plantars, pes cavus, and scoliosis occurred in one-third of patients. Cardiomyopathy (18%) and diabetes (5%) were less common. Sensory polyneuropathy (87.5%) was the most common nerve conduction abnormality. Cortical somatosensory evoked responses were absent in all 43 tested patients (100%). Brainstem auditory evoked response test was done in 24 patients and it showed absent reactions in six patients (25%). Visual evoked potential was tested in 24 patients and it showed absent P100 responses in five patients (21%). Cerebellar and cord atrophy was seen on magnetic resonance imaging in 50% of patients. Conclusion Most FRDA patients (86%) had an age at onset of less than 25 years, with typical symptoms of gait ataxia, areflexia, and loss of proprioception found in all patients. Dysarthria, nystagmus, amyotrophy, spasticity, extensor plantars, pes cavus, scoliosis, cardiomyopathy, and diabetes were not seen in all patients. Cerebellar atrophy can occur in FRDA patients. Knowledge regarding the clinical, radiologic, and electrophysiologic profile of FRDA will aid in proper phenotypic characterization.
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Affiliation(s)
- Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Meera Purushottam
- Molecular Genetics Lab, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Raviprakash Singh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Ramachandra Yelamanchi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vikram Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pramod K. Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sanjeev Jain
- Molecular Genetics Lab, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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13
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Edzeamey FJ, Ramchunder Z, Pourzand C, Anjomani Virmouni S. Emerging antioxidant therapies in Friedreich's ataxia. Front Pharmacol 2024; 15:1359618. [PMID: 38379897 PMCID: PMC10876797 DOI: 10.3389/fphar.2024.1359618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Friedreich's ataxia (FRDA) is a rare childhood neurologic disorder, affecting 1 in 50,000 Caucasians. The disease is caused by the abnormal expansion of the GAA repeat sequence in intron 1 of the FXN gene, leading to the reduced expression of the mitochondrial protein frataxin. The disease is characterised by progressive neurodegeneration, hypertrophic cardiomyopathy, diabetes mellitus and musculoskeletal deformities. The reduced expression of frataxin has been suggested to result in the downregulation of endogenous antioxidant defence mechanisms and mitochondrial bioenergetics, and the increase in mitochondrial iron accumulation thereby leading to oxidative stress. The confirmation of oxidative stress as one of the pathological signatures of FRDA led to the search for antioxidants which can be used as therapeutic modality. Based on this observation, antioxidants with different mechanisms of action have been explored for FRDA therapy since the last two decades. In this review, we bring forth all antioxidants which have been investigated for FRDA therapy and have been signed off for clinical trials. We summarise their various target points in FRDA disease pathway, their performances during clinical trials and possible factors which might have accounted for their failure or otherwise during clinical trials. We also discuss the limitation of the studies completed and propose possible strategies for combinatorial therapy of antioxidants to generate synergistic effect in FRDA patients.
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Affiliation(s)
- Fred Jonathan Edzeamey
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, College of Health, Medicine, and Life Sciences (CHMLS), Brunel University London, Uxbridge, United Kingdom
| | - Zenouska Ramchunder
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, College of Health, Medicine, and Life Sciences (CHMLS), Brunel University London, Uxbridge, United Kingdom
| | - Charareh Pourzand
- Department of Life Sciences, University of Bath, Bath, United Kingdom
- Centre for Therapeutic Innovation, University of Bath, Bath, United Kingdom
| | - Sara Anjomani Virmouni
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, College of Health, Medicine, and Life Sciences (CHMLS), Brunel University London, Uxbridge, United Kingdom
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14
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Fernández AG. Vestibular Pathology as Early Finding of Friedreich's Ataxia in a 16 Years Old Woman. Indian J Otolaryngol Head Neck Surg 2024; 76:1247-1250. [PMID: 38440644 PMCID: PMC10908728 DOI: 10.1007/s12070-023-04249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 03/06/2024] Open
Abstract
Friedreich's ataxia is degenerative disease frequently starting around puberty and it's characterized by a progressive gait ataxia, limb weakness, apparition of Babinsky sign, loss of deep tendon reflex, dysarthria and skeletal deformities. The development of vestibular pathology is common but not completely understood. A 16 years old woman with early vestibular defects in relation to a latter Friedreich's ataxia diagnosis is reported.
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Affiliation(s)
- Andrés González Fernández
- Department of Otolaryngology and Head and Neck Surgery, Virgen del Camino Hospital, Pamplona, Navarra Spain
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15
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Bachurin SS, Yurushkin MV, Slynko IA, Kletskii ME, Burov ON, Berezovskiy DP. Structural peculiarities of tandem repeats and their clinical significance. Biochem Biophys Res Commun 2024; 692:149349. [PMID: 38056160 DOI: 10.1016/j.bbrc.2023.149349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
While it is well established that a mere 2% of human DNA nucleotides are involved in protein coding, the remainder of the DNA plays a vital role in the preservation of normal cellular genetic function. A significant proportion of tandem repeats (TRs) are present in non-coding DNA. TRs - specific sequences of nucleotides that entail numerous repetitions of a given fragment. In this study, we employed our novel algorithm grounded in finite automata theory, which we refer to as Dafna, to investigate for the first time the likelihood of these nucleotide sequences forming non-canonical DNA structures (NS). Such structures include G-quadruplexes, i-motifs, hairpins, and triplexes. The tandem repeats under consideration in our research encompassed sequences containing 1 to 6 nucleotides per repeated fragment. For comparison, we employed a set of randomly generated sequences of the same length (60 nucleotides) as a benchmark. The outcomes of our research exposed a disparity between the potential for NS formation in random sequences and tandem repeats. Our findings affirm that the propensity of DNA and RNA to form NS is closely tied to various genetic disorders, including Huntington's disease, Fragile X syndrome, and Friedreich's ataxia. In the concluding discussion, we present a proposal for a new therapeutic mechanism to address these diseases. This novel approach revolves around the ability of specific nucleic acid fragments to form multiple types of NS.
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Affiliation(s)
- Stanislav S Bachurin
- Department of General and Clinical Biochemistry N2, Rostov State Medical University, 29 Nakhichevanskiy Lane, Rostov-on-Don, 344022, Russian Federation; LambasLab, Bar Rav Hai David 30, Haifa, 3559203, Israel.
| | | | - Ilya A Slynko
- LambasLab, Bar Rav Hai David 30, Haifa, 3559203, Israel
| | - Mikhail E Kletskii
- Department of Chemistry, Southern Federal University, 7 Zorge Str., Rostov-on-Don, 344090, Russian Federation
| | - Oleg N Burov
- Department of Chemistry, Southern Federal University, 7 Zorge Str., Rostov-on-Don, 344090, Russian Federation
| | - Dmitriy P Berezovskiy
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Build. 4, 2 Bolshaya Pirogovskaya Str., Moscow, 119435, Russian Federation
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16
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Smith FM, Kosman DJ. Loss of filamentous actin, tight junction protein expression, and paracellular barrier integrity in frataxin-deficient human brain microvascular endothelial cells-implications for blood-brain barrier physiology in Friedreich's ataxia. Front Mol Biosci 2024; 10:1299201. [PMID: 38274097 PMCID: PMC10808331 DOI: 10.3389/fmolb.2023.1299201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Friedreich's Ataxia (FRDA) is the most prevalent inherited ataxia. FRDA results from loss of Frataxin (FXN), an essential mitochondrial iron trafficking protein. FRDA starts with an early burst of neurodegeneration of the dorsal root ganglion and cerebellar dentate nuclei, followed by progressive brain iron accumulation in the latter. End stage disease includes cardiac fibrosis that contributes to hypertrophic cardiomyopathy. The microvasculature plays an essential barrier role in both brain and heart homeostasis, thus an investigation of this tissue system in FRDA is essential to the delineation of the cellular dysfunction in this genetic disorder. Previous reports have identified cytoskeletal alterations in non-barrier forming FRDA cell models, but physiological consequences are limited. Methods: We investigated brain microvascular endothelial cell integrity in FRDA in a model of the blood-brain barrier (BBB). We have knocked down FXN in immortalized human brain microvascular endothelial cells (hBMVEC), which compose the microcapillaries of the BBB, by using shRNA. We confirmed known cellular pathophysiologies of FXN-knockdown including decreased energy metabolism, markers of oxidative stress, and increased cell size. Results: We investigated cytoskeletal architecture, identifying decreased filamentous actin and Occludin and Claudin-5 tight junction protein expression in shFXN hBMVECs. This was consistent with decreased transendothelial electrical resistance (TEER) and increased paracellular tracer flux during early barrier formation. shFXN hBMVEC start with only 67% barrier integrity of the controls, and flux a paracellular tracer at 800% of physiological levels. Discussion: We identified that insufficient FXN levels in the hBMVEC BBB model causes changes in cytoskeletal architecture and tight junction protein abundance, co-incident with increased barrier permeability. Changes in the integrity of the BBB may be related to patient brain iron accumulation, neuroinflammation, neurodegeneration, and stroke. Furthermore, our findings implicate other barrier cells, e.g., the cardiac microvasculature, loci of disease pathology in FRDA.
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Affiliation(s)
- Frances M. Smith
- Jacobs School of Medicine and Biomedical Sciences, Department of Biochemistry, The State University of New York at Buffalo, Buffalo, NY, United States
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Rojsajjakul T, Selvan N, De B, Rosenberg JB, Kaminsky SM, Sondhi D, Janki P, Crystal RG, Mesaros C, Khanna R, Blair IA. Expression and processing of mature human frataxin after gene therapy in mice. RESEARCH SQUARE 2023:rs.3.rs-3788652. [PMID: 38234818 PMCID: PMC10793484 DOI: 10.21203/rs.3.rs-3788652/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Friedreich's ataxia is a degenerative and progressive multisystem disorder caused by mutations in the highly conserved frataxin (FXN) gene that results in FXN protein deficiency and mitochondrial dysfunction. While gene therapy approaches are promising, consistent induction of therapeutic FXN protein expression that is sub-toxic has proven challenging, and numerous therapeutic approaches are being tested in animal models. FXN (hFXN in humans, mFXN in mice) is proteolytically modified in mitochondria to produce mature FXN. However, unlike endogenous hFXN, endogenous mFXN is further processed into N-terminally truncated, extra-mitochondrial mFXN forms of unknown function. This study assessed mature exogenous hFXN expression levels in the heart and liver of C57Bl/6 mice 7-10 months after intravenous administration of a recombinant adeno-associated virus encoding hFXN (AAVrh.10hFXN) and examined the potential for hFXN truncation in mice. AAVrh.10hFXN induced dose-dependent expression of hFXN in the heart and liver. Interestingly, hFXN was processed into truncated forms, but found at lower levels than mature hFXN. However, the truncations were at different positions than mFXN. AAVrh.10hFXN induced mature hFXN expression in mouse heart and liver at levels that approximated endogenous mFXN levels. These results demonstrate that AAVrh.10hFXN may induce expression of therapeutic levels of mature hFXN in mice.
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18
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Bouchard C, Gérard C, Yanyabé SGF, Majeau N, Aloui M, Buisson G, Yameogo P, Couture V, Tremblay JP. Finding an Appropriate Mouse Model to Study the Impact of a Treatment for Friedreich Ataxia on the Behavioral Phenotype. Genes (Basel) 2023; 14:1654. [PMID: 37628705 PMCID: PMC10454134 DOI: 10.3390/genes14081654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Friedreich ataxia (FRDA) is a progressive neurodegenerative disease caused by a GAA repeat in the intron 1 of the frataxin gene (FXN) leading to a lower expression of the frataxin protein. The YG8sR mice are Knock-Out (KO) for their murine frataxin gene but contain a human frataxin transgene derived from an FRDA patient with 300 GAA repeats. These mice are used as a FRDA model but even with a low frataxin concentration, their phenotype is mild. We aimed to find an optimized mouse model with a phenotype comparable to the human patients to study the impact of therapy on the phenotype. We compared two mouse models: the YG8sR injected with an AAV. PHP.B coding for a shRNA targeting the human frataxin gene and the YG8-800, a new mouse model with a human transgene containing 800 GAA repeats. Both mouse models were compared to Y47R mice containing nine GAA repeats that were considered healthy mice. Behavior tests (parallel rod floor apparatus, hanging test, inverted T beam, and notched beam test) were carried out from 2 to 11 months and significant differences were noticed for both YG8sR mice injected with an anti-FXN shRNA and the YG8-800 mice compared to healthy mice. In conclusion, YG8sR mice have a slight phenotype, and injecting them with an AAV-PHP.B expressing an shRNA targeting frataxin does increase their phenotype. The YG8-800 mice have a phenotype comparable to the human ataxic phenotype.
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Affiliation(s)
- Camille Bouchard
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Catherine Gérard
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Solange Gni-fiene Yanyabé
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Nathalie Majeau
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Malek Aloui
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
| | - Gabrielle Buisson
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
| | - Pouiré Yameogo
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Vanessa Couture
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
| | - Jacques P. Tremblay
- Centre de Recherche du CHU, Québec-Université Laval, Québec, QC G1V 4G2, Canada (N.M.); (M.A.); (G.B.)
- Département de Médecine Moléculaire, l’Université Laval Québec, Québec, QC G1V 4G2, Canada
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19
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Luffarelli R, Panarello L, Quatrana A, Tiano F, Fortuni S, Rufini A, Malisan F, Testi R, Condò I. Interferon Gamma Enhances Cytoprotective Pathways via Nrf2 and MnSOD Induction in Friedreich's Ataxia Cells. Int J Mol Sci 2023; 24:12687. [PMID: 37628866 PMCID: PMC10454386 DOI: 10.3390/ijms241612687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Friedreich's ataxia (FRDA) is a rare monogenic disease characterized by multisystem, slowly progressive degeneration. Because of the genetic defect in a non-coding region of FXN gene, FRDA cells exhibit severe deficit of frataxin protein levels. Hence, FRDA pathophysiology is characterized by a plethora of metabolic disruptions related to iron metabolism, mitochondrial homeostasis and oxidative stress. Importantly, an impairment of the antioxidant defences exacerbates the oxidative damage. This appears closely associated with the disablement of key antioxidant proteins, such as the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) and the mitochondrial superoxide dismutase (MnSOD). The cytokine interferon gamma (IFN-γ) has been shown to increase frataxin expression in FRDA cells and to improve functional deficits in FRDA mice. Currently, IFN-γ represents a potential therapy under clinical evaluation in FRDA patients. Here, we show that IFN-γ induces a rapid expression of Nrf2 and MnSOD in different cell types, including FRDA patient-derived fibroblasts. Our data indicate that IFN-γ signals two separate pathways to enhance Nrf2 and MnSOD levels in FRDA fibroblasts. MnSOD expression increased through an early transcriptional regulation, whereas the levels of Nrf2 are induced by a post-transcriptional mechanism. We demonstrate that the treatment of FRDA fibroblasts with IFN-γ stimulates a non-canonical Nrf2 activation pathway through p21 and potentiates antioxidant responses under exposure to hydrogen peroxide. Moreover, IFN-γ significantly reduced the sensitivity to hydrogen peroxide-induced cell death in FRDA fibroblasts. Collectively, these results indicate the presence of multiple pathways triggered by IFN-γ with therapeutic relevance to FRDA.
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Affiliation(s)
- Riccardo Luffarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Luca Panarello
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Andrea Quatrana
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Francesca Tiano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Silvia Fortuni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Alessandra Rufini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
- Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Florence Malisan
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Roberto Testi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
| | - Ivano Condò
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (R.L.); (L.P.); (A.Q.); (F.T.); (S.F.); (A.R.); (F.M.); (R.T.)
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20
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Munoz-Zuluaga C, Gertz M, Yost-Bido M, Greco A, Gorman N, Chen A, Kooner V, Rosenberg JB, De BP, Kaminsky SM, Borczuk A, Ricart Arbona RJ, Martin HR, Monette S, Khanna R, Barth JA, Crystal RG, Sondhi D. Identification of Safe and Effective Intravenous Dose of AAVrh.10hFXN to Treat the Cardiac Manifestations of Friedreich's Ataxia. Hum Gene Ther 2023; 34:605-615. [PMID: 37166361 PMCID: PMC10354731 DOI: 10.1089/hum.2023.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023] Open
Abstract
Friedreich's ataxia (FA) is a life-threatening autosomal recessive disorder characterized by neurological and cardiac dysfunction. Arrhythmias and heart failure are the main cause of premature death. From prior studies in murine models of FA, adeno-associated virus encoding the normal human frataxin gene (AAVrh.10hFXN) effectively treated the cardiac manifestations of the disease. However, the therapeutic dose window is limited by high level of human frataxin (hFXN) gene expression associated with toxicity. As a therapeutic goal, since FA heterozygotes have no clinical manifestations of FA, we estimated the level of frataxin (FXN) necessary to convert the heart of a homozygote to that of a heterozygote. In noncardiac cells, FA heterozygotes have 30-80% of normal FXN levels (17.7-47.2 ng/mg, average 32.5 ng/mg) and FA homozygotes 2-30% normal levels (1.2-17.7 ng/mg, average 9.4 ng/mg). Therefore, an AAV vector would need to augment endogenous in an FA homozygote by >8.3 ng/mg. To determine the required dose of AAVrh.10hFXN, we administered 1.8 × 1011, 5.7 × 1011, or 1.8 × 1012 gc/kg of AAVrh.10hFXN intravenously (IV) to muscle creatine kinase (mck)-Cre conditional knockout Fxn mice, a cardiac and skeletal FXN knockout model. The minimally effective dose was 5.7 × 1011 gc/kg, resulting in cardiac hFXN levels of 6.1 ± 4.2 ng/mg and a mild (p < 0.01 compared with phosphate-buffered saline controls) improvement in mortality. A dose of 1.8 × 1012 gc/kg resulted in cardiac hFXN levels of 33.7 ± 6.4 ng/mg, a significant improvement in ejection fraction and fractional shortening (p < 0.05, both comparisons) and a 21.5% improvement in mortality (p < 0.001). To determine if the significantly effective dose of 1.8 × 1012 gc/kg could achieve human FA heterozygote levels in a large animal, this dose was administered IV to nonhuman primates. After 12 weeks, the vector-expressed FXN in the heart was 17.8 ± 4.9 ng/mg, comparable to the target human levels. These data identify both minimally and significantly effective therapeutic doses that are clinically relevant for the treatment of the cardiac manifestations of FA.
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Affiliation(s)
| | - Monica Gertz
- Department of Genetic Medicine, New York, New York, USA
| | | | | | | | - Alvin Chen
- Department of Genetic Medicine, New York, New York, USA
| | - Vikrum Kooner
- Department of Genetic Medicine, New York, New York, USA
| | | | - Bishnu P. De
- Department of Genetic Medicine, New York, New York, USA
| | | | - Alain Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Rodolfo J. Ricart Arbona
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Heather R. Martin
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Sebastien Monette
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Dolan Sondhi
- Department of Genetic Medicine, New York, New York, USA
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21
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Henden L, Fearnley LG, Grima N, McCann EP, Dobson-Stone C, Fitzpatrick L, Friend K, Hobson L, Chan Moi Fat S, Rowe DB, D'Silva S, Kwok JB, Halliday GM, Kiernan MC, Mazumder S, Timmins HC, Zoing M, Pamphlett R, Adams L, Bahlo M, Blair IP, Williams KL. Short tandem repeat expansions in sporadic amyotrophic lateral sclerosis and frontotemporal dementia. SCIENCE ADVANCES 2023; 9:eade2044. [PMID: 37146135 PMCID: PMC10162670 DOI: 10.1126/sciadv.ade2044] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Pathogenic short tandem repeat (STR) expansions cause over 20 neurodegenerative diseases. To determine the contribution of STRs in sporadic amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), we used ExpansionHunter, REviewer, and polymerase chain reaction validation to assess 21 neurodegenerative disease-associated STRs in whole-genome sequencing data from 608 patients with sporadic ALS, 68 patients with sporadic FTD, and 4703 matched controls. We also propose a data-derived outlier detection method for defining allele thresholds in rare STRs. Excluding C9orf72 repeat expansions, 17.6% of clinically diagnosed ALS and FTD cases had at least one expanded STR allele reported to be pathogenic or intermediate for another neurodegenerative disease. We identified and validated 162 disease-relevant STR expansions in C9orf72 (ALS/FTD), ATXN1 [spinal cerebellar ataxia type 1 (SCA1)], ATXN2 (SCA2), ATXN8 (SCA8), TBP (SCA17), HTT (Huntington's disease), DMPK [myotonic dystrophy type 1 (DM1)], CNBP (DM2), and FMR1 (fragile-X disorders). Our findings suggest clinical and pathological pleiotropy of neurodegenerative disease genes and highlight their importance in ALS and FTD.
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Affiliation(s)
- Lyndal Henden
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Liam G Fearnley
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Natalie Grima
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Emily P McCann
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Carol Dobson-Stone
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Lauren Fitzpatrick
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Kathryn Friend
- SA Pathology, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Lynne Hobson
- SA Pathology, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Sandrine Chan Moi Fat
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Dominic B Rowe
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Susan D'Silva
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - John B Kwok
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Glenda M Halliday
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Srestha Mazumder
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Margaret Zoing
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Roger Pamphlett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Discipline of Pathology, The University of Sydney, Sydney, NSW 2050, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Lorel Adams
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Ian P Blair
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Kelly L Williams
- Macquarie University Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
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22
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Simona K, Veronika M, Zahinoor I, Martin V. Neuropsychiatric symptoms in spinocerebellar ataxias and Friedreich ataxia. Neurosci Biobehav Rev 2023; 150:105205. [PMID: 37137435 DOI: 10.1016/j.neubiorev.2023.105205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/14/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023]
Abstract
Apart from its role in motor coordination, the importance of the cerebellum in cognitive and affective processes has been recognized in the past few decades. Spinocerebellar ataxias (SCA) and Friedreich ataxia (FRDA) are rare neurodegenerative diseases of the cerebellum presenting mainly with a progressive loss of gait and limb coordination, dysarthria, and other motor disturbances, but also a range of cognitive and neuropsychiatric symptoms. This narrative review summarizes the current knowledge on neuropsychiatric impairment in SCA and FRDA. We discuss the prevalence, clinical features and treatment approaches in the most commonly reported domains of depression, anxiety, apathy, agitation and impulse dyscontrol, and psychosis. Since these symptoms have a considerable impact on patients' quality of life, we argue that further research is mandated to improve the detection and treatment options of neuropsychiatric co-morbidities in ataxia patients.
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Affiliation(s)
- Karamazovova Simona
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic
| | - Matuskova Veronika
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic.
| | - Ismail Zahinoor
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Vyhnalek Martin
- Center of Hereditary Ataxias, Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic
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23
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Costa I, Barbosa DJ, Silva V, Benfeito S, Borges F, Remião F, Silva R. Research Models to Study Ferroptosis's Impact in Neurodegenerative Diseases. Pharmaceutics 2023; 15:pharmaceutics15051369. [PMID: 37242612 DOI: 10.3390/pharmaceutics15051369] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Ferroptosis is a type of regulated cell death promoted by the appearance of oxidative perturbations in the intracellular microenvironment constitutively controlled by glutathione peroxidase 4 (GPX4). It is characterized by increased production of reactive oxygen species, intracellular iron accumulation, lipid peroxidation, inhibition of system Xc-, glutathione depletion, and decreased GPX4 activity. Several pieces of evidence support the involvement of ferroptosis in distinct neurodegenerative diseases. In vitro and in vivo models allow a reliable transition to clinical studies. Several in vitro models, including differentiated SH-SY5Y and PC12 cells, among others, have been used to investigate the pathophysiological mechanisms of distinct neurodegenerative diseases, including ferroptosis. In addition, they can be useful in the development of potential ferroptosis inhibitors that can be used as disease-modifying drugs for the treatment of such diseases. On the other hand, in vivo models based on the manipulation of rodents and invertebrate animals, such as Drosophila melanogaster, Caenorhabditis elegans, and zebrafish, have been increasingly used for research in neurodegeneration. This work provides an up-to-date review of the main in vitro and in vivo models that can be used to evaluate ferroptosis in the most prevalent neurodegenerative diseases, and to explore potential new drug targets and novel drug candidates for effective disease-modifying therapies.
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Affiliation(s)
- Inês Costa
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Daniel José Barbosa
- TOXRUN-Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Vera Silva
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- CIQUP-IMS-Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Sofia Benfeito
- CIQUP-IMS-Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Fernanda Borges
- CIQUP-IMS-Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Fernando Remião
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Renata Silva
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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24
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Tiberi J, Segatto M, Fiorenza MT, La Rosa P. Apparent Opportunities and Hidden Pitfalls: The Conflicting Results of Restoring NRF2-Regulated Redox Metabolism in Friedreich's Ataxia Pre-Clinical Models and Clinical Trials. Biomedicines 2023; 11:biomedicines11051293. [PMID: 37238963 DOI: 10.3390/biomedicines11051293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Friedreich's ataxia (FRDA) is an autosomal, recessive, inherited neurodegenerative disease caused by the loss of activity of the mitochondrial protein frataxin (FXN), which primarily affects dorsal root ganglia, cerebellum, and spinal cord neurons. The genetic defect consists of the trinucleotide GAA expansion in the first intron of FXN gene, which impedes its transcription. The resulting FXN deficiency perturbs iron homeostasis and metabolism, determining mitochondrial dysfunctions and leading to reduced ATP production, increased reactive oxygen species (ROS) formation, and lipid peroxidation. These alterations are exacerbated by the defective functionality of the nuclear factor erythroid 2-related factor 2 (NRF2), a transcription factor acting as a key mediator of the cellular redox signalling and antioxidant response. Because oxidative stress represents a major pathophysiological contributor to FRDA onset and progression, a great effort has been dedicated to the attempt to restore the NRF2 signalling axis. Despite this, the beneficial effects of antioxidant therapies in clinical trials only partly reflect the promising results obtained in preclinical studies conducted in cell cultures and animal models. For these reasons, in this critical review, we overview the outcomes obtained with the administration of various antioxidant compounds and critically analyse the aspects that may have contributed to the conflicting results of preclinical and clinical studies.
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Affiliation(s)
- Jessica Tiberi
- Division of Neuroscience, Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Marco Segatto
- Department of Bioscience and Territory, University of Molise, Contrada Fonte Lappone, 86090 Pesche, Italy
| | - Maria Teresa Fiorenza
- Division of Neuroscience, Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- European Center for Brain Research, IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00179 Rome, Italy
| | - Piergiorgio La Rosa
- Division of Neuroscience, Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- European Center for Brain Research, IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00179 Rome, Italy
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25
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Lew SY, Mohd Hisam NS, Phang MWL, Syed Abdul Rahman SN, Poh RYY, Lim SH, Kamaruzzaman MA, Chau SC, Tsui KC, Lim LW, Wong KH. Adenosine Improves Mitochondrial Function and Biogenesis in Friedreich's Ataxia Fibroblasts Following L-Buthionine Sulfoximine-Induced Oxidative Stress. BIOLOGY 2023; 12:biology12040559. [PMID: 37106759 PMCID: PMC10136261 DOI: 10.3390/biology12040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
Adenosine is a nucleoside that is widely distributed in the central nervous system and acts as a central excitatory and inhibitory neurotransmitter in the brain. The protective role of adenosine in different pathological conditions and neurodegenerative diseases is mainly mediated by adenosine receptors. However, its potential role in mitigating the deleterious effects of oxidative stress in Friedreich's ataxia (FRDA) remains poorly understood. We aimed to investigate the protective effects of adenosine against mitochondrial dysfunction and impaired mitochondrial biogenesis in L-buthionine sulfoximine (BSO)-induced oxidative stress in dermal fibroblasts derived from an FRDA patient. The FRDA fibroblasts were pre-treated with adenosine for 2 h, followed by 12.50 mM BSO to induce oxidative stress. Cells in medium without any treatments or pre-treated with 5 µM idebenone served as the negative and positive controls, respectively. Cell viability, mitochondrial membrane potential (MMP), aconitase activity, adenosine triphosphate (ATP) level, mitochondrial biogenesis, and associated gene expressions were assessed. We observed disruption of mitochondrial function and biogenesis and alteration in gene expression patterns in BSO-treated FRDA fibroblasts. Pre-treatment with adenosine ranging from 0-600 µM restored MMP, promoted ATP production and mitochondrial biogenesis, and modulated the expression of key metabolic genes, namely nuclear respiratory factor 1 (NRF1), transcription factor A, mitochondrial (TFAM), and NFE2-like bZIP transcription factor 2 (NFE2L2). Our study demonstrated that adenosine targeted mitochondrial defects in FRDA, contributing to improved mitochondrial function and biogenesis, leading to cellular iron homeostasis. Therefore, we suggest a possible therapeutic role for adenosine in FRDA.
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Affiliation(s)
- Sze Yuen Lew
- Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Michael Weng Lok Phang
- Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Rozaida Yuen Ying Poh
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Siew Huah Lim
- Department of Chemistry, Faculty of Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Amir Kamaruzzaman
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia
| | - Sze Chun Chau
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Chun Tsui
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lee Wei Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kah Hui Wong
- Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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26
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Lin CYR, Kuo SH. Ataxias: Hereditary, Acquired, and Reversible Etiologies. Semin Neurol 2023; 43:48-64. [PMID: 36828010 DOI: 10.1055/s-0043-1763511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A variety of etiologies can cause cerebellar dysfunction, leading to ataxia symptoms. Therefore, the accurate diagnosis of the cause for cerebellar ataxia can be challenging. A step-wise investigation will reveal underlying causes, including nutritional, toxin, immune-mediated, genetic, and degenerative disorders. Recent advances in genetics have identified new genes for both autosomal dominant and autosomal recessive ataxias, and new therapies are on the horizon for targeting specific biological pathways. New diagnostic criteria for degenerative ataxias have been proposed, specifically for multiple system atrophy, which will have a broad impact on the future clinical research in ataxia. In this article, we aim to provide a review focus on symptoms, laboratory testing, neuroimaging, and genetic testing for the diagnosis of cerebellar ataxia causes, with a special emphasis on recent advances. Strategies for the management of cerebellar ataxia is also discussed.
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Affiliation(s)
- Chi-Ying R Lin
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas.,Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, Texas
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York.,Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York
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Mitochondrial Dysfunction in Cardiac Arrhythmias. Cells 2023; 12:cells12050679. [PMID: 36899814 PMCID: PMC10001005 DOI: 10.3390/cells12050679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Electrophysiological and structural disruptions in cardiac arrhythmias are closely related to mitochondrial dysfunction. Mitochondria are an organelle generating ATP, thereby satisfying the energy demand of the incessant electrical activity in the heart. In arrhythmias, the homeostatic supply-demand relationship is impaired, which is often accompanied by progressive mitochondrial dysfunction leading to reduced ATP production and elevated reactive oxidative species generation. Furthermore, ion homeostasis, membrane excitability, and cardiac structure can be disrupted through pathological changes in gap junctions and inflammatory signaling, which results in impaired cardiac electrical homeostasis. Herein, we review the electrical and molecular mechanisms of cardiac arrhythmias, with a particular focus on mitochondrial dysfunction in ionic regulation and gap junction action. We provide an update on inherited and acquired mitochondrial dysfunction to explore the pathophysiology of different types of arrhythmias. In addition, we highlight the role of mitochondria in bradyarrhythmia, including sinus node dysfunction and atrioventricular node dysfunction. Finally, we discuss how confounding factors, such as aging, gut microbiome, cardiac reperfusion injury, and electrical stimulation, modulate mitochondrial function and cause tachyarrhythmia.
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Smith FM, Kosman DJ. Frataxin-deficient human brain microvascular endothelial cells lose polymerized actin and are paracellularly permeable -implications for blood-brain barrier integrity in Friedreich's Ataxia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.09.527936. [PMID: 36798283 PMCID: PMC9934603 DOI: 10.1101/2023.02.09.527936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Background Friedreich's Ataxia (FRDA) is the most prevalent inherited ataxia; the disease results from loss of Frataxin, an essential mitochondrial iron trafficking protein. FRDA presents as neurodegeneration of the dorsal root ganglion and cerebellar dentate nuclei, followed by brain iron accumulation in the latter. End stage disease includes cardiac fibrosis that contributes to hypertrophic cardiomyopathy. The microvasculature plays an essential barrier role in both the brain and heart, thus an investigation of this tissue system in FRDA is essential to the delineation of the cellular dysfunction in this genetic disorder. Here, we investigate brain microvascular endothelial cell integrity in FRDA in a model of the blood-brain barrier (BBB). Methods We used lentiviral mediated shRNA delivery to generate a novel FRDA model in immortalized human brain microvascular endothelial cells (hBMVEC) that compose the microcapillaries of the BBB. We verified known cellular pathophysiologies of FXN knockdown including increased oxidative stress, loss of energy metabolism, and increased cell size. Furthermore, we investigated cytoskeletal architecture including the abundance and organization of filamentous actin, and barrier physiology via transendothelial electrical resistance and fluorescent tracer flux. Results shFXN hBMVEC display the known FRDA cell morbidity including increased oxidative stress, decreased energy metabolism, and an increase in cell size. We demonstrate that shFXN hBMVEC have less overall filamentous actin, and that filamentous actin is lost at the cell membrane and cortical actin ring. Consistent with loss of cytoskeletal structure and anchorage, we found decreased barrier strength and increased paracellular tracer flux in the shFXN hBMVEC transwell model. Conclusion We identified that insufficient FXN levels in the hBMVEC BBB model causes changes in cytoskeletal architecture and increased barrier permeability, cell pathologies that may be related to patient brain iron accumulation, neuroinflammation, neurodegeneration, and stroke. Our findings implicate other barrier cells, e.g., the cardiac microvasculature, likely contributory also to disease pathology in FRDA.
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Affiliation(s)
- Frances M Smith
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, The University of New York at Buffalo
| | - Daniel J Kosman
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, The University of New York at Buffalo
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29
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Popoiu TA, Dudek J, Maack C, Bertero E. Cardiac Involvement in Mitochondrial Disorders. Curr Heart Fail Rep 2023; 20:76-87. [PMID: 36802007 PMCID: PMC9977856 DOI: 10.1007/s11897-023-00592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 02/21/2023]
Abstract
PURPOSE OF REVIEW We review pathophysiology and clinical features of mitochondrial disorders manifesting with cardiomyopathy. RECENT FINDINGS Mechanistic studies have shed light into the underpinnings of mitochondrial disorders, providing novel insights into mitochondrial physiology and identifying new therapeutic targets. Mitochondrial disorders are a group of rare genetic diseases that are caused by mutations in mitochondrial DNA (mtDNA) or in nuclear genes that are essential to mitochondrial function. The clinical picture is extremely heterogeneous, the onset can occur at any age, and virtually, any organ or tissue can be involved. Since the heart relies primarily on mitochondrial oxidative metabolism to fuel contraction and relaxation, cardiac involvement is common in mitochondrial disorders and often represents a major determinant of their prognosis.
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Affiliation(s)
- Tudor-Alexandru Popoiu
- Department of Translational Research, Comprehensive Heart Failure Center, University Clinic Würzburg, Wurzburg, Germany
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Jan Dudek
- Department of Translational Research, Comprehensive Heart Failure Center, University Clinic Würzburg, Wurzburg, Germany
| | - Christoph Maack
- Department of Translational Research, Comprehensive Heart Failure Center, University Clinic Würzburg, Wurzburg, Germany
| | - Edoardo Bertero
- Department of Translational Research, Comprehensive Heart Failure Center, University Clinic Würzburg, Wurzburg, Germany.
- Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Genoa, Italy.
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30
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Bildirici Y, Kocaaga A, Yimenicioglu S. Clinical, neuroimaging and genetic findings in children with hereditary ataxia: single center study. Mol Biol Rep 2023; 50:1367-1373. [PMID: 36462087 DOI: 10.1007/s11033-022-08148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The genetics of hereditary ataxia (HA) are complex and multigenic. The diversity of genes that cause ataxia varies considerably between populations. We aimed to investigate the clinical, neuroimaging, and genetic findings of HA in children from a tertiary center in Turkey. METHODS The clinical and neuroimaging evaluations of patients, laboratory investigations, and molecular genetic evaluations of those with ataxia were performed at the pediatrics, pediatric neurology, and genetics outpatient clinics between October 2020 and October 2021. With repeated expansions in the ATXN 1, 2, 3, 7, and 8 genes for spinocerebellar ataxia (SCA) and FXN genes for Friedreich's ataxia (FA), whole-exome sequencing (WES) was used to analyze every patient. RESULTS 25 patients from 24 families had ataxia and an unsteady gait as their main symptoms. The patients had a mean age of 8.5 ± 3.78 years, and the symptoms had begun at a mean age of 2 ± 0.62 years; five of these were males and three were females. A genetic cause of ataxia was found in 8/25 patients (32%). Seven of the eight gene mutations detected in the patients were novel mutations. Spinocerebellar ataxia was found in 16% of cases (n = 4), L-2-Hydroxyglutaric aciduria was found in 12% of cases (n = 3), and ataxia-telangiectasia was found in 4% of cases (n = 1). CONCLUSION Our research adds to the body of knowledge by describing the clinical and genetic traits of HA patients in our area and by finding unusual gene changes linked to ataxia.
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Affiliation(s)
- Yasar Bildirici
- Department of Pediatrics, Health Ministry Eskisehir City Hospital, 71 Evler Mahallesi, Çavdarlar Sk., Odunpazarı, 26080, Eskişehir, Turkey
| | - Ayca Kocaaga
- Department of Medical Genetics, Health Ministry Eskisehir City Hospital, 71 Evler Mahallesi, Çavdarlar Sk., Odunpazarı, 26080, Eskişehir, Turkey
| | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Health Ministry Eskisehir City Hospital, 71 Evler Mahallesi, Çavdarlar Sk., Odunpazarı, 26080, Eskişehir, Turkey.
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31
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Ronco R, Perini C, Currò R, Dominik N, Facchini S, Gennari A, Simone R, Stuart S, Nagy S, Vegezzi E, Quartesan I, El-Saddig A, Lavin T, Tucci A, Szymura A, Novis De Farias LE, Gary A, Delfeld M, Kandikatla P, Niu N, Tawde S, Shaw J, Polke J, Reilly MM, Wood NW, Crespan E, Gomez C, Chen JYH, Schmahmann JD, Gosal D, Houlden H, Das S, Cortese A. Truncating Variants in RFC1 in Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome. Neurology 2023; 100:e543-e554. [PMID: 36289003 PMCID: PMC9931080 DOI: 10.1212/wnl.0000000000201486] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/14/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is an autosomal recessive neurodegenerative disease characterized by adult-onset and slowly progressive sensory neuropathy, cerebellar dysfunction, and vestibular impairment. In most cases, the disease is caused by biallelic (AAGGG)n repeat expansions in the second intron of the replication factor complex subunit 1 (RFC1). However, a small number of cases with typical CANVAS do not carry the common biallelic repeat expansion. The objective of this study was to expand the genotypic spectrum of CANVAS by identifying sequence variants in RFC1-coding region associated with this condition. METHODS Fifteen individuals diagnosed with CANVAS and carrying only 1 heterozygous (AAGGG)n expansion in RFC1 underwent whole-genome sequencing or whole-exome sequencing to test for the presence of a second variant in RFC1 or other unrelated gene. To assess the effect of truncating variants on RFC1 expression, we tested the level of RFC1 transcript and protein on patients' derived cell lines. RESULTS We identified 7 patients from 5 unrelated families with clinically defined CANVAS carrying a heterozygous (AAGGG)n expansion together with a second truncating variant in trans in RFC1, which included the following: c.1267C>T (p.Arg423Ter), c.1739_1740del (p.Lys580SerfsTer9), c.2191del (p.Gly731GlufsTer6), and c.2876del (p.Pro959GlnfsTer24). Patient fibroblasts containing the c.1267C>T (p.Arg423Ter) or c.2876del (p.Pro959GlnfsTer24) variants demonstrated nonsense-mediated mRNA decay and reduced RFC1 transcript and protein. DISCUSSION Our report expands the genotype spectrum of RFC1 disease. Full RFC1 sequencing is recommended in cases affected by typical CANVAS and carrying monoallelic (AAGGG)n expansions. In addition, it sheds further light on the pathogenesis of RFC1 CANVAS because it supports the existence of a loss-of-function mechanism underlying this complex neurodegenerative condition.
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Affiliation(s)
- Riccardo Ronco
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Cecilia Perini
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Riccardo Currò
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Natalia Dominik
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Stefano Facchini
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Alice Gennari
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Roberto Simone
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Skye Stuart
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Sara Nagy
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Elisa Vegezzi
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ilaria Quartesan
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Amar El-Saddig
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Timothy Lavin
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Arianna Tucci
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Agnieszka Szymura
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Luiz Eduardo Novis De Farias
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Alexander Gary
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Megan Delfeld
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Priscilla Kandikatla
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nifang Niu
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Sanjukta Tawde
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Joseph Shaw
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - James Polke
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Mary M Reilly
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nick W Wood
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Emmanuele Crespan
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Christopher Gomez
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jin Yun Helen Chen
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jeremy Dan Schmahmann
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Gosal
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Henry Houlden
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Soma Das
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Andrea Cortese
- From the Department of Neuromuscular Diseases (R.R., R.C., N.D., S.F., Alice Gennari, R.S., S.S., S.N., A.T., A.S., L.E.N.D.F., M.M.R., N.W.W., H.H., A.C.), UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Brain and Behavioral Sciences (R.R., R.C., I.Q., A.C.), University of Pavia, Pavia, Italy; Institute of Molecular Genetics IGM-CNR "Luigi Luca Cavalli-Sforza" (C.P., E.C.), Italy; Department of Neurology (S.N.), University Hospital Basel, University of Basel, Switzerland; IRCCS Mondino Foundation (E.V.), Pavia, Italy; Manchester Centre for Clinical Neurosciences (A.E.-S., T.L., D.G.), Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Clinical Pharmacology (A.T.), William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Departamento de Distúrbios do Movimento (L.E.N.D.F.), Hospital Das Clínicas Da Universidade Federal Do Paraná, Curitiba, Brazil; University of Chicago Medical Center (Alexander Gary, M.D., P.K., S.D.), The University of Chicago, IL; Department of Human Genetics (N.N., S.T.), The University of Chicago, IL; Neurogenetics (J.S., J.P.), University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (C.G.), The University of Chicago, IL; and Ataxia Center (J.Y.H.C., J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston.
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Kalef-Ezra E, Edzeamey FJ, Valle A, Khonsari H, Kleine P, Oggianu C, Al-Mahdawi S, Pook MA, Anjomani Virmouni S. A new FRDA mouse model [ Fxn null:YG8s(GAA) > 800] with more than 800 GAA repeats. Front Neurosci 2023; 17:930422. [PMID: 36777637 PMCID: PMC9909538 DOI: 10.3389/fnins.2023.930422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Friedreich's ataxia (FRDA) is an inherited recessive neurodegenerative disorder caused by a homozygous guanine-adenine-adenine (GAA) repeat expansion within intron 1 of the FXN gene, which encodes the essential mitochondrial protein frataxin. There is still no effective therapy for FRDA, therefore the development of optimal cell and animal models of the disease is one of the priorities for preclinical therapeutic testing. Methods We obtained the latest FRDA humanized mouse model that was generated on the basis of our previous YG8sR, by Jackson laboratory [YG8JR, Fxn null:YG8s(GAA) > 800]. We characterized the behavioral, cellular, molecular and epigenetics properties of the YG8JR model, which has the largest GAA repeat sizes compared to all the current FRDA mouse models. Results We found statistically significant behavioral deficits, together with reduced levels of frataxin mRNA and protein, and aconitase activity in YG8JR mice compared with control Y47JR mice. YG8JR mice exhibit intergenerational GAA repeat instability by the analysis of parent and offspring tissue samples. Somatic GAA repeat instability was also detected in individual brain and cerebellum tissue samples. In addition, increased DNA methylation of CpG U13 was identified in FXN GAA repeat region in the brain, cerebellum, and heart tissues. Furthermore, we show decreased histone H3K9 acetylation and increased H3K9 methylation of YG8JR cerebellum tissues within the FXN gene, upstream and downstream of the GAA repeat region compared to Y47JR controls. Discussion These studies provide a detailed characterization of the GAA repeat expansion-based YG8JR transgenic mouse models that will help investigations of FRDA disease mechanisms and therapy.
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Affiliation(s)
- Ester Kalef-Ezra
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Fred Jonathan Edzeamey
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Adamo Valle
- Energy Metabolism and Nutrition, Research Institute of Health Sciences (IUNICS), University of Balearic Islands, Palma, Spain,Health Research Institute of Balearic Islands (IdISBa), Palma, Spain,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBERobn CB06/03/0043), Instituto de Salud Carlos III, Madrid, Spain
| | - Hassan Khonsari
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Paula Kleine
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Carlo Oggianu
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Sahar Al-Mahdawi
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Mark A. Pook
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Sara Anjomani Virmouni
- Ataxia Research Group, Division of Biosciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom,*Correspondence: Sara Anjomani Virmouni,
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Pan X, Dutta D, Lu S, Bellen HJ. Sphingolipids in neurodegenerative diseases. Front Neurosci 2023; 17:1137893. [PMID: 36875645 PMCID: PMC9978793 DOI: 10.3389/fnins.2023.1137893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Neurodegenerative Diseases (NDDs) are a group of disorders that cause progressive deficits of neuronal function. Recent evidence argues that sphingolipid metabolism is affected in a surprisingly broad set of NDDs. These include some lysosomal storage diseases (LSDs), hereditary sensory and autonomous neuropathy (HSAN), hereditary spastic paraplegia (HSP), infantile neuroaxonal dystrophy (INAD), Friedreich's ataxia (FRDA), as well as some forms of amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD). Many of these diseases have been modeled in Drosophila melanogaster and are associated with elevated levels of ceramides. Similar changes have also been reported in vertebrate cells and mouse models. Here, we summarize studies using fly models and/or patient samples which demonstrate the nature of the defects in sphingolipid metabolism, the organelles that are implicated, the cell types that are initially affected, and potential therapeutics for these diseases.
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Affiliation(s)
- Xueyang Pan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, United States
| | - Debdeep Dutta
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, United States
| | - Shenzhao Lu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, United States
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, United States.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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Profeta V, McIntyre K, Wells M, Park C, Lynch DR. Omaveloxolone: an activator of Nrf2 for the treatment of Friedreich ataxia. Expert Opin Investig Drugs 2023; 32:5-16. [PMID: 36708320 DOI: 10.1080/13543784.2023.2173063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Friedreich ataxia (FRDA) is a rare autosomal recessive degenerative disorder characterized by ataxia, dysarthria, diabetes, cardiomyopathy, scoliosis, and occasionally vision loss in late-stage disease. The discovery of the abnormal gene in FRDA and its product frataxin has provided insight into the pathophysiology and mechanisms of treatment. AREAS COVERED Although the neurologic phenotype of FRDA is well defined, there are currently no established pharmacological treatments. Omaveloxolone, a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, is currently under review by the Food and Drug Administration (FDA) and has the potential to be the first approved treatment for FRDA. In the present report, we have reviewed the basic and clinical literature on Nrf2 deficiency in FRDA, and evidence for the benefit of omaveloxolone. EXPERT OPINION The present perspective suggests that omaveloxolone is a rational and efficacious therapy that is possibly disease modifying in treatment of FRDA.
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Affiliation(s)
- Victoria Profeta
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kellie McIntyre
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - McKenzie Wells
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Courtney Park
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Lynch
- Departments of Pediatrics and Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bizzoca A, Jirillo E, Flace P, Gennarini G. Overall Role of Contactins Expression in Neurodevelopmental Events and Contribution to Neurological Disorders. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-128217. [PMID: 36515028 DOI: 10.2174/1871527322666221212160048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neurodegenerative disorders may depend upon a misregulation of the pathways which sustain neurodevelopmental control. In this context, this review article focuses on Friedreich ataxia (FA), a neurodegenerative disorder resulting from mutations within the gene encoding the Frataxin protein, which is involved in the control of mitochondrial function and oxidative metabolism. OBJECTIVE The specific aim of the present study concerns the FA molecular and cellular substrates, for which available transgenic mice models are proposed, including mutants undergoing misexpression of adhesive/morphoregulatory proteins, in particular belonging to the Contactin subset of the immunoglobulin supergene family. METHODS In both mutant and control mice, neurogenesis was explored by morphological/morphometric analysis through the expression of cell type-specific markers, including -tubulin, the Contactin-1 axonal adhesive glycoprotein, as well as the Glial Fibrillary Acidic Protein (GFAP). RESULTS Specific consequences were found to arise from the chosen misexpression approach, consisting of a neuronal developmental delay associated with glial upregulation. Protective effects against the arising phenotype resulted from antioxidants (essentially epigallocatechin gallate (EGCG)) administration, which was demonstrated through the profiles of neuronal (-tubulin and Contactin 1) as well as glial (GFAP) markers, in turn indicating the concomitant activation of neurodegeneration and neuro repair processes. The latter also implied activation of the Notch-1 signaling. CONCLUSION Overall, this study supports the significance of changes in morphoregulatory proteins expression in the FA pathogenesis and of antioxidant administration in counteracting it, which, in turn, allows to devise potential therapeutic approaches.
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Affiliation(s)
- Antonella Bizzoca
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Paolo Flace
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
| | - Gianfranco Gennarini
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs. Medical School. University of Bari. Piazza Giulio Cesare, 11. I-70124 Bari. Italy
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Angulo MB, Bertalovitz A, Argenziano MA, Yang J, Patel A, Zesiewicz T, McDonald TV. Frataxin deficiency alters gene expression in Friedreich ataxia derived IPSC-neurons and cardiomyocytes. Mol Genet Genomic Med 2022; 11:e2093. [PMID: 36369844 PMCID: PMC9834160 DOI: 10.1002/mgg3.2093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/16/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Friedreich's ataxia (FRDA) is an autosomal recessive disease, whereby homozygous inheritance of an expanded GAA trinucleotide repeat expansion in the first intron of the FXN gene leads to transcriptional repression of the encoded protein frataxin. FRDA is a progressive neurodegenerative disorder, but the primary cause of death is heart disease which occurs in 60% of the patients. Several functions of frataxin have been proposed, but none of them fully explain why its deficiency causes the FRDA phenotypes nor why the most affected cell types are neurons and cardiomyocytes. METHODS To investigate, we generated iPSC-derived neurons (iNs) and cardiomyocytes (iCMs) from an FRDA patient and upregulated FXN expression via lentivirus without altering genomic GAA repeats at the FXN locus. RESULTS RNA-seq and differential gene expression enrichment analyses demonstrated that frataxin deficiency affected the expression of glycolytic pathway genes in neurons and extracellular matrix pathway genes in cardiomyocytes. Genes in these pathways were differentially expressed when compared to a control and restored to control levels when FRDA cells were supplemented with frataxin. CONCLUSIONS These results offer novel insight into specific roles of frataxin deficiency pathogenesis in neurons and cardiomyocytes.
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Affiliation(s)
- Mariana B. Angulo
- Heart Institute, Morsani College of Medicine, University of South FloridaTampaFloridaUSA,Department of Molecular Pharmacology & PhysiologyMorsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Alexander Bertalovitz
- Heart Institute, Morsani College of Medicine, University of South FloridaTampaFloridaUSA,Department of Medicine (Cardiology)Morsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Mariana A. Argenziano
- Heart Institute, Morsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Jiajia Yang
- Heart Institute, Morsani College of Medicine, University of South FloridaTampaFloridaUSA,Department of Molecular Pharmacology & PhysiologyMorsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Aarti Patel
- Department of Medicine (Cardiology)Morsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Theresa Zesiewicz
- Department of NeurologyMorsani College of Medicine, University of South FloridaTampaFloridaUSA
| | - Thomas V. McDonald
- Heart Institute, Morsani College of Medicine, University of South FloridaTampaFloridaUSA,Department of Molecular Pharmacology & PhysiologyMorsani College of Medicine, University of South FloridaTampaFloridaUSA,Department of Medicine (Cardiology)Morsani College of Medicine, University of South FloridaTampaFloridaUSA
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Joers JM, Adanyeguh IM, Deelchand DK, Hutter DH, Eberly LE, Iltis I, Bushara KO, Lenglet C, Henry PG. Spinal cord magnetic resonance imaging and spectroscopy detect early-stage alterations and disease progression in Friedreich ataxia. Brain Commun 2022; 4:fcac246. [PMID: 36300142 PMCID: PMC9581897 DOI: 10.1093/braincomms/fcac246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/04/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023] Open
Abstract
Friedreich ataxia is the most common hereditary ataxia. Atrophy of the spinal cord is one of the hallmarks of the disease. MRI and magnetic resonance spectroscopy are powerful and non-invasive tools to investigate pathological changes in the spinal cord. A handful of studies have reported cross-sectional alterations in Friedreich ataxia using MRI and diffusion MRI. However, to our knowledge no longitudinal MRI, diffusion MRI or MRS results have been reported in the spinal cord. Here, we investigated early-stage cross-sectional alterations and longitudinal changes in the cervical spinal cord in Friedreich ataxia, using a multimodal magnetic resonance protocol comprising morphometric (anatomical MRI), microstructural (diffusion MRI), and neurochemical (1H-MRS) assessments.We enrolled 28 early-stage individuals with Friedreich ataxia and 20 age- and gender-matched controls (cross-sectional study). Disease duration at baseline was 5.5 ± 4.0 years and Friedreich Ataxia Rating Scale total neurological score at baseline was 42.7 ± 13.6. Twenty-one Friedreich ataxia participants returned for 1-year follow-up, and 19 of those for 2-year follow-up (cohort study). Each visit consisted in clinical assessments and magnetic resonance scans. Controls were scanned at baseline only. At baseline, individuals with Friedreich ataxia had significantly lower spinal cord cross-sectional area (-31%, P = 8 × 10-17), higher eccentricity (+10%, P = 5 × 10-7), lower total N-acetyl-aspartate (tNAA) (-36%, P = 6 × 10-9) and higher myo-inositol (mIns) (+37%, P = 2 × 10-6) corresponding to a lower ratio tNAA/mIns (-52%, P = 2 × 10-13), lower fractional anisotropy (-24%, P = 10-9), as well as higher radial diffusivity (+56%, P = 2 × 10-9), mean diffusivity (+35%, P = 10-8) and axial diffusivity (+17%, P = 4 × 10-5) relative to controls. Longitudinally, spinal cord cross-sectional area decreased by 2.4% per year relative to baseline (P = 4 × 10-4), the ratio tNAA/mIns decreased by 5.8% per year (P = 0.03), and fractional anisotropy showed a trend to decrease (-3.2% per year, P = 0.08). Spinal cord cross-sectional area correlated strongly with clinical measures, with the strongest correlation coefficients found between cross-sectional area and Scale for the Assessment and Rating of Ataxia (R = -0.55, P = 7 × 10-6) and between cross-sectional area and Friedreich ataxia Rating Scale total neurological score (R = -0.60, P = 4 × 10-7). Less strong but still significant correlations were found for fractional anisotropy and tNAA/mIns. We report here the first quantitative longitudinal magnetic resonance results in the spinal cord in Friedreich ataxia. The largest longitudinal effect size was found for spinal cord cross-sectional area, followed by tNAA/mIns and fractional anisotropy. Our results provide direct evidence that abnormalities in the spinal cord result not solely from hypoplasia, but also from neurodegeneration, and show that disease progression can be monitored non-invasively in the spinal cord.
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Affiliation(s)
| | | | - Dinesh K Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Diane H Hutter
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Isabelle Iltis
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | | | - Pierre-Gilles Henry
- Correspondence to: Pierre-Gilles Henry, Ph.D Associate Professor, Center for Magnetic Resonance Research 2021 6th Street SE Minneapolis MN 55455, USA E-mail:
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Buesch K, Zhang R. A systematic review of disease prevalence, health-related quality of life, and economic outcomes associated with Friedreich's Ataxia. Curr Med Res Opin 2022; 38:1739-1749. [PMID: 35983717 DOI: 10.1080/03007995.2022.2112870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Friedreich ataxia (FA) is a rare, inherited neuromuscular disease characterized by an early onset and progressive limb and gait ataxia. Currently, there are no approved treatments for FA. It is important to understand the burden of FA, including its extent and the most salient elements. The objective of this study is therefore to systematically review the literature regarding the aspects of prevalence, health-related quality of life (HRQoL), and economic outcomes that are associated with FA, and to subsequently identify relevant knowledge gaps. METHODS Three systematic literature reviews were conducted to assess publications regarding FA prevalence, HRQoL, and economic outcomes. Search strategies were implemented in MEDLINE (Ovid) and EMBASE databases; study selection and quality assessment were conducted using current best practices. For each review, study characteristics and findings were summarized. RESULTS A total of 36 studies were included. Review of prevalence studies (n = 22) indicated variation in the number of cases by region, and many regions were not represented at all. Regarding HRQoL (n = 12 studies), physical domains were consistently impacted, although findings regarding other domains and overall HRQoL were less clear. Cost studies (n = 2) encompassed 4 regions and revealed that costs related to the provision of care, including non-medical direct costs and indirect costs, accounted for the majority of FA-related costs. DISCUSSION Findings from this systematic review revealed several knowledge gaps that would preclude the conduct of a robust assessment of the benefits and outcomes associated with a disease-modifying FA therapy. Additional understanding regarding patient and caregiver HRQoL and costs is required.
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Masnovo C, Lobo AF, Mirkin SM. Replication dependent and independent mechanisms of GAA repeat instability. DNA Repair (Amst) 2022; 118:103385. [PMID: 35952488 PMCID: PMC9675320 DOI: 10.1016/j.dnarep.2022.103385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/20/2022]
Abstract
Trinucleotide repeat instability is a driver of human disease. Large expansions of (GAA)n repeats in the first intron of the FXN gene are the cause Friedreich's ataxia (FRDA), a progressive degenerative disorder which cannot yet be prevented or treated. (GAA)n repeat instability arises during both replication-dependent processes, such as cell division and intergenerational transmission, as well as in terminally differentiated somatic tissues. Here, we provide a brief historical overview on the discovery of (GAA)n repeat expansions and their association to FRDA, followed by recent advances in the identification of triplex H-DNA formation and replication fork stalling. The main body of this review focuses on the last decade of progress in understanding the mechanism of (GAA)n repeat instability during DNA replication and/or DNA repair. We propose that the discovery of additional mechanisms of (GAA)n repeat instability can be achieved via both comparative approaches to other repeat expansion diseases and genome-wide association studies. Finally, we discuss the advances towards FRDA prevention or amelioration that specifically target (GAA)n repeat expansions.
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Affiliation(s)
- Chiara Masnovo
- Department of Biology, Tufts University, Medford, MA 02155, USA
| | - Ayesha F Lobo
- Department of Biology, Tufts University, Medford, MA 02155, USA
| | - Sergei M Mirkin
- Department of Biology, Tufts University, Medford, MA 02155, USA.
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Russo LP, Haddad D, Bauman D, Fam MM. The Use of Enhanced Recovery After Surgery Protocols and Sugammadex in a Friedreich Ataxia Patient Who Underwent Robotic Surgery: A Case Report of a Patient Who Required No Postoperative Opioids and Was Discharged Home Earlier Than Anticipated. Cureus 2022; 14:e29590. [PMID: 36312625 PMCID: PMC9595352 DOI: 10.7759/cureus.29590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Robotic surgery has shown to have numerous benefits over traditional and laparoscopic surgery, namely, superior precision and improved recovery with shorter hospital stays. However, robotic surgery also presents several issues, including hemodynamic changes related to positioning and the use of pneumoperitoneum. These matters can be problematic in patients with neuromuscular conditions such as Friedreich ataxia (FRDA). Due to a baseline weakened musculature and a higher prevalence of cardiac disease and scoliosis, patients with FRDA may not be as likely to tolerate the cardiopulmonary physiologic changes associated with robotic surgery. Additionally, positioning for robotic surgery can be challenging in FRDA patients who have progressed to spasticity and contractures. To the best of our knowledge, there are no case reports of approaches specifically discussing anesthesia management for robotic surgery in the FRDA patient population. Anesthesia in general must be carefully planned in FRDA patients to allow for the best possible recovery and minimize complications. Due to the underlying neuromuscular compromise seen in these patients, their ability to recover from the pharmacologic and physiologic changes associated with anesthesia can be more difficult. They are prone to sensitivity to opioids, sedatives, and neuromuscular blocking agents (NMBAs) and are less likely to tolerate hemodynamic changes. Our review revealed no literature to suggest the routine use of Enhanced Recovery After Surgery (ERAS) protocols in FRDA patients or in patients with neuromuscular disease in general. The use of sugammadex has also been shown to be safe, and literature suggests superiority in both the general population and those with neuromuscular conditions. Our understanding is that there is very limited literature in regard to the safe use of sugammadex in FRDA patients.
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Fichera M, Castaldo A, Mongelli A, Marchini G, Gellera C, Nanetti L, Mariotti C. Comorbidities in Friedreich ataxia: incidence and manifestations from early to advanced disease stages. Neurol Sci 2022; 43:6831-6838. [DOI: 10.1007/s10072-022-06360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
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Vinante E, Colombo E, Paparella G, Martinuzzi M, Martinuzzi A. Respiratory Function in Friedreich’s Ataxia. CHILDREN 2022; 9:children9091319. [PMID: 36138628 PMCID: PMC9497209 DOI: 10.3390/children9091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Background: Friedreich’s ataxia is an inherited, rare, progressive disorder of children and young adults. It is characterized by ataxia, loss of gait, scoliosis, cardiomyopathy, dysarthria and dysphagia, with reduced life expectancy. Alterations of respiratory dynamics and parameters are frequently observed. However, in the literature there are few, dated studies with small cohorts. Our study aims to make an objective analysis of the respiratory condition of both early and late stage FRDA patients, looking for correlations with the motor, skeletal, speech and genetic aspects of this condition. Materials and methods: This retrospective observational study is based on the collection of clinical and instrumental respiratory data of 44 subjects between 13 and 51 years attending a tertiary rehabilitation centre in northern Italy. The analysis was carried out using Pearson’s correlation test, ANOVA test and post hoc tests. Results: Data show the presence of a recurrent pattern of respiratory dysfunction of a restrictive type, with reduction in forced vital capacity and of flow and pressure parameters. The severity of the respiratory condition correlates with the disease severity (measured with disease-specific scales), with pneumophonic alterations and with the severity of the thoracic scoliotic curve. Conclusions: Respiratory function is impaired at various degrees in FRDA. The complex condition of inco-ordination and hyposthenia in FRDA affects daytime and night-time respiratory efficiency. We believe that the respiratory deficit and the inefficiency of cough are indeed a clinical problem deserving consideration, especially in the context of the concomitant postural difficulty and the possible presence of dysphagia. Therefore, the rehabilitation project for the subject with FRDA should also consider the respiratory function.
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Affiliation(s)
- Elena Vinante
- IRCCS “E. Medea”, Department of Neurorehabilitation, 31015 Conegliano, Italy
| | - Elena Colombo
- IRCCS “E. Medea”, Department of Neurorehabilitation, 31015 Conegliano, Italy
| | - Gabriella Paparella
- IRCCS “E. Medea”, Department of Neurorehabilitation, 31015 Conegliano, Italy
| | | | - Andrea Martinuzzi
- IRCCS “E. Medea”, Department of Neurorehabilitation, 31015 Conegliano, Italy
- Correspondence: ; Tel.: +39-0438-414296
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Poda A, Klevor R, Salym A, Sarih I, Salhi S, Nissrine L, Kissani N. Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:97. [PMID: 36033924 PMCID: PMC9391624 DOI: 10.1186/s41983-022-00531-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral neuropathies constitute a common complaint in general and neurology practice, and are a source of handicap to patients. Epidemiological data in the Middle East and North Africa region as well as in the African continent are sparse. Nevertheless, regional etiological profiles are crucial in navigating the diagnostic maze of neuropathies. This study outlines the etiological profile of peripheral neuropathies in an academic hospital in southern Morocco. Results A total of 180 cases were recorded in a span of 8 years (22.5 cases per year). The mean age of patients was 42.35 years. Male gender was predominant (68.88%), with a sex ratio of 2.2. Motor symptoms were the most frequently reported (86.6%). The axonal form (40.56%) was the most frequently encountered electrophysiologic form. The most frequent etiologies in the study were diabetes (26.7%), acute polyradiculoneuropathy (26.1%) and amyotrophic lateral sclerosis (16.1%). Alcohol neuropathy was found in 2.2% of the cohort. No cause was found in 5% of cases. Outcome was mostly favorable under treatment, although 10 deaths due to acute polyradiculoneuropathy were recorded (mortality = 21.3%). Conclusions Knowledge of the etiological profile of peripheral neuropathies should guide clinicians to an early diagnosis and aid in an adapted management of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41983-022-00531-4.
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Stokreef S, Lemos M, Quintas S. Importance of an echocardiogram in the evaluation of ataxia. BMJ Case Rep 2022; 15:e248691. [PMID: 35896307 PMCID: PMC9335040 DOI: 10.1136/bcr-2021-248691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a boy in his middle childhood with gait ataxia and loss of reflexes with a 1-year onset. He had a background of an autism spectrum disorder but was otherwise healthy. A paediatric cardiology assessment was requested to investigate possible cardiac involvement associated to his neurological symptoms. Even though he had no cardiac symptoms and a normal electrocardiography, the echocardiogram revealed severe asymmetric left ventricle hypertrophy consistent with hypertrophic cardiomyopathy. This prompted genetic testing and the diagnosis of Friedreich's ataxia was confirmed.
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Affiliation(s)
- Sarah Stokreef
- Pediatrics, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Mariana Lemos
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Portugal
| | - Sofia Quintas
- Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
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Wang D, Ho ES, Cotticelli MG, Xu P, Napierala JS, Hauser LA, Napierala M, Himes BE, Wilson RB, Lynch DR, Mesaros C. Skin fibroblast metabolomic profiling reveals that lipid dysfunction predicts the severity of Friedreich's ataxia. J Lipid Res 2022; 63:100255. [PMID: 35850241 PMCID: PMC9399481 DOI: 10.1016/j.jlr.2022.100255] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/26/2022] Open
Abstract
Friedreich's ataxia (FRDA) is an autosomal recessive neurodegenerative disorder caused by a triplet guanine-adenine-adenine (GAA) repeat expansion in intron 1 of the FXN gene, which leads to decreased levels of the frataxin protein. Frataxin is involved in the formation of iron-sulfur (Fe-S) cluster prosthetic groups for various metabolic enzymes. To provide a better understanding of the metabolic status of patients with FRDA, here we used patient-derived fibroblast cells as a surrogate tissue for metabolic and lipidomic profiling by liquid chromatography-high resolution mass spectrometry. We found elevated HMG-CoA and β-hydroxybutyrate-CoA levels, implying dysregulated fatty acid oxidation, which was further demonstrated by elevated acyl-carnitine levels. Lipidomic profiling identified dysregulated levels of several lipid classes in FRDA fibroblast cells when compared with non-FRDA fibroblast cells. For example, levels of several ceramides were significantly increased in FRDA fibroblast cells; these results positively correlated with the GAA repeat length and negatively correlated with the frataxin protein levels. Furthermore, stable isotope tracing experiments indicated increased ceramide synthesis, especially for long-chain fatty acid-ceramides, in FRDA fibroblast cells compared with ceramide synthesis in healthy control fibroblast cells. In addition, PUFA-containing triglycerides and phosphatidylglycerols were enriched in FRDA fibroblast cells and negatively correlated with frataxin levels, suggesting lipid remodeling as a result of FXN deficiency. Altogether, we demonstrate patient-derived fibroblast cells exhibited dysregulated metabolic capabilities, and their lipid dysfunction predicted the severity of FRDA, making them a useful surrogate to study the metabolic status in FRDA.
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Affiliation(s)
- Dezhen Wang
- Center for Excellence in Environmental Toxicology, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elaine S. Ho
- Center for Excellence in Environmental Toxicology, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M. Grazia Cotticelli
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peining Xu
- Center for Excellence in Environmental Toxicology, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill S. Napierala
- University of Alabama at Birmingham, Department of Biochemistry and Molecular Genetics, UAB Stem Cell Institute, Birmingham, Alabama, USA
| | - Lauren A. Hauser
- Department of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Abramson Research, Philadelphia, Pennsylvania, USA
| | - Marek Napierala
- University of Alabama at Birmingham, Department of Biochemistry and Molecular Genetics, UAB Stem Cell Institute, Birmingham, Alabama, USA
| | - Blanca E. Himes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert B. Wilson
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David R. Lynch
- Department of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Abramson Research, Philadelphia, Pennsylvania, USA
| | - Clementina Mesaros
- Center for Excellence in Environmental Toxicology, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,For correspondence: Clementina Mesaros
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Jarry VDM, Pereira FV, Dalaqua M, Duarte JÁ, França Junior MC, Reis F. Common and uncommon neuroimaging manifestations of ataxia: an illustrated guide for the trainee radiologist. Part 2 - neoplastic, congenital, degenerative, and hereditary diseases. Radiol Bras 2022; 55:259-266. [PMID: 35983347 PMCID: PMC9380611 DOI: 10.1590/0100-3984.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Ataxia is defined as a lack of coordination of voluntary movement, caused by a variety of factors. Ataxia can be classified by the age at onset and type (chronic or acute). The causative lesions involve the cerebellum and cerebellar connections. The correct, appropriate use of neuroimaging, particularly magnetic resonance imaging, can make the diagnosis relatively straightforward and facilitate implementation of the appropriate clinical management. The purpose of this pictorial essay is to describe the imaging findings of ataxia, based on cases obtained from the archives of a tertiary care hospital, with a review of the most important findings. We also discuss and review the imaging aspects of neoplastic diseases, malformations, degenerative diseases, and hereditary diseases related to ataxia.
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Affiliation(s)
| | | | | | | | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Brazil
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Chan W, Yang S, Wang J, Tong S, Lin M, Lu P, Yao R, Wu L, Chen L, Guo Y, Shen J, Liu T, Li F, Chen H, Zhang H, Wang S, Fu L. Clinical characteristics and survival of children with hypertrophic cardiomyopathy in China: A multicentre retrospective cohort study. EClinicalMedicine 2022; 49:101466. [PMID: 35747179 PMCID: PMC9157015 DOI: 10.1016/j.eclinm.2022.101466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Few data on paediatric hypertrophic cardiomyopathy (HCM) are available in developing countries. A multicentre, retrospective, cohort study was conducted to profile the clinical characteristics and survival of children with HCM in China. METHODS We collected longitudinal data on children with HCM aged 0-18 years at three participating institutions between January 1, 2010 and December 31, 2019. Patients were identified by searching for the diagnosis using ICD-10 codes from the electronic medical records database. HCM was diagnosed morphologically with echocardiography or cardiovascular magnetic resonance imaging. The exclusion criteria were secondary aetiologies of myocardial hypertrophy. The primary outcomes were all-cause death or heart transplantation. The Kaplan-Meier method was used to estimate the survival rate of different groups. FINDINGS A total of 564 children were recruited, with a median age at diagnosis of 1.0 year (interquartile range, IQR: 0.4-8.0 years), followed for a median of 2.6 years (1977 patient-years, IQR:0.5, 5.9 years). The underlying aetiology was sarcomeric (382, 67.7%), inborn errors of metabolism (IEMs) (108, 19.2%), and RASopathies (74, 13.1%). A total of 149 patients (26.4%) died and no patients underwent heart transplantation during follow-up. The survival probability was 71.1% (95% confidence interval [CI], 66.3%-75.3%) at 5 years. Patients with IEMs or those diagnosed during infancy had the poorest outcomes, with an estimated 5-year survival rate of 16.9% (95% CI, 7.7%-29.1%) and 56.0% (95% CI, 48.8%-62.5%), respectively. Heart failure was the leading cause of death in the cohort (90/149, 60.4%), while sudden cardiac death was the leading cause in patients with sarcomeric HCM (32/66, 48.5%). INTERPRETATION There is a high proportion of patients with IEM and a low proportion of patients with neuromuscular disease in children with HCM in China. Overall, mortality remains high in China, especially in patients with IEMs and those diagnosed during infancy. FUNDING National Natural Science Fund of China (81770380, 81974029), China Project of Shanghai Municipal Science and Technology Commission (20MC1920400, 21Y31900301).
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Affiliation(s)
- Wenxiu Chan
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jian Wang
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shilu Tong
- Department of Clinical epidemiology and Biostatistics, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Minyin Lin
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Pengtao Lu
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Ruen Yao
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lanping Wu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ying Guo
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Tingliang Liu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Fen Li
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Huiwen Chen
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
| | - Hao Zhang
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
- Corresponding author at: Shanghai Clinical Research Centre for Rare Paediatric Disease, No. 1678 Dongfang Road, Shanghai 200127, China.
| | - Shushui Wang
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
- Corresponding author at: Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China.
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Research Division of Cardiovascular Disease, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Corresponding author at: Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, No. 1678 Dongfang Road, Shanghai 200127, China.
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Hanaford AR, Cho YJ, Nakai H. AAV-vector based gene therapy for mitochondrial disease: progress and future perspectives. Orphanet J Rare Dis 2022; 17:217. [PMID: 35668433 PMCID: PMC9169410 DOI: 10.1186/s13023-022-02324-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/09/2022] [Indexed: 12/11/2022] Open
Abstract
Mitochondrial diseases are a group of rare, heterogeneous diseases caused by gene mutations in both nuclear and mitochondrial genomes that result in defects in mitochondrial function. They are responsible for significant morbidity and mortality as they affect multiple organ systems and particularly those with high energy-utilizing tissues, such as the nervous system, skeletal muscle, and cardiac muscle. Virtually no effective treatments exist for these patients, despite the urgent need. As the majority of these conditions are monogenic and caused by mutations in nuclear genes, gene replacement is a highly attractive therapeutic strategy. Adeno-associated virus (AAV) is a well-characterized gene replacement vector, and its safety profile and ability to transduce quiescent cells nominates it as a potential gene therapy vehicle for several mitochondrial diseases. Indeed, AAV vector-based gene replacement is currently being explored in clinical trials for one mitochondrial disease (Leber hereditary optic neuropathy) and preclinical studies have been published investigating this strategy in other mitochondrial diseases. This review summarizes the preclinical findings of AAV vector-based gene replacement therapy for mitochondrial diseases including Leigh syndrome, Barth syndrome, ethylmalonic encephalopathy, and others.
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Affiliation(s)
- Allison R Hanaford
- Center for Integrative Brain Research, Seattle Children's Reserach Institute, Seattle, WA, 98101, USA.
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, OR, 97239, USA.
| | - Yoon-Jae Cho
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, OR, 97239, USA
- Division of Pediatric Neurology, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Hiroyuki Nakai
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, 97239, USA
- Department of Molecular Immunology and Microbiology, Oregon Health and Science University, Portland, OR, 97239, USA
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, 97006, USA
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49
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Fernandez S, Wofford JD, Shepherd RE, Vali SW, Dancis A, Lindahl PA. Yeast cells depleted of the frataxin homolog Yfh1 redistribute cellular iron: Studies using Mössbauer spectroscopy and mathematical modeling. J Biol Chem 2022; 298:101921. [PMID: 35413285 PMCID: PMC9130540 DOI: 10.1016/j.jbc.2022.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Abstract
The neurodegenerative disease Friedreich's ataxia arises from a deficiency of frataxin, a protein that promotes iron-sulfur cluster (ISC) assembly in mitochondria. Here, primarily using Mössbauer spectroscopy, we investigated the iron content of a yeast strain in which expression of yeast frataxin homolog 1 (Yfh1), oxygenation conditions, iron concentrations, and metabolic modes were varied. We found that aerobic fermenting Yfh1-depleted cells grew slowly and accumulated FeIII nanoparticles, unlike WT cells. Under hypoxic conditions, the same mutant cells grew at rates similar to WT cells, had similar iron content, and were dominated by FeII rather than FeIII nanoparticles. Furthermore, mitochondria from mutant hypoxic cells contained approximately the same levels of ISCs as WT cells, confirming that Yfh1 is not required for ISC assembly. These cells also did not accumulate excessive iron, indicating that iron accumulation into yfh1-deficient mitochondria is stimulated by O2. In addition, in aerobic WT cells, we found that vacuoles stored FeIII, whereas under hypoxic fermenting conditions, vacuolar iron was reduced to FeII. Under respiring conditions, vacuoles of Yfh1-deficient cells contained FeIII, and nanoparticles accumulated only under aerobic conditions. Taken together, these results informed a mathematical model of iron trafficking and regulation in cells that could semiquantitatively simulate the Yfh1-deficiency phenotype. Simulations suggested partially independent regulation in which cellular iron import is regulated by ISC activity in mitochondria, mitochondrial iron import is regulated by a mitochondrial FeII pool, and vacuolar iron import is regulated by cytosolic FeII and mitochondrial ISC activity.
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Affiliation(s)
- Salvador Fernandez
- Department of Chemistry, Texas A&M University, College Station, Texas, USA
| | - Joshua D Wofford
- Department of Chemistry, College of Science and Mathematics, Charleston Southern University, Charleston South Carolina, USA
| | - Rachel E Shepherd
- Department of Chemistry, Texas A&M University, College Station, Texas, USA
| | - Shaik Waseem Vali
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA
| | - Andrew Dancis
- Department of Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Lindahl
- Department of Chemistry, Texas A&M University, College Station, Texas, USA; Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA.
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50
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Ashrafi MR, Pourbakhtyaran E, Rohani M, Shalbafan B, Tavasoli AR, Hosseinpour S, Rasulinezhad M, Rezaei Z, Zare Dehnavi A, Hosseiny SMM, Haghighi R, Ghabeli H, Heidari M. Follow‐up of 25 patients with treatable ataxia: A comprehensive case series study. Clin Case Rep 2022; 10:e05777. [PMID: 35474986 PMCID: PMC9020174 DOI: 10.1002/ccr3.5777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open
Abstract
Autosomal recessive cerebellar ataxias are a group of heterogeneous early‐onset progressive disorders that some of them are treatable. We performed a 4‐year follow‐up for 25 patients who had treatable ataxia. According to our study, patients would benefit from early detection of treatable ataxia, close observation, and follow‐up.
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Affiliation(s)
- Mahmoud Reza Ashrafi
- Department of Paediatrics Division of Paediatric Neurology, Growth and Development Research Center Children's Medical Centre Paediatrics Centre of Excellence Tehran University of Medical Sciences Tehran Iran
| | - Elham Pourbakhtyaran
- Department of Paediatrics Division of Paediatric Neurology, Growth and Development Research Center Children's Medical Centre Paediatrics Centre of Excellence Tehran University of Medical Sciences Tehran Iran
| | - Mohammad Rohani
- Department of Neurology School of Medicine Hazrat Rasool‐E Akram General Hospital Iran University of Medical Sciences Tehran Iran
| | - Bita Shalbafan
- Clinical Research Development Center of Labbafinejad Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Ali Reza Tavasoli
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
| | - Sareh Hosseinpour
- Department of Pediatric Neurology Vali‐e‐Asr Hospital Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Maryam Rasulinezhad
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
| | - Zahra Rezaei
- Department of Paediatrics Division of Paediatric Neurology, Growth and Development Research Center Children's Medical Centre Paediatrics Centre of Excellence Tehran University of Medical Sciences Tehran Iran
| | - Ali Zare Dehnavi
- Department of Paediatrics Division of Paediatric Neurology, Growth and Development Research Center Children's Medical Centre Paediatrics Centre of Excellence Tehran University of Medical Sciences Tehran Iran
| | - Seyyed Mohammad Mahdi Hosseiny
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
| | - Roya Haghighi
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
| | - Homa Ghabeli
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
| | - Morteza Heidari
- Department of Paediatrics Division of Paediatric Neurology, Growth and Development Research Center Children's Medical Centre Paediatrics Centre of Excellence Tehran University of Medical Sciences Tehran Iran
- Pediatric Neurology Division Children's Medical Center Pediatrics Center of Excellence Myelin Disorders Clinic Tehran University of Medical Sciences Tehran Iran
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