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Lauer A, Speroni SL, Choi M, Da X, Duncan C, McCarthy S, Krishnan V, Lusk CA, Rohde D, Hansen MB, Kalpathy-Cramer J, Loes DJ, Caruso PA, Williams DA, Mouridsen K, Emblem KE, Eichler FS, Musolino PL. Hematopoietic stem-cell gene therapy is associated with restored white matter microvascular function in cerebral adrenoleukodystrophy. Nat Commun 2023; 14:1900. [PMID: 37019892 PMCID: PMC10076264 DOI: 10.1038/s41467-023-37262-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Abstract
Blood-brain barrier disruption marks the onset of cerebral adrenoleukodystrophy (CALD), a devastating cerebral demyelinating disease caused by loss of ABCD1 gene function. The underlying mechanism are not well understood, but evidence suggests that microvascular dysfunction is involved. We analyzed cerebral perfusion imaging in boys with CALD treated with autologous hematopoietic stem-cells transduced with the Lenti-D lentiviral vector that contains ABCD1 cDNA as part of a single group, open-label phase 2-3 safety and efficacy study (NCT01896102) and patients treated with allogeneic hematopoietic stem cell transplantation. We found widespread and sustained normalization of white matter permeability and microvascular flow. We demonstrate that ABCD1 functional bone marrow-derived cells can engraft in the cerebral vascular and perivascular space. Inverse correlation between gene dosage and lesion growth suggests that corrected cells contribute long-term to remodeling of brain microvascular function. Further studies are needed to explore the longevity of these effects.
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Affiliation(s)
- Arne Lauer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Neuroradiology, Heidelberg University, Heidelberg, Germany
| | - Samantha L Speroni
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Myoung Choi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiao Da
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Christine Duncan
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, USA
| | - Siobhan McCarthy
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Vijai Krishnan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Cole A Lusk
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David Rohde
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Mikkel Bo Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Daniel J Loes
- Suburban Radiologic Consultants, Ltd, Minneapolis, MN, USA
| | - Paul A Caruso
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - David A Williams
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, USA
| | - Kim Mouridsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kyrre E Emblem
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Florian S Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia L Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Athinoula A. Martinos Centre for Biomedical Imaging, Charlestown, MA, USA.
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Mallack EJ, Van Haren KP, Torrey A, van de Stadt S, Engelen M, Raymond GV, Fatemi A, Eichler FS. Presymptomatic Lesion in Childhood Cerebral Adrenoleukodystrophy: Timing and Treatment. Neurology 2022; 99:e512-e520. [PMID: 35609989 PMCID: PMC9421600 DOI: 10.1212/wnl.0000000000200571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We sought to characterize the natural history and standard-of-care practices between the radiologic appearance of brain lesions, the appearance of lesional enhancement, and treatment with hematopoietic stem-cell transplant or gene therapy among boys diagnosed with presymptomatic childhood-onset cerebral adrenoleukodystrophy (CCALD). METHODS We analyzed a multicenter, mixed retrospective/prospective cohort of patients diagnosed with presymptomatic CCALD (Neurologic Function Score = 0, Loes Score [LS] = 0.5-9.0, and age <13 years). Two time-to-event survival analyses were conducted: (1) time from CCALD lesion onset-to-lesional enhancement and (2) time from enhancement-to-treatment. The analysis was repeated in the subset of patients with (1) the earliest evidence of CCALD, defined as an MRI LS ≤ 1, and (2) patients diagnosed between 2016 and 2021. RESULTS Seventy-one boys were diagnosed with presymptomatic cerebral lesions at a median age of 6.4 years [2.4-12.1] with a LS of 1.5 [0.5-9.0]. Fifty percent of patients had lesional enhancement at diagnosis. In the remaining 50%, the median Kaplan-Meier (KM)-estimate of time from diagnosis-to-lesional enhancement was 6.0 months (95% CI 3.6-17.8). The median KM-estimate of time from enhancement-to-treatment is 3.8 months (95% CI 2.8-5.9); 2 patients (4.2%) developed symptoms before treatment. Patients with a diagnostic LS ≤ 1 were younger (5.8 years [2.4-11.5]), had a time-to-enhancement of 4.7 months (95% CI 2.7-9.30), and were treated in 3.8 months (95% CI 3.1-7.1); no patients developed symptoms before treatment. Time from CCALD diagnosis-to-treatment decreased over the course of the study (ρ = -0.401, p = 0.003). DISCUSSION Our findings offer a more refined understanding of the timing of lesion formation, enhancement, and treatment among boys with presymptomatic CCALD. These data offer benchmarks for standardizing clinical care and designing future clinical trials.
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Affiliation(s)
- Eric James Mallack
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston.
| | - Keith P Van Haren
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Anna Torrey
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Stephanie van de Stadt
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Marc Engelen
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Gerald V Raymond
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Ali Fatemi
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Florian S Eichler
- From the Department of Pediatrics (E.J.M., A.T.), Division of Child Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital; Department of Pediatrics (E.J.M.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (K.P.V.H.), Stanford University Schoolds of Medicine, Lucile Packard Children's Hospital, CA; Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, the Netherlands; Department of Genetic Medicine (G.V.R.), Johns Hopkins University, Baltimore, MD; The Moser Center for Leukodystrophies (A.F.), Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD; and Department of Neurology (F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston
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Mallack EJ, Askin G, van de Stadt S, Caruso PA, Musolino PL, Engelen M, Niogi SN, Eichler FS. A Longitudinal Analysis of Early Lesion Growth in Presymptomatic Patients with Cerebral Adrenoleukodystrophy. AJNR Am J Neuroradiol 2021; 42:1904-1911. [PMID: 34503945 PMCID: PMC8562733 DOI: 10.3174/ajnr.a7250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral adrenoleukodystrophy is a devastating neurological disorder caused by mutations in the ABCD1 gene. Our aim was to model and compare the growth of early cerebral lesions from longitudinal MRIs obtained in presymptomatic patients with progressive and arrested cerebral adrenoleukodystrophy using quantitative MR imaging-based lesion volumetry. MATERIALS AND METHODS We retrospectively quantified and modeled the longitudinal growth of early cerebral lesions from 174 MRIs obtained from 36 presymptomatic male patients with cerebral adrenoleukodystrophy. Lesions were manually segmented using subject-specific lesion-intensity thresholding. Volumes were calculated and plotted across time. Lesion velocity and acceleration were calculated between sequentially paired and triplet MRIs, respectively. Linear mixed-effects models were used to assess differences in growth parameters between progressive and arrested phenotypes. RESULTS The median patient age was 7.4 years (range, 3.9-37.0 years). Early-stage cerebral disease progression was inversely correlated with age (ρ = -0.6631, P < .001), early lesions can grow while appearing radiographically stable, lesions undergo sustained acceleration in progressive cerebral adrenoleukodystrophy (β = 0.10 mL/month2 [95% CI, 0.05-0.14 mL/month2], P < .001), and growth trajectories diverge between phenotypes in the presymptomatic time period. CONCLUSIONS Measuring the volumetric changes in newly developing cerebral lesions across time can distinguish cerebral adrenoleukodystrophy phenotypes before symptom onset. When factored into the overall clinical presentation of a patient with a new brain lesion, quantitative MR imaging-based lesion volumetry may aid in the accurate prediction of patients eligible for therapy.
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Affiliation(s)
- E J Mallack
- From the Department of Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics (E.J.M.), Division of Child Neurology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - G Askin
- Department of Population Health Sciences (G.A.), Division of Biostatistics
| | - S van de Stadt
- Amsterdam Leukodystrophy Center (S.v.d.S, M.E.), Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - P A Caruso
- Department of Radiology (P.A.C.), Division of Neuroradiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - P L Musolino
- From the Department of Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - M Engelen
- Amsterdam Leukodystrophy Center (S.v.d.S, M.E.), Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - S N Niogi
- Department of Radiology (S.N.N.), Weill Cornell Medicine, New York, New York
- Department of Radiology (S.N.N.), Weill Cornell Medicine, New York, New York
| | - F S Eichler
- From the Department of Neurology (E.J.M., P.L.M, F.S.E.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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4
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van de Stadt SIW, Huffnagel IC, Turk BR, van der Knaap MS, Engelen M. Imaging in X-Linked Adrenoleukodystrophy. Neuropediatrics 2021; 52:252-260. [PMID: 34192790 DOI: 10.1055/s-0041-1730937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance imaging (MRI) is the gold standard for the detection of cerebral lesions in X-linked adrenoleukodystrophy (ALD). ALD is one of the most common peroxisomal disorders and is characterized by a defect in degradation of very long chain fatty acids (VLCFA), resulting in accumulation of VLCFA in plasma and tissues. The clinical spectrum of ALD is wide and includes adrenocortical insufficiency, a slowly progressive myelopathy in adulthood, and cerebral demyelination in a subset of male patients. Cerebral demyelination (cerebral ALD) can be treated with hematopoietic cell transplantation (HCT) but only in an early (pre- or early symptomatic) stage and therefore active MRI surveillance is recommended for male patients, both pediatric and adult. Although structural MRI of the brain can detect the presence and extent of cerebral lesions, it does not predict if and when cerebral demyelination will occur. There is a great need for imaging techniques that predict onset of cerebral ALD before lesions appear. Also, imaging markers for severity of myelopathy as surrogate outcome measure in clinical trials would facilitate drug development. New quantitative MRI techniques are promising in that respect. This review focuses on structural and quantitative imaging techniques-including magnetic resonance spectroscopy, diffusion tensor imaging, MR perfusion imaging, magnetization transfer (MT) imaging, neurite orientation dispersion and density imaging (NODDI), and myelin water fraction imaging-used in ALD and their role in clinical practice and research opportunities for the future.
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Affiliation(s)
- Stephanie I W van de Stadt
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Irene C Huffnagel
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bela R Turk
- Departments of Neurology and Pediatrics, Moser Center for Leukodystrophies, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | - Marjo S van der Knaap
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Singhapakdi K, Sharma K, Maertens P. Fulminating Autoimmune Demyelination with Optic Neuropathy in a Case of Pediatric Cerebral Adrenoleukodystrophy: Case Report and Review of the Literature. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractX-linked adrenoleukodystrophy (ALD) is a leukodystrophy characterized not only by progressive loss of myelin in the central nervous system due to dysmyelination, but also by acute, subacute, or chronic inflammatory demyelination. This results in the phenotypic variability of cerebral ALD (cerALD), which is independent of the genotype. In this article, we reported a fulminant presentation with fluctuating encephalopathy and visual loss in a patient with childhood onset cerALD. Brain MRI showed symmetric confluent occipito-temporal demyelination with severe disruption of the blood–brain barrier and prechiasmal optic neuropathy. The patient's cerebral spinal fluid (CSF) demonstrated an elevated IgG index, myelin basic proteins, and oligoclonal bands. Within 48 hours of receiving immunomodulating therapy, the patient's symptoms of psychomotor slowing, visual impairment, and areflexia partially resolved. High plasma C26:0 levels and high ratios of C24/22 and C26/22 were diagnostic of ALD. It has been shown that environmental factors play an important role in the inflammatory demyelination responsible for the severe phenotypes of cerALD.
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Affiliation(s)
- Kanya Singhapakdi
- Department of Pediatrics, University of South Alabama, Mobile, Alabama, United States
| | - Kamal Sharma
- Department of Pediatric Critical Care, Pediatric Critical Care Division, University of South Alabama, Mobile, Alabama, United States
| | - Paul Maertens
- Department of Neurology, Child Neurology Division, University of South Alabama, Mobile, Alabama, United States
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Pierpont EI, Nascene DR, Shanley R, Kenney-Jung DL, Ziegler RS, Miller WP, Gupta AO, Lund TC, Orchard PJ, Eisengart JB. Neurocognitive benchmarks following transplant for emerging cerebral adrenoleukodystrophy. Neurology 2020; 95:e591-e600. [PMID: 32616675 PMCID: PMC7455349 DOI: 10.1212/wnl.0000000000009929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/10/2020] [Indexed: 01/16/2023] Open
Abstract
Objective To quantify benchmark treatment outcomes that may be enabled by newborn screening surveillance for X-linked adrenoleukodystrophy (ALD), we report neurocognitive, neuropsychiatric, and MRI change for boys who underwent hematopoietic stem cell transplant (HSCT) at initial stages of demyelination, prior to neurocognitive signs of disease. Methods Retrospective chart review identified 36 patients whose cerebral ALD was detected and treated early, with lesion severity less than 5 on the ALD-specific MRI scoring system. Median age at transplant was 7.3 years (range, 4.0–16.1). Progression of radiologic disease on MRI in the 2 years following HSCT was examined relative to the severity of the initial lesion for 33 patients, and longitudinal neurocognitive and neuropsychiatric outcomes were studied for 30 patients. Results Patients whose pretransplant lesion extended beyond the splenium of the corpus callosum and adjacent periventricular white matter (MRI severity score >2) demonstrated lower posttransplant neurocognitive scores, more neuropsychiatric symptoms, and more disease progression on MRI than patients with a less severe lesion. Changes from baseline neurocognitive functioning were greater at 2 years posttransplant as compared to 1 year. There was greater variance and risk of lesion progression as pretransplant MRI severity increased. Conclusion To realize the full benefits of newborn screening, clinicians must detect very small demyelinating lesions during surveillance and intervene quickly. Novel interventions that reduce risks inherent in allogeneic transplantation are needed. Trial endpoints should include direct neurocognitive assessment and extend at least 2 years posttreatment to provide the greatest sensitivity to detect neurocognitive morbidity.
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Affiliation(s)
- Elizabeth I Pierpont
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA.
| | - David R Nascene
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Ryan Shanley
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Daniel L Kenney-Jung
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Richard S Ziegler
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Weston P Miller
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Ashish O Gupta
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Troy C Lund
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Paul J Orchard
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
| | - Julie B Eisengart
- From the Departments of Pediatrics (E.I.P., R.S.Z., W.P.M., A.O.G., T.C.L., P.J.O., J.B.E.), Radiology (D.R.N.), Bioinformatics and Biostatistics Core (R.S.), and Neurology (D.L.K.-J.), University of Minnesota, Minneapolis; and Sangamo Therapeutics (W.P.M.), Richmond, CA
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7
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Lund TC, Ng M, Orchard PJ, Loes DJ, Raymond GV, Gupta A, Kenny-Jung D, Nascene DR. Volume of Gadolinium Enhancement and Successful Repair of the Blood-Brain Barrier in Cerebral Adrenoleukodystrophy. Biol Blood Marrow Transplant 2020; 26:1894-1899. [PMID: 32599216 DOI: 10.1016/j.bbmt.2020.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
Abstract
Up to 40% of boys with adrenoleukodystrophy develop a severe central nervous system demyelinating form (cALD) characterized by white matter changes and gadolinium enhancement on magnetic resonance imaging (MRI). Hematopoietic cell transplant (HCT) is the only proven means to attenuate cALD progression. The elimination of active neuroinflammation is indicated radiographically by the resolution of gadolinium (Gd) enhancement and correlates to speed of donor neutrophil recovery. We analyzed 66 boys with cALD undergoing HCT for biomarkers correlating with early (30 days post-HCT) Gd signal resolution. We found that log Gd volume (cm3) on pre-HCT MRI strongly positively correlated to day 30 Gd resolution (P = .0003) with smaller volume correlating to higher proportion resolved, as was the baseline gadolinium intensity score (P = .04), plasma chitotriosidase activity (P = .04), and faster absolute neutrophil count recovery (P = .03). In multivariate analysis, log Gd volume remained superior in determining which patients would have Gd signal resolution by 30 days post-HCT (P = .016). A final analysis indicated that early Gd resolution also correlated with less neurologic progression from baseline to 1 year following HCT (P = .006). MRI Gd volume may serve as a contributing biomarker to better delineate outcomes and an important metric in comparing therapies in the treatment of cALD.
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Affiliation(s)
- Troy C Lund
- Division of Pediatric Blood and Marrow Transplant, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Michelle Ng
- Division of Pediatric Blood and Marrow Transplant, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Paul J Orchard
- Division of Pediatric Blood and Marrow Transplant, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Loes
- Department of Diagnostic Radiology, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Gerald V Raymond
- Department of Genetic Medicine, Johns Hopkins, Baltimore, Maryland
| | - Ashish Gupta
- Division of Pediatric Blood and Marrow Transplant, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Dan Kenny-Jung
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - David R Nascene
- Department of Diagnostic Radiology, University of Minnesota Medical Center, Minneapolis, Minnesota
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8
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Richmond PA, van der Kloet F, Vaz FM, Lin D, Uzozie A, Graham E, Kobor M, Mostafavi S, Moerland PD, Lange PF, van Kampen AHC, Wasserman WW, Engelen M, Kemp S, van Karnebeek CDM. Multi-Omic Approach to Identify Phenotypic Modifiers Underlying Cerebral Demyelination in X-Linked Adrenoleukodystrophy. Front Cell Dev Biol 2020; 8:520. [PMID: 32671069 PMCID: PMC7330173 DOI: 10.3389/fcell.2020.00520] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
X-linked adrenoleukodystrophy (ALD) is a peroxisomal metabolic disorder with a highly complex clinical presentation. ALD is caused by mutations in the ABCD1 gene, and is characterized by the accumulation of very long-chain fatty acids in plasma and tissues. Disease-causing mutations are 'loss of function' mutations, with no prognostic value with respect to the clinical outcome of an individual. All male patients with ALD develop spinal cord disease and a peripheral neuropathy in adulthood, although age of onset is highly variable. However, the lifetime prevalence to develop progressive white matter lesions, termed cerebral ALD (CALD), is only about 60%. Early identification of transition to CALD is critical since it can be halted by allogeneic hematopoietic stem cell therapy only in an early stage. The primary goal of this study is to identify molecular markers which may be prognostic of cerebral demyelination from a simple blood sample, with the hope that blood-based assays can replace the current protocols for diagnosis. We collected six well-characterized brother pairs affected by ALD and discordant for the presence of CALD and performed multi-omic profiling of blood samples including genome, epigenome, transcriptome, metabolome/lipidome, and proteome profiling. In our analysis we identify discordant genomic alleles present across all families as well as differentially abundant molecular features across the omics technologies. The analysis was focused on univariate modeling to discriminate the two phenotypic groups, but was unable to identify statistically significant candidate molecular markers. Our study highlights the issues caused by a large amount of inter-individual variation, and supports the emerging hypothesis that cerebral demyelination is a complex mix of environmental factors and/or heterogeneous genomic alleles. We confirm previous observations about the role of immune response, specifically auto-immunity and the potential role of PFN1 protein overabundance in CALD in a subset of the families. We envision our methodology as well as dataset has utility to the field for reproducing previous or enabling future modifier investigations.
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Affiliation(s)
- Phillip A. Richmond
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Frans van der Kloet
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frederic M. Vaz
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Chemistry, Amsterdam Gastroenterology & Metabolism, Amsterdam, Netherlands
| | - David Lin
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Anuli Uzozie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital, Vancouver, BC, Canada
| | - Emma Graham
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Michael Kobor
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Sara Mostafavi
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Perry D. Moerland
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Philipp F. Lange
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital, Vancouver, BC, Canada
| | - Antoine H. C. van Kampen
- Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Wyeth W. Wasserman
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Neuroscience, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Stephan Kemp
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Chemistry, Amsterdam Gastroenterology & Metabolism, Amsterdam, Netherlands
- Department of Pediatric Neurology, Amsterdam Neuroscience, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Clara D. M. van Karnebeek
- Center for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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9
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Turk BR, Theda C, Fatemi A, Moser AB. X-linked adrenoleukodystrophy: Pathology, pathophysiology, diagnostic testing, newborn screening and therapies. Int J Dev Neurosci 2020; 80:52-72. [PMID: 31909500 PMCID: PMC7041623 DOI: 10.1002/jdn.10003] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Adrenoleukodystrophy (ALD) is a rare X-linked disease caused by a mutation of the peroxisomal ABCD1 gene. This review summarizes our current understanding of the pathogenic cell- and tissue-specific roles of lipid species in the context of experimental therapeutic strategies and provides an overview of critical historical developments, therapeutic trials and the advent of newborn screening in the USA. In ALD, very long-chain fatty acid (VLCFA) chain length-dependent dysregulation of endoplasmic reticulum stress and mitochondrial radical generating systems inducing cell death pathways has been shown, providing the rationale for therapeutic moiety-specific VLCFA reduction and antioxidant strategies. The continuing increase in newborn screening programs and promising results from ongoing and recent therapeutic investigations provide hope for ALD.
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Affiliation(s)
- Bela R. Turk
- Hugo W Moser Research InstituteKennedy Krieger InstituteBaltimoreMDUSA
| | - Christiane Theda
- Neonatal ServicesRoyal Women's HospitalMurdoch Children's Research Institute and University of MelbourneMelbourneVICAustralia
| | - Ali Fatemi
- Hugo W Moser Research InstituteKennedy Krieger InstituteBaltimoreMDUSA
| | - Ann B. Moser
- Hugo W Moser Research InstituteKennedy Krieger InstituteBaltimoreMDUSA
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10
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Lin JE, Armour EA, Heshmati A, Umandap C, Couto JJ, Iglesias AD, Mallack EJ, Bain JM. Pearls & Oy-sters: Adolescent-onset adrenomyeloneuropathy and arrested cerebral adrenoleukodystrophy. Neurology 2020; 93:81-84. [PMID: 31285402 DOI: 10.1212/wnl.0000000000007755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jieru E Lin
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Eric A Armour
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Arezou Heshmati
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Christine Umandap
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Julia J Couto
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Alejandro D Iglesias
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Eric J Mallack
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
| | - Jennifer M Bain
- From the Department of Medicine (J.E.L.), University of Illinois at Chicago; Division of Child Neurology, Department of Neurology (J.E.L., E.A.A., A.H., J.M.B.), Division of Medical Genetics, Department of Pediatrics (C.U., A.D.I.), and Department of Anesthesia (J.C.), Columbia University College of Physicians and Surgeons; The Columbia University Irving Medical Center (J.E.L, E.A.A, A.H, J.M.B, C.U., A.D.I, J.J.C); and Division of Child Neurology (E.J.M.), Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
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11
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Turk BR, Theda C, Fatemi A, Moser AB. X-linked Adrenoleukodystrophy: Pathology, Pathophysiology, Diagnostic Testing, Newborn Screening, and Therapies. Int J Dev Neurosci 2019:S0736-5748(19)30133-9. [PMID: 31778737 DOI: 10.1016/j.ijdevneu.2019.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/21/2019] [Accepted: 11/21/2019] [Indexed: 01/22/2023] Open
Abstract
Adrenoleukodystrophy (ALD) is a rare X-linked disease caused by a mutation of the peroxisomal ABCD1 gene. This review summarizes our current understanding of the pathogenic cell- and tissue-specific role of lipid species in the context of experimental therapeutic strategies and provides an overview of critical historical developments, therapeutic trials, and the advent of newborn screening in the United States. In ALD, very long chain fatty acid (VLCFA) chain-length-dependent dysregulation of endoplasmic reticulum stress and mitochondrial radical generating systems inducing cell death pathways has been shown, providing the rationale for therapeutic moiety-specific VLCFA reduction and antioxidant strategies. The continuing increase in newborn screening programs and promising results from ongoing and recent therapeutic investigations provide hope for ALD.
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Affiliation(s)
- Bela R Turk
- Hugo W Moser Research Institute, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD, USA.
| | - Christiane Theda
- Neonatal Services, Royal Women's Hospital, Murdoch Children's Research Institute and University of Melbourne, 20 Flemington Road, Parkville, VIC, 3052, Melbourne, Australia.
| | - Ali Fatemi
- Hugo W Moser Research Institute, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD, USA.
| | - Ann B Moser
- Hugo W Moser Research Institute, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD, USA.
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12
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Furlan FLS, Lemes MA, Suguimatsu LCF, Pires CTF, Santos MLSF. X-LINKED ADRENOLEUKODYSTROPHY IN BRAZIL: A CASE SERIES. ACTA ACUST UNITED AC 2019; 37:465-471. [PMID: 31241695 PMCID: PMC6821490 DOI: 10.1590/1984-0462/;2019;37;4;00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe patients with different phenotypes of X-linked adrenoleukodystrophy: pre-symptomatic, cerebral demyelinating inflammatory adrenoleukodystrophy, adrenomyeloneuropathy and adrenal insufficiency only. METHODS Specific data related to epidemiology, phenotype, diagnosis and treatment of 24 patients with X-linked adrenoleukodystrophy were collected. A qualitative cross-sectional and descriptive-exploratory analysis was performed using medical records from a reference center in Neuropediatrics in Curitiba, Brazil, as well as an electronic questionnaire. RESULTS The majority (79%) of patients had cerebral demyelinating inflammatory adrenoleukodystrophy, presenting aphasia, hyperactivity and vision disorders as the main initial symptoms. These symptoms appeared, on average, between six and seven years of age. There was a mean delay of 11 months between the onset of symptoms/signs and the diagnosis. Patients sought diagnosis mainly with neuropediatricians, and the main requested tests were dosage of very long chain fatty acids and brain magnetic resonance. CONCLUSIONS All phenotypes of X-linked adrenoleukodystrophy, except for myelopathy in women, were presented in the studied population, which mainly consisted of children and adolescents. Prevalent signs and symptoms registered in the literature were observed. Most of the patients with cerebral demyelinating inflammatory adrenoleukodystrophy were not diagnosed in time for hematopoietic stem cell transplantation.
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13
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Zhang Y, Cui G, Wang Y, Gong Y, Wang Y. SIRT1 activation alleviates brain microvascular endothelial dysfunction in peroxisomal disorders. Int J Mol Med 2019; 44:995-1005. [PMID: 31257461 PMCID: PMC6657955 DOI: 10.3892/ijmm.2019.4250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/11/2019] [Indexed: 02/03/2023] Open
Abstract
Peroxisomal disorders are genetically heterogeneous metabolic disorders associated with a deficit of very long chain fatty acid β-oxidation that commonly manifest as early-onset neurodegeneration. Brain microvascular endothelial dysfunction with increased permeability to monocytes has been described in X-linked adrenoleukodystrophy, one of the most common peroxisomal disorders caused by mutations of the ATP binding cassette subfamily D member 1 (ABCD1) gene. The present study demonstrated that dysregulation of sirtuin 1 (SIRT1) in human brain microvascular endothelial cells (HBMECs) mediates changes in adhesion molecules and tight-junction protein expression, as well as increased adhesion to monocytes associated with peroxisomal dysfunction due to ABCD1 or hydroxysteroid 17-β dehydrogenase 4 silencing. Furthermore, enhancement of the function of SIRT1 by resve-ratrol attenuated this molecular and functional dysregulation of HBMECs via modulation of the nuclear factor-κB and Krüppel-like factor 4 signaling pathways.
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Affiliation(s)
- Yunshan Zhang
- Department of Anatomy and Embryology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yue Wang
- Department of Neurobiology and Anatomy, Xuzhou Key Laboratory of Neurobiology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yi Gong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yulan Wang
- Department of Anatomy and Embryology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
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14
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Bergner CG, van der Meer F, Winkler A, Wrzos C, Türkmen M, Valizada E, Fitzner D, Hametner S, Hartmann C, Pfeifenbring S, Stoltenburg-Didinger G, Brück W, Nessler S, Stadelmann C. Microglia damage precedes major myelin breakdown in X-linked adrenoleukodystrophy and metachromatic leukodystrophy. Glia 2019; 67:1196-1209. [PMID: 30980503 PMCID: PMC6594046 DOI: 10.1002/glia.23598] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) and metachromatic leukodystrophy (MLD) are two relatively common examples of hereditary demyelinating diseases caused by a dysfunction of peroxisomal or lysosomal lipid degradation. In both conditions, accumulation of nondegraded lipids leads to the destruction of cerebral white matter. Because of their high lipid content, oligodendrocytes are considered key to the pathophysiology of these leukodystrophies. However, the response to allogeneic stem cell transplantation points to the relevance of cells related to the hematopoietic lineage. In the present study, we aimed to better characterize the pathogenetic role of microglia in the above-mentioned diseases. Applying recently established microglia markers to human autopsy cases of X-ALD and MLD we were able to delineate distinct lesion stages in evolving demyelinating lesions. The immune-phenotype of microglia was altered already early in lesion evolution, and microglia loss preceded full-blown myelin degeneration both in X-ALD and MLD. DNA fragmentation indicating phagocyte death was observed in areas showing microglia loss. The morphology and dynamics of phagocyte decay differed between the diseases and between lesion stages, hinting at distinct pathways of programmed cell death. In summary, the present study shows an early and severe damage to microglia in the pathogenesis of X-ALD and MLD. This hints at a central pathophysiologic role of these cells in the diseases and provides evidence for an ongoing transfer of toxic substrates primarily enriched in myelinating cells to microglia.
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Affiliation(s)
- Caroline G Bergner
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Anne Winkler
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Claudia Wrzos
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mevlude Türkmen
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany
| | - Emil Valizada
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Dirk Fitzner
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Simon Hametner
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Christian Hartmann
- Institute of Pathology, Section of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Sabine Pfeifenbring
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Wolfgang Brück
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Nessler
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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15
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Lee CAA, Seo HS, Armien AG, Bates FS, Tolar J, Azarin SM. Modeling and rescue of defective blood-brain barrier function of induced brain microvascular endothelial cells from childhood cerebral adrenoleukodystrophy patients. Fluids Barriers CNS 2018; 15:9. [PMID: 29615068 PMCID: PMC5883398 DOI: 10.1186/s12987-018-0094-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/06/2018] [Indexed: 01/12/2023] Open
Abstract
Background X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene. 40% of X-ALD patients will convert to the deadly childhood cerebral form (ccALD) characterized by increased permeability of the brain endothelium that constitutes the blood–brain barrier (BBB). Mutation information and molecular markers investigated to date are not predictive of conversion. Prior reports have focused on toxic metabolic byproducts and reactive oxygen species as instigators of cerebral inflammation and subsequent immune cell invasion leading to BBB breakdown. This study focuses on the BBB itself and evaluates differences in brain endothelium integrity using cells from ccALD patients and wild-type (WT) controls. Methods The blood–brain barrier of ccALD patients and WT controls was modeled using directed differentiation of induced pluripotent stem cells (iPSCs) into induced brain microvascular endothelial cells (iBMECs). Immunocytochemistry and PCR confirmed characteristic expression of brain microvascular endothelial cell (BMEC) markers. Barrier properties of iBMECs were measured via trans-endothelial electrical resistance (TEER), sodium fluorescein permeability, and frayed junction analysis. Electron microscopy and RNA-seq were used to further characterize disease-specific differences. Oil-Red-O staining was used to quantify differences in lipid accumulation. To evaluate whether treatment with block copolymers of poly(ethylene oxide) and poly(propylene oxide) (PEO–PPO) could mitigate defective properties, ccALD-iBMECs were treated with PEO–PPO block copolymers and their barrier properties and lipid accumulation levels were quantified. Results iBMECs from patients with ccALD had significantly decreased TEER (2592 ± 110 Ω cm2) compared to WT controls (5001 ± 172 Ω cm2). They also accumulated lipid droplets to a greater extent than WT-iBMECs. Upon treatment with a PEO–PPO diblock copolymer during the differentiation process, an increase in TEER and a reduction in lipid accumulation were observed for the polymer treated ccALD-iBMECs compared to untreated controls. Conclusions The finding that BBB integrity is decreased in ccALD and can be rescued with block copolymers opens the door for the discovery of BBB-specific molecular markers that can indicate the onset of ccALD and has therapeutic implications for preventing the conversion to ccALD. Electronic supplementary material The online version of this article (10.1186/s12987-018-0094-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine A A Lee
- Department of Genetics and Cell Development, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Hannah S Seo
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Anibal G Armien
- Ultrastructural Pathology Unit, Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - Frank S Bates
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jakub Tolar
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Samira M Azarin
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, 55455, USA.
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16
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Lauer A, Da X, Hansen MB, Boulouis G, Ou Y, Cai X, Liberato Celso Pedrotti A, Kalpathy-Cramer J, Caruso P, Hayden DL, Rost N, Mouridsen K, Eichler FS, Rosen B, Musolino PL. ABCD1 dysfunction alters white matter microvascular perfusion. Brain 2017; 140:3139-3152. [PMID: 29136088 PMCID: PMC5841142 DOI: 10.1093/brain/awx262] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/18/2017] [Indexed: 12/17/2022] Open
Abstract
Cerebral X-linked adrenoleukodystrophy is a devastating neurodegenerative disorder caused by mutations in the ABCD1 gene, which lead to a rapidly progressive cerebral inflammatory demyelination in up to 60% of affected males. Selective brain endothelial dysfunction and increased permeability of the blood–brain barrier suggest that white matter microvascular dysfunction contributes to the conversion to cerebral disease. Applying a vascular model to conventional dynamic susceptibility contrast magnetic resonance perfusion imaging, we demonstrate that lack of ABCD1 function causes increased capillary flow heterogeneity in asymptomatic hemizygotes predominantly in the white matter regions and developmental stages with the highest probability for conversion to cerebral disease. In subjects with ongoing inflammatory demyelination we observed a sequence of increased capillary flow heterogeneity followed by blood–brain barrier permeability changes in the perilesional white matter, which predicts lesion progression. These white matter microvascular alterations normalize within 1 year after treatment with haematopoietic stem cell transplantation. For the first time in vivo, our studies unveil a model to assess how ABCD1 alters white matter microvascular function and explores its potential as an earlier biomarker for monitoring disease progression and response to treatment.
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Affiliation(s)
- Arne Lauer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neuroradiology, Goethe University, Frankfurt a.M., Germany
| | - Xiao Da
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | - Gregoire Boulouis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Yangming Ou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Xuezhu Cai
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | | | - Paul Caruso
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas L Hayden
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kim Mouridsen
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Florian S Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia L Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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Therapeutic strategies in adrenoleukodystrophy. Wien Med Wochenschr 2017; 167:219-226. [PMID: 28493141 DOI: 10.1007/s10354-016-0534-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/02/2016] [Indexed: 12/23/2022]
Abstract
Adrenoleukodystrophy (ALD) is an X‑linked hereditary disorder due to mutations of the ABCD1 gene, which encodes a peroxisomal transport protein necessary for very long-chain fatty acid degradation (VLCFA). Toxic accumulation thereof is associated with a proinflammatory state and eventual cell death in multiple tissues. ALD may manifest either as a fatal, rapidly progressive demyelinating disease in boys and adult men, or as a slowly progressive adult-onset long-tract myelopathy along with peripheral neuropathy. Our understanding of manifold mechanisms implicated in the disease pathology is currently incomplete, as neither genotype-phenotype correlation nor the trigger for cerebral disease has been described. Therapy objectives are therefore broadly aimed at correcting either the gene mutation or downstream molecular effects, such as oxidative stress. Advancements in disease detection, including the newly implemented newborn screening in the US and imaging modalities, allow for more timely intervention in the form of hematopoietic stem cell transplantation (HSCT), which may only be performed in early cerebral disease states.
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McKinney A, Benson J, Nascene D, Eisengart J, Salmela M, Loes D, Zhang L, Patel K, Raymond G, Miller W. Childhood Cerebral Adrenoleukodystrophy: MR Perfusion Measurements and Their Use in Predicting Clinical Outcome after Hematopoietic Stem Cell Transplantation. AJNR Am J Neuroradiol 2016; 37:1713-20. [PMID: 27079370 PMCID: PMC5018408 DOI: 10.3174/ajnr.a4773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/08/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE MR perfusion has shown abnormalities of affected WM in cerebral X-linked adrenoleukodystrophy, but serial data is needed to explore the import of such findings after hematopoietic stem cell transplantation. Our aim was to prospectively measure MR perfusion parameters in patients with cerebral adrenoleukodystrophy pre- and post-hematopoietic stem cell transplantation, and to correlate those measurements with clinical outcome. MATERIALS AND METHODS Ten patients with cerebral adrenoleukodystrophy prospectively underwent DSC-MR perfusion imaging at <45 days pre- (baseline), 30-60 days post-, and 1 year post-hematopoietic stem cell transplantation. MR perfusion measurements in the 10 patients and 8 controls were obtained from the parieto-occipital WM, splenium of the corpus callosum, leading enhancing edge, and normal-appearing frontal white matter. MR imaging severity scores and clinical neurologic function and neurocognitive scores were also obtained. MR perfusion values were analyzed in the patients with cerebral adrenoleukodystrophy at each time point and compared with those in controls. Correlations were calculated between the pre-hematopoietic stem cell transplantation MR perfusion values and 1-year clinical scores, with P value adjustment for multiple comparisons. RESULTS At baseline in patients with cerebral adrenoleukodystrophy, both relative CBV and relative CBF within the splenium of the corpus callosum and parieto-occipital WM significantly differed from those in controls (P = .005-.031) and remained so 1 year post-hematopoietic stem cell transplantation (P = .003-.005). Meanwhile, no MR perfusion parameter within the leading enhancing edge differed significantly from that in controls at baseline or at 1 year (P = .074-.999) or significantly changed by 1 year post-hematopoietic stem cell transplantation (P = .142-.887). Baseline Loes scores correlated with 1-year clinical neurologic function (r = 0.813, P < .0001), while splenium of the corpus callosum relative CBV also significantly correlated with 1-year neurologic function scale and the neurocognitive full-scale intelligence quotient and performance intelligence quotient scores (r = -0.730-0.815, P = .007-.038). CONCLUSIONS Leading enhancing edge measurements likely remain normal post-hematopoietic stem cell transplantation in cerebral adrenoleukodystrophy, suggesting local disease stabilization. Meanwhile, parieto-occipital WM and splenium of the corpus callosum relative CBV and relative CBF values worsened; this change signified irreversible injury. Baseline splenium of the corpus callosum relative CBV may predict clinical outcomes following hematopoietic stem cell transplantation.
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Affiliation(s)
- A.M. McKinney
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - J. Benson
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - D.R. Nascene
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - J. Eisengart
- Pediatrics (J.E., G.R.), Division of Clinical Behavioral Neuroscience, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - M.B. Salmela
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - D.J. Loes
- Suburban Radiologic Consultants (D.J.L.), Minneapolis, Minnesota
| | - L. Zhang
- Clinical and Translational Science Institute (L.Z.), University of Minnesota, Minneapolis, Minnesota
| | - K. Patel
- Radiology Associates of the Fox Valley (K.P.), Neenah, Wisconsin
| | - G.V. Raymond
- Pediatrics (J.E., G.R.), Division of Clinical Behavioral Neuroscience, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - W.P. Miller
- Department of Pediatrics (W.P.M.), Pediatric Blood and Marrow Transplantation Division, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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Dahmoush HM, Melhem ER, Vossough A. Metabolic, endocrine, and other genetic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:1221-1259. [PMID: 27430466 DOI: 10.1016/b978-0-444-53486-6.00063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Metabolic, endocrine, and genetic diseases of the brain include a very large array of disorders caused by a wide range of underlying abnormalities and involving a variety of brain structures. Often these disorders manifest as recognizable, though sometimes overlapping, patterns on neuroimaging studies that may enable a diagnosis based on imaging or may alternatively provide enough clues to direct further diagnostic evaluation. The diagnostic workup can include various biochemical laboratory or genetic studies. In this chapter, after a brief review of normal white-matter development, we will describe a variety of leukodystrophies resulting from metabolic disorders involving the brain, including mitochondrial and respiratory chain diseases. We will then describe various acidurias, urea cycle disorders, disorders related to copper and iron metabolism, and disorders of ganglioside and mucopolysaccharide metabolism. Lastly, various other hypomyelinating and dysmyelinating leukodystrophies, including vanishing white-matter disease, megalencephalic leukoencephalopathy with subcortical cysts, and oculocerebrorenal syndrome will be presented. In the following section on endocrine disorders, we will examine various disorders of the hypothalamic-pituitary axis, including developmental, inflammatory, and neoplastic diseases. Neonatal hypoglycemia will also be briefly reviewed. In the final section, we will review a few of the common genetic phakomatoses. Throughout the text, both imaging and brief clinical features of the various disorders will be discussed.
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Affiliation(s)
- Hisham M Dahmoush
- Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Elias R Melhem
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
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20
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Bouquet F, Dehais C, Sanson M, Lubetzki C, Louapre C. Dramatic worsening of adult-onset X-linked adrenoleukodystrophy after head trauma. Neurology 2015; 85:1991-3. [PMID: 26537054 DOI: 10.1212/wnl.0000000000002173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/27/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Floriane Bouquet
- From the Département de Neurologie (F.B., C. Lubetzki, C. Louapre) and Service de Neurologie Mazarin (C.D., M.S.), Hôpital Pitié-Salpêtrière, Paris, France; and A.A. Martinos Center for Biomedical Imaging (C. Louapre), MGH, Harvard Medical School, Charlestown, MA
| | - Caroline Dehais
- From the Département de Neurologie (F.B., C. Lubetzki, C. Louapre) and Service de Neurologie Mazarin (C.D., M.S.), Hôpital Pitié-Salpêtrière, Paris, France; and A.A. Martinos Center for Biomedical Imaging (C. Louapre), MGH, Harvard Medical School, Charlestown, MA
| | - Marc Sanson
- From the Département de Neurologie (F.B., C. Lubetzki, C. Louapre) and Service de Neurologie Mazarin (C.D., M.S.), Hôpital Pitié-Salpêtrière, Paris, France; and A.A. Martinos Center for Biomedical Imaging (C. Louapre), MGH, Harvard Medical School, Charlestown, MA
| | - Catherine Lubetzki
- From the Département de Neurologie (F.B., C. Lubetzki, C. Louapre) and Service de Neurologie Mazarin (C.D., M.S.), Hôpital Pitié-Salpêtrière, Paris, France; and A.A. Martinos Center for Biomedical Imaging (C. Louapre), MGH, Harvard Medical School, Charlestown, MA
| | - Céline Louapre
- From the Département de Neurologie (F.B., C. Lubetzki, C. Louapre) and Service de Neurologie Mazarin (C.D., M.S.), Hôpital Pitié-Salpêtrière, Paris, France; and A.A. Martinos Center for Biomedical Imaging (C. Louapre), MGH, Harvard Medical School, Charlestown, MA.
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21
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Musolino PL, Gong Y, Snyder JMT, Jimenez S, Lok J, Lo EH, Moser AB, Grabowski EF, Frosch MP, Eichler FS. Brain endothelial dysfunction in cerebral adrenoleukodystrophy. Brain 2015; 138:3206-20. [PMID: 26377633 DOI: 10.1093/brain/awv250] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/03/2015] [Indexed: 01/31/2023] Open
Abstract
See Aubourg (doi:10.1093/awv271) for a scientific commentary on this article.X-linked adrenoleukodystrophy is caused by mutations in the ABCD1 gene leading to accumulation of very long chain fatty acids. Its most severe neurological manifestation is cerebral adrenoleukodystrophy. Here we demonstrate that progressive inflammatory demyelination in cerebral adrenoleukodystrophy coincides with blood-brain barrier dysfunction, increased MMP9 expression, and changes in endothelial tight junction proteins as well as adhesion molecules. ABCD1, but not its closest homologue ABCD2, is highly expressed in human brain microvascular endothelial cells, far exceeding its expression in the systemic vasculature. Silencing of ABCD1 in human brain microvascular endothelial cells causes accumulation of very long chain fatty acids, but much later than the immediate upregulation of adhesion molecules and decrease in tight junction proteins. This results in greater adhesion and transmigration of monocytes across the endothelium. PCR-array screening of human brain microvascular endothelial cells after ABCD1 silencing revealed downregulation of both mRNA and protein levels of the transcription factor c-MYC (encoded by MYC). Interestingly, MYC silencing mimicked the effects of ABCD1 silencing on CLDN5 and ICAM1 without decreasing the levels of ABCD1 protein itself. Together, these data demonstrate that ABCD1 deficiency induces significant alterations in brain endothelium via c-MYC and may thereby contribute to the increased trafficking of leucocytes across the blood-brain barrier as seen in cerebral adrenouleukodystrophy.
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Affiliation(s)
- Patricia L Musolino
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Yi Gong
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Juliet M T Snyder
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sandra Jimenez
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Josephine Lok
- 3 Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Eng H Lo
- 3 Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ann B Moser
- 4 Hugo W Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Eric F Grabowski
- 5 Department of Paediatric Haematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Frosch
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 6 C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA
| | - Florian S Eichler
- 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 2 Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, MA, USA
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22
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Gong Y, Mu D, Prabhakar S, Moser A, Musolino P, Ren J, Breakefield XO, Maguire CA, Eichler FS. Adenoassociated virus serotype 9-mediated gene therapy for x-linked adrenoleukodystrophy. Mol Ther 2015; 23:824-834. [PMID: 25592337 DOI: 10.1038/mt.2015.6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/29/2014] [Indexed: 12/23/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a devastating neurological disorder caused by mutations in the ABCD1 gene that encodes a peroxisomal ATP-binding cassette transporter (ABCD1) responsible for transport of CoA-activated very long-chain fatty acids (VLCFA) into the peroxisome for degradation. We used recombinant adenoassociated virus serotype 9 (rAAV9) vector for delivery of the human ABCD1 gene (ABCD1) to mouse central nervous system (CNS). In vitro, efficient delivery of ABCD1 gene was achieved in primary mixed brain glial cells from Abcd1-/- mice as well as X-ALD patient fibroblasts. Importantly, human ABCD1 localized to the peroxisome, and AAV-ABCD1 transduction showed a dose-dependent effect in reducing VLCFA. In vivo, AAV9-ABCD1 was delivered to Abcd1-/- mouse CNS by either stereotactic intracerebroventricular (ICV) or intravenous (IV) injections. Astrocytes, microglia and neurons were the major target cell types following ICV injection, while IV injection also delivered to microvascular endothelial cells and oligodendrocytes. IV injection also yielded high transduction of the adrenal gland. Importantly, IV injection of AAV9-ABCD1 reduced VLCFA in mouse brain and spinal cord. We conclude that AAV9-mediated ABCD1 gene transfer is able to reach target cells in the nervous system and adrenal gland as well as reduce VLCFA in culture and a mouse model of X-ALD.
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Affiliation(s)
- Yi Gong
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dakai Mu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shilpa Prabhakar
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann Moser
- Peroxisome Disease Lab, Hugo W Moser Research Institute, Baltimore, Maryland, USA
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - JiaQian Ren
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Xandra O Breakefield
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Casey A Maguire
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Florian S Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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23
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24
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Musolino PL, Lund TC, Pan J, Escolar ML, Paker AM, Duncan CN, Eichler FS. Hematopoietic stem cell transplantation in the leukodystrophies: a systematic review of the literature. Neuropediatrics 2014; 45:169-74. [PMID: 24459069 PMCID: PMC4157669 DOI: 10.1055/s-0033-1364179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study is to systematically review the literature on worldwide numbers of leukodystrophy patients undergoing hematopoietic stem cell transplantation (HSCT) as well as the safety and efficacy of the procedure in this patient population. MATERIALS AND METHODS A PubMed and EMBASE search up to June 2012 was conducted with a manual search of references from relevant articles. Selected studies were evaluated using internationally accepted criteria. The effect estimates of HSCT upon survival in early-stage disease versus late-stage disease were compared. RESULTS One hundred and fifty-two studies qualified for inclusion and reported on a total of 689 patients. Study quality ranged from poor to good; no study was rated excellent. Small sample sizes limited most studies. Meta-analysis in a subset of larger studies indicates that transplantation in earlier stages of disease fairs better than in the late stages. Beyond survival, little longitudinal data on functional outcome is reported and neurological outcome is sparse. CONCLUSION Further studies are needed to determine the neurological outcome following HSCT in the leukodystrophies. HSCT in the early stages of cerebral disease is still recommended for select leukodystrophies.
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Affiliation(s)
- Patricia L. Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Troy C. Lund
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jessica Pan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Maria L. Escolar
- Department of Pediatrics, University of Pittsburgh, One Children’s Hospital Drive, Pittsburgh, Pennsylvania, United States
| | - Asif M. Paker
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Christine N. Duncan
- Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Florian S. Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States
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Krishna SH, McKinney AM, Lucato LT. Congenital Genetic Inborn Errors of Metabolism Presenting as an Adult or Persisting Into Adulthood: Neuroimaging in the More Common or Recognizable Disorders. Semin Ultrasound CT MR 2014; 35:160-91. [DOI: 10.1053/j.sult.2013.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Weber FD, Wiesinger C, Forss-Petter S, Regelsberger G, Einwich A, Weber WHA, Köhler W, Stockinger H, Berger J. X-linked adrenoleukodystrophy: very long-chain fatty acid metabolism is severely impaired in monocytes but not in lymphocytes. Hum Mol Genet 2013; 23:2542-50. [PMID: 24363066 PMCID: PMC3990157 DOI: 10.1093/hmg/ddt645] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a fatal neurodegenerative disease caused by mutations in the ABCD1 gene, encoding a member of the peroxisomal ABC transporter family. The ABCD1 protein transports CoA-activated very long-chain fatty acids (VLCFAs) into peroxisomes for degradation via β-oxidation. In the severest form, X-ALD patients suffer from inflammatory demyelination of the brain. As the extent of the metabolic defect in the main immune cells is unknown, we explored their phenotypes concerning mRNA expression pattern of the three peroxisomal ABC transporters, VLCFA accumulation and peroxisomal β-oxidation. In controls, ABCD1 expression was high in monocytes, intermediate in B cells and low in T cells; ABCD2 expression was extremely low in monocytes, intermediate in B cells and highest in T cells; ABCD3 mRNA was equally distributed. In X-ALD patients, the expression patterns remained unaltered; accordingly, monocytes, which lack compensatory VLCFA transport by ABCD2, displayed the severest biochemical phenotype with a 6-fold accumulation of C26:0 and a striking 70% reduction in peroxisomal β-oxidation activity. In contrast, VLCFA metabolism was close to control values in B cells and T cells, supporting the hypothesis that sufficient ABCD2 is present to compensate for ABCD1 deficiency. Thus, the vulnerability of the main immune cell types is highly variable in X-ALD. Based on these results, we propose that in X-ALD the halt of inflammation after allogeneic hematopoietic stem cell transplantation relies particularly on the replacement of the monocyte lineage. Additionally, these findings support the concept that ABCD2 is a target for pharmacological induction as an alternative therapeutic strategy.
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Affiliation(s)
- Franziska D Weber
- Center for Brain Research, Medical University of Vienna, Spitalgasse 4, Vienna A-1090, Austria
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Berger J, Forss-Petter S, Eichler FS. Pathophysiology of X-linked adrenoleukodystrophy. Biochimie 2013; 98:135-42. [PMID: 24316281 PMCID: PMC3988840 DOI: 10.1016/j.biochi.2013.11.023] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/22/2013] [Indexed: 12/26/2022]
Abstract
Currently the molecular basis for the clinical heterogeneity of X-linked adrenoleukodystrophy (X-ALD) is poorly understood. The genetic bases for all different phenotypic variants of X-ALD are mutations in the gene encoding the peroxisomal ATP-binding cassette (ABC) transporter, ABCD1 (formerly adrenoleukodystrophy protein, ALDP). ABCD1 transports CoA-activated very long-chain fatty acids from the cytosol into the peroxisome for degradation. The phenotypic variability is remarkable ranging from cerebral inflammatory demyelination of childhood onset, leading to death within a few years, to adults remaining pre-symptomatic through more than five decades. There is no general genotype–phenotype correlation in X-ALD. The default manifestation of mutations in ABCD1 is adrenomyeloneuropathy, a slowly progressive dying-back axonopathy affecting both ascending and descending spinal cord tracts as well as in some cases, a peripheral neuropathy. In about 60% of male X-ALD patients, either in childhood (35–40%) or in adulthood (20%), an initial, clinically silent, myelin destabilization results in conversion to a devastating, rapidly progressive form of cerebral inflammatory demyelination. Here, ABCD1 remains a susceptibility gene, necessary but not sufficient for inflammatory demyelination to occur. Although the accumulation of very long-chain fatty acids appears to be essential for the pathomechanism of all phenotypes, the molecular mechanisms underlying these phenotypes are fundamentally different. Cell autonomous processes such as oxidative stress and energy shortage in axons as well as non-cell autonomous processes involving axon–glial interactions seem pertinent to the dying-back axonopathy. Various dynamic mechanisms may underlie the initiation of inflammation, the altered immune reactivity, the propagation of inflammation, as well as the mechanisms leading to the arrest of inflammation after hematopoietic stem cell transplantation. An improved understanding of the molecular mechanisms involved in these events is required for the development of urgently needed therapeutics. Adrenomyeloneuropathy (AMN) is proposed to be the core syndrome of X-ALD. The cerebral inflammatory demyelinating form of X-ALD is independent of AMN. The same genetic basis but fundamentally different pathomechanisms lead to AMN and cerebral ALD. Genetic, epigenetic and environmental factors modulate onset and severity of AMN and cerebral ALD.
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Affiliation(s)
- J Berger
- Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria.
| | - S Forss-Petter
- Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria
| | - F S Eichler
- Department for Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street ACC 708, Boston, MA 02114, USA
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Abstract
Vascular cognitive impairment defines alterations in cognition, ranging from subtle deficits to full-blown dementia, attributable to cerebrovascular causes. Often coexisting with Alzheimer's disease, mixed vascular and neurodegenerative dementia has emerged as the leading cause of age-related cognitive impairment. Central to the disease mechanism is the crucial role that cerebral blood vessels play in brain health, not only for the delivery of oxygen and nutrients, but also for the trophic signaling that inextricably links the well-being of neurons and glia to that of cerebrovascular cells. This review will examine how vascular damage disrupts these vital homeostatic interactions, focusing on the hemispheric white matter, a region at heightened risk for vascular damage, and on the interplay between vascular factors and Alzheimer's disease. Finally, preventative and therapeutic prospects will be examined, highlighting the importance of midlife vascular risk factor control in the prevention of late-life dementia.
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Affiliation(s)
- Costantino Iadecola
- Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021, USA.
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