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Garavaglia B, Nasca A, Mitola S, Ingrassia R. WDR45-dependent impairment of cell cycle in fibroblasts of patients with beta propeller protein-associated neurodegeneration (BPAN). BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2024; 1871:119842. [PMID: 39265886 DOI: 10.1016/j.bbamcr.2024.119842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/29/2024] [Accepted: 09/06/2024] [Indexed: 09/14/2024]
Abstract
De novo mutations in the WDR45 gene have been found in patients affected by Neurodegeneration with Brain Iron Accumulation type 5 (NBIA5 or BPAN), with Non-Transferrin Bound Iron (NTBI) accumulation in the basal ganglia and WDR45-dependent impairment of autophagy. Here we show the downregulation of TFEB and cell cycle impairment in BPAN primary fibroblasts. Noteworthy, TFEB overexpression rescued this impairment, depicting a novel WDR45-dependent cell cycle phenotype.
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Affiliation(s)
- Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit - Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessia Nasca
- Medical Genetics and Neurogenetics Unit - Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Stefania Mitola
- Section of Biotechnologies, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Rosaria Ingrassia
- Section of Biotechnologies, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
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2
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Bukaeva A, Myasnikov R, Kulikova O, Meshkov A, Kiseleva A, Petukhova A, Zotova E, Sparber P, Ershova A, Sotnikova E, Kudryavtseva M, Zharikova A, Koretskiy S, Mershina E, Ramensky V, Zaicenoka M, Vyatkin Y, Muraveva A, Abisheva A, Nikityuk T, Sinitsyn V, Divashuk M, Dadali E, Pokrovskaya M, Drapkina O. A Rare Coincidence of Three Inherited Diseases in a Family with Cardiomyopathy and Multiple Extracardiac Abnormalities. Int J Mol Sci 2024; 25:7556. [PMID: 39062799 PMCID: PMC11277405 DOI: 10.3390/ijms25147556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
A genetic diagnosis of primary cardiomyopathies can be a long-unmet need in patients with complex phenotypes. We investigated a three-generation family with cardiomyopathy and various extracardiac abnormalities that had long sought a precise diagnosis. The 41-year-old proband had hypertrophic cardiomyopathy (HCM), left ventricular noncompaction, myocardial fibrosis, arrhythmias, and a short stature. His sister showed HCM, myocardial hypertrabeculation and fibrosis, sensorineural deafness, and congenital genitourinary malformations. Their father had left ventricular hypertrophy (LVH). The proband's eldest daughter demonstrated developmental delay and seizures. We performed a clinical examination and whole-exome sequencing for all available family members. All patients with HCM/LVH shared a c.4411-2A>C variant in ALPK3, a recently known HCM-causative gene. Functional studies confirmed that this variant alters ALPK3 canonical splicing. Due to extracardiac symptoms in the female patients, we continued the search and found two additional single-gene disorders. The proband's sister had a p.Trp329Gly missense in GATA3, linked to hypoparathyroidism, sensorineural deafness, and renal dysplasia; his daughter had a p.Ser251del in WDR45, associated with beta-propeller protein-associated neurodegeneration. This unique case of three monogenic disorders in one family shows how a comprehensive approach with thorough phenotyping and extensive genetic testing of all symptomatic individuals provides precise diagnoses and appropriate follow-up, embodying the concept of personalized medicine. We also present the first example of a splicing functional study for ALPK3 and describe the genotype-phenotype correlations in cardiomyopathy.
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Affiliation(s)
- Anna Bukaeva
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Roman Myasnikov
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Olga Kulikova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Alexey Meshkov
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
- National Medical Research Center of Cardiology, 121552 Moscow, Russia
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (P.S.); (E.D.)
- Department of General and Medical Genetics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Anna Kiseleva
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Anna Petukhova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Evgenia Zotova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Peter Sparber
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (P.S.); (E.D.)
| | - Alexandra Ershova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Evgeniia Sotnikova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Maria Kudryavtseva
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Anastasia Zharikova
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Sergey Koretskiy
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Elena Mershina
- Medical Research and Educational Center, Lomonosov Moscow State University, 119991 Moscow, Russia; (E.M.); (V.S.)
| | - Vasily Ramensky
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119991 Moscow, Russia
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University, 119991 Moscow, Russia
| | | | - Yuri Vyatkin
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Alisa Muraveva
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Alexandra Abisheva
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Tatiana Nikityuk
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Valentin Sinitsyn
- Medical Research and Educational Center, Lomonosov Moscow State University, 119991 Moscow, Russia; (E.M.); (V.S.)
| | - Mikhail Divashuk
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
- All-Russia Research Institute of Agricultural Biotechnology, 127550 Moscow, Russia
| | - Elena Dadali
- Research Centre for Medical Genetics, 115522 Moscow, Russia; (P.S.); (E.D.)
| | - Maria Pokrovskaya
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
| | - Oxana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia; (R.M.); (O.K.); (A.M.); (A.K.); (A.P.); (E.Z.); (A.E.); (E.S.); (M.K.); (A.Z.); (S.K.); (V.R.); (Y.V.); (A.M.); (A.A.); (T.N.); (M.D.); (M.P.); (O.D.)
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Papandreou A, Singh N, Gianfrancesco L, Budinger D, Barwick K, Agrotis A, Luft C, Shao Y, Lenaerts AS, Gregory A, Jeong SY, Hogarth P, Hayflick S, Barral S, Kriston-Vizi J, Gissen P, Kurian MA, Ketteler R. Cardiac glycosides restore autophagy flux in an iPSC-derived neuronal model of WDR45 deficiency. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.13.556416. [PMID: 37745522 PMCID: PMC10515824 DOI: 10.1101/2023.09.13.556416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Beta-Propeller Protein-Associated Neurodegeneration (BPAN) is one of the commonest forms of Neurodegeneration with Brain Iron Accumulation, caused by mutations in the gene encoding the autophagy-related protein, WDR45. The mechanisms linking autophagy, iron overload and neurodegeneration in BPAN are poorly understood and, as a result, there are currently no disease-modifying treatments for this progressive disorder. We have developed a patient-derived, induced pluripotent stem cell (iPSC)-based midbrain dopaminergic neuronal cell model of BPAN (3 patient, 2 age-matched controls and 2 isogenic control lines) which shows defective autophagy and aberrant gene expression in key neurodegenerative, neurodevelopmental and collagen pathways. A high content imaging-based medium-throughput blinded drug screen using the FDA-approved Prestwick library identified 5 cardiac glycosides that both corrected disease-related defective autophagosome formation and restored BPAN-specific gene expression profiles. Our findings have clear translational potential and emphasise the utility of iPSC-based modelling in elucidating disease pathophysiology and identifying targeted therapeutics for early-onset monogenic disorders.
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Affiliation(s)
- Apostolos Papandreou
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
- Laboratory for Molecular Cell Biology, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nivedita Singh
- Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Lorita Gianfrancesco
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Dimitri Budinger
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Katy Barwick
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Alexander Agrotis
- Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Christin Luft
- Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Ying Shao
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | | | | | | | | | | | - Serena Barral
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Janos Kriston-Vizi
- Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Paul Gissen
- Inborn Errors of Metabolism, Genetics & Genomic Medicine Programme, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Manju A Kurian
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- These authors contributed equally
| | - Robin Ketteler
- Laboratory for Molecular Cell Biology, University College London, London, UK
- Department of Human Medicine, Medical School Berlin, Berlin, Germany
- These authors contributed equally
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Peng Q, Cui Y, Wu J, Wu L, Liu J, Han Y, Lu G. A c.726C>G (p.Tyr242Ter) nonsense mutation-associated with splicing alteration (NASA) of WDR45 gene underlies β-propeller protein-associated neurodegeneration (BPAN). Heliyon 2024; 10:e30438. [PMID: 38765101 PMCID: PMC11098806 DOI: 10.1016/j.heliyon.2024.e30438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024] Open
Abstract
Neurodegeneration with brain iron accumulation (NBIA) is a clinically and genetically heterogeneous disease characterized by increased iron deposition in the basal ganglia and progressive degeneration of the nervous system in adulthood. However, in early childhood, there were no characteristic features to perform early diagnosis. In our study, a female child exhibited global developmental delay, intellectual disability, and febrile seizure without other distinct clinical phenotypes. Through whole exome sequencing (WES), a de novo nonsense mutation (c.726C > G, p. Tyr242Ter) of WDR45 gene was identified in this child. She was finally diagnosed as β-propeller protein-associated neurodegeneration (BPAN), one of the recently identified subtypes of NBIA. This mutation could act as a premature stop codon (PSC) which rendered the mutated transcripts to be degraded by nonsense-mediated mRNA decay (NMD), leading to decreased levels of PSC-containing mRNAs. Additionally, through mini-gene splicing assays, this mutation could result in an unprecedented novel transcript with the exon 9 of WDR45 excluded by nonsense-associated splicing alteration (NASA). Transcriptome sequencing (RNA-seq) on total RNAs from PBMCs of the trio revealed three types of alternative splicing events in the patient. Further research implied that downregulation of iron transport genes (TFRC, TFR2, SCARA5) might be the underlying mechanism for the iron accumulation in patients with deficient WDR45. This is the first report about NASA happening in WDR45. It implies that nonsense mutations approximal to splicing sites could affect the disease pathogenesis through more than one molecular mechanism and should be taken into consideration when conducting genetic counseling.
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Affiliation(s)
- Qiongling Peng
- Department of Child Healthcare, Shenzhen Bao'an Women's and Children's Hospital, 56 Yulyu Road, Bao'an District, Shenzhen, 518000, China
| | - Ying Cui
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, China
| | - Jin Wu
- Laboratory of Translational Medicine Research, Department of Pathology, Affiliated Deyang People's Hospital of Sichuan Traditional Medical University, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
- Deyang Key Laboratory of Tumor Molecular Research, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
| | - Lianying Wu
- Laboratory of Translational Medicine Research, Department of Pathology, Affiliated Deyang People's Hospital of Sichuan Traditional Medical University, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
- Deyang Key Laboratory of Tumor Molecular Research, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
| | - Jiajia Liu
- Department of Child Healthcare, Shenzhen Bao'an Women's and Children's Hospital, 56 Yulyu Road, Bao'an District, Shenzhen, 518000, China
| | - Yangyun Han
- Sichuan Clinical Medical Research Center for Neurological Diseases, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
| | - Guanting Lu
- Laboratory of Translational Medicine Research, Department of Pathology, Affiliated Deyang People's Hospital of Sichuan Traditional Medical University, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
- Deyang Key Laboratory of Tumor Molecular Research, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
- Sichuan Clinical Medical Research Center for Neurological Diseases, No. 103 First Section of Taishanbei Road, Jingyang District, Deyang, 618000, China
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Salimi Z, Afsharinasab M, Rostami M, Eshaghi Milasi Y, Mousavi Ezmareh SF, Sakhaei F, Mohammad-Sadeghipour M, Rasooli Manesh SM, Asemi Z. Iron chelators: as therapeutic agents in diseases. Ann Med Surg (Lond) 2024; 86:2759-2776. [PMID: 38694398 PMCID: PMC11060230 DOI: 10.1097/ms9.0000000000001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/03/2024] [Indexed: 05/04/2024] Open
Abstract
The concentration of iron is tightly regulated, making it an essential element. Various cellular processes in the body rely on iron, such as oxygen sensing, oxygen transport, electron transfer, and DNA synthesis. Iron excess can be toxic because it participates in redox reactions that catalyze the production of reactive oxygen species and elevate oxidative stress. Iron chelators are chemically diverse; they can coordinate six ligands in an octagonal sequence. Because of the ability of chelators to trap essential metals, including iron, they may be involved in diseases caused by oxidative stress, such as infectious diseases, cardiovascular diseases, neurodegenerative diseases, and cancer. Iron-chelating agents, by tightly binding to iron, prohibit it from functioning as a catalyst in redox reactions and transfer iron and excrete it from the body. Thus, the use of iron chelators as therapeutic agents has received increasing attention. This review investigates the function of various iron chelators in treating iron overload in different clinical conditions.
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Affiliation(s)
- Zohreh Salimi
- Department of Clinical Biochemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan
| | - Mehdi Afsharinasab
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran
| | - Mehdi Rostami
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad
| | - Yaser Eshaghi Milasi
- Department of Clinical Biochemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan
| | - Seyedeh Fatemeh Mousavi Ezmareh
- Department of Clinical Biochemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan
| | - Fariba Sakhaei
- Department of Clinical Biochemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan
| | - Maryam Mohammad-Sadeghipour
- Department of Clinical Biochemistry, Afzalipoor Faculty of Medicine, Kerman University of Medical Sciences, Kerman
| | | | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
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Klein Haneveld MJ, Hieltjes IJ, Langendam MW, Cornel MC, Gaasterland CMW, van Eeghen AM. Improving care for rare genetic neurodevelopmental disorders: A systematic review and critical appraisal of clinical practice guidelines using AGREE II. Genet Med 2024; 26:101071. [PMID: 38224026 DOI: 10.1016/j.gim.2024.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
PURPOSE Rare genetic neurodevelopmental disorders associated with intellectual disability require lifelong multidisciplinary care. Clinical practice guidelines may support healthcare professionals in their daily practice, but guideline development for rare conditions can be challenging. In this systematic review, the characteristics and methodological quality of internationally published recommendations for this population are described to provide an overview of current guidelines and inform future efforts of European Reference Network ITHACA (Intellectual disability, TeleHealth, Autism, and Congenital Anomalies). METHODS MEDLINE, Embase, and Orphanet were systematically searched to identify guidelines for conditions classified as "rare genetic intellectual disability" (ORPHA:183757). Methodological quality was assessed using the Appraisal of Guidelines, Research, and Evaluation II tool. RESULTS Seventy internationally published guidelines, addressing the diagnosis and/or management of 28 conditions, were included. The methodological rigor of development was highly variable with limited reporting of literature searches and consensus methods. Stakeholder involvement and editorial independence varied as well. Implementation was rarely addressed. CONCLUSION Comprehensive, high-quality guidelines are lacking for many rare genetic neurodevelopmental disorders. Use and transparent reporting of sound development methodologies, active involvement of affected individuals and families, robust conflict of interest procedures, and attention to implementation are vital for enhancing the impact of clinical practice recommendations.
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Affiliation(s)
- Mirthe J Klein Haneveld
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands; European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability ERN-ITHACA, Clinical Genetics Department, Robert Debré University Hospital, Paris, France; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Iméze J Hieltjes
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands; Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Miranda W Langendam
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Martina C Cornel
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Human Genetics, Amsterdam, The Netherlands
| | - Charlotte M W Gaasterland
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands; European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability ERN-ITHACA, Clinical Genetics Department, Robert Debré University Hospital, Paris, France; Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Agnies M van Eeghen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands; European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability ERN-ITHACA, Clinical Genetics Department, Robert Debré University Hospital, Paris, France; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands.
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7
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Esbit S, Sidlow R. A Case of Beta-Propeller Protein-Associated Neurodegeneration With a Unique Truncating Variant in the WDR45 Gene and Uncommon Clinical and Radiologic Findings. Cureus 2024; 16:e58127. [PMID: 38741870 PMCID: PMC11088971 DOI: 10.7759/cureus.58127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Beta-propeller protein-associated neurodegeneration (BPAN), a subtype of neurodegeneration with brain iron accumulation, is caused by variants in the WDR45 gene. In this paper, we describe a patient with an atypical presentation of BPAN whose whole exome sequencing revealed a previously unattested truncating variant in the WDR45 gene (c.830+3G>C/p.Leu278Ter), the pathogenicity of which was verified by RNA transcriptomics. A number of uncommon neuroanatomic and clinical findings in our patient are discussed, expanding the phenotype associated with BPAN. This unique case challenges existing genotype-phenotype correlations and highlights the role of X chromosome skewing in shaping the clinical spectrum of BPAN.
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Affiliation(s)
- Simon Esbit
- Medicine, Medical School for International Health, Ben Gurion University of the Negev, Be'er Sheva, ISR
| | - Richard Sidlow
- Medical Genetics and Metabolism, Valley Children's Hospital, Madera, USA
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Mollereau B, Hayflick SJ, Escalante R, Mauthe M, Papandreou A, Iuso A, Celle M, Aniorte S, Issa AR, Lasserre JP, Lesca G, Thobois S, Burger P, Walter L. A burning question from the first international BPAN symposium: is restoration of autophagy a promising therapeutic strategy for BPAN? Autophagy 2023; 19:3234-3239. [PMID: 37565733 PMCID: PMC10621268 DOI: 10.1080/15548627.2023.2247314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
Beta-propeller protein-associated neurodegeneration (BPAN) is a rare neurodegenerative disease associated with severe cognitive and motor deficits. BPAN pathophysiology and phenotypic spectrum are still emerging due to the fact that mutations in the WDR45 (WD repeat domain 45) gene, a regulator of macroautophagy/autophagy, were only identified a decade ago. In the first international symposium dedicated to BPAN, which was held in Lyon, France, a panel of international speakers, including several researchers from the autophagy community, presented their work on human patients, cellular and animal models, carrying WDR45 mutations and their homologs. Autophagy researchers found an opportunity to explore the defective function of autophagy mechanisms associated with WDR45 mutations, which underlie neuronal dysfunction and early death. Importantly, BPAN is one of the few human monogenic neurological diseases targeting a regulator of autophagy, which raises the possibility that it is a relevant model to directly assess the roles of autophagy in neurodegeneration and to develop autophagy restorative therapeutic strategies for more common disorders.Abbreviations: ATG: autophagy related; BPAN: beta-propeller protein-associated neurodegeneration; ER: endoplasmic reticulum; KO: knockout; NBIA: neurodegeneration with brain iron accumulation; PtdIns3P: phosphatidylinositol-3-phosphate; ULK1: unc-51 like autophagy activating kinase 1; WDR45: WD repeat domain 45; WIPI: WD repeat domain, phosphoinositide interacting.
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Affiliation(s)
- Bertrand Mollereau
- Laboratory of Biology and Modelling of the Cell, ENS of Lyon, University of Lyon, University of Claude Bernard Lyon 1, CNRS UMR 5239, INSERM U1210, UMS 3444 Biosciences Lyon Gerland, Lyon, France
| | - Susan J Hayflick
- Departments of Molecular and Medical Genetics, Pediatrics, and Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ricardo Escalante
- Instituto de Investigaciones Biomédicas Alberto Sols. CSIC-UAM, Madrid, Spain
| | - Mario Mauthe
- Department of Biomedical Sciences of Cells & Systems, Molecular Cell Biology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Apostolos Papandreou
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK
- Medical Research Council Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Arcangela Iuso
- Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Marion Celle
- Laboratory of Biology and Modelling of the Cell, ENS of Lyon, University of Lyon, University of Claude Bernard Lyon 1, CNRS UMR 5239, INSERM U1210, UMS 3444 Biosciences Lyon Gerland, Lyon, France
| | - Sahra Aniorte
- Laboratory of Biology and Modelling of the Cell, ENS of Lyon, University of Lyon, University of Claude Bernard Lyon 1, CNRS UMR 5239, INSERM U1210, UMS 3444 Biosciences Lyon Gerland, Lyon, France
| | - Abdul Raouf Issa
- Laboratory of Biology and Modelling of the Cell, ENS of Lyon, University of Lyon, University of Claude Bernard Lyon 1, CNRS UMR 5239, INSERM U1210, UMS 3444 Biosciences Lyon Gerland, Lyon, France
| | - Jean Paul Lasserre
- Laboratory of NRGEN, Univ. Bordeaux, CNRS, INCIA, UMR 5287, Bordeaux, France
| | - Gaetan Lesca
- Service de Génétique, Hospices Civils de Lyon, Lyon, France
- Institut Neuromyogene, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261-INSERM U1315, Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Thobois
- Service de Neurologie C, Movement disorders unit, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, CNRS, Bron, France
- Faculté de Médecine et de Maieutique Charles Mérieux, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pauline Burger
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Université de Strasbourg, INSERM U1258, CNRS UMR7104, Illkirch, France
| | - Ludivine Walter
- Laboratory of Biology and Modelling of the Cell, ENS of Lyon, University of Lyon, University of Claude Bernard Lyon 1, CNRS UMR 5239, INSERM U1210, UMS 3444 Biosciences Lyon Gerland, Lyon, France
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Suárez-Carrillo A, Álvarez-Córdoba M, Romero-González A, Talaverón-Rey M, Povea-Cabello S, Cilleros-Holgado P, Piñero-Pérez R, Reche-López D, Gómez-Fernández D, Romero-Domínguez JM, Munuera-Cabeza M, Díaz A, González-Granero S, García-Verdugo JM, Sánchez-Alcázar JA. Antioxidants Prevent Iron Accumulation and Lipid Peroxidation, but Do Not Correct Autophagy Dysfunction or Mitochondrial Bioenergetics in Cellular Models of BPAN. Int J Mol Sci 2023; 24:14576. [PMID: 37834028 PMCID: PMC11340724 DOI: 10.3390/ijms241914576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/15/2023] Open
Abstract
Neurodegeneration with brain iron accumulation (NBIA) is a group of rare neurogenetic disorders frequently associated with iron accumulation in the basal nuclei of the brain. Among NBIA subtypes, β-propeller protein-associated neurodegeneration (BPAN) is associated with mutations in the autophagy gene WDR45. The aim of this study was to demonstrate the autophagic defects and secondary pathological consequences in cellular models derived from two patients harboring WDR45 mutations. Both protein and mRNA expression levels of WDR45 were decreased in patient-derived fibroblasts. In addition, the increase of LC3B upon treatments with autophagy inducers or inhibitors was lower in mutant cells compared to control cells, suggesting decreased autophagosome formation and impaired autophagic flux. A transmission electron microscopy (TEM) analysis showed mitochondrial vacuolization associated with the accumulation of lipofuscin-like aggregates containing undegraded material. Autophagy dysregulation was also associated with iron accumulation and lipid peroxidation. In addition, mutant fibroblasts showed altered mitochondrial bioenergetics. Antioxidants such as pantothenate, vitamin E and α-lipoic prevented lipid peroxidation and iron accumulation. However, antioxidants were not able to correct the expression levels of WDR45, neither the autophagy defect nor cell bioenergetics. Our study demonstrated that WDR45 mutations in BPAN cellular models impaired autophagy, iron metabolism and cell bioenergetics. Antioxidants partially improved cell physiopathology; however, autophagy and cell bioenergetics remained affected.
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Affiliation(s)
- Alejandra Suárez-Carrillo
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Mónica Álvarez-Córdoba
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Ana Romero-González
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Marta Talaverón-Rey
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Suleva Povea-Cabello
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Paula Cilleros-Holgado
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Rocío Piñero-Pérez
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Diana Reche-López
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - David Gómez-Fernández
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - José Manuel Romero-Domínguez
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Manuel Munuera-Cabeza
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
| | - Antonio Díaz
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, New York, NY 10461, USA;
- Institute for Aging Studies, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Susana González-Granero
- Laboratory of Comparative Neurobiology, Cavanilles Institute of Biodiversity and Evolutionary Biology, University of Valencia and CIBERNED-ISCIII, 46100 Valencia, Spain; (S.G.-G.); (J.M.G.-V.)
| | - José Manuel García-Verdugo
- Laboratory of Comparative Neurobiology, Cavanilles Institute of Biodiversity and Evolutionary Biology, University of Valencia and CIBERNED-ISCIII, 46100 Valencia, Spain; (S.G.-G.); (J.M.G.-V.)
| | - José A. Sánchez-Alcázar
- Centro Andaluz de Biología del Desarrollo, ABD-CSIC-Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.S.-C.); (M.Á.-C.); (A.R.-G.); (M.T.-R.); (S.P.-C.); (P.C.-H.); (R.P.-P.); (D.R.-L.); (D.G.-F.); (J.M.R.-D.); (M.M.-C.)
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Collet‐Vidiella R, Olmedo‐Saura G, Ruiz‐Barrio I, Martínez‐Viguera A, Rodriguez‐Santiago B, Bernal S, Kulisevsky J, Pagonabarraga J. Late-Onset Beta-Propeller Protein-Associated Neurodegeneration: A Case Report. Mov Disord Clin Pract 2023; 10:1211-1214. [PMID: 37635772 PMCID: PMC10450230 DOI: 10.1002/mdc3.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
| | | | - Iñigo Ruiz‐Barrio
- Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | - Benjamin Rodriguez‐Santiago
- Genetics DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Sara Bernal
- Genetics DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
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11
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Susgun S, Demirel M, Yalcin Cakmakli G, Salman B, K Oguz K, Elibol B, Ugur Iseri SA, Yapıcı Z. Targeted resequencing reveals high-level mosaicism for a novel frameshift variant in WDR45 associated with beta-propeller protein-associated neurodegeneration. Int J Neurosci 2023:1-6. [PMID: 37099669 DOI: 10.1080/00207454.2023.2208279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Beta-propeller protein-associated neurodegeneration (BPAN) is a rare X-linked dominant neurodegenerative disease, which is characterized by iron accumulation in the basal ganglia. BPAN is associated with pathogenic variation in WDR45, which has been reported almost exclusively in females most probably due to male lethality in the hemizygous state. METHODS Whole exome sequencing (WES) and targeted deep sequencing were performed for a male with a clinical diagnosis of BPAN at the age of 37. RESULTS The novel frameshift variant in WDR45 detected by WES was further analyzed with targeted resequencing to detect a mosaicism level of 85.5% in the blood sample of the proband. DISCUSSION Although the main role of WDR45 remains elusive, recent studies show that WDR45 may contribute to neurodegeneration through defects in autophagy, iron storage and ferritin metabolism, mitochondria organization, and endoplasmic reticulum homeostasis. The extend of spatiotemporal haploinsufficiency of WDR45 frameshifting variants caused by mosaicism in males may lead to variable clinical severity, which may be hard to elaborate clinically. Promising genetic analysis strategies using targeted deep sequencing may help determine the clinical outcome of somatic mosaicism in neurological disorders including BPAN. Additionally, we suggest that deep sequencing should be conducted in cerebrospinal fluid samples to provide more reliable results in terms of reflecting the mosaicism level in the brain for future studies.
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Affiliation(s)
- Seda Susgun
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
- Department of Medical Biology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mert Demirel
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gul Yalcin Cakmakli
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Baris Salman
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Kader K Oguz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Elibol
- Department of Neurology, Institute of Neurological Sciences and Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sibel Aylin Ugur Iseri
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Zuhal Yapıcı
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Talaverón-Rey M, Álvarez-Córdoba M, Villalón-García I, Povea-Cabello S, Suárez-Rivero JM, Gómez-Fernández D, Romero-González A, Suárez-Carrillo A, Munuera-Cabeza M, Cilleros-Holgado P, Reche-López D, Piñero-Pérez R, Sánchez-Alcázar JA. Alpha-lipoic acid supplementation corrects pathological alterations in cellular models of pantothenate kinase-associated neurodegeneration with residual PANK2 expression levels. Orphanet J Rare Dis 2023; 18:80. [PMID: 37046296 PMCID: PMC10091671 DOI: 10.1186/s13023-023-02687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Neurodegeneration with brain iron accumulation (NBIA) disorders are a group of neurodegenerative diseases that have in common the accumulation of iron in the basal nuclei of the brain which are essential components of the extrapyramidal system. Frequent symptoms are progressive spasticity, dystonia, muscle rigidity, neuropsychiatric symptoms, and retinal degeneration or optic nerve atrophy. One of the most prevalent subtypes of NBIA is Pantothenate kinase-associated neurodegeneration (PKAN). It is caused by pathogenic variants in the gene of pantothenate kinase 2 (PANK2) which encodes the enzyme responsible for the first reaction on the coenzyme A (CoA) biosynthesis pathway. Thus, deficient PANK2 activity induces CoA deficiency as well as low expression levels of 4'-phosphopantetheinyl proteins which are essential for mitochondrial metabolism. METHODS This study is aimed at evaluating the role of alpha-lipoic acid (α-LA) in reversing the pathological alterations in fibroblasts and induced neurons derived from PKAN patients. Iron accumulation, lipid peroxidation, transcript and protein expression levels of PANK2, mitochondrial ACP (mtACP), 4''-phosphopantetheinyl and lipoylated proteins, as well as pyruvate dehydrogenase (PDH) and Complex I activity were examined. RESULTS Treatment with α-LA was able to correct all pathological alterations in responsive mutant fibroblasts with residual PANK2 enzyme expression. However, α-LA had no effect on mutant fibroblasts with truncated/incomplete protein expression. The positive effect of α-LA in particular pathogenic variants was also confirmed in induced neurons derived from mutant fibroblasts. CONCLUSIONS Our results suggest that α-LA treatment can increase the expression levels of PANK2 and reverse the mutant phenotype in PANK2 responsive pathogenic variants. The existence of residual enzyme expression in some affected individuals raises the possibility of treatment using high dose of α-LA.
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Affiliation(s)
- Marta Talaverón-Rey
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Mónica Álvarez-Córdoba
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Irene Villalón-García
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Suleva Povea-Cabello
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Juan M Suárez-Rivero
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - David Gómez-Fernández
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Ana Romero-González
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Alejandra Suárez-Carrillo
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Manuel Munuera-Cabeza
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Paula Cilleros-Holgado
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Diana Reche-López
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - Rocío Piñero-Pérez
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain
| | - José A Sánchez-Alcázar
- Centro Andaluz de Biología del Desarrollo (CABD-CSIC-UPO), Universidad Pablo de Olavide, 41013, Seville, Spain.
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Neurodegeneration with brain iron accumulation: a case series highlighting phenotypic and genotypic diversity in 20 Indian families. Neurogenetics 2023; 24:113-127. [PMID: 36790591 DOI: 10.1007/s10048-023-00712-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
Neurodegeneration with brain iron accumulation (NBIA) is an umbrella term encompassing various inherited neurological disorders characterised by abnormal iron accumulation in basal ganglia. We aimed to study the clinical, radiological and molecular spectrum of disorders with NBIA. All molecular-proven cases of NBIA presented in the last 5 years at 2 tertiary care genetic centres were compiled. Demographic details and clinical and neuroimaging findings were collated. We describe 27 individuals from 20 unrelated Indian families with causative variants in 5 NBIA-associated genes. PLA2G6-associated neurodegeneration (PLAN) was the most common, observed in 13 individuals from 9 families. They mainly presented in infancy with neuroregression and hypotonia. A recurrent pathogenic variant in COASY was observed in two neonates with prenatal-onset severe neurodegeneration. Pathogenic bi-allelic variants in PANK2, FA2H and C19ORF12 genes were observed in the rest, and these individuals presented in late childhood and adolescence with gait abnormalities and extrapyramidal symptoms. No intrafamilial and interfamilial variability were observed. Iron deposition on neuroimaging was seen in only 6/17 (35.3%) patients. A total of 22 causative variants across 5 genes were detected including a multiexonic duplication in PLA2G6. The variants c.1799G > A and c.2370 T > G in PLA2G6 were observed in three unrelated families. In silico assessments of 8 amongst 9 novel variants were also performed. We present a comprehensive compilation of the phenotypic and genotypic spectrum of various subtypes of NBIA from the Indian subcontinent. Clinical presentation of NBIAs is varied and not restricted to extrapyramidal symptoms or iron accumulation on neuroimaging.
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Papandreou A, Soo AKS, Spaull R, Mankad K, Kurian MA, Sudhakar S. Expanding the Spectrum of Early Neuroradiologic Findings in β Propeller Protein-Associated Neurodegeneration. AJNR Am J Neuroradiol 2022; 43:1810-1814. [PMID: 36328404 DOI: 10.3174/ajnr.a7693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE β propeller protein-associated neurodegeneration (BPAN) is the most common neurodegeneration with brain iron accumulation disorder. Typical radiologic findings are T2 hypointensity in the substantia nigra and globus pallidus, as well as a T1 halolike substantia nigra hyperintense signal surrounding a hypointense central area. However, these findings are often subtle or absent on initial scans, risking diagnostic delay. In this study, we sought to investigate radiologic findings that could aid in the early diagnosis of BPAN. MATERIALS AND METHODS A retrospective cohort study was performed in a national referral center, including all pediatric patients with confirmed pathogenic WDR45 mutations and consistent clinical semiology. MR imaging findings were independently reported by 2 pediatric neuroradiologists. RESULTS Fifteen patients were included in the study, and 27 scans were available for review. The initial neuroimaging study was undertaken at a mean age of 3.2 years. Iron deposition was uncommon in patients younger than 4 years of age. Neuroradiologic features from very early on included dentate, globus pallidus, and substantia nigra swelling, as well as a thin corpus callosum and small pontine volume. Optic nerve thinning was also present in all patients. CONCLUSIONS Our study highlights the key early MR imaging features of BPAN. Iron deposition in the globus pallidus and substantia nigra is not common in children younger than 4 years of age; clinicians should not be deterred from suspecting BPAN in the presence of the findings described in this study and the appropriate clinical context.
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Affiliation(s)
- A Papandreou
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK .,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - A K S Soo
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - R Spaull
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - K Mankad
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - M A Kurian
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - S Sudhakar
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Chiapparini L, Zorzi G. Early Neuroimaging Markers in β Propeller Protein-Associated Neurodegeneration. AJNR Am J Neuroradiol 2022; 43:1815-1816. [PMID: 36396333 DOI: 10.3174/ajnr.a7723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - G Zorzi
- Department of Paediatric Neuroscience Fondazione Institute for Hospitalization and Healthcare Istituto Neurologico Carlo Besta Milan, Italy
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16
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Interactions of dopamine, iron, and alpha-synuclein linked to dopaminergic neuron vulnerability in Parkinson's disease and neurodegeneration with brain iron accumulation disorders. Neurobiol Dis 2022; 175:105920. [DOI: 10.1016/j.nbd.2022.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022] Open
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17
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Almannai M, Marafi D, El-Hattab AW. WIPI proteins: Biological functions and related syndromes. Front Mol Neurosci 2022; 15:1011918. [PMID: 36157071 PMCID: PMC9500159 DOI: 10.3389/fnmol.2022.1011918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
WIPI (WD-repeat protein Interacting with PhosphoInositides) are important effectors in autophagy. These proteins bind phosphoinositides and recruit autophagy proteins. In mammals, there are four WIPI proteins: WIPI1, WIPI2, WIPI3 (WDR45B), and WIPI4 (WDR45). These proteins consist of a seven-bladed β-propeller structure. Recently, pathogenic variants in genes encoding these proteins have been recognized to cause human diseases with a predominant neurological phenotype. Defects in WIPI2 cause a disease characterized mainly by intellectual disability and variable other features while pathogenic variants in WDR45B and WDR45 have been recently reported to cause El-Hattab-Alkuraya syndrome and beta-propeller protein-associated neurodegeneration (BPAN), respectively. Whereas, there is no disease linked to WIPI1 yet, one study linked it neural tube defects (NTD). In this review, the role of WIPI proteins in autophagy is discussed first, then syndromes related to these proteins are summarized.
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Affiliation(s)
- Mohammed Almannai
- Genetics and Precision Medicine Department, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- *Correspondence: Mohammed Almannai
| | - Dana Marafi
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Ayman W. El-Hattab
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pediatrics, University Hospital Sharjah, Sharjah, United Arab Emirates
- Genetics and Metabolic Department, KidsHeart Medical Center, Abu Dhabi, United Arab Emirates
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18
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Gavazzi F, Pierce SR, Vithayathil J, Cunningham K, Anderson K, McCann J, Moll A, Muirhead K, Sherbini O, Prange E, Dubbs H, Tochen L, Fraser J, Helbig I, Lewin N, Thakur N, Adang LA. Psychometric outcome measures in beta-propeller protein-associated neurodegeneration (BPAN). Mol Genet Metab 2022; 137:26-32. [PMID: 35878504 PMCID: PMC9613602 DOI: 10.1016/j.ymgme.2022.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Beta-propeller protein-associated neurodegeneration (BPAN) is a rare neurodegenerative disorder characterized by iron accumulation in the brain with spectrum of neurodevelopmental and movement phenotypes. In anticipation of future clinical trials and to inform clinical care, there is an unmet need to capture the phenotypic diversity of this rare disorder and better define disease subtypes. METHODS A total of 27 individuals with BPAN were included in our natural history study, from which traditional outcome measures were obtained in 18 subjects. Demographic and diagnostic information, along with acquisition of basic developmental skills and overall neurologic severity were extracted from the medical records. Functional outcome measures were administered at the time of the evaluation or applied retrospectively at the last clinical encounter for patients who were not able to travel for in person. Based on age and functional level, the following assessments were administered: Leiter-3, Gross Motor Function Measure (GMFM)-66 Item Sets, Vineland-3, and Peabody-2. RESULTS Overall, cognitive function was more impaired compared to gross motor function. Onset of symptoms of BPAN within the first 6 months of life was associated with decreased gain of ambulation and gain of spoken language (ambulation: log-rank test p = 0.0015; gain of first word: p = 0.0015). There was no difference in age at seizure onset by age at initial symptom onset (p = 0.8823). Collection of prospective outcome measures was limited by attention and behavior in our patient population, reinforcing the complexity of phenotype assessment and inadequacy of available standardized tests. Overall, gross motor and adaptive behavior assessments were better able to capture the dynamic range of function across the BPAN population than the fine motor and non-verbal cognitive tests. Floor effects were noted across outcome measures in a subset of individuals for cognitive and adaptive behavior tests. CONCLUSION Our data suggest the distinct phenotypes of BPAN: a severe, early onset form and an attenuated form with higher cognitive capabilities. Early age at onset was a key factor in predicting future neurologic impairment.
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Affiliation(s)
- Francesco Gavazzi
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Samuel R Pierce
- Departmen of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph Vithayathil
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristin Cunningham
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kim Anderson
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacob McCann
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashley Moll
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kayla Muirhead
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Omar Sherbini
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Prange
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly Dubbs
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Tochen
- Children's National Medical Center, Department of Neurology, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Jamie Fraser
- Rare Disease Institute, Division of Genetics and Metabolism, Children's National Hospital, Washington, DC, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Lewin
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nivedita Thakur
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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19
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Cerebral Iron Deposition in Neurodegeneration. Biomolecules 2022; 12:biom12050714. [PMID: 35625641 PMCID: PMC9138489 DOI: 10.3390/biom12050714] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Disruption of cerebral iron regulation appears to have a role in aging and in the pathogenesis of various neurodegenerative disorders. Possible unfavorable impacts of iron accumulation include reactive oxygen species generation, induction of ferroptosis, and acceleration of inflammatory changes. Whole-brain iron-sensitive magnetic resonance imaging (MRI) techniques allow the examination of macroscopic patterns of brain iron deposits in vivo, while modern analytical methods ex vivo enable the determination of metal-specific content inside individual cell-types, sometimes also within specific cellular compartments. The present review summarizes the whole brain, cellular, and subcellular patterns of iron accumulation in neurodegenerative diseases of genetic and sporadic origin. We also provide an update on mechanisms, biomarkers, and effects of brain iron accumulation in these disorders, focusing on recent publications. In Parkinson’s disease, Friedreich’s disease, and several disorders within the neurodegeneration with brain iron accumulation group, there is a focal siderosis, typically in regions with the most pronounced neuropathological changes. The second group of disorders including multiple sclerosis, Alzheimer’s disease, and amyotrophic lateral sclerosis shows iron accumulation in the globus pallidus, caudate, and putamen, and in specific cortical regions. Yet, other disorders such as aceruloplasminemia, neuroferritinopathy, or Wilson disease manifest with diffuse iron accumulation in the deep gray matter in a pattern comparable to or even more extensive than that observed during normal aging. On the microscopic level, brain iron deposits are present mostly in dystrophic microglia variably accompanied by iron-laden macrophages and in astrocytes, implicating a role of inflammatory changes and blood–brain barrier disturbance in iron accumulation. Options and potential benefits of iron reducing strategies in neurodegeneration are discussed. Future research investigating whether genetic predispositions play a role in brain Fe accumulation is necessary. If confirmed, the prevention of further brain Fe uptake in individuals at risk may be key for preventing neurodegenerative disorders.
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Towards Precision Therapies for Inherited Disorders of Neurodegeneration with Brain Iron Accumulation. Tremor Other Hyperkinet Mov (N Y) 2021; 11:51. [PMID: 34909266 PMCID: PMC8641530 DOI: 10.5334/tohm.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Neurodegeneration with brain iron accumulation (NBIA) disorders comprise a group of rare but devastating inherited neurological diseases with unifying features of progressive cognitive and motor decline, and increased iron deposition in the basal ganglia. Although at present there are no proven disease-modifying treatments, the severe nature of these monogenic disorders lends to consideration of personalized medicine strategies, including targeted gene therapy. In this review we summarize the progress and future direction towards precision therapies for NBIA disorders. Methods: This review considered all relevant publications up to April 2021 using a systematic search strategy of PubMed and clinical trials databases. Results: We review what is currently known about the underlying pathophysiology of NBIA disorders, common NBIA disease pathways, and how this knowledge has influenced current management strategies and clinical trial design. The safety profile, efficacy and clinical outcome of clinical studies are reviewed. Furthermore, the potential for future therapeutic approaches is also discussed. Discussion: Therapeutic options in NBIAs remain very limited, with no proven disease-modifying treatments at present. However, a number of different approaches are currently under development with increasing focus on targeted precision therapies. Recent advances in the field give hope that novel strategies, such as gene therapy, gene editing and substrate replacement therapies are both scientifically and financially feasible for these conditions. Highlights This article provides an up-to-date review of the current literature about Neurodegeneration with Brain Iron Accumulation (NBIA), with a focus on disease pathophysiology, current and previously trialed therapies, and future treatments in development, including consideration of potential genetic therapy approaches.
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