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Laugwitz L, Santhanakumaran V, Spieker M, Boehringer J, Bender B, Gieselmann V, Beck‐Woedl S, Bruchelt G, Harzer K, Kraegeloh‐Mann I, Groeschel S. Extremely low arylsulfatase A enzyme activity does not necessarily cause symptoms: A long‐term follow‐up and review of the literature. JIMD Rep 2022; 63:292-302. [PMID: 35822086 PMCID: PMC9259399 DOI: 10.1002/jmd2.12293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 01/22/2023] Open
Abstract
Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disease caused by deficiency of arylsulfatase A (ARSA). Heterozygous carriers of disease‐causing variants and individuals harbouring pseudodeficiency alleles in the ARSA gene exhibit reduced ARSA activity. In the context of these genotypes, low ARSA activity has been suggested to lead to an atypical form of MLD or other neurological abnormalities, but data are limited. The aim of our study was to analyse the impact of low ARSA activity in two subjects who are heterozygous for the ARSA pseudodeficiency allele and a disease‐causing variant. Biochemical testing included ARSA activity measurements and urinary sulfatide analysis. Biochemical data of a large cohort of MLD patients, heterozygotes, pseudodeficient individuals and healthy controls were analysed. MRI was performed at 3T using T1‐ and T2‐weighted sequences and MR spectroscopy. We present two long‐term follow‐ups who are heterozygous for the ARSA pseudodeficiency allele and a disease‐causing variant in the ARSA gene in cis. The two related index cases exhibit markedly reduced ARSA activity compared to controls and heterozygous carriers. The neurological evaluation and MRI do not reveal any abnormalities. Our data underline that extremely low enzyme activity due to a pseudodeficiency allele and a disease‐causing variant in the ARSA gene even in cis does not lead to clinical symptoms or pre‐symptomatic MRI changes suspicious for MLD. The review of literature corroborates that any association of low ARSA activity with disease features remains questionable. It seems important to combine the measurement of ARSA activity with elevated sulfatide as well as genetic testing, as done in current newborn screening approaches. Heterozygosity for metachromatic leukodystrophy and an arylsulfatase A pseudodeficiency allele does not cause neurological or neuropsychiatric features.
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Affiliation(s)
- Lucia Laugwitz
- Institute of Medical Genetics and Applied Genomics University of Tübingen Tübingen Germany
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Vidiyaah Santhanakumaran
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Mareike Spieker
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Judith Boehringer
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology Radiologic Clinics, University of Tübingen Tübingen Germany
| | - Volkmar Gieselmann
- Institute of Biochemistry and Molecular Biology University of Bonn Bonn Germany
| | - Stefanie Beck‐Woedl
- Institute of Medical Genetics and Applied Genomics University of Tübingen Tübingen Germany
| | - Gernot Bruchelt
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Klaus Harzer
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Ingeborg Kraegeloh‐Mann
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
| | - Samuel Groeschel
- Department of Neuropediatrics, Developmental Neurology and Social Paediatrics University of Tübingen Tübingen Germany
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Ben Halim N, Dorboz I, Kefi R, Kharrat N, Eymard-Pierre E, Nagara M, Romdhane L, Ben Alaya-Bouafif N, Rebai A, Miladi N, Boespflug-Tanguy O, Abdelhak S. Determination of arylsulfatase A pseudodeficiency allele and haplotype frequency in the Tunisian population. Neurol Sci 2015; 37:403-9. [PMID: 26577183 DOI: 10.1007/s10072-015-2417-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023]
Abstract
Arylsulfatase A (ASA) is a lysosomal enzyme involved in the catabolism of cerebroside sulfate. ASA deficiency is associated with metachromatic leukodystrophy (MLD). Low ASA activities have also been reported in a more common condition with no apparent clinical consequences termed ASA pseudo-deficiency (ASA-PD) which is associated with two linked mutations in the ASA gene (c.1049A>G and c.*96A>G). This study aimed to investigate the frequency of the two ASA-PD variants and their linkage disequilibrium (LD) among Tunisians. ASA-PD variants were detected in 129 healthy Tunisians and their frequencies were compared to those described worldwide. The frequency of the PD allele was estimated at 17.4% for the overall sample, with c.1049A>G and c.*96A>G frequencies of 25.6 and 17.4%, respectively. This study also revealed a high LD between the two ASA-PD variants (r(2) = 0.61). Inter-population analysis revealed similarities in the ASA-PD genetic structure between Tunisians and populations from Middle East with c.*96A>G frequencies being the highest in the world. A significant North vs. South genetic differentiation in the ASA-PD frequency was also observed in Tunisian population who seems genetically intermediate between Africans, Middle-Easterners and Europeans. This is the first report on the allele frequency of the ASA-PD in North Africa, revealing a relatively high frequency of the PD allele among Tunisians. This study gives also evidence on the importance of discriminating ASA-PD allele from pathological mutations causing MLD and supporting enzymatic activity testing with both sulfatiduria determination and genetic testing in the differential diagnosis of MLD in the Tunisian population.
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Affiliation(s)
- Nizar Ben Halim
- Laboratoire de Génomique Biomédicale et Oncogénétique, Institut Pasteur de Tunis, BP 74, 13 Place Pasteur, 1002, Tunis, Belvédère, Tunisia.
| | - Imen Dorboz
- Child Neurological Diseases Unit, Faculty of Medicine, 1007, Tunis, Tunisia.,INSERM U676, 75935, Paris Cedex 19, France
| | - Rym Kefi
- Laboratoire de Génomique Biomédicale et Oncogénétique, Institut Pasteur de Tunis, BP 74, 13 Place Pasteur, 1002, Tunis, Belvédère, Tunisia
| | - Najla Kharrat
- Bioinformatics Unit, Centre of Biotechnology of Sfax, 3018, Sfax, Tunisia
| | - Eleonore Eymard-Pierre
- Faculté de Médecine, INSERM UMR 931, GReD, 63000, Clermont-Ferrand, France.,Department of Genetics and Cytogenetics, CHU de Clermont-Ferrand, 63003, Clermont-Ferrand Cedax 1, France
| | - Majdi Nagara
- Laboratoire de Génomique Biomédicale et Oncogénétique, Institut Pasteur de Tunis, BP 74, 13 Place Pasteur, 1002, Tunis, Belvédère, Tunisia
| | - Lilia Romdhane
- Laboratoire de Génomique Biomédicale et Oncogénétique, Institut Pasteur de Tunis, BP 74, 13 Place Pasteur, 1002, Tunis, Belvédère, Tunisia
| | | | - Ahmed Rebai
- Bioinformatics Unit, Centre of Biotechnology of Sfax, 3018, Sfax, Tunisia
| | - Najoua Miladi
- Child Neurological Diseases Unit, Faculty of Medicine, 1007, Tunis, Tunisia
| | - Odile Boespflug-Tanguy
- INSERM U676, 75935, Paris Cedex 19, France.,Assistance Publique des Hôpitaux de Paris (APHP), Centre de Reference « leucodystrophies », Hôpital Robert Debré, 75019, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, 75205, Paris Cedex 13, France
| | - Sonia Abdelhak
- Laboratoire de Génomique Biomédicale et Oncogénétique, Institut Pasteur de Tunis, BP 74, 13 Place Pasteur, 1002, Tunis, Belvédère, Tunisia
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Acharya MM, Khamesra SH, Katyare SS. Picrotoxin-induced convulsions and lysosomal function in the rat brain. Indian J Clin Biochem 2012; 20:56-60. [PMID: 23105495 DOI: 10.1007/bf02893043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effect of picrotoxin-induced convulsions on lysosomal function in rat brain were evaluated by measuring the free as well as total acid phosphatase, cathepsin D, acid ribonuclease (RNAse II) and acid deoxyribonuclease (DNAse II) activities. Following picrotoxin treatment the free RNAse II activity increased whereas the total activities of practically all the other enzymes decreased. Paradoxically, the cathepsin D activity, free as well the total was completely abolished. In case of all the enzymes the ratio of Total activity/Free activity decreased indicating increased lysosomal membrane fragility which could lead to process of neurodegeneration in the epileptic animals.
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Affiliation(s)
- Munjal M Acharya
- Department of Biochemistry, Faculty of Science, M.S. University of Baroda, 390002 Vadodara, Gujarat India
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Abstract
Lafora disease is a rare, fatal, autosomal recessive, progressive myoclonic epilepsy. It may also be considered as a disorder of carbohydrate metabolism because of the formation of polyglucosan inclusion bodies in neural and other tissues due to abnormalities of the proteins laforin or malin. The condition is characterized by epilepsy, myoclonus and dementia. Diagnostic findings on MRI and neurophysiological testing are not definitive and biopsy or genetic studies may be required. Therapy in Lafora disease is currently limited to symptomatic management of the epilepsy, myoclonus and intercurrent complications. With a greater understanding of the pathophysiological processes involved, there is justified hope for future therapies.
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Affiliation(s)
- Thomas S Monaghan
- Department of Neurology and Neuroscience, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin 9, Ireland
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Park JK, Orvisky E, Tayebi N, Kaneski C, Lamarca ME, Stubblefield BK, Martin BM, Schiffmann R, Sidransky E. Myoclonic epilepsy in Gaucher disease: genotype-phenotype insights from a rare patient subgroup. Pediatr Res 2003; 53:387-95. [PMID: 12595585 DOI: 10.1203/01.pdr.0000049515.79882.94] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Gaucher disease, the inherited deficiency of lysosomal glucocerebrosidase, presents with a wide spectrum of manifestations. Although Gaucher disease has been divided into three clinical types, patients with atypical presentations continue to be recognized. A careful phenotypic and genotypic assessment of patients with unusual symptoms may help define factors that modify phenotype in this disorder. One such example is a rare subgroup of patients with type 3 Gaucher disease who develop progressive myoclonic epilepsy. We evaluated 16 patients with myoclonic epilepsy, nine of whom were diagnosed by age 4 y with severe visceral involvement and myoclonus, and seven with a more chronic course, who were studied between ages 22 and 40. All of the patients had abnormal horizontal saccadic eye movements. Fourteen different genotypes were encountered, yet there were several shared alleles, including V394L (seen on two alleles), G377S (seen on three alleles), and L444P, N188S, and recombinant alleles (each found on four alleles). V394L, G377S, and N188S are mutations that have previously been associated with non-neuronopathic Gaucher disease. The spectrum of genotypes differed significantly from other patients with type 3 Gaucher disease, where genotypes L444P/L444P and R463C/null allele predominated. Northern blot studies revealed a normal glucocerebrosidase transcript, whereas Western studies showed that the patients studied lacked the processed 56 kD isoform of the enzyme, consistent with neuronopathic Gaucher disease. Brain autopsy samples from two patients demonstrated elevated levels of glucosylsphingosine, a toxic glycolipid, which could contribute to the development of myoclonus. Thus, although there were certain shared mutant alleles found in these patients, both the lack of a shared genotype and the variability in clinical presentations suggest that other modifiers must contribute to this rare phenotype.
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Affiliation(s)
- Joseph K Park
- Clinical Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Battisti C, Loudianos G, Rufa A, Dotti MT, Sangiorgi S, Dessì V, Lovicu M, Pirastu M, Federico A. Detection of a rare Wilson disease mutation associated with arylsulfatase A pseudodeficiency. AMERICAN JOURNAL OF MEDICAL GENETICS 1999; 85:175-8. [PMID: 10406672 DOI: 10.1002/(sici)1096-8628(19990716)85:2<175::aid-ajmg13>3.0.co;2-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have studied a patient with Wilson disease (WD), belonging to a family segregating late-onset, dominant cerebellar ataxia. Analysis of the WD gene showed that the patient is a compound heterozygote, carrying the 14His1069Gln mutation from the father and the 8Gly710Ser mutation from the mother. The 8Gly710Ser is a mutation described previously only in a Swedish patient. Our patient is also homozygous for arylsulfatase A pseudodeficiency. This genetic defect, which has been reported in association with other neuropsychiatric syndromes, has not been described in WD.
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Affiliation(s)
- C Battisti
- Institute of Neurological Sciences, Unit of Neurometabolic Disease, University of Siena, Italy
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Cavanagh JB. Corpora-amylacea and the family of polyglucosan diseases. BRAIN RESEARCH. BRAIN RESEARCH REVIEWS 1999; 29:265-95. [PMID: 10209236 DOI: 10.1016/s0165-0173(99)00003-x] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The history, characters, composition and topography of corpora amylacea (CA) in man and the analogous polyglucosan bodies (PGB) in other species are documented, noting particularly the wide variation in the numbers found with age and in neurological disease. Their origins from both neurons and glia and their probable migrations and ultimate fate are discussed. Their presence is also noted in other organs, particularly in the heart. The occurrence in isolated cases of occasional 'massive' usually focal accumulations of similar polyglucosan bodies in association with certain chronic neurological diseases is noted and the specific conditions Adult Polyglucosan body disease and type IV glycogenosis where they are found throughout the nervous system in great excess is discussed. The distinctive differences of CA from the PGB of Lafora body disease and Bielschowsky body disease are emphasised. When considering their functional roles, a parallel is briefly drawn on the one hand between normal CA and the bodies in the polyglucosan disorders and on the other with the lysosomal system and its associated storage diseases. It is suggested that these two systems are complementary ways by which large, metabolically active cells such as neurons, astrocytes, cardiac myocytes and probably many other cell types, dispose of the products of stressful metabolic events throughout life and the continuing underlying process of aging and degradation of long lived cellular proteins. Each debris disposal system must be regulated in its own way and must inevitably, a priori, be heir to metabolic defects that give rise in each to its own set of metabolic disorders.
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Affiliation(s)
- J B Cavanagh
- Department of Clinical Neurosciences, Institute of Psychiatry, De Crespigny Avenue, London SE5 8AF, UK
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