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Marelli C, Lamari F, Rainteau D, Lafourcade A, Banneau G, Humbert L, Monin ML, Petit E, Debs R, Castelnovo G, Ollagnon E, Lavie J, Pilliod J, Coupry I, Babin PJ, Guissart C, Benyounes I, Ullmann U, Lesca G, Thauvin-Robinet C, Labauge P, Odent S, Ewenczyk C, Wolf C, Stevanin G, Hajage D, Durr A, Goizet C, Mochel F. Plasma oxysterols: biomarkers for diagnosis and treatment in spastic paraplegia type 5. Brain 2019; 141:72-84. [PMID: 29228183 DOI: 10.1093/brain/awx297] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022] Open
Abstract
The hereditary spastic paraplegias are an expanding and heterogeneous group of disorders characterized by spasticity in the lower limbs. Plasma biomarkers are needed to guide the genetic testing of spastic paraplegia. Spastic paraplegia type 5 (SPG5) is an autosomal recessive spastic paraplegia due to mutations in CYP7B1, which encodes a cytochrome P450 7α-hydroxylase implicated in cholesterol and bile acids metabolism. We developed a method based on ultra-performance liquid chromatography electrospray tandem mass spectrometry to validate two plasma 25-hydroxycholesterol (25-OHC) and 27-hydroxycholesterol (27-OHC) as diagnostic biomarkers in a cohort of 21 patients with SPG5. For 14 patients, SPG5 was initially suspected on the basis of genetic analysis, and then confirmed by increased plasma 25-OHC, 27-OHC and their ratio to total cholesterol. For seven patients, the diagnosis was initially based on elevated plasma oxysterol levels and confirmed by the identification of two causal CYP7B1 mutations. The receiver operating characteristic curves analysis showed that 25-OHC, 27-OHC and their ratio to total cholesterol discriminated between SPG5 patients and healthy controls with 100% sensitivity and specificity. Taking advantage of the robustness of these plasma oxysterols, we then conducted a phase II therapeutic trial in 12 patients and tested whether candidate molecules (atorvastatin, chenodeoxycholic acid and resveratrol) can lower plasma oxysterols and improve bile acids profile. The trial consisted of a three-period, three-treatment crossover study and the six different sequences of three treatments were randomized. Using a linear mixed effect regression model with a random intercept, we observed that atorvastatin decreased moderately plasma 27-OHC (∼30%, P < 0.001) but did not change 27-OHC to total cholesterol ratio or 25-OHC levels. We also found an abnormal bile acids profile in SPG5 patients, with significantly decreased total serum bile acids associated with a relative decrease of ursodeoxycholic and lithocholic acids compared to deoxycholic acid. Treatment with chenodeoxycholic acid restored bile acids profile in SPG5 patients. Therefore, the combination of atorvastatin and chenodeoxycholic acid may be worth considering for the treatment of SPG5 patients but the neurological benefit of these metabolic interventions remains to be evaluated in phase III therapeutic trials using clinical, imaging and/or electrophysiological outcome measures with sufficient effect sizes. Overall, our study indicates that plasma 25-OHC and 27-OHC are robust diagnostic biomarkers of SPG5 and shall be used as first-line investigations in any patient with unexplained spastic paraplegia.
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Affiliation(s)
- Cecilia Marelli
- Gui de Chauliac University Hospital, Department of Neurology, Montpellier, France.,Gui de Chauliac University Hospital, Expert Center for Neurogenetic Diseases and Adult Mitochondrial and Metabolic Diseases, Montpellier, France
| | - Foudil Lamari
- APHP, La Pitié-Salpêtrière University Hospital, Department of Biochemistry, Paris, France.,University Pierre and Marie Curie, Neurometabolic Research Group, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Reference Center for Adult Neurometabolic Diseases, Paris, France
| | - Dominique Rainteau
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Alexandre Lafourcade
- APHP, Hôpital La Pitié-Salpêtrière, Département de Biostatistiques, Santé publique et Information médicale, Centre de Pharmacoépidémiologie (Cephepi), F-75013, Paris, France
| | - Guillaume Banneau
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Functional Unit of Molecular and Cellular Neurogenetics, Paris, France
| | - Lydie Humbert
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Marie-Lorraine Monin
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Elodie Petit
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Rabab Debs
- APHP, La Pitié-Salpêtrière University Hospital, Department of Neurology, Paris, France
| | | | - Elisabeth Ollagnon
- La Croix-Rousse University Hospital, Department of Genetics, Lyon, France
| | - Julie Lavie
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Julie Pilliod
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Isabelle Coupry
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Patrick J Babin
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Claire Guissart
- Institut Universitaire de Recherche Clinique, Laboratoire de Génétique Moléculaire, Montpellier, France
| | - Imen Benyounes
- APHP, La Pitié-Salpêtrière University Hospital, Department of Biochemistry, Paris, France
| | - Urielle Ullmann
- Institut de Pathologie et Génétique, Centre de Génétique Humaine, Gosselies, Belgium
| | - Gaetan Lesca
- Lyon University Hospital, Department of Medical Genetics, Lyon, France
| | | | - Pierre Labauge
- Gui de Chauliac University Hospital, Department of Neurology, Montpellier, France.,Gui de Chauliac University Hospital, Reference Center for Adult Leukodystrophy, Montpellier, France
| | - Sylvie Odent
- Rennes University Hospital, Department of Clinical Genetics, Rennes, France
| | - Claire Ewenczyk
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Claude Wolf
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Giovanni Stevanin
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Ecole Pratique des Hautes Etudes, PSL Research University, Neurogenetic lab, Paris, France
| | - David Hajage
- APHP, Hôpital La Pitié-Salpêtrière, Département de Biostatistiques, Santé publique et Information médicale, Centre de Pharmacoépidémiologie (Cephepi), F-75013, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, France
| | - Alexandra Durr
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Neurogenetic Reference Center, Paris, France
| | - Cyril Goizet
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France.,Bordeaux University Hospital, Department of Medical Genetics, Bordeaux, France.,Bordeaux University Hospital, Neurogenetic Reference Center, Bordeaux, France
| | - Fanny Mochel
- APHP, La Pitié-Salpêtrière University Hospital, Reference Center for Adult Neurometabolic Diseases, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
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