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Hickman JL, Lafreniere M, Bennett JL, Forbes E, Feuerstein J. Periodic Alternating Nystagmus, Ataxia, and Spasticity: A Unique Presentation of Spastic Paraplegia 7-Related Hereditary Spastic Paraplegia. Mov Disord Clin Pract 2024; 11:441-443. [PMID: 38396346 PMCID: PMC10982591 DOI: 10.1002/mdc3.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/21/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Affiliation(s)
- Jordan L. Hickman
- Medical Scientist Training ProgramUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Marrisa Lafreniere
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jeffrey L. Bennett
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of OphthalmologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Emily Forbes
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jeanne Feuerstein
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurologyRocky Mountain Regional VA Medical CenterAuroraColoradoUSA
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Lopergolo D, Rosini F, Pretegiani E, Bargagli A, Serchi V, Rufa A. Autosomal recessive cerebellar ataxias: a diagnostic classification approach according to ocular features. Front Integr Neurosci 2024; 17:1275794. [PMID: 38390227 PMCID: PMC10883068 DOI: 10.3389/fnint.2023.1275794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/10/2023] [Indexed: 02/24/2024] Open
Abstract
Autosomal recessive cerebellar ataxias (ARCAs) are a heterogeneous group of neurodegenerative disorders affecting primarily the cerebellum and/or its afferent tracts, often accompanied by damage of other neurological or extra-neurological systems. Due to the overlap of clinical presentation among ARCAs and the variety of hereditary, acquired, and reversible etiologies that can determine cerebellar dysfunction, the differential diagnosis is challenging, but also urgent considering the ongoing development of promising target therapies. The examination of afferent and efferent visual system may provide neurophysiological and structural information related to cerebellar dysfunction and neurodegeneration thus allowing a possible diagnostic classification approach according to ocular features. While optic coherence tomography (OCT) is applied for the parametrization of the optic nerve and macular area, the eye movements analysis relies on a wide range of eye-tracker devices and the application of machine-learning techniques. We discuss the results of clinical and eye-tracking oculomotor examination, the OCT findings and some advancing of computer science in ARCAs thus providing evidence sustaining the identification of robust eye parameters as possible markers of ARCAs.
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Affiliation(s)
- Diego Lopergolo
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- UOC Neurologia e Malattie Neurometaboliche, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesca Rosini
- UOC Stroke Unit, Department of Emergenza-Urgenza, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Elena Pretegiani
- Unit of Neurology, Centre Hospitalier Universitaire Vaudoise Lausanne, Unit of Neurology and Cognitive Neurorehabilitation, Universitary Hospital of Fribourg, Fribourg, Switzerland
| | - Alessia Bargagli
- Evalab-Neurosense, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Valeria Serchi
- Evalab-Neurosense, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- UOC Neurologia e Malattie Neurometaboliche, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Evalab-Neurosense, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
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Pedroso JL, Vale TC, Freitas JLD, Araújo FMM, Meira AT, Neto PB, França MC, Tumas V, Teive HAG, Barsottini OGP. Movement disorders in hereditary spastic paraplegias. Arq Neuropsiquiatr 2023; 81:1000-1007. [PMID: 38035585 PMCID: PMC10689114 DOI: 10.1055/s-0043-1777005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Hereditary or familial spastic paraplegias (SPG) comprise a group of genetically and phenotypically heterogeneous diseases characterized by progressive degeneration of the corticospinal tracts. The complicated forms evolve with other various neurological signs and symptoms, including movement disorders and ataxia. OBJECTIVE To summarize the clinical descriptions of SPG that manifest with movement disorders or ataxias to assist the clinician in the task of diagnosing these diseases. METHODS We conducted a narrative review of the literature, including case reports, case series, review articles and observational studies published in English until December 2022. RESULTS Juvenile or early-onset parkinsonism with variable levodopa-responsiveness have been reported, mainly in SPG7 and SPG11. Dystonia can be observed in patients with SPG7, SPG11, SPG22, SPG26, SPG35, SPG48, SPG49, SPG58, SPG64 and SPG76. Tremor is not a frequent finding in patients with SPG, but it is described in different types of SPG, including SPG7, SPG9, SPG11, SPG15, and SPG76. Myoclonus is rarely described in SPG, affecting patients with SPG4, SPG7, SPG35, SPG48, and SPOAN (spastic paraplegia, optic atrophy, and neuropathy). SPG4, SPG6, SPG10, SPG27, SPG30 and SPG31 may rarely present with ataxia with cerebellar atrophy. And autosomal recessive SPG such as SPG7 and SPG11 can also present with ataxia. CONCLUSION Patients with SPG may present with different forms of movement disorders such as parkinsonism, dystonia, tremor, myoclonus and ataxia. The specific movement disorder in the clinical manifestation of a patient with SPG may be a clinical clue for the diagnosis.
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Affiliation(s)
- Jose Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Hospital Universitário, Departamento de Clínica Médica, Serviço de Neurologia, Juiz de Fora MG, Brazil.
| | | | - Filipe Miranda Milagres Araújo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências Comportamental, Ribeirão Preto SP, Brazil.
| | - Alex Tiburtino Meira
- Universidade Federal da Paraíba, Departamento de Medicina Interna, Serviço de Neurologia, João Pessoa PB, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brazil.
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil.
| | - Marcondes C. França
- Universidade Estadual de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências Comportamental, Ribeirão Preto SP, Brazil.
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Traschütz A, Adarmes-Gómez AD, Anheim M, Baets J, Brais B, Gagnon C, Gburek-Augustat J, Doss S, Hanağası HA, Kamm C, Klivenyi P, Klockgether T, Klopstock T, Minnerop M, Münchau A, Renaud M, Santorelli FM, Schöls L, Thieme A, Vielhaber S, van de Warrenburg BP, Zanni G, Hilgers RD, Synofzik M. Responsiveness of the Scale for the Assessment and Rating of Ataxia and Natural History in 884 Recessive and Early Onset Ataxia Patients. Ann Neurol 2023; 94:470-485. [PMID: 37243847 DOI: 10.1002/ana.26712] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The Scale for the Assessment and Rating of Ataxia (SARA) is the most widely applied clinical outcome assessment (COA) for genetic ataxias, but presents metrological and regulatory challenges. To facilitate trial planning, we characterize its responsiveness (including subitem-level relations to ataxia severity and patient-focused outcomes) across a large number of ataxias, and provide first natural history data for several of them. METHODS Subitem-level correlation and distribution-based analysis of 1,637 SARA assessments in 884 patients with autosomal recessive/early onset ataxia (370 with 2-8 longitudinal assessments) were complemented by linear mixed effects modeling to estimate progression and sample sizes. RESULTS Although SARA subitem responsiveness varied between ataxia severities, gait/stance showed a robust granular linear scaling across the broadest range (SARA < 25). Responsiveness was diminished by incomplete subscale use at intermediate or upper levels, nontransitions ("static periods"), and fluctuating decreases/increases. All subitems except nose-finger showed moderate-to-strong correlations to activities of daily living, indicating that metric properties-not content validity-limit SARA responsiveness. SARA captured mild-to-moderate progression in many genotypes (eg, SYNE1-ataxia: 0.55 points/yr, ataxia with oculomotor apraxia type 2: 1.14 points/yr, POLG-ataxia: 1.56 points/yr), but no change in others (autosomal recessive spastic ataxia of Charlevoix-Saguenay, COQ8A-ataxia). Whereas sensitivity to change was optimal in mild ataxia (SARA < 10), it substantially deteriorated in advanced ataxia (SARA > 25; 2.7-fold sample size). Use of a novel rank-optimized SARA without subitems finger-chase and nose-finger reduces sample sizes by 20 to 25%. INTERPRETATION This study comprehensively characterizes COA properties and annualized changes of the SARA across and within a large number of ataxias. It suggests specific approaches for optimizing its responsiveness that might facilitate regulatory qualification and trial design. ANN NEUROL 2023;94:470-485.
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Affiliation(s)
- Andreas Traschütz
- Research Division "Translational Genomics of Neurodegenerative Diseases," Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Astrid D Adarmes-Gómez
- Movement Disorders Unit, Department of Neurology and Clinical Neurophysiology, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Center for Biomedical Research Network on Neurodegenerative Diseases, Madrid, Spain
| | - Mathieu Anheim
- Department of Neurology, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France
- Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
- Institute of Genetics and Molecular and Cellular Biology, INSERM-U964/CNRS-UMR7104/University of Strasbourg, Illkirch, France
| | - Jonathan Baets
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Neuromuscular Reference Center, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
| | - Bernard Brais
- Department of Neurology, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Cynthia Gagnon
- CHUS Research Center and Health and Social Services Center of Saguenay-Lac-Saint-Jean, Faculty of Medicine, University of Sherbrooke, Quebec, Quebec, Canada
| | - Janina Gburek-Augustat
- Division of Neuropediatrics, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Sarah Doss
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, Berlin, Germany
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haşmet A Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christoph Kamm
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Peter Klivenyi
- Interdisciplinary Excellence Center, Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Thomas Klopstock
- Department of Neurology, Friedrich Baur Institute, Ludwig Maximilian University of Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology, Munich, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Mathilde Renaud
- Clinical Genetics Service, CHRU of Nancy, Nancy, France
- INSERM-U1256 NGERE, University of Lorraine, Nancy, France
| | | | - Ludger Schöls
- Research Division "Translational Genomics of Neurodegenerative Diseases," Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro and Behavioral Sciences, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Childrens' Hospital, IRCCS, Rome, Italy
| | | | - Matthis Synofzik
- Research Division "Translational Genomics of Neurodegenerative Diseases," Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Abstract
Degenerative ataxias and hereditary spastic paraplegias (HSPs) form a continuous, often overlapping disease spectrum sharing not only phenotypic features and underlying genes, but also cellular pathways and disease mechanisms. Mitochondrial metabolism presents a major molecular theme underlying both multiple ataxias and HSPs, thus indicating a heightened vulnerability of Purkinje cells, spinocerebellar tracts, and motor neurons to mitochondrial dysfunction, which is of particular interest for translational approaches. Mitochondrial dysfunction might be the primary (upstream) or secondary (downstream) result of a genetic defect, with underlying genetic defects in nuclear-encoded genes being much more frequent than in mtDNA genes in both, ataxias and HSPs. Here, we outline the substantial number of ataxias, spastic ataxias and HSPs caused by mutated genes implicated in (primary or secondary) mitochondrial dysfunction, highlighting several key "mitochondrial" ataxias and HSPs which are of particular interest for their frequency, pathogenesis and translational opportunities. We then showcase prototypic mitochondrial mechanisms by which disruption of these ataxia and HSP genes contributes to Purkinje cells or corticospinal neuron dysfunction, thus elucidating hypotheses on Purkinje cells and corticospinal neuron vulnerability to mitochondrial dysfunction.
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Affiliation(s)
- Matthis Synofzik
- Department of Neurodegenerative Diseases, Center for Neurology & Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Elena Rugarli
- Institute for Genetics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Evan Reid
- Cambridge Institute for Medical Research and Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca Schüle
- Department of Neurodegenerative Diseases, Center for Neurology & Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Seo Y, Lim HT, Lee BJ, Han J. Expanding SPG7 dominant optic atrophy phenotype: Infantile nystagmus and optic atrophy without spastic paraplegia. Am J Med Genet A 2023; 191:582-585. [PMID: 36367250 DOI: 10.1002/ajmg.a.63037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/19/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
Spastic paraplegia is a neurodegenerative disorder characterized by progressive leg weakness and spasticity due to degeneration of corticospinal axons. SPG7 encodes paraplegin, and pathogenic variants in the gene cause hereditary spastic paraplegia as an autosomal recessive trait. Various ophthalmological findings including optic atrophy, ophthalmoplegia, or nystagmus have been reported in patients with spastic paraplegia type 7. We report a 15-year-old male patient with a novel heterozygous variant, c.1224T>G:p.(Asp408Glu) in SPG7 (NM_003119.3) causing early onset isolated optic atrophy and infantile nystagmus prior to the onset of neurological symptoms. Therefore, SPG7 should be considered a cause of infantile nystagmus with optic atrophy.
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Affiliation(s)
- Yuri Seo
- Department of Ophthalmology, Institute of Vision Research, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | | | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinu Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Coarelli G, Wirth T, Tranchant C, Koenig M, Durr A, Anheim M. The inherited cerebellar ataxias: an update. J Neurol 2023; 270:208-22. [PMID: 36152050 DOI: 10.1007/s00415-022-11383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 01/07/2023]
Abstract
This narrative review aims at providing an update on the management of inherited cerebellar ataxias (ICAs), describing main clinical entities, genetic analysis strategies and recent therapeutic developments. Initial approach facing a patient with cerebellar ataxia requires family medical history, physical examination, exclusions of acquired causes and genetic analysis, including Next-Generation Sequencing (NGS). To guide diagnosis, several algorithms and a new genetic nomenclature for recessive cerebellar ataxias have been proposed. The challenge of NGS analysis is the identification of causative variant, trio analysis being usually the most appropriate option. Public genomic databases as well as pathogenicity prediction software facilitate the interpretation of NGS results. We also report on key clinical points for the diagnosis of the main ICAs, including Friedreich ataxia, CANVAS, polyglutamine spinocerebellar ataxias, Fragile X-associated tremor/ataxia syndrome. Rarer forms should not be neglected because of diagnostic biomarkers availability, disease-modifying treatments, or associated susceptibility to malignancy. Diagnostic difficulties arise from allelic and phenotypic heterogeneity as well as from the possibility for one gene to be associated with both dominant and recessive inheritance. To complicate the phenotype, cerebellar cognitive affective syndrome can be associated with some subtypes of cerebellar ataxia. Lastly, we describe new therapeutic leads: antisense oligonucleotides approach in polyglutamine SCAs and viral gene therapy in Friedreich ataxia. This review provides support for diagnosis, genetic counseling and therapeutic management of ICAs in clinical practice.
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Ebrahimi-Fakhari D, Saffari A, Pearl PL. Childhood-onset hereditary spastic paraplegia and its treatable mimics. Mol Genet Metab 2022; 137:436-444. [PMID: 34183250 PMCID: PMC8843241 DOI: 10.1016/j.ymgme.2021.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 12/24/2022]
Abstract
Early-onset forms of hereditary spastic paraplegia and inborn errors of metabolism that present with spastic diplegia are among the most common "mimics" of cerebral palsy. Early detection of these heterogenous genetic disorders can inform genetic counseling, anticipatory guidance, and improve outcomes, particularly where specific treatments exist. The diagnosis relies on clinical pattern recognition, biochemical testing, neuroimaging, and increasingly next-generation sequencing-based molecular testing. In this short review, we summarize the clinical and molecular understanding of: 1) childhood-onset and complex forms of hereditary spastic paraplegia (SPG5, SPG7, SPG11, SPG15, SPG35, SPG47, SPG48, SPG50, SPG51, SPG52) and, 2) the most common inborn errors of metabolism that present with phenotypes that resemble hereditary spastic paraplegia.
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Affiliation(s)
- Darius Ebrahimi-Fakhari
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, USA.
| | - Afshin Saffari
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Lindig T, Ruff C, Rattay TW, König S, Schöls L, Schüle R, Nägele T, Ernemann U, Klose U, Bender B. Detection of spinal long fiber tract degeneration in HSP: Improved diffusion tensor imaging. Neuroimage Clin 2022; 36:103213. [PMID: 36270162 PMCID: PMC9668628 DOI: 10.1016/j.nicl.2022.103213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
Spinal diffusion tensor imaging (sDTI) is still a challenging technique for selectively evaluating anatomical areas like the pyramidal tracts (PT), dorsal columns (DC), and anterior horns (AH) in clinical routine and for reliably quantifying white matter anisotropy and diffusivity. In neurodegenerative diseases, the value of sDTI is promising but not yet well understood. The objective of this prospective, single-center study was to evaluate the long fiber tract degeneration within the spinal cord in normal aging (n = 125) and to prove its applicability in pathologic conditions as in patients with molecular genetically confirmed hereditary spastic paraplegias (HSP; n = 40), a prototypical disease of the first motor neuron and in some genetic variants with affection of the dorsal columns. An optimized monopolar Stejskal-Tanner sequence for high-resolution, axial sDTI of the cervical spinal cord at 3.0 T with advanced standardized evaluation methods was developed for a robust DTI value estimation of PT, DC, and AH in both groups. After sDTI measurement at C2, an automatic motion correction and an advanced semi-automatic ROI-based, standardized evaluation of white matter anisotropy and diffusivity was performed to obtain regional diffusivity measures for PT, DC, and AH. Reliable and stable sDTI values were acquired in a healthy population without significant decline between age 20 and 65. Reference values for PT, DC, and AH for fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) were established. In HSP patients, the decline of the long spinal fiber tracts could be demonstrated by diffusivity abnormalities in the pyramidal tracts with significantly reduced PTFA (p < 0.001), elevated PTRD (p = 0.002) and reduced PTMD (p = 0.003) compared to healthy controls. Furthermore, FA was significantly reduced in DCFA (p < 0.001) with no differences in AH. In a genetically homogeneous subgroup of SPG4 patients (n = 12) with affection of the dorsal columns, DCRD significantly correlated with the overall disease severity as measured by the Spastic Paraplegia Rating Scale (SPRS) (r = - 0.713, p = 0.009). With the most extensive sDTI study in vivo to date, we showed that axial sDTI combined with motion correction and advanced data post-processing strategies enables robust measurements and is ready to use, allowing recognition and quantification of disease- and age-related changes of the PT, DC, and AH. These results may also encourage the usage of sDTI in other neurodegenerative diseases with spinal cord involvement to explore its capability as selective biomarkers.
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Affiliation(s)
- Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Christer Ruff
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany.
| | - Tim W Rattay
- Center for Neurology, Department of Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany; German Research Center for Neurodegenerative Diseases (DZNE), Otfried-Müller-Str. 23, Tübingen 72076, Germany
| | - Stephan König
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Ludger Schöls
- Center for Neurology, Department of Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany; German Research Center for Neurodegenerative Diseases (DZNE), Otfried-Müller-Str. 23, Tübingen 72076, Germany
| | - Rebecca Schüle
- Center for Neurology, Department of Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany; German Research Center for Neurodegenerative Diseases (DZNE), Otfried-Müller-Str. 23, Tübingen 72076, Germany
| | - Thomas Nägele
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, Tübingen 72076, Germany
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Nuzhnyi EP, Abramycheva NY, Safonov DG, Fedotova EY, Illarioshkin SN. Massive Parallel Sequencing and the Problem of Overlapping Phenotypes in Hereditary Spastic Paraplegias and Spinocerebellar Ataxias. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422040111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Klockgether T, Ashizawa T, Brais B, Chuang R, Durr A, Fogel B, Greenfield J, Hagen S, Jardim LB, Jiang H, Onodera O, Pedroso JL, Soong BW, Szmulewicz D, Graessner H, Synofzik M. Paving the Way Toward Meaningful Trials in Ataxias: An Ataxia Global Initiative Perspective. Mov Disord 2022; 37:1125-1130. [PMID: 35475582 DOI: 10.1002/mds.29032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 01/22/2023] Open
Affiliation(s)
- Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Tetsuo Ashizawa
- Houston Methodist Research Institute and Weil Cornell Medical College at Houston Methodist, Houston, Texas, USA
| | | | | | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, Paris Brain Institute - ICM, INSERM, CNRS, APHP, University Hospital de la Pitié-Salpêtrière Paris, Paris, France
| | - Brent Fogel
- Departments of Neurology and Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Sue Hagen
- National Ataxia Foundation, Minneapolis, Minnesota, USA
| | - Laura Bannach Jardim
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Hong Jiang
- Xiangya Hospital, Central South University, Changsha, China
| | - Osamu Onodera
- Brain Research Institute, Niigata University, Niigata, Japan
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bin-Weng Soong
- National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Taipei Neurologic Institute, Taipei Medical University, Taipei, Taiwan
| | | | - Holm Graessner
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Center for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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12
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Vander Stichele G, Durr A, Yoon G, Schüle R, Blackstone C, Esposito G, Buffel C, Oliveira I, Freitag C, van Rooijen S, Hoffmann S, Thielemans L, Cowling BS. An integrated modelling methodology for estimating global incidence and prevalence of hereditary spastic paraplegia subtypes SPG4, SPG7, SPG11, and SPG15. BMC Neurol 2022; 22:115. [PMID: 35331153 PMCID: PMC8944001 DOI: 10.1186/s12883-022-02595-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Hereditary spastic paraplegias (HSPs) are progressively debilitating neurodegenerative disorders that follow heterogenous patterns of Mendelian inheritance. Available epidemiological evidence provides limited incidence and prevalence data, especially at the genetic subtype level, preventing a realistic estimation of the true social burden of the disease. The objectives of this study were to (1) review the literature on epidemiology of HSPs; and (2) develop an epidemiological model of the prevalence of HSP, focusing on four common HSP genetic subtypes at the country and region-level. Methods A model was constructed estimating the incidence at birth, survival, and prevalence of four genetic subtypes of HSP based on the most appropriate published literature. The key model parameters were assessed by HSP clinical experts, who provided feedback on the validity of assumptions. A model was then finalized and validated through comparison of outputs against available evidence. The global, regional, and national prevalence and patient pool were calculated per geographic region and per genetic subtype. Results The HSP global prevalence was estimated to be 3.6 per 100,000 for all HSP forms, whilst the estimated global prevalence per genetic subtype was 0.90 (SPG4), 0.22 (SPG7), 0.34 (SPG11), and 0.13 (SPG15), respectively. This equates to an estimated 3365 (SPG4) and 872 (SPG11) symptomatic patients, respectively, in the USA. Conclusions This is the first epidemiological model of HSP prevalence at the genetic subtype-level reported at multiple geographic levels. This study offers additional data to better capture the burden of illness due to mutations in common genes causing HSP, that can inform public health policy and healthcare service planning, especially in regions with higher estimated prevalence of HSP. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02595-4.
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Affiliation(s)
- Geert Vander Stichele
- Integrated Strategic Market Access Services (ISMS), Rodendijk 60Y, 2980, Zoersel, Belgium.,GenBytes, Schoondreef 7, 2330, Merksplas, Belgium
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, Paris, France
| | - Grace Yoon
- Divisions of Neurology and Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rebecca Schüle
- Hertie Institute for Clinical Brain Research, Tubingen, Germany
| | - Craig Blackstone
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Giovanni Esposito
- Integrated Strategic Market Access Services (ISMS), Rodendijk 60Y, 2980, Zoersel, Belgium
| | - Connor Buffel
- Integrated Strategic Market Access Services (ISMS), Rodendijk 60Y, 2980, Zoersel, Belgium
| | - Inês Oliveira
- Integrated Strategic Market Access Services (ISMS), Rodendijk 60Y, 2980, Zoersel, Belgium
| | | | | | | | - Leen Thielemans
- Dynacure, 67400, Illkirch, France.,2 Bridge, Rodendijk 60/X, 2980, Zoersel, Belgium
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13
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Sáenz‐Farret M, Lang AE, Kalia L, Cunha I, Sousa M, Kuhlman G, Ganos C, Munhoz RP, Fasano A, Piña‐Avilés CE, Zúñiga‐Ramírez C. SPG7
and movement disorders: beyond the spastic paraplegia. Mov Disord Clin Pract 2022; 9:522-529. [PMID: 35586535 PMCID: PMC9092757 DOI: 10.1002/mdc3.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Spastic paraplegia type 7 (SPG7) mutations can present either as a pure form or a complex phenotype with movement disorders. Objective Describe the main features of subjects with SPG7 mutations associated with movement disorders. Methods We analyzed the clinical and paraclinical information of subjects with SPG7 mutations associated with movement disorders. Results Sixteen affected subjects from 11 families were identified. Male sex predominated (10 of 16) and the mean age at onset was 41.25 ± 16.1 years. A cerebellar syndrome was the most frequent clinical movement disorder phenotype (7 of 16); however, parkinsonism (2 of 16), dystonia (1 of 16), and mixed phenotypes between them were also seen. The "ears of the lynx" sign was found in four subjects. A total of nine SPG7 variants were found, of which the most frequent was the c.1529C > T (p.Ala510Val). Conclusion This case series expands the motor phenotype associated with SPG7 mutations. Clinicians must consider this entity in single or familial cases with combined movement disorders.
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Affiliation(s)
- Michel Sáenz‐Farret
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | - Lorraine Kalia
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | - Inês Cunha
- Neurology Department Coimbra Hospital and Universitary Centre
| | - Mário Sousa
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Greg Kuhlman
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin Berlin Germany
| | - Renato P. Munhoz
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | | | - Carlos Zúñiga‐Ramírez
- Movement Disorders and Neurodegenerative Diseases Unit Hospital Civil de Guadalajara “Fray Antonio Alcalde”. Guadalajara Mexico
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14
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Boyenle ID, Oyedele AK, Ogunlana AT, Adeyemo AF, Oyelere FS, Akinola OB, Adelusi TI, Ehigie LO, Ehigie AF. Targeting the mitochondrial permeability transition pore for drug discovery: Challenges and opportunities. Mitochondrion 2022; 63:57-71. [PMID: 35077882 DOI: 10.1016/j.mito.2022.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 12/29/2022]
Abstract
Several drug targets have been amenable to drug discovery pursuit not until the characterization of the mitochondrial permeability transition pore (MPTP), a pore with an undefined molecular identity that forms on the inner mitochondrial membrane upon mitochondrial permeability transition (MPT) under the influence of calcium overload and oxidative stress. The opening of the pore which is presumed to cause cell death in certain human diseases also has implications under physiological parlance. Different models for this pore have been postulated following its first identification in the last six decades. The mitochondrial community has witnessed many protein candidates such as; voltage-dependent anion channel (VDAC), adenine nucleotide translocase (ANT), Mitochondrial phosphate carrier (PiC), Spastic Paralegin (SPG7), disordered proteins, and F1Fo ATPase. However, genetic studies have cast out most of these candidates with only F1Fo ATPase currently under intense argument. Cyclophilin D (CyPD) remains the widely accepted positive regulator of the MPTP known to date, but no drug candidate has emerged as its inhibitor, raising concern issues for therapeutics. Thus, in this review, we discuss various models of MPTP reported with the hope of stimulating further research in this field. We went beyond the classical description of the MPTP to ascribe a 'two-edged sword property' to the pore for therapeutic function in human disease because its inhibition and activation have pharmacological relevance. We suggested putative proteins upstream to CyPD that can regulate its activity and prevent cell deaths in neurodegenerative disease and ischemia-reperfusion injury.
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Affiliation(s)
- Ibrahim Damilare Boyenle
- Membrane Biochemistry and Biophysics Research Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; Computational Biology/Drug Discovery Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Abdulquddus Kehinde Oyedele
- Computational Biology/Drug Discovery Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Abdeen Tunde Ogunlana
- Computational Biology/Drug Discovery Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Aishat Folashade Adeyemo
- Membrane Biochemistry and Biophysics Research Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | - Olateju Balikis Akinola
- Membrane Biochemistry and Biophysics Research Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Temitope Isaac Adelusi
- Computational Biology/Drug Discovery Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Leonard Ona Ehigie
- Computational Biology/Drug Discovery Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Adeola Folasade Ehigie
- Membrane Biochemistry and Biophysics Research Laboratory, Department of Biochemistry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
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15
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Méreaux JL, Banneau G, Papin M, Coarelli G, Valter R, Raymond L, Kol B, Ariste O, Parodi L, Tissier L, Mairey M, Ait Said S, Gautier C, Guillaud-Bataille M, Forlani S, de la Grange P, Brice A, Vazza G, Durr A, Leguern E, Stevanin G. Clinical and genetic spectra of 1550 index patients with hereditary spastic paraplegia. Brain 2022; 145:1029-1037. [PMID: 34983064 DOI: 10.1093/brain/awab386] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/07/2021] [Accepted: 08/29/2021] [Indexed: 11/13/2022] Open
Abstract
Hereditary spastic paraplegia refers to rare genetic neurodevelopmental and/or neurodegenerative disorders in which spasticity due to length-dependent damage to the upper motor neuron is a core sign. Their high clinical and genetic heterogeneity makes their diagnosis challenging. Multigene panels allow a high-throughput targeted analysis of the increasing number of genes involved using next-generation sequencing. We report here the clinical and genetic results of 1550 index cases tested for variants in a panel of hereditary spastic paraplegia related genes analyzed in routine diagnosis. A causative variant was found in 475 patients (30.7%) in 35/65 screened genes. SPAST and SPG7 were the most frequently mutated genes, representing 142 (9.2%) and 75 (4.8%) index cases of the whole series, respectively. KIF1A, ATL1, SPG11, KIF5A and REEP1 represented more than 1% (> 17 cases) each. There were 661 causative variants (382 different ones) and 30 of them were structural variants. This large cohort allowed us obtaining an overview of the clinical and genetic spectrum of hereditary spastic paraplegia in clinical practice. Because of the wide phenotypic variability, there was no very specific sign that could predict the causative gene but there were some constellations of symptoms that were found often related to specific subtypes. Finally, we confirmed the diagnostic effectiveness of a targeted sequencing panel as a first-line genetic test in hereditary spastic paraplegia. This is a pertinent strategy because of the relative frequency of several known genes (i.e.: SPAST, KIF1A) and it allows identifying variants in the rarest involved genes and to detect structural rearrangements via coverage analysis, which is less efficient in exome data sets. It is crucial because these structural variants represent a significant proportion of the pathogenic hereditary spastic paraplegia variants (∼6% of patients), notably for SPAST and REEP1. In a subset of 42 index cases negative for the targeted multigene panel, subsequent whole exome sequencing allowed to reach a theoretical diagnosis yield of ∼50%. We then propose a two-step strategy combining the use of a panel of genes followed by whole exome sequencing in negative cases.
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Affiliation(s)
- Jean-Loup Méreaux
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France.,Rouen University Hospital, 76000 Rouen, France
| | - Guillaume Banneau
- APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France.,Département de Génétique Médicale, Institut Fédératif de Biologie, Hôpital Purpan, 31000 Toulouse, France
| | - Mélanie Papin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France
| | - Giulia Coarelli
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Rémi Valter
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France
| | - Laure Raymond
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France
| | - Bophara Kol
- APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Olivier Ariste
- GenoDiag-GenoSplice, Paris Biotech Santé, 75014 Paris, France
| | - Livia Parodi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France.,Department of Biology, University of Padua, 35100 Padua, Italy
| | - Laurène Tissier
- APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Mathilde Mairey
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France
| | - Samia Ait Said
- APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Celia Gautier
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France
| | | | | | - Sylvie Forlani
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | | | - Alexis Brice
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Giovanni Vazza
- Department of Biology, University of Padua, 35100 Padua, Italy
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Eric Leguern
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
| | - Giovanni Stevanin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.,3Paris Sciences Lettres University, EPHE, 75000 Paris, France.,APHP, Sorbonne Université, Department of Medical Genetics, 75013 Paris, France
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16
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Elsayed LEO, Eltazi IZ, Ahmed AE, Stevanin G. Insights into Clinical, Genetic, and Pathological Aspects of Hereditary Spastic Paraplegias: A Comprehensive Overview. Front Mol Biosci 2021; 8:690899. [PMID: 34901147 PMCID: PMC8662366 DOI: 10.3389/fmolb.2021.690899] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/19/2021] [Indexed: 12/31/2022] Open
Abstract
Hereditary spastic paraplegias (HSP) are a heterogeneous group of motor neurodegenerative disorders that have the core clinical presentation of pyramidal syndrome which starts typically in the lower limbs. They can present as pure or complex forms with all classical modes of monogenic inheritance reported. To date, there are more than 100 loci/88 spastic paraplegia genes (SPG) involved in the pathogenesis of HSP. New patterns of inheritance are being increasingly identified in this era of huge advances in genetic and functional studies. A wide range of clinical symptoms and signs are now reported to complicate HSP with increasing overall complexity of the clinical presentations considered as HSP. This is especially true with the emergence of multiple HSP phenotypes that are situated in the borderline zone with other neurogenetic disorders. The genetic diagnostic approaches and the utilized techniques leave a diagnostic gap of 25% in the best studies. In this review, we summarize the known types of HSP with special focus on those in which spasticity is the principal clinical phenotype ("SPGn" designation). We discuss their modes of inheritance, clinical phenotypes, underlying genetics, and molecular pathways, providing some observations about therapeutic opportunities gained from animal models and functional studies. This review may pave the way for more analytic approaches that take into consideration the overall picture of HSP. It will shed light on subtle associations that can explain the occurrence of the disease and allow a better understanding of its observed variations. This should help in the identification of future biomarkers, predictors of disease onset and progression, and treatments for both better functional outcomes and quality of life.
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Affiliation(s)
- Liena E. O. Elsayed
- Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University [PNU], Riyadh, Saudi Arabia
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Ammar E. Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Giovanni Stevanin
- Institut du Cerveau – Paris Brain Institute - ICM, Sorbonne Université, INSERM, CNRS, APHP, Paris, France
- CNRS, INCIA, Université de Bordeaux, Bordeaux, France
- Ecole Pratique des Hautes Etudes, EPHE, PSL Research University, Paris, France
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17
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Baviera-Muñoz R, Campins-Romeu M, Carretero-Vilarroig L, Sastre-Bataller I, Martínez-Torres I, Vázquez-Costa JF, Muelas N, Sevilla T, Vílchez JJ, Aller E, Jaijo T, Bataller L, Espinós C. Clinical and genetic characteristics of 21 Spanish patients with biallelic pathogenic SPG7 mutations. J Neurol Sci 2021; 429:118062. [PMID: 34500365 DOI: 10.1016/j.jns.2021.118062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/27/2022]
Abstract
Spastic paraplegia type 7 (SPG7) is one of the most common hereditary spastic paraplegias. SPG7 mutations most often lead to spastic paraparesis (HSP) and/or hereditary cerebellar ataxia (HCA), frequently with mixed phenotypes. We sought to clinically and genetically characterize a Spanish cohort of SPG7 patients. Patients were recruited from our HCA and HSP cohorts. We identified twenty-one patients with biallelic pathogenic SPG7 mutations. Mean age at onset was 37.4 years (SD ± 14.3). The most frequent phenotype was spastic ataxia (57%), followed by pure spastic paraplegia (19%) and complex phenotypes (19%). Isolated patients presented with focal or multifocal dystonia, subclinical myopathy or ophthalmoplegia. p.Ala510Val was the most frequent pathogenic variant encountered. Compound heterozygous for p.Ala510Val displayed younger onset (p < 0.05) and more complex phenotypes (p < 0.05) than p.Ala510Val homozygotes. Two novel variants were found: p.Lys559Argfs*33 and p.Ala312Glu. In conclusion, spastic ataxia is the most common phenotype found in Spanish patients. Nonetheless, SPG7 analysis should also be considered in patients with less frequent clinical findings such as dystonia or ophthalmoplegia especially when these symptoms are associated with mild spastic ataxia.
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Affiliation(s)
- Raquel Baviera-Muñoz
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Marina Campins-Romeu
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Lidón Carretero-Vilarroig
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Cell Biology Department, University of Valencia, Valencia, Spain
| | - Isabel Sastre-Bataller
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Irene Martínez-Torres
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Juan F Vázquez-Costa
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Nuria Muelas
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain
| | - Teresa Sevilla
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Juan J Vílchez
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Elena Aller
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Department of Genetics, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Teresa Jaijo
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Department of Genetics, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Luis Bataller
- Department of Neurology, Hospital Universitari I Politècnic La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Department of Medicine, University of Valencia, Valencia, Spain.
| | - Carmen Espinós
- Rare Diseases Joint Unit, CIPF-IIS La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Laboratory of Rare Neurodegenerative Diseases, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain
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18
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Bhattacharjee S, Noushad M, Sadler M. Early Onset Degenerative Parkinsonism - Consider SPG7 Mutation. Neurol India 2021; 69:1051-1052. [PMID: 34507444 DOI: 10.4103/0028-3886.325330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 43-year-old man presented with ataxia and stiffness of lower limbs for approximately last 10 years. The clinical examination revealed bilateral parkinsonism The magnetic resonance imaging of the brain and spine showed no structural abnormality to explain his symptoms. However, the dopamine transporter scan showed abnormal tracer uptake in both basal ganglia, suggestive of degenerative parkinsonism. The next generation sequencing of spastic paraparesis gene panel revealed probably pathogenic novel mutation in the SPG7 gene. Though the exact mechanism of parkinsonism in SPG 7 mutation is unclear, mitochondrial dysfunction and oxidative stress seem to play a key role. SPG7 mutation should be considered as a cause of early onset degenerative parkinsonism when no alternative explanation can be found.
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Affiliation(s)
| | - Muhammad Noushad
- Department of Neurology, Plymouth Hospital NHS Trust, Plymouth, United Kingdom
| | - Martin Sadler
- Department of Neurology, Plymouth Hospital NHS Trust, Plymouth, United Kingdom
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19
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Campins-Romeu M, Baviera-Muñoz R, Sastre-Bataller I, Bataller L, Jaijo T, Martínez-Torres I. Hereditary Spastic Paraplegia 7 Presenting as Multifocal Dystonia with Prominent Cranio-Cervical Involvement. Mov Disord Clin Pract 2021; 8:966-968. [PMID: 34405107 DOI: 10.1002/mdc3.13257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Marina Campins-Romeu
- Movement Disorders Unit, Department of Neurology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Raquel Baviera-Muñoz
- Movement Disorders Unit, Department of Neurology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Isabel Sastre-Bataller
- Movement Disorders Unit, Department of Neurology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Luis Bataller
- Movement Disorders Unit, Department of Neurology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Teresa Jaijo
- Department of Genetics Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Irene Martínez-Torres
- Movement Disorders Unit, Department of Neurology Hospital Universitari i Politècnic La Fe Valencia Spain
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20
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Darios F, Coarelli G, Durr A. Genetics in hereditary spastic paraplegias: Essential but not enough. Curr Opin Neurobiol 2021; 72:8-14. [PMID: 34403957 DOI: 10.1016/j.conb.2021.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022]
Abstract
Hereditary spastic paraplegias consist of a group of rare neurodegenerative diseases characterized by lower limb spasticity. These inherited Mendelian disorders show high genetic variability associated with wide clinical diversity. Pathophysiological investigations have suggested that mutations in genes affecting the same cellular pathway generally lead to similar clinical symptoms, highlighting the importance of genetic mutation in these diseases. However, phenotype-genotype correlations have failed to explain the observed large inter-individual variability linked to mutations in a single gene, suggesting that genetics alone is not sufficient to explain symptom diversity. The identification of biomarkers, such as neurofilament light chain, could fill the gap and predict disease evolution.
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Affiliation(s)
- Frédéric Darios
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm U1127, CNRS UMR7225, Paris, 75013, France.
| | - Giulia Coarelli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm U1127, CNRS UMR7225, Paris, 75013, France; AP-HP, Hôpital de la Pitié Salpêtrière, Paris, 75013, France
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm U1127, CNRS UMR7225, Paris, 75013, France; AP-HP, Hôpital de la Pitié Salpêtrière, Paris, 75013, France.
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21
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Galatolo D, De Michele G, Silvestri G, Leuzzi V, Casali C, Musumeci O, Antenora A, Astrea G, Barghigiani M, Battini R, Battisti C, Caputi C, Cioffi E, De Michele G, Dotti MT, Fico T, Fiorillo C, Galosi S, Lieto M, Malandrini A, Melone MAB, Mignarri A, Natale G, Pegoraro E, Petrucci A, Ricca I, Riso V, Rossi S, Rubegni A, Scarlatti A, Tinelli F, Trovato R, Tedeschi G, Tessa A, Filla A, Santorelli FM. NGS in Hereditary Ataxia: When Rare Becomes Frequent. Int J Mol Sci 2021; 22:8490. [PMID: 34445196 DOI: 10.3390/ijms22168490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
The term hereditary ataxia (HA) refers to a heterogeneous group of neurological disorders with multiple genetic etiologies and a wide spectrum of ataxia-dominated phenotypes. Massive gene analysis in next-generation sequencing has entered the HA scenario, broadening our genetic and clinical knowledge of these conditions. In this study, we employed a targeted resequencing panel (TRP) in a large and highly heterogeneous cohort of 377 patients with a clinical diagnosis of HA, but no molecular diagnosis on routine genetic tests. We obtained a positive result (genetic diagnosis) in 33.2% of the patients, a rate significantly higher than those reported in similar studies employing TRP (average 19.4%), and in line with those performed using exome sequencing (ES, average 34.6%). Moreover, 15.6% of the patients had an uncertain molecular diagnosis. STUB1, PRKCG, and SPG7 were the most common causative genes. A comparison with published literature data showed that our panel would have identified 97% of the positive cases reported in previous TRP-based studies and 92% of those diagnosed by ES. Proper use of multigene panels, when combined with detailed phenotypic data, seems to be even more efficient than ES in clinical practice.
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22
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Abstract
Spastic paraplegia type 7 (SPG7) is one of the most common forms of autosomal recessive hereditary spastic paraplegia, which can lead to a hybrid spastic-ataxic phenotype. Recently, novel complicated forms of SPG7, including cognitive and social impairment phenotypes, have been reported. We present a SPG7 case with two pathogenic variants in compound heterozygosity in the SPG7 gene, featuring a cerebellar cognitive affective syndrome with psychosis not yet described in the literature.
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Affiliation(s)
| | | | - David Feder
- Department of Neurosciences, Centro Universitário FMABC, Santo Andre, São Paulo, Brazil
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23
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Dosi C, Pasquariello R, Ticci C, Astrea G, Trovato R, Rubegni A, Tessa A, Cioni G, Santorelli FM, Battini R. Neuroimaging patterns in paediatric onset hereditary spastic paraplegias. J Neurol Sci 2021; 425:117441. [PMID: 33866115 DOI: 10.1016/j.jns.2021.117441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/06/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
Hereditary spastic paraplegias (HSPs) are a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and weakness of the lower limbs with a notable phenotypic variation and an autosomal recessive (AR), autosomal dominant (AD), and X-linked inheritance pattern. The recent clinical use of next generation sequencing methods has facilitated the diagnostic approach to HSPs, but the diagnosis remains quite challenging considering its wide clinical and genetic heterogeneity. In this scenario, magnetic resonance imaging (MRI) emerges as a valuable tool in helping to exclude mimicking disorders and to guide genetic testing. The aim of this study is to investigate the presence of possible patterns of morphostructural MRI findings that may provide relevant clues for a specific genetic HSP subtype. In our cohort, for example, white matter abnormalities were the most common finding followed by the thinning of the corpus callosum, which, interestingly, presented different thinning characteristics depending on the HSP subtype.
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Affiliation(s)
- Claudia Dosi
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy
| | | | - Chiara Ticci
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy
| | - Guja Astrea
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy
| | - Rosanna Trovato
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy
| | - Anna Rubegni
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy
| | | | - Giovanni Cioni
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, 56125 Pisa, Italy
| | | | - Roberta Battini
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, 56125 Pisa, Italy.
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24
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Bogdanova-Mihaylova P, Chen H, Plapp HM, Gorman C, Alexander MD, McHugh JC, Moran S, Early A, Cassidy L, Lynch T, Murphy SM, Walsh RA. Neurophysiological and ophthalmological findings of SPG7-related spastic ataxia: a phenotype study in an Irish cohort. J Neurol 2021; 268:3897-3907. [PMID: 33774748 DOI: 10.1007/s00415-021-10507-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mutations in SPG7 are increasingly identified as a common cause of spastic ataxia. We describe a cohort of Irish patients with recessive SPG7-associated phenotype. METHODS Comprehensive phenotyping was performed with documentation of clinical, neurophysiological, optical coherence tomography (OCT) and genetic data from individuals with SPG7 attending two academic neurology units in Dublin, including the National Ataxia Clinic. RESULTS Thirty-two symptomatic individuals from 25 families were identified. Mean age at onset was 39.1 years (range 12-61), mean disease duration 17.8 years (range 5-45), mean disease severity as quantified with the scale for the assessment and rating of ataxia 9/40 (range 3-29). All individuals displayed variable ataxia and spasticity within a spastic-ataxic phenotype, and additional ocular abnormalities. Two had spasmodic dysphonia and three had colour vision deficiency. Brain imaging consistently revealed cerebellar atrophy (n = 29); neurophysiology demonstrated a length-dependent large-fibre axonal neuropathy in 2/27 studied. The commonest variant was c.1529C > T (p.Ala510Val), present in 21 families. Five novel variants were identified. No significant thinning of average retinal nerve fibre layer (RNFL) was demonstrated on OCT (p = 0.61), but temporal quadrant reduction was evident compared to controls (p < 0.05), with significant average and temporal RNFL decline over time. Disease duration, severity and visual acuity were not correlated with RNFL thickness. CONCLUSIONS Our results highlight that recessive SPG7 mutations may account for spastic ataxia with peripheral neuropathy in only a small proportion of patients. RNFL abnormalities with predominant temporal RNFL reduction are common and OCT should be considered part of the routine assessment in spastic ataxia.
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Affiliation(s)
- Petya Bogdanova-Mihaylova
- National Ataxia Clinic, Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland.
| | - Hongying Chen
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Ciara Gorman
- Department of Clinical Neurophysiology, Tallaght University Hospital, Dublin 24, Ireland
| | - Michael D Alexander
- Department of Clinical Neurophysiology, Tallaght University Hospital, Dublin 24, Ireland.,Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - John C McHugh
- Department of Clinical Neurophysiology, Tallaght University Hospital, Dublin 24, Ireland
| | - Sharon Moran
- National Ataxia Clinic, Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Anne Early
- Department of Ophthalmology, Tallaght University Hospital, Dublin 24, Ireland
| | - Lorraine Cassidy
- Department of Ophthalmology, Tallaght University Hospital, Dublin 24, Ireland
| | - Timothy Lynch
- Dublin Neurological Institute at the Mater Hospital, University College Dublin, Dublin, Ireland.,Health Affairs, University College Dublin, Dublin, Ireland
| | - Sinéad M Murphy
- National Ataxia Clinic, Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland.,Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Richard A Walsh
- National Ataxia Clinic, Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland.,Dublin Neurological Institute at the Mater Hospital, University College Dublin, Dublin, Ireland.,Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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25
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Abstract
Hereditary spastic paraplegias (HSPs) are a group of rare, inherited, neurological diseases characterized by broad clinical and genetic heterogeneity. Lower-limb spasticity with first motoneuron involvement is the core symptom of all HSPs. As spasticity is a syndrome and not a disease, it develops on top of other neurological signs (ataxia, dystonia, and parkinsonism). Indeed, the definition of genes responsible for HSPs goes beyond the 79 identified SPG genes. In order to avoid making a catalog of the different genes involved in HSP in any way, we have chosen to focus on the HSP with cerebellar ataxias since this is a frequent association described for several genes. This overlap leads to an intermediary group of spastic ataxias which is actively genetically and clinically studied. The most striking example is SPG7, which is responsible for HSP or cerebellar ataxia or both. There are no specific therapies against HSPs, and there is a dearth of randomized trials in patients with HSP, especially on spasticity when it likely results from other mechanisms. Thus far, no gene-specific therapy has been developed for HSP, but emerging therapies in animal models and neurons derived from induced pluripotent stem cells are potential treatments for patients.
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Affiliation(s)
- Pauline Lallemant-Dudek
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Frederic Darios
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Alexandra Durr
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Genetic Department, Pitié-Salpêtrière University Hospital, Paris, France
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26
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Abstract
Ataxia encompasses a large group of rare disorders characterized by irregular movements, decreased coordination, imbalance, kinetic tremor, wide-based stance, and dysarthria. Evaluating ataxia can be challenging considering the volume of disorders and their complex pathologies involving diverse genetic and clinical factors. This is a comprehensive review of the genetic ataxia literature, presenting updated guidelines for differential diagnosis. Age, time course, and family history provide initial guidance for evaluation of ataxia. As genetic testing is increasingly utilized, new genes are discovered and phenotypes for existing disorders are expanded. This review assists physicians by offering a diagnostic roadmap for suspected hereditary ataxia based on the current literature.
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Affiliation(s)
- Natalie Witek
- Rush Parkinson's Disease and Movement Disorders Program, 1725 W Harrison St. Suite 755, Chicago, IL, 60612, USA.
| | - Jacob Hawkins
- Rush Parkinson's Disease and Movement Disorders Program, 1725 W Harrison St. Suite 755, Chicago, IL, 60612, USA
| | - Deborah Hall
- Rush Parkinson's Disease and Movement Disorders Program, 1725 W Harrison St. Suite 755, Chicago, IL, 60612, USA
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27
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Estiar MA, Yu E, Haj Salem I, Ross JP, Mufti K, Akçimen F, Leveille E, Spiegelman D, Ruskey JA, Asayesh F, Dagher A, Yoon G, Tarnopolsky M, Boycott KM, Dupre N, Dion PA, Suchowersky O, Trempe JF, Rouleau GA, Gan-Or Z. Evidence for Non-Mendelian Inheritance in Spastic Paraplegia 7. Mov Disord 2021; 36:1664-1675. [PMID: 33598982 DOI: 10.1002/mds.28528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the typical inheritance of spastic paraplegia 7 is recessive, several reports have suggested that SPG7 variants may also cause autosomal dominant hereditary spastic paraplegia (HSP). OBJECTIVES We aimed to conduct an exome-wide genetic analysis on a large Canadian cohort of HSP patients and controls to examine the association of SPG7 and HSP. METHODS We analyzed 585 HSP patients from 372 families and 1175 controls, including 580 unrelated individuals. Whole-exome sequencing was performed on 400 HSP patients (291 index cases) and all 1175 controls. RESULTS The frequency of heterozygous pathogenic/likely pathogenic SPG7 variants (4.8%) among unrelated HSP patients was higher than among unrelated controls (1.7%; OR 2.88, 95% CI 1.24-6.66, P = 0.009). The heterozygous SPG7 p.(Ala510Val) variant was found in 3.7% of index patients versus 0.85% in unrelated controls (OR 4.42, 95% CI 1.49-13.07, P = 0.005). Similar results were obtained after including only genetically-undiagnosed patients. We identified four heterozygous SPG7 variant carriers with an additional pathogenic variant in known HSP genes, compared to zero in controls (OR 19.58, 95% CI 1.05-365.13, P = 0.0031), indicating potential digenic inheritance. We further identified four families with heterozygous variants in SPG7 and SPG7-interacting genes (CACNA1A, AFG3L2, and MORC2). Of these, there is especially compelling evidence for epistasis between SPG7 and AFG3L2. The p.(Ile705Thr) variant in AFG3L2 is located at the interface between hexamer subunits, in a hotspot of mutations associated with spinocerebellar ataxia type 28 that affect its proteolytic function. CONCLUSIONS Our results provide evidence for complex inheritance in SPG7-associated HSP, which may include recessive and possibly dominant and digenic/epistasis forms of inheritance. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | | | - Jay P Ross
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Kheireddin Mufti
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Fulya Akçimen
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Etienne Leveille
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada
| | - Grace Yoon
- Divisions of Neurology and Clinical and Metabolic Genetics, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mark Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicolas Dupre
- Neuroscience Axis, CHU de Québec, Université Laval, Québec City, Québec, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Patrick A Dion
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Oksana Suchowersky
- Departments of Medicine (Neurology) and Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Francois Trempe
- Department of Pharmacology & Therapeutics, McGill University, Montréal, Québec, Canada.,Centre de Recherche en Biologie Structurale, McGill University, Montréal, Québec, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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28
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Diniz de Lima F, Faber I, Servelhere KR, Bittar MFR, Martinez ARM, Piovesana LG, Martins MP, Martins CR, Benaglia T, de Sá Carvalho B, Nucci A, França MC. Randomized Trial of Botulinum Toxin Type A in Hereditary Spastic Paraplegia - The SPASTOX Trial. Mov Disord 2021; 36:1654-1663. [PMID: 33595142 DOI: 10.1002/mds.28523] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hereditary spastic paraplegia presents spasticity as the main clinical manifestation, reducing gait quality and producing incapacity. Management with botulinum toxin type A (BoNT-A) is not well elucidated. The objective of the current study was to evaluate the efficacy and safety of BoNT-A in patients with hereditary spastic paraplegias. METHODS This was a double-blind, randomized, placebo-controlled crossover trial. Each participant was randomly assigned to receive 1 injection session of either BoNT-A (100 IU/2 mL of Prosigne in each adductor magnus and each triceps surae) or saline 0.9% (2 mL). The primary outcome measure was change from baseline in maximal gait velocity, and secondary outcome measures included changes in gait at self-selected velocity, spasticity, muscle strength, Spastic Paraplegia Rating Scale, pain, fatigue, and subjective perception of improvement. We also looked at adverse events reported by the patients. RESULTS We enrolled 55 patients, 36 of whom were men and 41 with the pure phenotype. Mean age was 43 ± 13.4 years (range, 19-72 years), mean age of onset waws 27 ± 13.1 years (range, <1 to 55 yars), and mean disease duration was 17 ± 12.7 years (range, 1-62 years). Compared with baseline, we did not find significant differences between groups in primary and secondary outcomes, except for reduction in adductor tone (P = 0.01). The adverse events were transient and tolerable, and their incidence did not significantly differ between treatments (P = 0.17). CONCLUSIONS BoNT-A was safe in patients with hereditary spastic paraplegias and reduced the adductor tone, but it was not able to produce functional improvement considering the doses, injection protocol, measures, and instruments used. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Ingrid Faber
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | | | - Luiza G Piovesana
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Melina P Martins
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Tatiana Benaglia
- Department of Statistics, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Anamarli Nucci
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
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29
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Ravel JM, Benkirane M, Calmels N, Marelli C, Ory-Magne F, Ewenczyk C, Halleb Y, Tison F, Lecocq C, Pische G, Casenave P, Chaussenot A, Frismand S, Tyvaert L, Larrieu L, Pointaux M, Drouot N, Bossenmeyer-Pourié C, Oussalah A, Guéant JL, Leheup B, Bonnet C, Anheim M, Tranchant C, Lambert L, Chelly J, Koenig M, Renaud M. Expanding the clinical spectrum of STIP1 homology and U-box containing protein 1-associated ataxia. J Neurol 2021; 268:1927-1937. [PMID: 33417001 DOI: 10.1007/s00415-020-10348-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND STUB1 has been first associated with autosomal recessive (SCAR16, MIM# 615768) and later with dominant forms of ataxia (SCA48, MIM# 618093). Pathogenic variations in STUB1 are now considered a frequent cause of cerebellar ataxia. OBJECTIVE We aimed to improve the clinical, radiological, and molecular delineation of SCAR16 and SCA48. METHODS Retrospective collection of patients with SCAR16 or SCA48 diagnosed in three French genetic centers (Montpellier, Strasbourg and Nancy). RESULTS Here, we report four SCAR16 and nine SCA48 patients from two SCAR16 and five SCA48 unrelated French families. All presented with slowly progressive cerebellar ataxia. Additional findings included cognitive decline, dystonia, parkinsonism and swallowing difficulties. The age at onset was highly variable, ranging from 14 to 76 years. Brain MRI showed marked cerebellar atrophy in all patients. Phenotypic findings associated with STUB1 pathogenic variations cover a broad spectrum, ranging from isolated slowly progressive ataxia to severe encephalopathy, and include extrapyramidal features. We described five new pathogenic variations, two previously reported pathogenic variations, and two rare variants of unknown significance in association with STUB1-related disorders. We also report the first pathogenic variation associated with both dominant and recessive forms of inheritance (SCAR16 and SCA48). CONCLUSION Even though differences are observed between the recessive and dominant forms, it appears that a continuum exists between these two entities. While adding new symptoms associated with STUB1 pathogenic variations, we insist on the difficulty of genetic counselling in STUB1-related pathologies. Finally, we underscore the usefulness of DAT-scan as an additional clue for diagnosis.
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Affiliation(s)
- Jean-Marie Ravel
- Service de Génétique Médicale, Hôpitaux de Brabois, CHRU de Nancy, Rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
| | - Mehdi Benkirane
- Laboratoire de Génétique Moléculaire, CHU Montpellier, EA7402, Montpellier, France
- EA7402 Institut Universitaire de Recherche Clinique, Université de Montpellier, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier cedex 5, France
| | - Nadège Calmels
- Laboratoires de Diagnostic Génétique, Institut de Génétique Médicale D'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cecilia Marelli
- Expert Centre for Neurogenetic Diseases and Adult Mitochondrial and Metabolic Diseases, University Montpellier, CHU, Montpellier, France
- MMDN, University Montpellier, EPHE, INSERM, Montpellier, France
| | | | - Claire Ewenczyk
- Sorbonne Université, Institut du Cerveau et de la Moelle Épinière (ICM), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
- Service de génétique clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Yosra Halleb
- Laboratoire de Génétique Moléculaire, CHU Montpellier, EA7402, Montpellier, France
- EA7402 Institut Universitaire de Recherche Clinique, Université de Montpellier, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier cedex 5, France
| | - François Tison
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, Bordeaux, France
- Centre Mémoire de Ressources et de Recherches, CHU de Bordeaux, Pôle de Neurosciences Cliniques, Bordeaux, France
| | - Claire Lecocq
- Service de Neurologie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Guillaume Pische
- Service de Neurologie, Centre Hospitalier de Haguenau, Haguenau, France
| | | | - Annabelle Chaussenot
- Service de Génétique Médicale, Centre de Référence des Maladies Mitochondriales, Hôpital de l'Archet 2, Nice, France
| | | | | | - Lise Larrieu
- Laboratoire de Génétique Moléculaire, CHU Montpellier, EA7402, Montpellier, France
- EA7402 Institut Universitaire de Recherche Clinique, Université de Montpellier, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier cedex 5, France
| | - Morgane Pointaux
- Laboratoire de Génétique Moléculaire, CHU Montpellier, EA7402, Montpellier, France
- EA7402 Institut Universitaire de Recherche Clinique, Université de Montpellier, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier cedex 5, France
| | - Nathalie Drouot
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - Carine Bossenmeyer-Pourié
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
| | - Abderrahim Oussalah
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, 54000, Nancy, France
| | - Jean-Louis Guéant
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, 54000, Nancy, France
| | - Bruno Leheup
- Service de Génétique Médicale, Hôpitaux de Brabois, CHRU de Nancy, Rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
| | - Céline Bonnet
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
- Laboratoire de génétique médicale, CHRU Nancy, Nancy, France
| | - Mathieu Anheim
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098, Cedex, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Christine Tranchant
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098, Cedex, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Laëtitia Lambert
- Service de Génétique Médicale, Hôpitaux de Brabois, CHRU de Nancy, Rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France
| | - Jamel Chelly
- Laboratoires de Diagnostic Génétique, Institut de Génétique Médicale D'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - Michel Koenig
- Laboratoire de Génétique Moléculaire, CHU Montpellier, EA7402, Montpellier, France.
- EA7402 Institut Universitaire de Recherche Clinique, Université de Montpellier, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier cedex 5, France.
| | - Mathilde Renaud
- Service de Génétique Médicale, Hôpitaux de Brabois, CHRU de Nancy, Rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France.
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, 54000, Nancy, France.
- Service de Neurologie, CHRU Nancy, Nancy, France.
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Opel N, Thalamuthu A, Milaneschi Y, Grotegerd D, Flint C, Leenings R, Goltermann J, Richter M, Hahn T, Woditsch G, Berger K, Hermesdorf M, McIntosh A, Whalley HC, Harris MA, MacMaster FP, Walter H, Veer IM, Frodl T, Carballedo A, Krug A, Nenadic I, Kircher T, Aleman A, Groenewold NA, Stein DJ, Soares JC, Zunta-Soares GB, Mwangi B, Wu MJ, Walter M, Li M, Harrison BJ, Davey CG, Cullen KR, Klimes-Dougan B, Mueller BA, Sämann PG, Penninx B, Nawijn L, Veltman DJ, Aftanas L, Brak IV, Filimonova EA, Osipov EA, Reneman L, Schrantee A, Grabe HJ, Van der Auwera S, Wittfeld K, Hosten N, Völzke H, Sim K, Gotlib IH, Sacchet MD, Lagopoulos J, Hatton SN, Hickie I, Pozzi E, Thompson PM, Jahanshad N, Schmaal L, Baune BT, Dannlowski U. Brain structural abnormalities in obesity: relation to age, genetic risk, and common psychiatric disorders : Evidence through univariate and multivariate mega-analysis including 6420 participants from the ENIGMA MDD working group. Mol Psychiatry 2021; 26:4839-52. [PMID: 32467648 DOI: 10.1038/s41380-020-0774-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/18/2022]
Abstract
Emerging evidence suggests that obesity impacts brain physiology at multiple levels. Here we aimed to clarify the relationship between obesity and brain structure using structural MRI (n = 6420) and genetic data (n = 3907) from the ENIGMA Major Depressive Disorder (MDD) working group. Obesity (BMI > 30) was significantly associated with cortical and subcortical abnormalities in both mass-univariate and multivariate pattern recognition analyses independent of MDD diagnosis. The most pronounced effects were found for associations between obesity and lower temporo-frontal cortical thickness (maximum Cohen´s d (left fusiform gyrus) = -0.33). The observed regional distribution and effect size of cortical thickness reductions in obesity revealed considerable similarities with corresponding patterns of lower cortical thickness in previously published studies of neuropsychiatric disorders. A higher polygenic risk score for obesity significantly correlated with lower occipital surface area. In addition, a significant age-by-obesity interaction on cortical thickness emerged driven by lower thickness in older participants. Our findings suggest a neurobiological interaction between obesity and brain structure under physiological and pathological brain conditions.
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Rizzo G, Tonon C, Gramegna LL, Bassi MT, Lodi R, Liguori R. ''Eye of tiger sign" mimic in patients with spastic paraplegia gene 7 (SPG7) mutations. Parkinsonism Relat Disord 2020; 81:158-160. [PMID: 33157434 DOI: 10.1016/j.parkreldis.2020.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Giovanni Rizzo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy.
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy
| | - Maria Teresa Bassi
- Laboratory of Molecular Biology, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy
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Ringman JM, Qiao Y, Garbin A, Fisher BE, Fogel B, Watari Knoell K, Chui HC, Shi Y, Rexach JE. Emotional detachment, gait ataxia, and cerebellar dysconnectivity associated with compound heterozygous mutations in the SPG7 gene. Neurocase 2020; 26:299-304. [PMID: 32893728 PMCID: PMC7530119 DOI: 10.1080/13554794.2020.1817493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
We report a patient with autism-like deficits in emotional connectedness, executive dysfunction, and ataxia beginning at age 39. He had compound heterozygous variants in SPG7 (A510V and 1552+1 G>T substitutions), mutation of which is classically associated with spastic paraparesis. Diffusion MRI demonstrated abnormalities in the cerebellar outflow tracts. Transcranial magnetic stimulation showed a prolonged cortical silent period representing exaggerated cortical inhibition, as previously described with pure cerebellar degeneration. The acquired cerebellar cognitive affective syndrome in association with specific anatomic and neurophysiological abnormalities in the cerebellum expand the spectrum of SPG7-related neurodegeneration and support a role for cerebellar output in socio-emotional behavior.
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Affiliation(s)
- John M Ringman
- Memory and Aging Center, Department of Neurology, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Yuchuan Qiao
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Alexander Garbin
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, CA, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, CA, USA
| | - Brent Fogel
- Neurogenetics Program, Department of Neurology, UCLA , Los Angeles, CA, USA
| | - Kecia Watari Knoell
- Memory and Aging Center, Department of Neurology, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Helena C Chui
- Memory and Aging Center, Department of Neurology, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Yonggang Shi
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Jessica E Rexach
- Neurogenetics Program, Department of Neurology, UCLA , Los Angeles, CA, USA
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Abstract
Hereditary spastic paraparesis is a group of inherited neurological diseases characterized by underlying wide genetic heterogeneity. It should be suspected if there is a positive familial history, a common genetic alteration (i.e. SPG4, the most overall frequent form), or association with other signs, such as cerebellar ataxia (i.e. SPG7), early cognitive impairment or even cognitive deficit (i.e. SPG11), or peripheral neuropathy (i.e. SACS). The natural history is known for certain genetic subgroups, with genotype-phenotype correlations partially explaining childhood or late onset. However, the search for genetic modifying factors, in addition to the causal pathogenic variant or environmental influencers, is still needed. Novel approaches to provide etiological treatment are in the pipeline for SPG11. Symptomatic treatments are available but would benefit from randomized controlled trials.
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Affiliation(s)
- P Lallemant-Dudek
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.
| | - A Durr
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Genetics Department, Pitié-Salpêtrière University Hospital, Paris, France
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Montanaro D, Vavla M, Frijia F, Aghakhanyan G, Baratto A, Coi A, Stefan C, Girardi G, Paparella G, De Cori S, Totaro P, Lombardo F, Piccoli G, Martinuzzi A. Multimodal MRI Longitudinal Assessment of White and Gray Matter in Different SPG Types of Hereditary Spastic Paraparesis. Front Neurosci 2020; 14:325. [PMID: 32581663 PMCID: PMC7287014 DOI: 10.3389/fnins.2020.00325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/19/2020] [Indexed: 01/18/2023] Open
Abstract
Hereditary spastic paraplegias (HSP) are a group of genetically and clinically heterogeneous neurologic disorders. Hereby we describe a relatively large group of patients (pts) affected by HSP studied at baseline (31 pts) and at follow-up (mean period 28.9 ± 8.4 months; 23 pts) with multimodal advanced MRI: high-resolution T1 images for voxel-based morphometry (VBM) analysis, magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI). An age-matched healthy control (HC) group underwent the same neuroimaging protocol in a time schedule matched with the HSP patients. At baseline, VBM showed gray matter (GM) reduction in HSP in the right pre-frontal cortex and bilaterally in the thalami. MRS at baseline depicted in HSP patients compared to the HC group reduction of NAA/Cr ratio in the right pre-frontal region, increase of Cho/Cr ratio in the right pre-central regions, and increase of mI/Cr ratio on the left pre-central area. At cross-sectional follow-up analysis and longitudinal evaluation, no VBM and MRS statistically significant results were obtained. Tract-based spatial statistics (TBSS) analysis showed widespread DTI brain white matter (WM) alterations in patients compared to HC at baseline, which are characterized by reduction of fractional anisotropy (FA) and increase of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity, as confirmed on cross-analysis of the follow-up dataset. A longitudinal analysis with TBSS in HSP patients did not show significant variations, while upon applying region-based analysis we found increased FA and decreased MD and AD in specific brain WM fiber complex during follow-up. The changes were not correlated with the clinical presentation (pure vs complicated HSP), motor function, and motility indexes or history of specific treatments (botulinum toxin). In conclusion, the cross-sectional analysis of the multiparametric MRI data in our HSP patients confirmed the non-prominent involvement of the cortex in the primary motor regions but rather of other more associative areas. On the contrary, DTI demonstrated a widespread involvement of the brain WM, including the primary motor regions, which was confirmed at follow-up. The longitudinal analysis revealed an apparent inversion of tendency when considering the expected evolution of a neurodegenerative process: we detected an increase of FA and a decrease of MD and AD. These time-related modifications may suggest a repair attempt by the residual central WM fibers, which requires confirmation with a larger group of patients and with a longer time interval.
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Affiliation(s)
- Domenico Montanaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - M Vavla
- Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
| | - F Frijia
- U.O.C Bioengineering and Clinical Technology, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - G Aghakhanyan
- Department of Translational Research on New Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - A Baratto
- Department of Radiology S. Maria dei Battuti Hospital - Conegliano, ULSS2-Marca Trevigiana, Conegliano, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - C Stefan
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - G Girardi
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - G Paparella
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - S De Cori
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - P Totaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - F Lombardo
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - G Piccoli
- Department of Radiology S. Maria dei Battuti Hospital - Conegliano, ULSS2-Marca Trevigiana, Conegliano, Italy
| | - Andrea Martinuzzi
- Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
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Sultana S, Stewart J, van der Spoel AC. Truncated mutants of beta-glucosidase 2 (GBA2) are localized in the mitochondrial matrix and cause mitochondrial fragmentation. PLoS One 2020; 15:e0233856. [PMID: 32492073 PMCID: PMC7269613 DOI: 10.1371/journal.pone.0233856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022] Open
Abstract
The enzyme β-glucosidase 2 (GBA2) is clinically relevant because it is targeted by the drug miglustat (Zavesca®) and because it is involved in inherited diseases. Mutations in the GBA2 gene are associated with two neurological diseases on the ataxia-spasticity spectrum, hereditary spastic paraplegia 46 (SPG46) and Marinesco-Sjögren-like syndrome (MSS). To establish how GBA2 mutations give rise to neurological pathology, we have begun to investigate mutant forms of GBA2 encoded by disease-associated GBA2 alleles. Previously, we found that five GBA2 missense mutants and five C-terminally truncated mutants lacked enzyme activity. Here we have examined the cellular locations of wild-type (WT) and mutant forms of GBA2 by confocal and electron microscopy, using transfected cells. Similar to GBA2-WT, the D594H and M510Vfs*17 GBA2 mutants were located at the plasma membrane, whereas the C-terminally truncated mutants terminating after amino acids 233 and 339 (GBA2-233 and -339) were present in the mitochondrial matrix, induced mitochondrial fragmentation and loss of mitochondrial transmembrane potential. Deletional mutagenesis indicated that residues 161–200 are critical for the mitochondrial fragmentation of GBA2-233 and -339. Considering that the mitochondrial fragmentation induced by GBA2-233 and -339 is consistently accompanied by their localization to the mitochondrial matrix, our deletional analysis raises the possibility that that GBA2 residues 161–200 harbor an internal targeting sequence for transport to the mitochondrial matrix. Altogether, our work provides new insights into the behaviour of GBA2-WT and disease-associated forms of GBA2.
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Affiliation(s)
- Saki Sultana
- The Atlantic Research Centre, Department of Biochemistry & Molecular Biology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacklyn Stewart
- Biomedical Sciences Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aarnoud C. van der Spoel
- The Atlantic Research Centre, Department of Biochemistry & Molecular Biology, Dalhousie University, Halifax, Nova Scotia, Canada
- The Atlantic Research Centre, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
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Rudenskaya GE, Kadnikova VA, Ryzhkova OP. [Spastic ataxia of Charlevoix-Saguenay: the first Russian case report and literature review]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:85-91. [PMID: 32307416 DOI: 10.17116/jnevro202012002185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare autosomal recessive neurodegenerative disease related to SACS gene and characterized by cerebellar, pyramidal and some other signs. The disease was delineated in Quebec, where it cumulates due to founder effect and has similar phenotype with very early onset. ARSACS in other populations is more variable. The first Russian case of ARSACS in a 37-year-old woman, an only patient in a Lak (one of Dagestan ethnicities) family, is presented. Along with main typical features, she had atypical late disease onset (in 32 years) and moderate cognitive decline. MPS-panel 'hereditary paraplegias' detected an earlier reported homo- or hemizygous mutation c.72276C>T (p.Arg2426Stop) in SACS exon 10.
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Affiliation(s)
| | - V A Kadnikova
- Research Centre for Medical Genetics, Moscow, Russia
| | - O P Ryzhkova
- Research Centre for Medical Genetics, Moscow, Russia
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Verdura E, Schlüter A, Fernández‐Eulate G, Ramos‐Martín R, Zulaica M, Planas‐Serra L, Ruiz M, Fourcade S, Casasnovas C, López de Munain A, Pujol A. A deep intronic splice variant advises reexamination of presumably dominant SPG7 Cases. Ann Clin Transl Neurol 2020; 7:105-111. [PMID: 31854126 PMCID: PMC6952318 DOI: 10.1002/acn3.50967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify causative mutations in a patient affected by ataxia and spastic paraplegia. METHODS Whole-exome sequencing (WES) and whole-genome sequencing (WGS) were performed using patient's DNA sample. RT-PCR and cDNA Sanger sequencing were performed on RNA extracted from patient's fibroblasts, as well as western blot. RESULTS A novel missense variant in SPG7 (c.2195T> C; p.Leu732Pro) was first found by whole-exome sequencing (WES), while the second, also unreported, deep intronic variant (c.286 + 853A>G) was identified by whole-genome sequencing (WGS). RT-PCR confirmed the in silico predictions showing that this variant activated a cryptic splice site, inducing the inclusion of a pseudoexon into the mRNA sequence, which encoded a premature stop codon. Western blot showed decreased SPG7 levels in patient's fibroblasts. INTERPRETATION Identification of a deep intronic variant in SPG7, which could only have been detected by performing WGS, led to a diagnosis in this HSP patient. This case challenges the notion of an autosomal dominant inheritance for SPG7, and illustrates the importance of performing WGS subsequently or alternatively to WES to find additional mutations, especially in patients carrying one variant in a gene causing a predominantly autosomal recessive disease.
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Affiliation(s)
- Edgard Verdura
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Agatha Schlüter
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Gorka Fernández‐Eulate
- BiodonostiaNeurosciences AreaNeuromuscular diseases LaboratorySan SebastianBasque countrySpain
- CIBERNEDInstituto de Salud Carlos IIIMinistry of Science, Innovation and UniversitiesMadridSpain
- Department of NeurologyHospital Universitario DonostiaSan SebastianBasque countrySpain
| | - Raquel Ramos‐Martín
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
| | - Miren Zulaica
- BiodonostiaNeurosciences AreaNeuromuscular diseases LaboratorySan SebastianBasque countrySpain
- CIBERNEDInstituto de Salud Carlos IIIMinistry of Science, Innovation and UniversitiesMadridSpain
| | - Laura Planas‐Serra
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
| | - Montserrat Ruiz
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Stéphane Fourcade
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Carlos Casasnovas
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
- Neuromuscular UnitNeurology DepartmentHospital Universitari de Bellvitge, L'Hospitalet de LlobregatBarcelonaCataloniaSpain
| | - Adolfo López de Munain
- BiodonostiaNeurosciences AreaNeuromuscular diseases LaboratorySan SebastianBasque countrySpain
- CIBERNEDInstituto de Salud Carlos IIIMinistry of Science, Innovation and UniversitiesMadridSpain
- Department of NeurologyHospital Universitario DonostiaSan SebastianBasque countrySpain
- Department of NeurosciencesFaculty of Medicine and DentistryUPV‐EHUSan SebastianBasque countrySpain
| | - Aurora Pujol
- Neurometabolic Diseases LaboratoryBellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatBarcelonaCataloniaSpain
- Centre for Biomedical Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
- Catalan Institution of Research and Advanced Studies (ICREA)BarcelonaCataloniaSpain
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Finsterer J. Mitochondrial Parkinsonism due to SPG7/Paraplegin variants with secondary mtDNA depletion. Mov Disord 2019; 34:1931-1932. [PMID: 31845759 DOI: 10.1002/mds.27905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
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Abstract
The number of molecularly defined degenerative ataxia diseases is rapidly increasing, many of them involving complex multisystemic presentations including parkinsonism. The increasing number of novel ataxia genes -with most of them being ultra-rare - often makes it difficult for clinicians and scientists to identify the molecular diagnosis underlying these ataxia-parkinsonism syndromes. Here we aim to provide an overview on the most frequent diseases and molecular causes underlying ataxia-parkinsonism, focusing both on novel aspects of well-known causes of ataxia-parkinsonism (MSA-C, PSP-C, FXTAS, repeat-expansion spinocerebellar ataxias [SCAs], conventional mutation SCAs) as well as on more recently identified rare genetic causes of ataxia-parkinsonism (AT, POLG, SPG7). We demonstrate that frequency data and phenotype characteristics help to guide diagnostics in patients with unexplained ataxia-parkinsonism, while the newly identified rare genetic causes of ataxia-parkinsonism provide novel insights into molecular key pathways underlying the shared vulnerability of cerebellar and basal ganglia neurons.
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