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Sena LS, Furtado GV, Pedroso JL, Barsottini O, Cornejo-Olivas M, Nóbrega PR, Braga Neto P, Soares DMB, Vargas FR, Godeiro C, Medeiros PFVD, Camejo C, Toralles MBP, Fagundes NJR, Jardim LB, Saraiva-Pereira ML. Spinocerebellar ataxia type 2 has multiple ancestral origins. Parkinsonism Relat Disord 2024; 120:105985. [PMID: 38181536 DOI: 10.1016/j.parkreldis.2023.105985] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Spinocerebellar ataxia type 2 (SCA2) is a dominant neurodegenerative disorder due to expansions of a CAG repeat tract (CAGexp) at the ATXN2 gene. Previous studies found only one ancestral haplotype worldwide, with a C allele at rs695871. This homogeneity was unexpected, given the severe anticipations related to SCA2. We aimed to describe informative ancestral haplotypes found in South American SCA2 families. METHODS Seventy-seven SCA2 index cases were recruited from Brazil, Peru, and Uruguay; 263 normal chromosomes were used as controls. The SNPs rs9300319, rs3809274, rs695871, rs1236900 and rs593226, and the STRs D12S1329, D12S1333, D12S1672 and D12S1332, were used to reconstruct haplotypes. RESULTS Eleven ancestral haplotypes were found in SCA2 families. The most frequent ones were A-G-C-C-C (46.7 % of families), G-C-C-C-C (24.6 %) and A-C-C-C-C (10.3 %) and their mean (sd) CAGexp were 41.68 (3.55), 40.42 (4.11) and 45.67 (9.70) (p = 0.055), respectively. In contrast, the mean (sd) CAG lengths at normal alleles grouped per haplotypes G-C-G-A-T, A-G-C-C-C and G-C-C-C-C were 22.97 (3.93), 23.85 (3.59), and 30.81 (4.27) (p < 0.001), respectively. The other SCA2 haplotypes were rare: among them, a G-C-G-A-T lineage was found, evidencing a G allele in rs695871. CONCLUSION We identified several distinct ancestral haplotypes in SCA2 families, including an unexpected lineage with a G allele at rs695871, a variation never found in hundreds of SCA2 patients studied worldwide. SCA2 has multiple origins in South America, and more studies should be done in other regions of the world.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil.
| | - Gabriel Vasata Furtado
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Orlando Barsottini
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Mario Cornejo-Olivas
- Neurogenetics Working Group, Universidad Cientifica del Sur, 19 Panamericana S Avenue, 15067, Lima, 15067, Peru; Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancas St, 15003, Lima, Peru
| | - Paulo Ribeiro Nóbrega
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Centro Universitário Christus, Rua Alexandre Baraúna 949, 60430-160, Fortaleza, CE, Brazil
| | - Pedro Braga Neto
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Danyela Martins Bezerra Soares
- Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Fernando Regla Vargas
- Departamento de Genética e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca 94, 20211-010, Rio de Janeiro, Brazil; Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avenida Brasil 4365, 21040-900, Rio de Janeiro, Brazil
| | - Clecio Godeiro
- Departamento de Medicina Integrada, Hospital Universitário Onofre Lopes, Avenida Nilo Peçanha, 59012-300, Natal, Brazil
| | - Paula Frassinetti Vasconcelos de Medeiros
- Unidade Acadêmica de Medicina, Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande, Rua Carlos Chagas S/n, 58107-670, Campina Grande, Brazil
| | - Claudia Camejo
- Facultad de Medicina. Universidad de La República, Avenida General Flores 3461, 11700, Montevideo, Uruguay
| | | | - Nelson Jurandi Rosa Fagundes
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Departamento de Genética, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-002, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600, 90035-003, Porto Alegre, Brazil
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Sena LS, Lemes RB, Furtado GV, Saraiva-Pereira ML, Jardim LB. A model for the dynamics of expanded CAG repeat alleles: ATXN2 and ATXN3 as prototypes. Front Genet 2023; 14:1296614. [PMID: 38034492 PMCID: PMC10682950 DOI: 10.3389/fgene.2023.1296614] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background: Spinocerebellar ataxia types 2 (SCA2) and 3 (SCA3/MJD) are diseases due to dominant unstable expansions of CAG repeats (CAGexp). Age of onset of symptoms (AO) correlates with the CAGexp length. Repeat instability leads to increases in the expanded repeats, to important AO anticipations and to the eventual extinction of lineages. Because of that, compensatory forces are expected to act on the maintenance of expanded alleles, but they are poorly understood. Objectives: we described the CAGexp dynamics, adapting a classical equation and aiming to estimate for how many generations will the descendants of a de novo expansion last. Methods: A mathematical model was adapted to encompass anticipation, fitness, and allelic segregation; and empirical data fed the model. The arbitrated ancestral mutations included in the model had the lowest CAGexp and the highest AO described in the literature. One thousand generations were simulated until the alleles were eliminated, fixed, or 650 generations had passed. Results: All SCA2 lineages were eliminated in a median of 10 generations. In SCA3/MJD lineages, 593 were eliminated in a median of 29 generations. The other ones were eliminated due to anticipation after the 650th generation or remained indefinitely with CAG repeats transitioning between expanded and unexpanded ranges. Discussion: the model predicted outcomes compatible with empirical data - the very old ancestral SCA3/MJD haplotype, and the de novo SCA2 expansions -, which previously seemed to be contradictory. This model accommodates these data into understandable dynamics and might be useful for other CAGexp disorders.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Gabriel Vasata Furtado
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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de Oliveira CM, Leotti VB, Polita S, Anes M, Cappelli AH, Rocha AG, Ecco G, Bolzan G, Kersting N, Duarte JA, Saraiva-Pereira ML, Junior MCF, Rezende TJR, Jardim LB. The longitudinal progression of MRI changes in pre-ataxic carriers of SCA3/MJD. J Neurol 2023; 270:4276-4287. [PMID: 37193796 PMCID: PMC10187509 DOI: 10.1007/s00415-023-11763-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The natural history of magnetic resonance imaging (MRI) in pre-ataxic stages of spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is not well known. We report cross-sectional and longitudinal data obtained at this stage. METHODS Baseline (follow-up) observations included 32 (17) pre-ataxic carriers (SARA < 3) and 20 (12) related controls. The mutation length was used to estimate the time to onset (TimeTo) of gait ataxia. Clinical scales and MRIs were performed at baseline and after a median (IQR) of 30 (7) months. Cerebellar volumetries (ACAPULCO), deep gray-matter (T1-Multiatlas), cortical thickness (FreeSurfer), cervical spinal cord area (SCT) and white matter (DTI-Multiatlas) were assessed. Baseline differences between groups were described; variables that presented a p < 0.1 after Bonferroni correction were assessed longitudinally, using TimeTo and study time. For TimeTo strategy, corrections for age, sex and intracranial volume were done with Z-score progression. A significance level of 5% was adopted. RESULTS SCT at C1 level distinguished pre-ataxic carriers from controls. DTI measures of the right inferior cerebellar peduncle (ICP), bilateral middle cerebellar peduncles (MCP) and bilateral medial lemniscus (ML), also distinguished pre-ataxic carriers from controls, and progressed over TimeTo, with effect sizes varying from 0.11 to 0.20, larger than those of the clinical scales. No MRI variable showed progression over study time. DISCUSSION DTI parameters of the right ICP, left MCP and right ML were the best biomarkers for the pre-ataxic stage of SCA3/MJD. TimeTo is an interesting timescale, since it captured the longitudinal worsening of these structures.
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Affiliation(s)
- Camila Maria de Oliveira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra Polita
- Serviço de Radiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mauricio Anes
- Serviço de Física Médica e Radioproteção, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Amanda Henz Cappelli
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela Ecco
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Bolzan
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nathalia Kersting
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Avila Duarte
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Radiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcondes Cavalcante França Junior
- Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Neuroimaging Laboratory, Rua Vital Brasil, 89-99, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-888, Brazil
| | - Thiago Junqueira Ribeiro Rezende
- Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil.
- Neuroimaging Laboratory, Rua Vital Brasil, 89-99, Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-888, Brazil.
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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Jardim LB, Hasan A, Kuo SH, Magaña JJ, França M, Marques W, Camejo C, Santana-da-Silva LC, Leão EE, Espíndola G, Canals F, Miranda M, Salvatierra I, Cornejo-Olivas M, Fernandez-Ruiz J, Braga-Neto P, Dávila-Ortiz de Montellano DJ, Flores-Lagunes LL, Dupré N, Brais B, Vargas FR, Godeiro C, Coutinho L, Teive HG, Kaufmann M, Saffie P, Furtado GV, Saraiva-Pereira ML, Barsottini O, Pedroso JL, Rodríguez-Labrada R, Velázquez-Pérez L, Gomez C. An Exploratory Survey on the Care for Ataxic Patients in the American Continents and the Caribbean. Cerebellum 2023; 22:708-718. [PMID: 35796998 PMCID: PMC10461795 DOI: 10.1007/s12311-022-01442-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Little is known about access of rare disease carriers to health care. To increase this knowledge, the Pan American Hereditary Ataxia Network (PAHAN) conducted an exploratory survey about care for hereditary ataxias in American continents and the Caribbean. A questionnaire was sent to health professionals about the hereditary ataxias identified; access to care; and local teaching and research. The number of ataxics under current care per 100,000 inhabitants was subtracted from the expected overall prevalence of 6/100,000, to estimate the prevalence of uncovered ataxic patients. Local Human Development Indexes (HDI) were used to measure socio-economic factors. Twenty-six sites participated. Twelve sites had very high, 13 had high, and one site had medium HDI. Participants reported on 2239 and 602 patients with spinocerebellar ataxias and recessive forms under current care. The number of patients under current care per inhabitants varied between 0.14 and 12/100,000. The estimated prevalence of uncovered ataxic patients was inversely proportional to HDIs (rho = 0.665, p = 0.003). Access to diagnosis, pre-symptomatic tests, and rehabilitation were associated with HDIs. More and better molecular diagnostic tools, protocols and guidelines, and professional training for ataxia care were the top priorities common to all respondents. Evidence of inequalities was confirmed. Lower HDIs were associated with high potential numbers of uncovered ataxic subjects, and with lack of molecular diagnosis, pre-symptomatic testing, and rehabilitation. More and better diagnostic tools, guidelines, and professional training were priorities to all sites. PAHAN consortium might help with the last two tasks.
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Affiliation(s)
- Laura Bannach Jardim
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil.
| | - Ali Hasan
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Sheng-Han Kuo
- Columbia University, 710 West 168th Street, New York, NY, 10032, USA
| | - Jonathan Javier Magaña
- Instituto Nacional de Rehabilitación - LGII, Calz México-Xochimilco 289, Coapa, Guadalupe Tlalpan, Tlalpan, 14389, Ciudad de México, CDMX, México
| | - Marcondes França
- Universidade Estadual de Campinas, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil
| | - Wilson Marques
- Faculdade de Medicina, Universidade de São Paulo, R. Ten. Catão Roxo, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14015-010, Brazil
| | | | - Luiz Carlos Santana-da-Silva
- Instituto de Ciências Biológicas da Universidade Federal do Pará, Av. Perimetral, 2-224 - Guamá, Belém, 66077-830, Brazil
| | - Emília Embiruçu Leão
- Singular Medicina de Precisão, Rua Ewerton Visco, 290 - Sala 1301 - Caminho das Árvores, Salvador, 41820-022, Brazil
| | - Gisele Espíndola
- Hospital Universitário Polydoro Ernani de São Thiago da Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang - Trindade, Florianópolis, 88036-800, Brazil
| | - Francisca Canals
- Clinica Alemana, Av Vitacura 5951, Vitacura, Santiago, Región Metropolitana, Chile
| | - Marcelo Miranda
- Fundacion Diagnosis, Antonio Varas 175 of 32, Providencia, Santiago, Chile
| | - Igor Salvatierra
- Hospital Materno Infantil, Clinica Los Andes, GR46+9V7, El Alto, Bolívia
| | - Mario Cornejo-Olivas
- Instituto Nacional de Ciencias Neurologicas, Jr. Ancash 1271, Cercado de Lima 15003, Lima, Peru
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior de La Ciudad Universitaria, AV. Universidad 3000, 04510, Ciudad de México, México
| | - Pedro Braga-Neto
- Departamento de Medicina Clínica, Universidade Federal Do Ceará, Rua Pro. Costa Mendes, 1608 - Bloco Didático, 4° andar - Rodolfo Teófilo, Fortaleza, Brazil
| | | | - Luis Leonardo Flores-Lagunes
- Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, 14610, Ciudad de México, Mexico
| | - Nicolas Dupré
- Department of Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Bernard Brais
- Departments of Neurology and Neurosurgery and Human Genetics, Montreal Neurological Institute-Hospital, Faculty of Medicine, McGill University, University Street, Montreal, Quebec, 3801H3A 2B4, Canada
| | - Fernando Regla Vargas
- Laboratório de Epidemiologia de Malformações Congênitas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Clécio Godeiro
- Universidade Federal do Rio Grande do Norte, Campus Universitário - Lagoa Nova, Natal, 59078-970, Brazil
| | - Léo Coutinho
- Hospital das Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Helio G Teive
- Hospital das Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Marcelo Kaufmann
- Neurogenetics Unit, Hospital Jose Ramos Mejia, Gral. Urquiza 609, C1221 ADC, Buenos Aires, Argentina
| | - Paula Saffie
- Centro de Estudios de Trastornos del Movimiento, Avenida José Joaquín Prieto Vial #7271, Santiago, Chile
| | - Gabriel Vasata Furtado
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Prédio Anexo, Porto Alegre, 90035-003, Brazil
| | - Orlando Barsottini
- Universidade Federal do Estado de São Paulo, R. Napoleão de Barros, 715 - Vila Clementino, São Paulo, São Paulo, Brasil
| | - José Luiz Pedroso
- Universidade Federal do Estado de São Paulo, R. Napoleão de Barros, 715 - Vila Clementino, São Paulo, São Paulo, Brasil
| | - Roberto Rodríguez-Labrada
- Cuban Centre for Neurosciences, 190st number 19818 between 27th and 27th, 11600, Playa, Havana, Cuba
- Centro para la Investigación y Rehabilitación de las Ataxias Hereditarias, Libertad Street number 26, between 12th and 16th, 80100, Holguin, Cuba
| | - Luis Velázquez-Pérez
- Centro para la Investigación y Rehabilitación de las Ataxias Hereditarias, Libertad Street number 26, between 12th and 16th, 80100, Holguin, Cuba
- Cuban Academy of Sciences, Cuba St Number 460 Between Teniente Rey and Amargura. Habana Vieja, 10100, Havana, Cuba
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Dos Santos Pinheiro J, Sena LS, Donis KC, Furtado GV, Saraiva-Pereira ML, Jardim LB. Diagnostic Delay of Hereditary Ataxias in Brazil: the Case of Machado-Joseph Disease. Cerebellum 2023; 22:348-354. [PMID: 35426040 DOI: 10.1007/s12311-022-01404-5] [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] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is a rare disease with diagnosis offered by the Unified Health System in Brazil. Our aim was to investigate the diagnostic delay in an interval of 23 years in a public university hospital, and some potentially determining factors. METHODS A retrospective review of the medical records of subjects identified at our institution between 1999 and 2017 was carried out, including residents of Rio Grande do Sul. The diagnostic delay was equivalent to the difference between age at onset of symptoms and age at molecular diagnosis. Calendar years, educational level, sex, distance between the household and the clinics, age and being the index case were studied as modifying factors. RESULTS SCA3/MJD had a median diagnostic delay of 5 years. Index cases had delays of 6 versus 4 years (p<0.001) for subsequent family members. Delay correlated with age (rho=0.346, p<0.001), but not with age at disease onset (rho=0.005, p=0.91). No change was observed with the level of education of individuals or with the distance between household and hospital from 1999 to 2017. DISCUSSION The diagnostic delay of SCA3/MJD is high in our region, where its occurrence has been reported for years. Failure to change the delay over the years suggests ineffective dissemination to the population, but a smaller lag among younger people can portray the effect of digital inclusion.
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Affiliation(s)
- Jordânia Dos Santos Pinheiro
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Schenatto Sena
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karina Carvalho Donis
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Maria Luiza Saraiva-Pereira
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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6
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dos Santos VB, Ayres A, Kieling MLM, Miglorini EC, Jardim LB, Schumacher-Schuh AF, Rieder CRDM, de Castilhos RM, Spencer K, Rothe-Neves R, Olchik MR. Differences in spontaneous speech fluency between Parkinson's disease and spinocerebellar ataxia type 3. Front Neurol 2023; 14:1179287. [PMID: 37213898 PMCID: PMC10196352 DOI: 10.3389/fneur.2023.1179287] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 05/23/2023] Open
Abstract
Background The basal ganglia and cerebellum both have a role in speech production although the effect of isolated involvement of these structures on speech fluency remains unclear. Objective The study aimed to assess the differences in the articulatory pattern in patients with cerebellar vs. basal ganglia disorders. Methods A total of 20 individuals with Parkinson's disease (PD), 20 with spinocerebellar ataxia type 3 (SCA3), and 40 controls (control group, CG) were included. Diadochokinesis (DDK) and monolog tasks were collected. Results The only variable that distinguished SCA3 carriers from the CG was the number of syllables in the monolog, with SCA3 patients of a significantly lower number. For patients with PD, the number of syllables, phonation time, DDK, and monolog were significantly lower than for CG. Patients with PD were significantly worse compared to patients with SCA3 in the number of syllables and phonation time in DDK, and phonation time in monolog. Additionally, there was a significant correlation between the number of syllables in the monolog and the MDS-UPDRS III for participants with PD, and the Friedreich Ataxia Rating Scale for participants with SCA3 suggesting a relationship between speech and general motor functioning. Conclusion The monolog task is better at discriminating individuals with cerebellar vs. Parkinson's diseases as well as differentiating healthy control and was related to the severity of the disease.
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Affiliation(s)
- Vanessa Brzoskowski dos Santos
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Annelise Ayres
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maiara Laís Mallmann Kieling
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Elaine Cristina Miglorini
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Post-graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Internal Medicine, University of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Artur Francisco Schumacher-Schuh
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Pharmacology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Post-Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Raphael Machado de Castilhos
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Pharmacology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kristie Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, United States
| | - Rui Rothe-Neves
- Phonetics Laboratory of the Faculty of Letters, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maira Rozenfeld Olchik
- Post-graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Surgery and Orthopedics, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- *Correspondence: Maira Rozenfeld Olchik
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7
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de Oliveira CM, Leotti VB, Cappelli AH, Rocha AG, Ecco G, Bolzan G, Kersting N, Saraiva-Pereira ML, Jardim LB. Progression of Clinical and Eye Movement Markers in Preataxic Carriers of Machado-Joseph Disease. Mov Disord 2023; 38:26-34. [PMID: 36129443 DOI: 10.1002/mds.29226] [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: 07/22/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Little is known about preclinical stages of Machado-Joseph disease, a polyglutamine disorder characterized by progressive adult-onset ataxia. OBJECTIVE We aimed to describe the longitudinal progression of clinical and oculomotor variables in the preataxic phase of disease. METHODS Carriers and noncarriers were assessed at three visits. Preataxic carriers (Scale for Assessment and Rating of Ataxia score < 3) expected to start ataxia in ≤4 years were considered near onset (PAN). Progressions of ataxic and preataxic carriers, considering status at the end of the study, were described according to the start (or its prediction) of gait ataxia (TimeToAfterOnset) and according to the study time. RESULTS A total of 35 ataxics, 38 preataxics, and 22 noncarriers were included. The "TimeToAfterOnset" timeline showed that Neurological Examination Scale for Spinocerebellar Ataxias (NESSCA; effect size, 0.09), Inventory of Non-Ataxia Symptoms (INAS0.07), and the vestibulo-ocular reflex gain (0.12) progressed in preataxic carriers, and that most slopes accelerate in PAN, turning similar to those of ataxics. In the study time, NESSCA (1.36) and vertical pursuit gain (1.17) significantly worsened in PAN, and 6 of 11 PANs converted to ataxia. For a clinical trial with 80% power and 2-year duration, 57 PANs are needed in each study arm to detect a 50% reduction in the conversion rate. CONCLUSIONS NESSCA, INAS, vestibulo-ocular reflex, and vertical pursuit gains significantly worsened in the preataxic phase. The "TimeToAfterOnset" timeline unveiled that slopes of most variables are small in preataxics but increase and reach the ataxic slopes from 4 years before the onset of ataxia. For future trials in preataxic carriers, we recommend recruiting PANs and using the conversion rate as the primary outcome. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Camila Maria de Oliveira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda Henz Cappelli
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela Ecco
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Bolzan
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nathalia Kersting
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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8
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Peng L, Peng Y, Chen Z, Wang C, Long Z, Peng H, Shi Y, Shen L, Xia K, Leotti VB, Jardim LB, Tang B, Qiu R, Jiang H. The progression rate of spinocerebellar ataxia type 3 varies with disease stage. J Transl Med 2022; 20:226. [PMID: 35568848 PMCID: PMC9107762 DOI: 10.1186/s12967-022-03428-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In polyglutamine (polyQ) diseases, the identification of modifiers and the construction of prediction model for progression facilitate genetic counseling, clinical management and therapeutic interventions. METHODS Data were derived from the longest longitudinal study, with 642 examinations by International Cooperative Ataxia Rating Scale (ICARS) from 82 SCA3 participants. Using different time scales of disease duration, we performed multiple different linear, quadratic and piece-wise linear growth models to fit the relationship between ICARS scores and duration. Models comparison was employed to determine the best-fitting model according to goodness-of-fit tests, and the analysis of variance among nested models. RESULTS An acceleration was detected after 13 years of duration: ICARS scores progressed 2.445 (SE: 0.185) points/year before and 3.547 (SE: 0.312) points/year after this deadline. Piece-wise growth model fitted better to studied data than other two types of models. The length of expanded CAG repeat (CAGexp) in ATXN3 gene significantly influenced progression. Age at onset of gait ataxia (AOga), a proxy for aging process, was not an independent modifier but affected the correlation between CAGexp and progression. Additionally, gender had no significant effect on progression rate of ICARS. The piece-wise growth models were determined as the predictive models, and ICARS predictions from related models were available. CONCLUSIONS We first confirmed that ICARS progressed as a nonlinear pattern and varied according to different stages in SCA3. In addition to ATXN3 CAGexp, AOga or aging process regulated the progression by interacting with CAGexp.
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Affiliation(s)
- Linliu Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yun Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhao Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
| | - Chunrong Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhe Long
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Huirong Peng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yuting Shi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
| | - Kun Xia
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, 410008, Hunan, China
| | - Vanessa B Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Porto Alegre, 91509-900, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, 90035-003, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, 90035-903, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, 90035-903, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-903, Brazil
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
| | - Rong Qiu
- School of Computer Science and Engineering, Central South University, Changsha, 410083, Hunan, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,School of Basic Medical Science, Central South University, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, 410008, Hunan, China. .,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China.
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9
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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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10
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Miglorini EC, de Souza VHI, de Oliveira CM, Bolzan G, Saraiva-Pereira ML, Leotti VB, Jardim LB. Remote Measurement of Functional Status in Pre-symptomatic and Symptomatic Individuals with Machado-Joseph Disease. Cerebellum 2022; 22:475-477. [PMID: 35352290 PMCID: PMC8964238 DOI: 10.1007/s12311-022-01399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Elaine Cristina Miglorini
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Victor Henrique Ignácio de Souza
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Camila Maria de Oliveira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Gabriela Bolzan
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Building 43312, Porto Alegre, 91501-970, Brazil
| | - Maria Luiza Saraiva-Pereira
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Building 43312, Porto Alegre, 91501-970, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Prédio Anexo, 90.035-003, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Building 43-111, Porto Alegre, 91501-900, Brazil
- Grupo de Pesquisa e Pós-Graduação, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil.
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil.
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil.
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Building 43312, Porto Alegre, 91501-970, Brazil.
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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11
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Raposo M, Bettencourt C, Melo ARV, Ferreira AF, Alonso I, Silva P, Vasconcelos J, Kay T, Saraiva-Pereira ML, Costa MD, Vilasboas-Campos D, Bettencourt BF, Bruges-Armas J, Houlden H, Heutink P, Jardim LB, Sequeiros J, Maciel P, Lima M. Novel Machado-Joseph disease-modifying genes and pathways identified by whole-exome sequencing. Neurobiol Dis 2021; 162:105578. [PMID: 34871736 DOI: 10.1016/j.nbd.2021.105578] [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: 07/30/2021] [Revised: 11/08/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Machado-Joseph disease (MJD/SCA3) is a neurodegenerative polyglutamine disorder exhibiting a wide spectrum of phenotypes. The abnormal size of the (CAG)n at ATXN3 explains ~55% of the age at onset variance, suggesting the involvement of other factors, namely genetic modifiers, whose identification remains limited. Our aim was to find novel genetic modifiers, analyse their epistatic effects and identify disease-modifying pathways contributing to MJD variable expressivity. We performed whole-exome sequencing in a discovery sample of four age at onset concordant and four discordant first-degree relative pairs of Azorean patients, to identify candidate variants which genotypes differed for each discordant pair but were shared in each concordant pair. Variants identified by this approach were then tested in an independent multi-origin cohort of 282 MJD patients. Whole-exome sequencing identified 233 candidate variants, from which 82 variants in 53 genes were prioritized for downstream analysis. Eighteen disease-modifying pathways were identified; two of the most enriched pathways were relevant for the nervous system, namely the neuregulin signaling and the agrin interactions at neuromuscular junction. Variants at PARD3, NFKB1, CHD5, ACTG1, CFAP57, DLGAP2, ITGB1, DIDO1 and CERS4 modulate age at onset in MJD, with those identified in CFAP57, ACTG1 and DIDO1 showing consistent effects across cohorts of different geographical origins. Network analyses of the nine novel MJD modifiers highlighted several important molecular interactions, including genes/proteins previously related with MJD pathogenesis, namely between ACTG1/APOE and VCP/ITGB1. We describe novel pathways, modifiers, and their interaction partners, providing a broad molecular portrait of age at onset modulation to be further exploited as new disease-modifying targets for MJD and related diseases.
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Affiliation(s)
- Mafalda Raposo
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal.
| | - Conceição Bettencourt
- Department of Neurodegenerative Disease and Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.
| | - Ana Rosa Vieira Melo
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Ana F Ferreira
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal.
| | - Isabel Alonso
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Paulo Silva
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal.
| | - João Vasconcelos
- Departamento de Neurologia, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Teresa Kay
- Departamento de Genética Clínica, Hospital D. Estefânia, Lisboa, Portugal
| | - Maria Luiza Saraiva-Pereira
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Brazil; Serviço de Genética Médica/Centro de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Marta D Costa
- Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal; ICVS/3B's - Laboratório Associado, Braga/Guimarães, Portugal.
| | - Daniela Vilasboas-Campos
- Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal; ICVS/3B's - Laboratório Associado, Braga/Guimarães, Portugal
| | - Bruno Filipe Bettencourt
- Serviço Especializado de Epidemiologia e Biologia Molecular (SEEBMO), Hospital de Santo Espírito da Ilha Terceira (HSEIT), Angra do Heroísmo, Azores, Portugal
| | - Jácome Bruges-Armas
- Serviço Especializado de Epidemiologia e Biologia Molecular (SEEBMO), Hospital de Santo Espírito da Ilha Terceira (HSEIT), Angra do Heroísmo, Azores, Portugal; CHRC - Comprehensive Health Research Centre, Faculdade de Ciências Médicas & CEDOC - Chronic Diseases Research Center, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Henry Houlden
- Department of Molecular Neuroscience, Institute of Neurology, University College London and Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom, London.
| | - Peter Heutink
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Laura Bannach Jardim
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Serviço de Genética Médica/Centro de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Jorge Sequeiros
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal.
| | - Patrícia Maciel
- Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal; ICVS/3B's - Laboratório Associado, Braga/Guimarães, Portugal.
| | - Manuela Lima
- Instituto de Biologia Molecular e Celular (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal.
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12
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Pinto WBVDR, Salomão RPA, Bergamasco NC, da Cunha Ribas G, da Graça FF, Lopes-Cendes I, Bonadia L, de Souza PVS, Bulle Oliveira AS, Saraiva-Pereira ML, Jardim LB, Tumas V, Junior WM, França MC, Pedroso JL, Barsottini OGP, Teive HAG. DRPLA: An unusual disease or an underestimated cause of ataxia in Brazil? Parkinsonism Relat Disord 2021; 92:67-71. [PMID: 34700111 DOI: 10.1016/j.parkreldis.2021.10.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/13/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dentatorubral-pallidoluysian atrophy (DRPLA) is a rare autosomal dominant spinocerebellar ataxia caused by pathological expansion of CAG trinucleotide repeats in the ATN1 gene. Most cases were described in patients from Japanese ancestry who presented with adult-onset progressive cerebellar ataxia associated with cognitive impairment, choreoathetosis and other movement disorders. DRPLA has been rarely described in Brazilian patients. METHODS We performed a retrospective observational multicentric study including six different Neurology Centers in Brazil. All patients with genetically confirmed diagnosis of DRPLA had their medical records evaluated and clinical, genetic and neuroimaging features were analyzed. RESULTS We describe of eight Brazilian patients (5 male, 3 female) from four nuclear families with genetically confirmed DRPLA. The most common neurological features included cerebellar ataxia (n = 7), dementia (n = 3), chorea (n = 2), psychiatric disturbances (n = 2), progressive myoclonic epilepsy (n = 2) and severe bulbar signs (n = 1). Progressive myoclonic epilepsy was observed in two juvenile-onset cases before 20-year. A large CAG trinucleotide length was observed in the two juvenile-onset cases and genetic anticipation was observed in all cases. Neuroimaging studies disclosed cerebellar atrophy (n = 6), as well as brainstem and cerebellar atrophy (n = 2) and leukoencephalopathy (n = 1). CONCLUSION The patients described herein reinforce that clinical features of DRPLA are highly influenced by age of onset, genetic anticipation and CAG repetition lengths. There is a large complex spectrum of neurological features associated with DRPLA, varying from pure cerebellar ataxia to dementia associated with other movement disorders (myoclonus, choreoathetosis). DRPLA is an unusual cause of cerebellar ataxia and neurodegeneration in Brazilian patients.
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Affiliation(s)
| | - Rubens Paulo Araújo Salomão
- Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Nathália Cabral Bergamasco
- Movement Disorders Unit, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Gustavo da Cunha Ribas
- Movement Disorders Unit, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Felipe Franco da Graça
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil
| | - Iscia Lopes-Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil
| | - Luciana Bonadia
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil
| | - Paulo Victor Sgobbi de Souza
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Acary Souza Bulle Oliveira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Luiza Saraiva-Pereira
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil
| | - Vitor Tumas
- Faculdade de Medicina de Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Wilson Marques Junior
- Faculdade de Medicina de Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Marcondes C França
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Orlando G P Barsottini
- Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Hélio A G Teive
- Movement Disorders Unit, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
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13
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Martins AC, Rieck M, Leotti VB, Saraiva-Pereira ML, Jardim LB. Variants in Genes of Calpain System as Modifiers of Spinocerebellar Ataxia Type 3 Phenotype. J Mol Neurosci 2021; 71:1906-1913. [PMID: 34191270 DOI: 10.1007/s12031-021-01877-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
Calpain-mediated proteolysis has been proposed to modulate the pathogenesis of spinocerebellar ataxia type 3, also known as Machado-Joseph disease (SCA3/MJD), a disorder due to a CAG repeat expansion (CAGexp) at ATXN3. We aimed to investigate if single-nucleotide polymorphisms (SNPs) at calpain gene CAPN2 and at calpastatin gene CAST modulate the age at onset (AO) and disease progression in SCA3/MJD. A total of 287 SCA3/MJD symptomatic subjects (151 families) were included. AO was analyzed and controlled by the CAG repeat length of expanded allele and family. Candidate polymorphisms were chosen based on the literature and on a priori criteria. The CAG repeat length and SNPs were genotyped according to standard methods. AO of carriers of AA and AG + GGrs1559085 genotypes in CAST and with the median value of 75 repeats at the expanded allele were 34.23 (33.07-35.38) and 36.42 years (34.50-38.34), respectively (p = 0.049, mixed model treating the expanded CAG repeat size as fixed effect and family as random effect). Carriers of haplotype Crs27852/Grs1559085 had mean AO of 37.23 (12.76) and 33.42 years (12.20) (p = 0.047, Student's t test). Our data suggest an association between allele Grs1559085 and haplotype Crs27852/Grs1559085 at CAST and variations in the AO of SCA3/MJD subjects, independent from the effects of the CAGexp and family. The present results support the potential role of calpain cleavage pathway over modulation of SCA3/MJD phenotype.
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Affiliation(s)
- Ana Carolina Martins
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mariana Rieck
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. .,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil. .,Departamento de Medicina Interna, FAMED, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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14
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Sena LS, Dos Santos Pinheiro J, Hasan A, Saraiva-Pereira ML, Jardim LB. Spinocerebellar ataxia type 2 from an evolutionary perspective: Systematic review and meta-analysis. Clin Genet 2021; 100:258-267. [PMID: 33960424 DOI: 10.1111/cge.13978] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 01/27/2023]
Abstract
Dominant diseases due to expanded CAG repeat tracts, such as spinocerebellar ataxia type 2 (SCA2), are prone to anticipation and worsening of clinical picture in subsequent generations. There is insufficient data about selective forces acting on the maintenance of these diseases in populations. We made a systematic review and meta-analysis on the effect of the CAG length over age at onset, instability of transmissions, anticipation, de novo or sporadic cases, fitness, segregation of alleles, and ancestral haplotypes. The correlation between CAG expanded and age at onset was r2 = 0.577, and transmission of the mutant allele was associated with an increase of 2.42 CAG repeats in the next generation and an anticipation of 14.62 years per generation, on average. One de novo and 18 sporadic cases were detected. Affected SCA2 individuals seem to have more children than controls. The expanded allele was less segregated than the 22-repeat allele in children of SCA2 subjects. Several ancestral SCA2 haplotypes were published. Data suggest that SCA2 lineages may tend to disappear eventually, due to strong anticipation phenomena. Whether or not the novel cases come from common haplotypes associated with a predisposition to further expansions is a question that needs to be addressed by future studies.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jordânia Dos Santos Pinheiro
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ali Hasan
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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15
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Rodríguez-Labrada R, Martins AC, Magaña JJ, Vazquez-Mojena Y, Medrano-Montero J, Fernandez-Ruíz J, Cisneros B, Teive H, McFarland KN, Saraiva-Pereira ML, Cerecedo-Zapata CM, Gomez CM, Ashizawa T, Velázquez-Pérez L, Jardim LB. Founder Effects of Spinocerebellar Ataxias in the American Continents and the Caribbean. Cerebellum 2021; 19:446-458. [PMID: 32086717 DOI: 10.1007/s12311-020-01109-7] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxias (SCAs) comprise a heterogeneous group of autosomal dominant disorders. The relative frequency of the different SCA subtypes varies broadly among different geographical and ethnic groups as result of genetic drifts. This review aims to provide an update regarding SCA founders in the American continents and the Caribbean as well as to discuss characteristics of these populations. Clusters of SCAs were detected in Eastern regions of Cuba for SCA2, in South Brazil for SCA3/MJD, and in Southeast regions of Mexico for SCA7. Prevalence rates were obtained and reached 154 (municipality of Báguano, Cuba), 166 (General Câmara, Brazil), and 423 (Tlaltetela, Mexico) patients/100,000 for SCA2, SCA3/MJD, and SCA7, respectively. In contrast, the scattered families with spinocerebellar ataxia type 10 (SCA10) reported all over North and South Americas have been associated to a common Native American ancestry that may have risen in East Asia and migrated to Americas 10,000 to 20,000 years ago. The comprehensive review showed that for each of these SCAs corresponded at least the development of one study group with a large production of scientific evidence often generalizable to all carriers of these conditions. Clusters of SCA populations in the American continents and the Caribbean provide unusual opportunity to gain insights into clinical and genetic characteristics of these disorders. Furthermore, the presence of large populations of patients living close to study centers can favor the development of meaningful clinical trials, which will impact on therapies and on quality of life of SCA carriers worldwide.
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Affiliation(s)
| | - Ana Carolina Martins
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
| | - Jonathan J Magaña
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
| | - Yaimeé Vazquez-Mojena
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba
| | | | - Juan Fernandez-Ruíz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, 04510, Mexico City, Mexico
| | - Bulmaro Cisneros
- Department of Genetics and Molecular Biology, Center of Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico
| | - Helio Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná, Curitiba, PR, 80240-440, Brazil
| | | | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
| | - César M Cerecedo-Zapata
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
- Rehabilitation and Social Inclusion Center of Veracruz (CRIS-DIF), Xalapa, 91070, Veracruz, Mexico
| | | | - Tetsuo Ashizawa
- Program of Neuroscience, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba.
- Cuban Academy of Sciences, 10100, La Havana, Cuba.
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
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16
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de Oliveira CM, Leotti VB, Bolzan G, Cappelli AH, Rocha AG, Ecco G, Kersting N, Rieck M, Martins AC, Sena LS, Saraiva-Pereira ML, Jardim LB. Pre-ataxic Changes of Clinical Scales and Eye Movement in Machado-Joseph Disease: BIGPRO Study. Mov Disord 2021; 36:985-994. [PMID: 33438269 DOI: 10.1002/mds.28466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/09/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The pathological burden of spinocerebellar ataxia type 3, also known as Machado-Joseph disease (SCA3/MJD), accumulates before the beginning of symptoms. Our study aims at validating biomarkers for disease progression since pre-ataxic periods. We report on baseline findings of clinical scales and oculomotor neurophysiology. METHODS Ataxic (Scale for the Assessment and Rating of Ataxia > 2.5) and at 50% risk subjects were included. The latter were subdivided into noncarriers, pre-ataxic carriers near (PAN), or pre-ataxic carriers far from (PAFF) ataxia onset (AO), with 4 years from the predicted age at onset being the cutoff. The subjects were assessed by Neurological Examination Score for Spinocerebellar Ataxia (NESSCA), International Cooperative Ataxia Rating Scale (ICARS), Inventory of Non-Ataxic Signs (INAScount), Composite Cerebellar Functions Score and SCA Functional Index, and video-oculography, including the regression slope of vestibulo-ocular reflex gain (VORr), main sequence of volitional and reflexive vertical saccades, slow-phase velocity of central and gaze-evoked (SPV-GE) nystagmus, and vertical pursuit gain. Correction for multiple comparisons was performed; the threshold for statistical significance was P < 0.05. RESULTS A total of 35 ataxic, 14 PAN, 24 PAFF, and 22 noncarriers were included. All variables showed significant differences between groups and correlated to time to onset or time after onset, among all 73 SCA3/MJD carriers; none significantly changed with age in controls. NESSCA, ICARS, INAScount, VORr, main sequence of volitional saccades, and SPV-GE not only distinguished PAN from controls but also correlated with time left to AO. CONCLUSIONS Clinical scales and video-oculography variables were already altered in pre-ataxic SCA3/MJD carriers and worsened with time. NESSCA, ICARS, INAScount, VORr, main sequence of vertical volitional saccades, and SPV-GE are good candidates to measure preclinical changes in SCA3/MJD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Camila Maria de Oliveira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Bolzan
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda Henz Cappelli
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela Ecco
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nathalia Kersting
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mariana Rieck
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Carolina Martins
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Schenatto Sena
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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17
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Sena LS, Dos Santos Pinheiro J, Saraiva-Pereira ML, Jardim LB. Selective forces acting on spinocerebellar ataxia type 3/Machado-Joseph disease recurrency: A systematic review and meta-analysis. Clin Genet 2020; 99:347-358. [PMID: 33219521 DOI: 10.1111/cge.13888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/28/2020] [Revised: 10/25/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is a dominant neurodegenerative disease caused by the expansion of a CAG repeat tract in ATXN3. Anticipation and worsening of clinical picture in subsequent generations were repeatedly reported, but there is no indication that SCA3/MJD frequency is changing. Thus, we performed a systematic review and meta-analysis on phenomena with potential effect on SCA3/MJD recurrency in populations: instability of CAG repeat transmissions, anticipation, fitness, and segregation of alleles. Transmission of the mutant allele was associated with an increase of 1.23 CAG repeats in the next generation, and the average change in age at onset showed an anticipation of 7.75 years per generation; but biased recruitments cannot be ruled out. Affected SCA3/MJD individuals had 45% more children than related controls. Transmissions from SCA3/MJD carriers showed that the expanded allele was segregated in 64% of their children. In contrast, transmissions from normal subjects showed that the minor allele was segregated in 54%. The present meta-analysis concluded that there is a segregation distortion favoring the expanded allele, among children of carriers. Therefore, further studies on transmissions and anticipation phenomena as well as more observations about fertility are required to clarify these selective forces over SCA3/MJD.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jordânia Dos Santos Pinheiro
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Castilhos RM, Augustin MC, Santos JAD, Pedroso JL, Barsottini O, Saba R, Ferraz HB, Vargas FR, Furtado GV, Polese-Bonatto M, Rodrigues LP, Sena LS, Vargas CR, Saraiva-Pereira ML, Jardim LB, Neurogenética R. Free carnitine and branched chain amino acids are not good biomarkers in Huntington's disease. Arq Neuropsiquiatr 2020; 78:81-87. [PMID: 32159721 DOI: 10.1590/0004-282x20190152] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Huntington's disease (HD), caused by an expanded CAG repeat at HTT, has no treatment, and biomarkers are needed for future clinical trials. OBJECTIVE The objective of this study was to verify if free carnitine and branched chain amino acids levels behave as potential biomarkers in HD. METHODS Symptomatic and asymptomatic HD carriers and controls were recruited. Age, sex, body mass index (BMI), age of onset, disease duration, UHDRS scores, and expanded CAG tract were obtained; valine, leucine, isoleucine, and free carnitine were measured. Baseline and longitudinal analysis were performed. RESULTS Seventy-four symptomatic carriers, 20 asymptomatic carriers, and 22 non-carriers were included. At baseline, valine levels were reduced in symptomatic and asymptomatic HD carriers when compared to non-carriers. No difference in free carnitine or isoleucine+leucine levels were observed between groups. BMI of symptomatic individuals was lower than those of non-carriers. Valine levels correlated with BMI. Follow-up evaluation was performed in 43 symptomatic individuals. UHDRS total motor score increased 4.8 points/year on average. No significant reductions in BMI or valine were observed, whereas free carnitine and isoleucine+leucine levels increased. CONCLUSIONS Although valine levels were lower in HD carriers and were related to BMI losses observed in pre-symptomatic individuals, none of these metabolites seem to be biomarkers for HD.
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Affiliation(s)
- Raphael Machado Castilhos
- Programa de pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre RS, Brazil
| | - Marina Coutinho Augustin
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Augusto Dos Santos
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Disciplina de Neurologia Clínica, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Orlando Barsottini
- Disciplina de Neurologia Clínica, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Roberta Saba
- Disciplina de Neurologia Clínica, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Henrique Ballalai Ferraz
- Disciplina de Neurologia Clínica, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Fernando Regla Vargas
- Hospital Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Gabriel Vasata Furtado
- Programa de pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Marcia Polese-Bonatto
- Programa de pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Brazil
| | - Luiza Paulsen Rodrigues
- Programa de pós-graduação em Biologia Molecular e Celular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | - Lucas Schenatto Sena
- Programa de pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Carmen Regla Vargas
- Programa de pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Programa de pós-graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Programa de pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Programa de pós-graduação em Biologia Molecular e Celular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre RS, Brazil
| | - Rede Neurogenética
- Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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19
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Cornejo-Olivas M, Inca-Martinez M, Castilhos RM, Furtado GV, Mattos EP, Bampi GB, Leistner-Segal S, Marca V, Mazzetti P, Saraiva-Pereira ML, Jardim LB. Correction to: Genetic Analysis of Hereditary Ataxias in Peru Identifies SCA10 Families with Incomplete Penetrance. Cerebellum 2020; 19:216. [PMID: 31940124 DOI: 10.1007/s12311-020-01105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The original version of this article unfortunately contained some mistakes in Table 2. The additional row (just above SCA2) with the following information "SCA1, 1(1), 1, 50, 74, 24, 46 and 0/1" should be inserted.
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Affiliation(s)
- Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias, Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru.
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Miguel Inca-Martinez
- Neurogenetics Research Center, Instituto Nacional de Ciencias, Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Raphael Machado Castilhos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Preusser Mattos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giovana Bavia Bampi
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Leistner-Segal
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Victoria Marca
- Neurogenetics Research Center, Instituto Nacional de Ciencias, Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias, Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
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20
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Cornejo-Olivas M, Inca-Martinez M, Castilhos RM, Furtado GV, Mattos EP, Bampi GB, Leistner-Segal S, Marca V, Mazzetti P, Saraiva-Pereira ML, Jardim LB. Genetic Analysis of Hereditary Ataxias in Peru Identifies SCA10 Families with Incomplete Penetrance. Cerebellum 2020; 19:208-215. [PMID: 31900855 DOI: 10.1007/s12311-019-01098-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Relative frequency of hereditary ataxias remains unknown in many regions of Latin America. We described the relative frequency in spinocerebellar ataxias (SCA) due to (CAG)n and to (ATTCT)n expansions, as well as Friedreich ataxia (FRDA), among cases series of ataxic individuals from Peru. Among ataxic index cases from 104 families (38 of them with and 66 without autosomal dominant pattern of inheritance), we identified 22 SCA10, 8 SCA2, 3 SCA6, 2 SCA3, 2 SCA7, 1 SCA1, and 9 FRDA cases (or families). SCA10 was by far the most frequent one. Findings in SCA10 and FRDA families were of note. Affected genitors were not detected in 7 out of 22 SCA10 nuclear families; then overall maximal penetrance of SCA10 was estimated as 85%; in multiplex families, penetrance was 94%. Two out of nine FRDA cases carried only one allele with a GAA expansion. SCA10 was the most frequent hereditary ataxia in Peru. Our data suggested that ATTCT expansions at ATXN10 might not be fully penetrant and/or instability between generations might frequently cross the limits between non-penetrant and penetrant lengths. A unique distribution of inherited ataxias in Peru requires specific screening panels, considering SCA10 as first line of local diagnosis guidelines.
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Affiliation(s)
- Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru. .,Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Miguel Inca-Martinez
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru.,Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Raphael Machado Castilhos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Preusser Mattos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giovana Bavia Bampi
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Leistner-Segal
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Victoria Marca
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, Barrios Altos, 15003, Lima, Peru
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Instituto de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
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21
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Renaud M, Moreira MC, Ben Monga B, Rodriguez D, Debs R, Charles P, Chaouch M, Ferrat F, Laurencin C, Vercueil L, Mallaret M, M'Zahem A, Pacha LA, Tazir M, Tilikete C, Ollagnon E, Ochsner F, Kuntzer T, Jung HH, Beis JM, Netter JC, Djamshidian A, Bower M, Bottani A, Walsh R, Murphy S, Reiley T, Bieth É, Roelens F, Poll-The BT, Lourenço CM, Jardim LB, Straussberg R, Landrieu P, Roze E, Thobois S, Pouget J, Guissart C, Goizet C, Dürr A, Tranchant C, Koenig M, Anheim M. Clinical, Biomarker, and Molecular Delineations and Genotype-Phenotype Correlations of Ataxia With Oculomotor Apraxia Type 1. JAMA Neurol 2019; 75:495-502. [PMID: 29356829 DOI: 10.1001/jamaneurol.2017.4373] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Ataxia with oculomotor apraxia type 1 (AOA1) is an autosomal recessive cerebellar ataxia due to mutations in the aprataxin gene (APTX) that is characterized by early-onset cerebellar ataxia, oculomotor apraxia, axonal motor neuropathy, and eventual decrease of albumin serum levels. Objectives To improve the clinical, biomarker, and molecular delineation of AOA1 and provide genotype-phenotype correlations. Design, Setting, and Participants This retrospective analysis included the clinical, biological (especially regarding biomarkers of the disease), electrophysiologic, imaging, and molecular data of all patients consecutively diagnosed with AOA1 in a single genetics laboratory from January 1, 2002, through December 31, 2014. Data were analyzed from January 1, 2015, through January 31, 2016. Main Outcomes and Measures The clinical, biological, and molecular spectrum of AOA1 and genotype-phenotype correlations. Results The diagnosis of AOA1 was confirmed in 80 patients (46 men [58%] and 34 women [42%]; mean [SD] age at onset, 7.7 [7.4] years) from 51 families, including 57 new (with 8 new mutations) and 23 previously described patients. Elevated levels of α-fetoprotein (AFP) were found in 33 patients (41%); hypoalbuminemia, in 50 (63%). Median AFP level was higher in patients with AOA1 (6.0 ng/mL; range, 1.1-17.0 ng/mL) than in patients without ataxia (3.4 ng/mL; range, 0.8-17.2 ng/mL; P < .01). Decreased albumin levels (ρ = -0.532) and elevated AFP levels (ρ = 0.637) were correlated with disease duration. The p.Trp279* mutation, initially reported as restricted to the Portuguese founder haplotype, was discovered in 53 patients with AOA1 (66%) with broad white racial origins. Oculomotor apraxia was found in 49 patients (61%); polyneuropathy, in 74 (93%); and cerebellar atrophy, in 78 (98%). Oculomotor apraxia correlated with the severity of ataxia and mutation type, being more frequent with deletion or truncating mutations (83%) than with presence of at least 1 missense variant (17%; P < .01). Mean (SD) age at onset was higher for patients with at least 1 missense mutation (17.7 [11.4] vs 5.2 [2.6] years; P < .001). Conclusions and Relevance The AFP level, slightly elevated in a substantial fraction of patients, may constitute a new biomarker for AOA1. Oculomotor apraxia may be an optional finding in AOA1 and correlates with more severe disease. The p.Trp279* mutation is the most frequent APTX mutation in the white population. APTX missense mutations may be associated with a milder phenotype.
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Affiliation(s)
- Mathilde Renaud
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Maria-Céu Moreira
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France
| | - Bondo Ben Monga
- Faculté de Médecine et Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Diana Rodriguez
- Service de Neuropédiatrie, Hôpital d'Enfants Armand-Trousseau, Paris, France.,Centre de Référence de Neurogénétique, Hôpital Armand-Trousseau, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France.,Groupe de Recherch Clinique ConCer-LD, Sorbonne Universités, l'Université Pierre-et-Marie-Curie, Université Paris 06, Paris, France.,Neuroprotection du Cerveau en Développement, INSERM U1141, Paris, France
| | - Rabab Debs
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Perrine Charles
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Malika Chaouch
- Service de Neurologie, Etablissement Hospitalier Spécialisé, Algers, Algeria
| | - Farida Ferrat
- Service de Neurologie, Etablissement Hospitalier Spécialisé de Ben Aknoun, Algers, Algeria
| | - Chloé Laurencin
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Laurent Vercueil
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France.,INSERM U836, Grenoble Institut des Neurosciences, Bâtiment Edmond J. Safra, Chemin Fortuné Ferrini, La Tronche, France
| | - Martial Mallaret
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France
| | | | | | - Meriem Tazir
- Service de Neurologie, CHU Mustapha, Algers, Algeria
| | - Caroline Tilikete
- Service de Neuro-ophtalmologie, Hôpital Neurologique, CHU Lyon, Bron, France
| | | | | | | | - Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Jean-Marie Beis
- Institut Régional de Médecine Physique et de Réadaptation, Centre de Lay-Saint-Christophe, France
| | | | - Atbin Djamshidian
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mattew Bower
- Department of Neurology, University of Minnesota Health, Minneapolis, Minnesota
| | - Armand Bottani
- Service de Génétique, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Richard Walsh
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Sinead Murphy
- National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Thomas Reiley
- Department of Public Health and Environment, Greeley, Colorado
| | - Éric Bieth
- Service de Génétique Médicale, Hopital Purpan, Toulouse, France
| | | | - Bwee Tien Poll-The
- Pediatric Neurology, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Marques Lourenço
- Neurogenetics Unit, School of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rachel Straussberg
- Neurogenetics Clinic, Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine Tel Aviv University, Ramat Aviv, Israel
| | - Pierre Landrieu
- Service de Neurologie Pédiatrique, Hôpital Bicêtre, Paris, France
| | - Emmanuel Roze
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Stéphane Thobois
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Jean Pouget
- Service de Neurologie, Hôpital de la Timone, Marseille, France
| | - Claire Guissart
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Cyril Goizet
- Service de Génétique Médicale, CHU Bordeaux, Bordeaux, France.,INSERM U1211, Laboratoire Maladies Rares Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Alexandra Dürr
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Michel Koenig
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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22
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Castilhos RMD, Santos JAD, Augustin MC, Pedroso JL, Barsottini O, Saba R, Ferraz HB, Godeiro Junior C, Vargas FR, Salarini DZ, Furtado GV, Polese-Bonatto M, Rodrigues LP, Sena LS, Saraiva-Pereira ML, Jardim LB. Minimal prevalence of Huntington's disease in the South of Brazil and instability of the expanded CAG tract during intergenerational transmissions. Genet Mol Biol 2019; 42:329-336. [PMID: 31259362 PMCID: PMC6726154 DOI: 10.1590/1678-4685-gmb-2018-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022] Open
Abstract
Huntington’s disease (HD) is due to dominant expansions of the CAG repeat of the
HTT gene. Meiotic instability of the (CAG)n
might impact the disorder frequency. We report on HD minimal prevalence in Rio
Grande do Sul (RS) state, Brazil, and on intergenerational instability of the
(CAG)n in HD families. Symptomatic and at-risk subjects from 179
HD families were ascertained between 2013 and 2016. Clinical, molecular and
family history data were obtained. Expanded (CAG)n length differences
between parent and child (delta-expanded-(CAG)n) were calculated.
Effect of parental age on the (CAG)n instability upon transmission
was inferred by correlating delta-expanded-(CAG)n between siblings to
their age differences. HD minimal prevalence in RS state was estimated as
1.85:100,000 inhabitants. Alleles with (CAG)27-35 were found on
21/384 non-disease associated chromosomes (5.5%); among 253 expanded alleles,
four (1.6%) were within reduced penetrance range with (CAG)36-39. In
32 direct transmissions, mean instability was larger among paternal than
maternal transmissions. In direct transmissions and in 51 sibling pairs,
parental age at the time of child birth were not correlated with
delta-expanded-(CAG)n. Briefly, HD prevalence in RS state was
lower than those reported for European populations. Expanded (CAG)n
transmissions were unstable and not associated to parental age.
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Affiliation(s)
- Raphael Machado de Castilhos
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, RS, Brazil
| | - José Augusto Dos Santos
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Marina Coutinho Augustin
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - José Luiz Pedroso
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Orlando Barsottini
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Roberta Saba
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Henrique Ballalai Ferraz
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Clécio Godeiro Junior
- Departamento de Medicina Integrada, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Fernando Regla Vargas
- Hospital Graffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.,Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Gabriel Vasata Furtado
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Marcia Polese-Bonatto
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Luiza Paulsen Rodrigues
- Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Lucas Schenatto Sena
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, RS, Brazil
| | -
- Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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23
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Peluzzo TM, Bonadia LC, Donatti A, Molck MC, Jardim LB, Marques W, Lopes-Cendes IT, França MC. Frequency and Genetic Profile of Compound Heterozygous Friedreich's Ataxia Patients-the Brazilian Experience. Cerebellum 2019; 18:1143-1146. [PMID: 31243663 DOI: 10.1007/s12311-019-01055-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Friedreich ataxia (FRDA) is the most common autosomal recessive ataxia in Caucasian populations. It is caused by a homozygous GAA expansion in the first intron of the frataxin gene (FXN) (OMIM: 606829) in 96% of the affected individuals. The remaining patients have a GAA expansion in one allele and a point mutation in the other. Little is known about compound heterozygous patients outside Europe and North America. We have thus designed a study to determine the frequency and mutational profile of these patients in Brazil. To accomplish that, we recruited all patients with ataxia and at least one expanded GAA allele at FXN from 3 national reference centers. We identified those subjects with a single expansion and proceeded with further genetic testing (Sanger sequencing and CGH arrays) for those. There were 143 unrelated patients (128 families), five of which had a single expanded allele. We identified point mutations in three out of these five (3/128 = 2.34%). Two patients had the c.157delC variant, whereas one individual had the novel variant c.482+1G>T. These results indicate that FXN point mutations are rare, but exist in Brazilian patients with FRDA. This has obvious implications for diagnostic testing and genetic counseling.
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Affiliation(s)
- Thiago Mazzo Peluzzo
- Department of Medical Genetics and Genomic Medicine, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Luciana Cardoso Bonadia
- Department of Medical Genetics and Genomic Medicine, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Amanda Donatti
- Department of Medical Genetics and Genomic Medicine, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Miriam Coelho Molck
- Department of Medical Genetics and Genomic Medicine, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-003, Brazil
| | - Wilson Marques
- Department of Neurosciences and Behavior Sciences, Ribeirão Preto School of Medicine, University of São Paulo (HCFMRP-USP), Campus Universitário s/n Monte Alegre, Ribeirão Preto, SP, 14048-900, Brazil
| | - Iscia Teresinha Lopes-Cendes
- Department of Medical Genetics and Genomic Medicine, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil
| | - Marcondes C França
- Department of Neurology, School of Medicine, University of Campinas - UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz", Campinas, SP, 13083-887, Brazil.
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24
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Vieira TA, Trapp FB, Souza CFMD, Faccini LS, Jardim LB, Schwartz IVD, Riegel M, Vargas CR, Burin MG, Leistner-Segal S, Ashton-Prolla P, Giugliani R. Information and Diagnosis Networks - tools to improve diagnosis and treatment for patients with rare genetic diseases. Genet Mol Biol 2019; 42:155-164. [PMID: 31188934 PMCID: PMC6687351 DOI: 10.1590/1678-4685-gmb-2018-0214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Brazil is a country of continental dimensions and most genetic services are
concentrated in the Southeast and South, including the Medical Genetics Service
of the Hospital de Clínicas de Porto Alegre (MGS/HCPA). As many areas on the
country do not have adequate medical genetics support, networks were designed to
extend the service of the MGS/HCPA reference center. This paper presents the
information and diagnosis networks that have their headquarters at MGS/HCPA:
SIAT (National Information System on Teratogenic Agents),
SIEM (Information Service on Inborn Errors of Metabolism),
Alô Genética (Hello Genetics - Medical Genetics Information
Service for Primary Health Care Professionals); Rede MPS Brasil
(MPS-Mucopolysaccharidosis Brazil Network); Rede EIM Brasil
(IEM-Inborn Errors of Metabolism Brazil Network), Rede NPC
Brasil (Niemann-Pick C - NPC Brazil Network), Rede DLD
Brasil (LSD-Lysosomal Storage Disorders Brazil Network),
Rede DXB (MSUD-Maple Syrup Urine Disease Network),
RedeBRIM (Brazilian Network of Reference and Information in
Microdeletion Syndromes Project), Rede Neurogenética
(Neurogenetics Network), and Rede Brasileira de Câncer
Hereditário (Brazilian Hereditary Cancer Network). These tools are
very useful to provide access to a qualified information and/or diagnostic
service for specialized and non-specialized health services, bypassing
difficulties that preclude patients to access reference centers.
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Affiliation(s)
- Taiane Alves Vieira
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Research and Postgraduate Group - Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Lavínia Schuler Faccini
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Internal Medicine - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariluce Riegel
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carmen Regla Vargas
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maira Graeff Burin
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Sandra Leistner-Segal
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia Ashton-Prolla
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Research and Postgraduate Group - Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Giugliani
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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25
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Furtado GV, Oliveira CMD, Bolzan G, Saute JAM, Saraiva-Pereira ML, Jardim LB. State biomarkers for Machado Joseph disease: Validation, feasibility and responsiveness to change. Genet Mol Biol 2019; 42:238-251. [PMID: 31188927 PMCID: PMC6687346 DOI: 10.1590/1678-4685-gmb-2018-0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/04/2018] [Indexed: 12/18/2022] Open
Abstract
Machado-Joseph disease (SCA3/MJD) is the most common spinocerebellar ataxia worldwide, and particularly so in Southern Brazil. Due to an expanded polyglutamine at ataxin-3, SCA3/MJD presents a relentless course with no current disease modifying treatment. Clinical scales used to measure SCA3/MJD progression present moderate effect sizes, a major drawback for their use as main outcomes in clinical trials, given the rarity and slow progression of the disease. This limitation might be overcome by finding good surrogate markers. We present here a review of studies on peripheral and neurophysiological markers in SCA3/MJD that can be candidates for state biomarkers. Data on markers already studied were summarized, giving emphasis on validation against clinical scale, and responsiveness to change. While some biological fluid compounds and neurophysiological parameters showed poor responsiveness, others seemed to be good candidates. Some potential candidates that are waiting for responsiveness studies were serum levels of neuron specific enolase, vestibulo-ocular reflex and video-oculography. Candidates evaluated by RNA and microRNA expression levels need further studies to improve their measurements. Data on peripheral levels of Beclin-1 and DNAJB1 are promising but still incipient. We conclude that several potential candidates should follow onto validating studies for surrogate state biomarkers of SCA3/MJD.
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Affiliation(s)
- Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Camila Maria de Oliveira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriela Bolzan
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jonas Alex Morales Saute
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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26
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Giugliani R, Bender F, Couto R, Bochernitsan A, Brusius-Facchin AC, Burin M, Amorim T, Acosta AX, Purificação A, Leistner-Segal S, Saraiva-Pereira ML, Jardim LB, Matte U, Riegel M, Cardoso-Dos-Santos AC, Rodrigues G, Oliveira MZD, Tagliani-Ribeiro A, Heck S, Dresch V, Schuler-Faccini L, Kubaski F. Population medical genetics: translating science to the community. Genet Mol Biol 2019; 42:312-320. [PMID: 30985854 PMCID: PMC6687347 DOI: 10.1590/1678-4685-gmb-2018-0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/11/2018] [Indexed: 12/02/2022] Open
Abstract
Rare genetic disorders are currently in the spotlight due to the elevated number
of different conditions and significant total number of affected patients. The
study of these disorders is extremely helpful for the elucidation of
physiological processes related with complex disorders. Isolated populations are
instrumental for the study of genetic disorders, considering their homogeneity
and high proportion of affected patients in a small geographic area. These
favorable conditions lead to the creation of a new discipline, known as
“population medical genetics”, which integrates medical genetics, population
genetics, epidemiological genetics and community genetics. In order to develop
practical activities in this new discipline, the National Institute of
Population Medical Genetics (INaGeMP) was created in 2008 in Brazil. INaGeMP has
developed several tools and funded numerous research activities. In this review,
we highlight three successful projects developed in the first 10 years of
INaGeMP activities (2008-2018): a newborn screening pilot study for MPS VI in
Northeast Brazil, the study of Machado-Joseph disease in Brazilian families with
Azorian ancestry, and the high twinning rate in a small town in southern Brazil.
The results of these projects in terms of scientific output and contributions to
the affected communities highlight the success and importance of INaGeMP.
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Affiliation(s)
- Roberto Giugliani
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Bender
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rowena Couto
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bochernitsan
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ana Carolina Brusius-Facchin
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maira Burin
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tatiana Amorim
- APAE, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Angelina Xavier Acosta
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil.,Department of Pediatrics, Universidade Federal da Bahia, Salvador, BA, Brazi
| | | | - Sandra Leistner-Segal
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Medical Sciences Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Luiza Saraiva-Pereira
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Biochemistry, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Celular and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ursula Matte
- Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariluce Riegel
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Augusto César Cardoso-Dos-Santos
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Graziella Rodrigues
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Marcelo Zagonel de Oliveira
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Alice Tagliani-Ribeiro
- Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Selia Heck
- Prefeitura Municipal de Cândido Godói, Candido Godói, RS, Brazil
| | - Vanusa Dresch
- Prefeitura Municipal de Cândido Godói, Candido Godói, RS, Brazil
| | - Lavínia Schuler-Faccini
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
| | - Francyne Kubaski
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil
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de Mattos EP, Kolbe Musskopf M, Bielefeldt Leotti V, Saraiva-Pereira ML, Jardim LB. Genetic risk factors for modulation of age at onset in Machado-Joseph disease/spinocerebellar ataxia type 3: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2019; 90:203-210. [PMID: 30337442 DOI: 10.1136/jnnp-2018-319200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis of genetic risk factors for age at onset (AO) in spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD). METHODS Two authors independently reviewed reports on the mathematical relationship between CAG length at the expanded ATXN3 allele (CAGexp), and other genetic variants if available, and AO. Publications from January 1994 to September 2017 in English, Portuguese or Spanish and indexed in MEDLINE (PubMed), LILACS or EMBASE were considered. Inclusion criteria were reports with >20 SCA3/MJD carriers with molecular diagnosis performed by capillary electrophoresis. Non-overlapping cohorts were determined on contact with corresponding authors. A detailed analysis protocol was registered at the PROSPERO database prior to data extraction (CRD42017073071). RESULTS Eleven studies were eligible for meta-analysis, comprising 10 individual-participant (n=2099 subjects) and two aggregated data cohorts. On average, CAGexp explained 55.2% (95% CI 50.8 to 59.0; p<0.001) of AO variability. Population-specific factors accounted for 8.3% of AO variance. Cohorts clustered into distinct geographic groups, evidencing significantly earlier AO in non-Portuguese Europeans than in Portuguese/South Brazilians with similar CAGexp lengths. Presence of intermediate ATXN2 alleles (27-33 CAG repeats) significantly correlated with earlier AO. Familial factors accounted for ~10% of AO variability. CAGexp, origin, family effects and CAG length at ATXN2 together explained 73.5% of AO variance. CONCLUSIONS Current evidence supports genetic modulation of AO in SCA3/MJD by CAGexp, ATXN2 and family-specific and population-specific factors. Future studies should take these into account in the search for new genetic modifiers of AO, which could be of therapeutic relevance.
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Affiliation(s)
- Eduardo Preusser de Mattos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Biomedical Sciences of Cells & Systems, Section of Molecular Cell Biology, University Medical Center Groningen/Groningen University, Groningen, The Netherlands
| | - Maiara Kolbe Musskopf
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Friedreich ataxia (FRDA) is an autosomal recessive disorder due to mutations in the FXN gene. FRDA is characterized by the classical triad of ataxia, absent reflexes, and Babinski sign, but atypical presentations might also occur. Our aims were to describe the proportion of FRDA diagnoses in suspected families living in Rio Grande do Sul, South Brazil, and to estimate a minimum frequency of symptomatic subjects. Subjects that were evaluated by molecular analysis for FRDA at the Hospital de Clínicas de Porto Alegre were identified in our files. Patients' clinical manifestation and phenotypes were described and compared. The number of FRDA subjects alive in the last 5 years was determined. One hundred fifty-six index cases (families) were submitted to evaluation of GAA repeats at FXN since 1997: 27 were confirmed as FRDA patients. Therefore, the diagnostic yield was 17.3%. Proportion of classical, late onset, and retained reflexes subphenotypes were similar to those described by other studies. A minimum prevalence was estimated as 0.20:100.000 inhabitants. In conclusion, we verified that this FRDA population displayed the usual clinical characteristics, but with a lower period prevalence than those obtained in populations from Europe.
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Affiliation(s)
- Helena Fussiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, sala 220, Porto Alegre, 90035-003, Brazil
| | - Maria Luiza Saraiva-Pereira
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Prédio Anexo, Porto Alegre, 90035-003, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil
| | - Sandra Leistner-Segal
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, sala 220, Porto Alegre, 90035-003, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, sala 220, Porto Alegre, 90035-003, Brazil.
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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Palazzo RP, Jardim LB, Bacellar A, de Oliveira FR, Maraslis FT, Pereira CHJ, da Silva J, Maluf SW. DNA damage and repair in individuals with ataxia-telangiectasia and their parents. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 2018; 836:122-126. [DOI: 10.1016/j.mrgentox.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 04/04/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
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Sena LS, Castilhos RM, Mattos EP, Furtado GV, Pedroso JL, Barsottini O, de Amorim MMP, Godeiro C, Saraiva-Pereira ML, Jardim LB. Correction to: Selective Forces Related to Spinocerebellar Ataxia Type 2. Cerebellum 2018; 18:195. [PMID: 30450503 DOI: 10.1007/s12311-018-0991-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The original version of this article unfortunately contained a mistake. The spelling of the surname of one co-author from the publication entitled "Selective Forces Related to Spinocerebellar Ataxia Type 2" that was recently published in the journal "The Cerebelum" was incorrect.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Eduardo Preusser Mattos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Setor de Neurologia Geral e Ataxias. Disciplina de Neurologia Clínica da UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Orlando Barsottini
- Setor de Neurologia Geral e Ataxias. Disciplina de Neurologia Clínica da UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Clecio Godeiro
- Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Maggi FA, Braga-Neto P, Chien HF, Gama MTD, Rezende Filho FM, Saraiva-Pereira ML, Jardim LB, Voos MC, Pedroso JL, Barsottini OGP. Cross-cultural adaptation and validation of the International Cooperative Ataxia Rating Scale (ICARS) to Brazilian Portuguese. Arq Neuropsiquiatr 2018; 76:674-684. [PMID: 30427507 DOI: 10.1590/0004-282x20180098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The clinical assessment of patients with ataxias requires reliable scales. We aimed to translate, adapt and validate the International Cooperative Ataxia Rating Scale (ICARS) into Brazilian Portuguese. METHODS The steps of this study were forward translation, translation synthesis, backward translation, expert committee meeting, preliminary pilot testing and final assessment. Thirty patients were enrolled in the preliminary pilot testing and 61 patients were evaluated for construct validity, internal consistency, intra- and inter-rater reliability and external consistency. RESULTS This study showed good validity of the construct and high internal consistency for the full scale, except for the oculomotor domain (Cronbach's alpha = 0.316, intraclass correlation coefficients intra- = 82.4% and inter- = 79.2%). A high correlation with the Scale for the Assessment and Rating of Ataxia was observed. We found good intra-rater agreement and relative inter-rater disagreement, except in the posture and gait domain. CONCLUSION The present ICARS version is adapted for the Brazilian culture and can be used to assess our ataxic patients.
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Affiliation(s)
- Fernanda Aparecida Maggi
- Universidade Federal de São Paulo, Departamento de Neurologia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Pedro Braga-Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia.,Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brasil
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina, Intituto de Ortopedia e Traumatologia, São Paulo SP, Brasil
| | - Maria Thereza Drumond Gama
- Universidade Federal de São Paulo, Departamento de Neurologia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Flávio Moura Rezende Filho
- Universidade Federal de São Paulo, Departamento de Neurologia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Maria Luiza Saraiva-Pereira
- Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética e Serviço de Genética Médica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Bioquímica, Porto Alegre RS, Brasil
| | - Laura Bannach Jardim
- Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética e Serviço de Genética Médica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brasil
| | - Mariana Callil Voos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brasil
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, Divisão de Neurologia Geral, São Paulo SP, Brasil
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Rangel DM, Nóbrega PR, Saraiva-Pereira ML, Jardim LB, Braga-Neto P. A case series of hereditary cerebellar ataxias in a highly consanguineous population from Northeast Brazil. Parkinsonism Relat Disord 2018; 61:193-197. [PMID: 30389370 DOI: 10.1016/j.parkreldis.2018.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are few studies reporting characteristics of patients with cerebellar ataxias in the Brazilian population. The aim of this study was to provide a detailed neurological description of patients with hereditary ataxia followed by a neurology outpatient service in Brazil. METHODS Neurological and clinical evaluation of patients with hereditary ataxia was performed at a neurology service outpatient clinic of a hospital in Northeast Brazil between October 2013 and January 2015. RESULTS A total of 47 patients had ataxia as the main symptom. A high prevalence of consanguinity was found in the population studied (40.4%). Mean age was 38.4 ± 15.3 years, mean age at disease onset was 25.6 ± 17.3 years, mean disease duration was 12.8 ± 9.7 years, and mean score on the Scale for the Assessment and Rating of Ataxia (SARA) was 18.4 ± 7.7. Patients with recessive pattern of inheritance were younger, had earlier age at disease onset and greater severity of ataxia, measured by the SARA. Diagnosis was confirmed by molecular analysis, laboratory exams or biopsy in 42.56% (n = 20) of these patients. The most prevalent diseases were: Friedreich's ataxia in 35% (n = 7), Niemann-Pick type C (NPC) in 15% (n = 3), and ataxia with oculomotor apraxia type 2 in 15% (n = 3). CONCLUSIONS In contrast with other studies, our prevalence of recessive ataxias was much higher than that of dominant ataxias. These findings might be explained by the high number of patients living in rural areas with a higher rate of consanguineous marriages, absence of a dominant ataxia founder effect or difficult access to healthcare system.
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Affiliation(s)
- Deborah Moreira Rangel
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Center of Health Sciences, Universidade Estadual do Ceará, Brazil.
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Affiliation(s)
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre 90.035-903, Brazil; Department of Internal Medicine and Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Monte TL, Reckziegel ER, Augustin MC, Silva ASP, Locks-Coelho LD, Barsottini O, Pedroso JL, Vargas FR, Saraiva-Pereira ML, Leotti VB, Jardim LB. NESSCA Validation and Responsiveness of Several Rating Scales in Spinocerebellar Ataxia Type 2. Cerebellum 2018; 16:852-858. [PMID: 28456900 DOI: 10.1007/s12311-017-0855-8] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2), caused by a CAG expansion (CAGexp) at ATXN2, has a complex clinical picture. While validated ataxia scales are available, comprehensive instruments to measure all SCA2 neurological manifestations are required. This study aims to validate the Neurological Examination Score for the assessment of Spinocerebellar Ataxias (NESSCA) to be used in SCA2 and to compare its responsiveness to those obtained with other instruments. NESSCA, SARA, SCAFI, and CCFS scales were applied in symptomatic SCA2 patients. Correlations were done with age at onset, disease duration, CAGexp, and between scales. Responsiveness was estimated by comparing deltas of stable to worse patients after 12 months, according to Patient Global Impression of change, and the area under the curve (AUC) of the Receiver Operating Characteristics curve of scores range. Eighty-eight evaluations (49 patients) were obtained. NESSCA had an even distribution and correlated with disease duration (r = 0.55), SARA (r = 0.63), and CAGexp (rho = 0.32): both explained 44% of NESSCA variance. Deltas (95% CI) after 1 year in stable and worse patients were only significantly different for SARA. NESSCA, SARA, SCAFI, and CCFS AUC were 0.63, 0.81, 0.49, and 0.48, respectively. NESSCA is valid to be used in SCA2. However, the only instrument that presented good responsiveness to change in 1 year was SARA. We suggest that NESSCA can be used as a secondary outcome in future trials in SCA2 due to the burden of neurological disabilities related to disease progression.
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Affiliation(s)
- Thais L Monte
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Estela R Reckziegel
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina C Augustin
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda S P Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas D Locks-Coelho
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Orlando Barsottini
- Setor de Neurologia Geral e Ataxias, Disciplina de Neurologia Clínica da UNIFESP-Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José L Pedroso
- Setor de Neurologia Geral e Ataxias, Disciplina de Neurologia Clínica da UNIFESP-Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernando R Vargas
- Laboratório de Epidemiologia de Malformações Congênitas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Departamento de Genética e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90.035-903, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Matemática e Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil. .,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90.035-903, Brazil.
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Monte TL, Reckziegel EDR, Augustin MC, Locks-Coelho LD, Santos ASP, Furtado GV, de Mattos EP, Pedroso JL, Barsottini OP, Vargas FR, Saraiva-Pereira ML, Camey SA, Leotti VB, Jardim LB. The progression rate of spinocerebellar ataxia type 2 changes with stage of disease. Orphanet J Rare Dis 2018; 13:20. [PMID: 29370806 PMCID: PMC5785809 DOI: 10.1186/s13023-017-0725-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/05/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Spinocerebellar ataxia type 2 (SCA2) affects several neurological structures, giving rise to multiple symptoms. However, only the natural history of ataxia is well known, as measured during the study duration. We aimed to describe the progression rate of ataxia, by the Scale for the Assessment and Rating of Ataxia (SARA), as well as the progression rate of the overall neurological picture, by the Neurological Examination Score for Spinocerebellar Ataxias (NESSCA), and not only during the study duration but also in a disease duration model. Comparisons between these models might allow us to explore whether progression is linear during the disease duration in SCA2; and to look for potential modifiers. Results Eighty–eight evaluations were prospectively done on 49 symptomatic subjects; on average (SD), study duration and disease duration models covered 13 (2.16) months and 14 (6.66) years of individuals’ life, respectively. SARA progressed 1.75 (CI 95%: 0.92–2.57) versus 0.79 (95% CI 0.45 to 1.14) points/year in the study duration and disease duration models. NESSCA progressed 1.45 (CI 95%: 0.74–2.16) versus 0.41 (95% CI 0.24 to 0.59) points/year in the same models. In order to explain these discrepancies, the progression rates of the study duration model were plotted against disease duration. Then an acceleration was detected after 10 years of disease duration: SARA scores progressed 0.35 before and 2.45 points/year after this deadline (p = 0.013). Age at onset, mutation severity, and presence of amyotrophy, parkinsonism, dystonic manifestations and cognitive decline at baseline did not influence the rate of disease progression. Conclusions NESSCA and SARA progression rates were not constant during disease duration in SCA2: early phases of disease were associated with slower progressions. Modelling of future clinical trials on SCA2 should take this phenomenon into account, since disease duration might impact on inclusion criteria, sample size, and study duration. Our database is available online and accessible to future studies aimed to compare the present data with other cohorts. Electronic supplementary material The online version of this article (10.1186/s13023-017-0725-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thais Lampert Monte
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Lucas D Locks-Coelho
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda Senna P Santos
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Preusser de Mattos
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Setor de Neurologia Geral e Ataxias. Disciplina de Neurologia Clínica da UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Orlando Póvoas Barsottini
- Setor de Neurologia Geral e Ataxias. Disciplina de Neurologia Clínica da UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernando Regla Vargas
- Laboratório de Epidemiologia de Malformações Congênitas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Departamento de Genética e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Genética Médica Populacional, Rio de Janeiro, Brazil
| | - Maria-Luiza Saraiva-Pereira
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul, 90.035-903, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Suzi Alves Camey
- Grupo de Pesquisa e Pós-Graduação Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul, 90.035-903, Brazil. .,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Instituto Nacional de Genética Médica Populacional, Rio de Janeiro, Brazil.
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Abstract
Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is an autosomal dominant multiple neurological systems degenerative disorder caused by a CAG repeat expansion at ATXN3 gene. Only a few treatments were evaluated in randomized clinical trials (RCT) in SCA3/MJD patients, with a lack of evidence for both disease-modifying and symptomatic therapies. The present chapter discuss in detail major methodological issues for planning future RCT for SCA3/MJD. There are several potential therapies for SCA3/MJD with encouraging preclinical results. Route of treatment, dosage titration and potential therapy biomarkers might differ among candidate drugs; however, the core study design and protocol will be mostly the same. RCT against placebo group is the best study design to test a disease-modifying therapy; the same cannot be stated for some symptomatic treatments. Main outcomes for future RCT are clinical scales: the Scale for the Assessment and Rating of ataxia (SARA) is currently the instrument of choice to prove efficacy of disease-modifying or symptomatic treatments against ataxia, the most important disease feature. Ataxia quantitative scales or its composite scores can be used as primary outcomes to provide preliminary evidence of efficacy in phase 2 RCT, due to a greater sensitivity to change. Details regarding eligibility criteria, randomization, sample size estimation, duration and type of analysis for both disease modifying and symptomatic treatment trials, were also discussed. Finally, a section anticipates the methodological issues for testing novel drugs when an effective treatment is already available. We conclude emphasizing four points, the first being the need of RCT for a number of different aims in the care of SCA3/MJD. Due to large sample sizes needed to warrant power, RCT for disease-modifying therapies should be multicenter enterprises. There is an urge need for surrogate markers validated for several drug classes. Finally, engagement of at risk or presymptomatic individuals in future trials will enable major advances on treatment research for SCA3/MJD.
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Affiliation(s)
- Jonas Alex Morales Saute
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, HCPA, Porto Alegre, RS, Brazil
- Programa de Pós-Gradução em Medicina, Ciências Médicas Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Medicina Interna, UFRGS, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
- Laboratório de Identificação Genética, Centro de Pesquisa Experimental, HCPA, Porto Alegre, RS, Brazil.
- Programa de Pós-Gradução em Medicina, Ciências Médicas Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Departamento de Medicina Interna, UFRGS, Porto Alegre, RS, Brazil.
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Rio de Janeiro, Brazil.
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37
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Schöls L, Rattay TW, Martus P, Meisner C, Baets J, Fischer I, Jägle C, Fraidakis MJ, Martinuzzi A, Saute JA, Scarlato M, Antenora A, Stendel C, Höflinger P, Lourenco CM, Abreu L, Smets K, Paucar M, Deconinck T, Bis DM, Wiethoff S, Bauer P, Arnoldi A, Marques W, Jardim LB, Hauser S, Criscuolo C, Filla A, Züchner S, Bassi MT, Klopstock T, De Jonghe P, Björkhem I, Schüle R. Hereditary spastic paraplegia type 5: natural history, biomarkers and a randomized controlled trial. Brain 2017; 140:3112-3127. [PMID: 29126212 PMCID: PMC5841036 DOI: 10.1093/brain/awx273] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/22/2017] [Accepted: 08/26/2017] [Indexed: 12/31/2022] Open
Abstract
Spastic paraplegia type 5 (SPG5) is a rare subtype of hereditary spastic paraplegia, a highly heterogeneous group of neurodegenerative disorders defined by progressive neurodegeneration of the corticospinal tract motor neurons. SPG5 is caused by recessive mutations in the gene CYP7B1 encoding oxysterol-7α-hydroxylase. This enzyme is involved in the degradation of cholesterol into primary bile acids. CYP7B1 deficiency has been shown to lead to accumulation of neurotoxic oxysterols. In this multicentre study, we have performed detailed clinical and biochemical analysis in 34 genetically confirmed SPG5 cases from 28 families, studied dose-dependent neurotoxicity of oxysterols in human cortical neurons and performed a randomized placebo-controlled double blind interventional trial targeting oxysterol accumulation in serum of SPG5 patients. Clinically, SPG5 manifested in childhood or adolescence (median 13 years). Gait ataxia was a common feature. SPG5 patients lost the ability to walk independently after a median disease duration of 23 years and became wheelchair dependent after a median 33 years. The overall cross-sectional progression rate of 0.56 points on the Spastic Paraplegia Rating Scale per year was slightly lower than the longitudinal progression rate of 0.80 points per year. Biochemically, marked accumulation of CYP7B1 substrates including 27-hydroxycholesterol was confirmed in serum (n = 19) and cerebrospinal fluid (n = 17) of SPG5 patients. Moreover, 27-hydroxycholesterol levels in serum correlated with disease severity and disease duration. Oxysterols were found to impair metabolic activity and viability of human cortical neurons at concentrations found in SPG5 patients, indicating that elevated levels of oxysterols might be key pathogenic factors in SPG5. We thus performed a randomized placebo-controlled trial (EudraCT 2015-000978-35) with atorvastatin 40 mg/day for 9 weeks in 14 SPG5 patients with 27-hydroxycholesterol levels in serum as the primary outcome measure. Atorvastatin, but not placebo, reduced serum 27-hydroxycholesterol from 853 ng/ml [interquartile range (IQR) 683-1113] to 641 (IQR 507-694) (-31.5%, P = 0.001, Mann-Whitney U-test). Similarly, 25-hydroxycholesterol levels in serum were reduced. In cerebrospinal fluid 27-hydroxycholesterol was reduced by 8.4% but this did not significantly differ from placebo. As expected, no effects were seen on clinical outcome parameters in this short-term trial. In this study, we define the mutational and phenotypic spectrum of SPG5, examine the correlation of disease severity and progression with oxysterol concentrations, and demonstrate in a randomized controlled trial that atorvastatin treatment can effectively lower 27-hydroxycholesterol levels in serum of SPG5 patients. We thus demonstrate the first causal treatment strategy in hereditary spastic paraplegia.
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Affiliation(s)
- Ludger Schöls
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Tim W Rattay
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Jonathan Baets
- Neurogenetics Group, Center for Molecular Neurology, VIB, 2610 Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, 2610 Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, 2610 Antwerp, Belgium
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Christine Jägle
- Center for Rare Diseases and Institute of Human Genetics and Applied Genomics, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Matthew J Fraidakis
- Rare Neurological Diseases Unit, Department of Neurology, University Hospital ‘Attikon’, Medical School of the University of Athens, 12462 Athens, Greece
| | - Andrea Martinuzzi
- Scientific Institute IRCCS E. Medea, Conegliano Research Center, 31015 Conegliano, Italy
| | - Jonas Alex Saute
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, 90035 Porto Alegre, Brazil
- Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), 90040 Porto Alegre, Brazil
| | - Marina Scarlato
- Neurology Department and INSPE, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonella Antenora
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University Naples, 80131 Naples, Italy
| | - Claudia Stendel
- Department of Neurology, Friedrich Baur Institute, Ludwig-Maximilians-University, 80336 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Philip Höflinger
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Charles Marques Lourenco
- Departamento de Neurologia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, 14049 Ribeirao Preto, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), 90040 Porto Alegre, Brazil
| | - Lisa Abreu
- John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
| | - Katrien Smets
- Neurogenetics Group, Center for Molecular Neurology, VIB, 2610 Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, 2610 Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, 2610 Antwerp, Belgium
| | - Martin Paucar
- Department of Neurology, Karolinska University Hospital Huddinge and Department of Clinical Neuroscience, Karolinska Institute, 14152 Huddinge, Sweden
| | - Tine Deconinck
- Neurogenetics Group, Center for Molecular Neurology, VIB, 2610 Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, 2610 Antwerp, Belgium
| | - Dana M Bis
- John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
| | - Sarah Wiethoff
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
- Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Peter Bauer
- Institute of Medical Genetics and Applied Genomics, Eberhard-Karls-University, 72076 Tübingen, Germany
- CENTOGENE AG, 18057 Rostock, Germany
| | - Alessia Arnoldi
- Laboratory of Molecular Biology, Scientific Institute IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Wilson Marques
- Departamento de Neurologia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, 14049 Ribeirao Preto, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Genetics Identification Laboratory, Hospital de Clínicas de Porto Alegre, 90035 Porto Alegre, Brazil
- Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), 90040 Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), 90040 Porto Alegre, Brazil
| | - Stefan Hauser
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
| | - Chiara Criscuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University Naples, 80131 Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University Naples, 80131 Naples, Italy
| | - Stephan Züchner
- John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, 33136 Miami, Florida, USA
| | - Maria Teresa Bassi
- Laboratory of Molecular Biology, Scientific Institute IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Thomas Klopstock
- Department of Neurology, Friedrich Baur Institute, Ludwig-Maximilians-University, 80336 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Peter De Jonghe
- Neurogenetics Group, Center for Molecular Neurology, VIB, 2610 Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, 2610 Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, 2610 Antwerp, Belgium
| | - Ingemar Björkhem
- Karolinska University Hospital Huddinge, Karolinska Institute, 14152 Stockholm, Sweden
| | - Rebecca Schüle
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, 72076 Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), 72076 Tübingen, Germany
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38
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Burguez D, Polese-Bonatto M, Scudeiro LAJ, Björkhem I, Schöls L, Jardim LB, Matte U, Saraiva-Pereira ML, Siebert M, Saute JAM. Clinical and molecular characterization of hereditary spastic paraplegias: A next-generation sequencing panel approach. J Neurol Sci 2017; 383:18-25. [DOI: 10.1016/j.jns.2017.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/22/2017] [Accepted: 10/06/2017] [Indexed: 01/19/2023]
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Pedroso JL, Braga-Neto P, Escorcio-Bezerra ML, Abrahão A, de Albuquerque MVC, Filho FMR, de Souza PVS, de Rezende Pinto WBV, Borges FRP, Saraiva-Pereira ML, Jardim LB, Barsottini OGP. Non-motor and Extracerebellar Features in Spinocerebellar Ataxia Type 2. Cerebellum 2017; 16:34-39. [PMID: 26825292 DOI: 10.1007/s12311-016-0761-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant degenerative disease. Pathological studies have demonstrated not only cerebellar and brainstem atrophy, but substantia nigra, motoneurons, basal ganglia, thalamus, and peripheral nerves involvement. These findings may explain non-motor and extra-cerebellar features in SCA2. We accessed the non-motor symptoms and extra-cerebellar signs in SCA2 patients in order to provide a better understanding on pathophysiological mechanisms and natural history of brain degeneration in the disease. Thirty-three SCA2 patients were evaluated and compared with 26 healthy subjects. We investigated the following variables: sleep disorders, cognitive deficit, olfactory impairment, urinary dysfunction, psychiatric symptoms, cramps, pain, movement disorders, and weight loss. SCA2 had a high frequency of REM sleep behavior disorder (48.48 %, N = 16) as well as excessive daytime sleepiness (42.42 %, N = 14). Chorea was present in 15.15 % (N = 5), dystonia in 27.27 % (N = 9), and parkinsonism in 27.27 % (N = 9). Slow saccadic pursuit was present in 87.87 % (N = 29) and ophtalmoparesis in 78.78 % (N = 26) of patients. Regarding sleep disorders, 18.18 % (N = 6) of patients had restless leg syndrome. Dysphagia was present in 39.39 % (N = 13), weight loss 24.24 % (N = 8), and urinary dysfunction 27.27 % (N = 9). Cramps was present in only 6 % of patients (N = 2). This study highlighted the high frequency of non-motor symptoms and extra-cerebellar signs in SCA2. Our findings demonstrate the widespread of nervous system involvement in SCA2 patients and contribute to better understand the natural history of brain degeneration in this genetic condition.
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Affiliation(s)
- José Luiz Pedroso
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, CE, Brazil
| | | | - Agessandro Abrahão
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology and Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Orlando G P Barsottini
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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40
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Bezerra MLE, Pedroso JL, Braga-Neto P, Abrahao A, de Albuquerque MVC, Borges FRP, Saraiva-Pereira ML, Jardim LB, de Oliveira Braga NI, Manzano GM, Barsottini OGP. Pattern of Peripheral Nerve Involvement in Spinocerebellar Ataxia Type 2: a Neurophysiological Assessment. Cerebellum 2017; 15:767-773. [PMID: 26708559 DOI: 10.1007/s12311-015-0753-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathy is frequent in spinocerebellar ataxia type 2 (SCA2), but the pattern and characteristics of nerve involvement are still an unsettled issue. This study aimed to evaluate the prevalence, extent, and distribution of nerve involvement in SCA2 patients through neurophysiological studies. Thirty-one SCA2 patients and 20 control subjects were enrolled in this study. All subjects were prospectively evaluated through electromyography, including nerve conduction, needle electromyography in proximal and distal muscles of the upper and lower limbs, and sural radial amplitude ratio (SRAR). We aimed to differentiate distal axonopathy from diffuse nerve commitment, characterizing neuronopathy. Nerve involvement was observed in 83.6 % (26 individuals) of SCA2 patients. Among these, 19 had diffuse sensory abnormalities on nerve conduction predominantly on the upper limbs, with diffuse chronic denervation on needle electromyography and elevated SRAR values. Four individuals had only diffuse sensory involvement, and 2 had only motor involvement on needle evaluation and normal nerve conduction. These were interpreted as neuronopathy due to the diffuse distribution of the involvement. One individual had distal sensory axonopathy, with lower limb predominance. In this study, we found neuronopathy as the main pattern of nerve involvement in SCA2 patients and that motor involvement is a frequent feature. This information brings new insights into the understanding of the pathophysiology of nerve involvement in SCA2 and sets some key points about the phenotype, which is relevant to guide the genetic/molecular diagnosis.
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Affiliation(s)
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Agessandro Abrahao
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
- Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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41
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de Assis AM, Saute JAM, Longoni A, Haas CB, Torrez VR, Brochier AW, Souza GN, Furtado GV, Gheno TC, Russo A, Monte TL, Castilhos RM, Schumacher-Schuh A, D'Avila R, Donis KC, de Mello Rieder CR, Souza DO, Camey S, Leotti VB, Jardim LB, Portela LV. Peripheral Oxidative Stress Biomarkers in Spinocerebellar Ataxia Type 3/Machado-Joseph Disease. Front Neurol 2017; 8:485. [PMID: 28979235 PMCID: PMC5611390 DOI: 10.3389/fneur.2017.00485] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/31/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is a polyglutamine disorder with no current disease-modifying treatment. Conformational changes in mutant ataxin-3 trigger different pathogenic cascades, including reactive oxygen species (ROS) generation; however, the clinical relevance of oxidative stress elements as peripheral biomarkers of SCA3/MJD remains unknown. We aimed to evaluate ROS production and antioxidant defense capacity in symptomatic and presymptomatic SCA3/MJD individuals and correlate these markers with clinical and molecular data with the goal of assessing their properties as disease biomarkers. METHODS Molecularly confirmed SCA3/MJD carriers and controls were included in an exploratory case-control study. Serum ROS, measured by 2',7'-dichlorofluorescein diacetate (DCFH-DA) as well as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) antioxidant enzyme activities, levels were assessed. RESULTS Fifty-eight early/moderate stage symptomatic SCA3/MJD, 12 presymptomatic SCA3/MJD, and 47 control individuals were assessed. The DCFH-DA levels in the symptomatic group were 152.82 nmol/mg of protein [95% confidence interval (CI), 82.57-223.08, p < 0.001] higher than in the control and 243.80 nmol/mg of protein (95% CI, 130.64-356.96, p < 0.001) higher than in the presymptomatic group. The SOD activity in the symptomatic group was 3 U/mg of protein (95% CI, 0.015-6.00, p = 0.048) lower than in the presymptomatic group. The GSH-Px activity in the symptomatic group was 13.96 U/mg of protein (95% CI, 5.90-22.03, p < 0.001) lower than in the control group and 20.52 U/mg of protein (95% CI, 6.79-34.24, p < 0.001) lower than in the presymptomatic group and was inversely correlated with the neurological examination score for spinocerebellar ataxias (R = -0.309, p = 0.049). CONCLUSION Early/moderate stage SCA3/MJD patients presented a decreased antioxidant capacity and increased ROS generation. GSH-Px activity was the most promising oxidative stress disease biomarker in SCA3/MJD. Further longitudinal studies are necessary to identify both the roles of redox parameters in SCA3/MJD pathophysiology and as surrogate outcomes for clinical trials.
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Affiliation(s)
- Adriano M de Assis
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Saúde e Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas (UCPel), Pelotas, Brazil
| | - Jonas Alex Morales Saute
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Longoni
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Clarissa Branco Haas
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vitor Rocco Torrez
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andressa Wigner Brochier
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gabriele Nunes Souza
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gabriel Vasata Furtado
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tailise Conte Gheno
- Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Russo
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Thais Lampert Monte
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Raphael Machado Castilhos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Artur Schumacher-Schuh
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rui D'Avila
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Karina Carvalho Donis
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Carlos Roberto de Mello Rieder
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Neurologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Diogo Onofre Souza
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Suzi Camey
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Estatística, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Laboratório de Identificação Genética, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luis Valmor Portela
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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42
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Saute JAM, Souza CFMD, Poswar FDO, Donis KC, Campos LG, Deyl AVS, Burin MG, Vargas CR, Matte UDS, Giugliani R, Saraiva-Pereira ML, Vedolin LM, Gregianin LJ, Jardim LB. Neurological outcomes after hematopoietic stem cell transplantation for cerebral X-linked adrenoleukodystrophy, late onset metachromatic leukodystrophy and Hurler syndrome. Arq Neuropsiquiatr 2017; 74:953-966. [PMID: 27991992 DOI: 10.1590/0004-282x20160155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/24/2016] [Indexed: 01/12/2023]
Abstract
Objective To describe survival and neurological outcomes after HSCT for these disorders. Methods Seven CALD, 2 MLD and 2 MPS-IH patients underwent HSCT between 2007 and 2014. Neurological examinations, magnetic resonance imaging, molecular and biochemical studies were obtained at baseline and repeated when appropriated. Results Favorable outcomes were obtained with 4/5 related and 3/6 unrelated donors. Two patients died from procedure-related complications. Nine transplanted patients were alive after a median of 3.7 years: neurological stabilization was obtained in 5/6 CALD, 1/2 MLD, and one MPS-IH patient. Brain lesions of the MPS-IH patient were reduced four years after HSCT. Conclusion Good outcomes were obtained when HSCT was performed before adulthood, early in the clinical course, and/or from a related donor.
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Affiliation(s)
- Jonas Alex Morales Saute
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brasil
| | | | - Fabiano de Oliveira Poswar
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular; Porto Alegre RS, Brasil
| | - Karina Carvalho Donis
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre RS, Brasil
| | - Lillian Gonçalves Campos
- Hospital de Clínicas de Porto Alegre, Serviço de Radiologia, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brasil
| | | | - Maira Graeff Burin
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil
| | - Carmen Regla Vargas
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Farmacia, Porto Alegre, Brasil
| | - Ursula da Silveira Matte
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular; Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Terapia Gênica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Genética e Biologia Molecular, Porto Alegre RS, Brasil
| | - Roberto Giugliani
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular; Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Terapia Gênica, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Genética e Biologia Molecular, Porto Alegre RS, Brasil
| | - Maria Luiza Saraiva-Pereira
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular; Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Bioquímica, Porto Alegre RS, Brasil
| | - Leonardo Modesti Vedolin
- Hospital de Clínicas de Porto Alegre, Serviço de Radiologia, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brasil
| | - Lauro José Gregianin
- Hospital de Clínicas de Porto Alegre, Serviço de Oncologia Pediátrica, Porto Alegre, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Pediatria, Porto Alegre RS, Brasil
| | - Laura Bannach Jardim
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular; Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brasil
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43
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Marchetti DP, Donida B, Jacques CE, Deon M, Hauschild TC, Koehler-Santos P, de Moura Coelho D, Coitinho AS, Jardim LB, Vargas CR. Inflammatory profile in X-linked adrenoleukodystrophy patients: Understanding disease progression. J Cell Biochem 2017; 119:1223-1233. [PMID: 28722826 DOI: 10.1002/jcb.26295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 06/18/2017] [Accepted: 07/18/2017] [Indexed: 01/01/2023]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is an inherited disease characterized by progressive inflammatory demyelization in the brain, adrenal insufficiency, and an abnormal accumulation of very long chain fatty acids (VLCFA) in tissue and body fluids. Considering that inflammation might be involved in pathophysiology of X-ALD, we aimed to investigate pro- and anti-inflammatory cytokines in plasma from three different male phenotypes (CCER, AMN, and asymptomatic individuals). Our results showed that asymptomatic patients presented increased levels of pro-inflammatory cytokines IL-1β, IL-2, IL-8, and TNF-α and the last one was also higher in AMN phenotype. Besides, asymptomatic patients presented higher levels of anti-inflammatory cytokines IL-4 and IL-10. AMN patients presented higher levels of IL-2, IL-5, and IL-4. We might hypothesize that inflammation in X-ALD is related to plasmatic VLCFA concentration, since there were positive correlations between C26:0 plasmatic levels and pro-inflammatory cytokines in asymptomatic and AMN patients and negative correlation between anti-inflammatory cytokine and C24:0/C22:0 ratio in AMN patients. The present work yields experimental evidence that there is an inflammatory imbalance associated Th1, (IL-2, IL-6, and IFN-γ), Th2 (IL-4 and IL-10), and macrophages response (TNF-α and IL-1β) in the periphery of asymptomatic and AMN patients, and there is correlation between VLCFA plasmatic levels and inflammatory mediators in X-ALD. Furthermore, we might also speculate that the increase of plasmatic cytokines in asymptomatic patients could be considered an early biomarker of brain damage and maybe also a predictor of disease progression.
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Affiliation(s)
- Desirèe Padilha Marchetti
- Programa de Pós-Graduação em Ciências Biológicas, Bioquímica, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Donida
- Programa de Pós-Graduação em Ciências Biológicas, Bioquímica, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Eduardo Jacques
- Programa de Pós-Graduação em Ciências Biológicas, Bioquímica, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marion Deon
- Programa de Pós-Graduação em Ciências Farmacêuticas, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Serviço de Genética Médica, HCPA, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Patricia Koehler-Santos
- Unidade de Análises Moleculares e de Proteínas (UAMP), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniella de Moura Coelho
- Serviço de Genética Médica, HCPA, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Adriana Simon Coitinho
- Programa de Pós-Graduação em Ciências Biológicas, Fisiologia, UFRGS, Instituto de Ciências Básicas e da Saúde, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Serviço de Genética Médica, HCPA, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carmen Regla Vargas
- Programa de Pós-Graduação em Ciências Biológicas, Bioquímica, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.,Serviço de Genética Médica, HCPA, Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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44
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Burguêz D, Oliveira CMD, Rockenbach MABC, Fussiger H, Vedolin LM, Winckler PB, Maestri MK, Finkelsztejn A, Santorelli FM, Jardim LB, Saute JAM. Autosomal recessive spastic ataxia of Charlevoix-Saguenay: a family report from South Brazil. Arq Neuropsiquiatr 2017; 75:339-344. [PMID: 28658401 DOI: 10.1590/0004-282x20170044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/14/2017] [Indexed: 12/28/2022]
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset, neurodegenerative disorder caused by mutations in SACS, firstly reported in Quebec, Canada. The disorder is typically characterized by childhood onset ataxia, spasticity, neuropathy and retinal hypermyelination. The clinical picture of patients born outside Quebec, however, is often atypical. In the present article, the authors describe clinical and neuroradiological findings that raised the suspicion of an ARSACS diagnosis in two female cousins with Germanic background from Rio Grande do Sul, Brazil. We present a review on the neuroimaging, ophthalmologic and neurophysiologic clues for ARSACS diagnosis. The early-onset, slowly progressive, spastic-ataxia phenotype of reported patients was similar to ARSACS patients from Quebec. The SACS sequencing revealed the novel homozygous c.5150_5151insA frameshift mutation confirming the ARSACS diagnosis. ARSACS is a frequent cause of early onset ataxia/spastic-ataxia worldwide, with unknown frequency in Brazil.
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Affiliation(s)
- Daniela Burguêz
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil
| | | | | | - Helena Fussiger
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil
| | - Leonardo Modesti Vedolin
- Hospital de Clínicas de Porto Alegre, Serviço de Radiologia, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brasil
| | - Pablo Brea Winckler
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brasil
| | | | | | | | - Laura Bannach Jardim
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre RS, Brasil
| | - Jonas Alex Morales Saute
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Identificação Genética, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil
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45
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Fussiger H, Jardim LB, Saute JA. Letter re: Cathepsin A–related arteriopathy with strokes and leukoencephalopathy (CARASAL). Neurology 2017; 88:1776. [DOI: 10.1212/wnl.0000000000003898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Souza GN, Kersting N, Gonçalves TA, Pacheco DLO, Saraiva-Pereira ML, Camey SA, Saute JAM, Jardim LB. Cancer in Machado–Joseph disease patients—low frequency as a cause of death. Cancer Genet 2017; 212-213:19-23. [DOI: 10.1016/j.cancergen.2017.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/13/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
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47
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Saute JAM, Jardim LB. Challenges in quantifying ataxia in core and comorbid early onset ataxias. Dev Med Child Neurol 2017; 59:350-351. [PMID: 27800607 DOI: 10.1111/dmcn.13305] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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48
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da Silva Carvalho G, Saute JAM, Haas CB, Torrez VR, Brochier AW, Souza GN, Furtado GV, Gheno T, Russo A, Monte TL, Schumacher-Schuh A, D'Avila R, Donis KC, Castilhos RM, Souza DO, Saraiva-Pereira ML, Torman VL, Camey S, Portela LV, Jardim LB. Cytokines in Machado Joseph Disease/Spinocerebellar Ataxia 3. Cerebellum 2017; 15:518-25. [PMID: 26395908 DOI: 10.1007/s12311-015-0719-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of the present study is to describe the serum concentrations of a broad spectrum of cytokines in symptomatic and asymptomatic carriers of Machado Joseph disease (SCA3/MJD) CAG expansions. Molecularly confirmed carriers and controls were studied. Age at onset, disease duration, and clinical scales Scale for the Assessment and Rating of Ataxia (SARA), Neurological Examination Score for Spinocerebellar Ataxias (NESSCA), SCA Functional Index (SCAFI), and Composite Cerebellar Functional Score (CCFS) were obtained from the symptomatic carriers. Serum was obtained from all individuals and a cytokine panel "consisted of" eotaxin, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-α, IFN-γ, interleukin (IL)-1β, IL-1RA, IL-2, IL-2R, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, interferon gamma-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, monokine induced by gamma interferon (MIG), macrophage inflammatory protein (MIP)-a, MIP-b, regulated on activation, normal T cell expressed and secreted (RANTES) and tumor necrosis factor (TNF)-α was analyzed. In a subgroup of symptomatic carriers, the cytokine panel was repeated after 360 days. Cytokine distribution among groups was studied by discriminant analysis; changes in serum levels after 360 days were studied by generalized estimation equation. Sixty-six symptomatic carriers, 13 asymptomatic carriers, and 43 controls were studied. No differences in cytokine patterns were found between controls and carriers of the CAG expansions or between controls and symptomatic carriers only. In contrast, eotaxin concentrations were significantly higher in asymptomatic than in symptomatic carriers or in controls (p = 0.001, ANCOVA). Eotaxin did not correlate with age, disease duration, CAG expansion, NESSCA score, and SARA score. Among symptomatic carriers, eotaxin dropped after 360 days (p = 0.039, GEE). SCA3/MJD patients presented a benign pattern of serum cytokines. In contrast, levels of eotaxin, a peptide secreted by astrocytes, were elevated in the asymptomatic carriers, suggesting that a specific response of these cells can be related to symptom progression, in SCA3/MJD.
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Affiliation(s)
- Gerson da Silva Carvalho
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jonas Alex Morales Saute
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Clarissa Branco Haas
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vitor Rocco Torrez
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andressa Wigner Brochier
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriele Nunes Souza
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Vasata Furtado
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tailise Gheno
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Aline Russo
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Thais Lampert Monte
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Artur Schumacher-Schuh
- Neurology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Rui D'Avila
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Karina Carvalho Donis
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Raphael Machado Castilhos
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Diogo Onofre Souza
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Instituto Nacional de Ciência e Tecnologia em Excitotoxicidade e Neuroproteção (INCTEN), Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil
| | - Vanessa Leotti Torman
- Department of Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Suzi Camey
- Department of Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luis Valmor Portela
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Instituto Nacional de Ciência e Tecnologia em Excitotoxicidade e Neuroproteção (INCTEN), Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Post-Graduate Programme in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Post-Graduate Programme in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, Brazil.
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Klaes A, Reckziegel E, Franca MC, Rezende TJR, Vedolin LM, Jardim LB, Saute JA. MR Imaging in Spinocerebellar Ataxias: A Systematic Review. AJNR Am J Neuroradiol 2016; 37:1405-12. [PMID: 27173364 PMCID: PMC7960281 DOI: 10.3174/ajnr.a4760] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 11/25/2015] [Accepted: 01/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Polyglutamine expansion spinocerebellar ataxias are autosomal dominant slowly progressive neurodegenerative diseases with no current treatment. MR imaging is the best-studied surrogate biomarker candidate for polyglutamine expansion spinocerebellar ataxias, though with conflicting results. We aimed to review quantitative central nervous system MR imaging technique findings in patients with polyglutamine expansion spinocerebellar ataxias and correlations with well-established clinical and molecular disease markers. MATERIALS AND METHODS We searched MEDLINE, LILACS, and Cochrane data bases of clinical trials between January 1995 and January 2016, for quantitative MR imaging volumetric approaches, MR spectroscopy, diffusion tensor imaging, or other quantitative techniques, comparing patients with polyglutamine expansion spinocerebellar ataxias (SCAs) with controls. Pertinent details for each study regarding participants, imaging methods, and results were extracted. RESULTS After reviewing the 706 results, 18 studies were suitable for inclusion: 2 studies in SCA1, 1 in SCA2, 15 in SCA3, 1 in SCA7, 1 in SCA1 and SCA6 presymptomatic carriers, and none in SCA17 and dentatorubropallidoluysian atrophy. Cerebellar hemispheres and vermis, whole brain stem, midbrain, pons, medulla oblongata, cervical spine, striatum, and thalamus presented significant atrophy in SCA3. The caudate, putamen and whole brain stem presented similar sensitivity to change compared with ataxia scales after 2 years of follow-up in a single prospective study in SCA3. MR spectroscopy and DTI showed abnormalities only in cross-sectional studies in SCA3. Results from single studies in other polyglutamine expansion spinocerebellar ataxias should be replicated in different cohorts. CONCLUSIONS Additional cross-sectional and prospective volumetric analysis, MR spectroscopy, and DTI studies are necessary in polyglutamine expansion spinocerebellar ataxias. The properties of preclinical disease biomarkers (presymptomatic) of MR imaging should be targeted in future studies.
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Affiliation(s)
- A Klaes
- From the Departments of Radiology (A.K., L.M.V.)
| | - E Reckziegel
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - M C Franca
- Departments of Neurology (M.C.F., T.J.R.R.)
| | - T J R Rezende
- Departments of Neurology (M.C.F., T.J.R.R.) Cosmic Rays and Chronology (T.J.R.R.), Universidade Estadual de Campinas, Campinas, Brazil
| | - L M Vedolin
- From the Departments of Radiology (A.K., L.M.V.) Department of Internal Medicine (L.M.V., L.B.J.)
| | - L B Jardim
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Internal Medicine (L.M.V., L.B.J.) Postgraduate Program in Medicine: Medical Sciences (L.B.J.), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J A Saute
- Medical Genetics Services (E.R., L.B.J., J.A.M.S.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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50
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Poswar FDO, da Fonseca RMT, de Albuquerque LCP, Zhou Q, Jardim LB, Monte TL, Aksentijevich I, Saute JAM. Adenosine deaminase 2 deficiency presenting as spastic paraplegia and systemic vasculitis. J Neurol 2016; 263:818-20. [PMID: 26914925 DOI: 10.1007/s00415-016-8070-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Fabiano de Oliveira Poswar
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Zip Code 90.035-903, Brazil
| | | | | | - Qing Zhou
- National Institutes of Health, National Human Genome Research Institute, Bethesda, USA
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Zip Code 90.035-903, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thais Lampert Monte
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ivona Aksentijevich
- National Institutes of Health, National Human Genome Research Institute, Bethesda, USA
| | - Jonas Alex Morales Saute
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Zip Code 90.035-903, Brazil. .,Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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