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Iyer S, Sam FS, DiPrimio N, Preston G, Verheijen J, Murthy K, Parton Z, Tsang H, Lao J, Morava E, Perlstein EO. Repurposing the aldose reductase inhibitor and diabetic neuropathy drug epalrestat for the congenital disorder of glycosylation PMM2-CDG. Dis Model Mech 2019; 12:dmm.040584. [PMID: 31636082 PMCID: PMC6899038 DOI: 10.1242/dmm.040584] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022] Open
Abstract
Phosphomannomutase 2 deficiency, or PMM2-CDG, is the most common congenital disorder of glycosylation and affects over 1000 patients globally. There are no approved drugs that treat the symptoms or root cause of PMM2-CDG. To identify clinically actionable compounds that boost human PMM2 enzyme function, we performed a multispecies drug repurposing screen using a novel worm model of PMM2-CDG, followed by PMM2 enzyme functional studies in PMM2-CDG patient fibroblasts. Drug repurposing candidates from this study, and drug repurposing candidates from a previously published study using yeast models of PMM2-CDG, were tested for their effect on human PMM2 enzyme activity in PMM2-CDG fibroblasts. Of the 20 repurposing candidates discovered in the worm-based phenotypic screen, 12 were plant-based polyphenols. Insights from structure–activity relationships revealed epalrestat, the only antidiabetic aldose reductase inhibitor approved for use in humans, as a first-in-class PMM2 enzyme activator. Epalrestat increased PMM2 enzymatic activity in four PMM2-CDG patient fibroblast lines with genotypes R141H/F119L, R141H/E139K, R141H/N216I and R141H/F183S. PMM2 enzyme activity gains ranged from 30% to 400% over baseline, depending on genotype. Pharmacological inhibition of aldose reductase by epalrestat may shunt glucose from the polyol pathway to glucose-1,6-bisphosphate, which is an endogenous stabilizer and coactivator of PMM2 homodimerization. Epalrestat is a safe, oral and brain penetrant drug that was approved 27 years ago in Japan to treat diabetic neuropathy in geriatric populations. We demonstrate that epalrestat is the first small molecule activator of PMM2 enzyme activity with the potential to treat peripheral neuropathy and correct the underlying enzyme deficiency in a majority of pediatric and adult PMM2-CDG patients. Editor's choice: Drug repurposing screens using worm and patient fibroblast models of PMM2-CDG led to the discovery of epalrestat, the first activator of PMM2 that targets the root cause of disease.
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Affiliation(s)
- Sangeetha Iyer
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Feba S Sam
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Nina DiPrimio
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Graeme Preston
- Department of Clinical Genomics and Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Jan Verheijen
- Department of Clinical Genomics and Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Kausalya Murthy
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Zachary Parton
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Hillary Tsang
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Jessica Lao
- Perlara PBC, 2625 Alcatraz Ave #435, Berkeley, CA 94705, USA
| | - Eva Morava
- Department of Clinical Genomics and Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Iyer S, Mast JD, Tsang H, Rodriguez TP, DiPrimio N, Prangley M, Sam FS, Parton Z, Perlstein EO. Drug screens of NGLY1 deficiency in worm and fly models reveal catecholamine, NRF2 and anti-inflammatory-pathway activation as potential clinical approaches. Dis Model Mech 2019; 12:dmm.040576. [PMID: 31615832 PMCID: PMC6899034 DOI: 10.1242/dmm.040576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/17/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022] Open
Abstract
N-glycanase 1 (NGLY1) deficiency is an ultra-rare and complex monogenic glycosylation disorder that affects fewer than 40 patients globally. NGLY1 deficiency has been studied in model organisms such as yeast, worms, flies and mice. Proteasomal and mitochondrial homeostasis gene networks are controlled by the evolutionarily conserved transcriptional regulator NRF1, whose activity requires deglycosylation by NGLY1. Hypersensitivity to the proteasome inhibitor bortezomib is a common phenotype observed in whole-animal and cellular models of NGLY1 deficiency. Here, we describe unbiased phenotypic drug screens to identify FDA-approved drugs that are generally recognized as safe natural products, and novel chemical entities, that rescue growth and development of NGLY1-deficient worm and fly larvae treated with a toxic dose of bortezomib. We used image-based larval size and number assays for use in screens of a 2560-member drug-repurposing library and a 20,240-member lead-discovery library. A total of 91 validated hit compounds from primary invertebrate screens were tested in a human cell line in an NRF2 activity assay. NRF2 is a transcriptional regulator that regulates cellular redox homeostasis, and it can compensate for loss of NRF1. Plant-based polyphenols make up the largest class of hit compounds and NRF2 inducers. Catecholamines and catecholamine receptor activators make up the second largest class of hits. Steroidal and non-steroidal anti-inflammatory drugs make up the third largest class. Only one compound was active in all assays and species: the atypical antipsychotic and dopamine receptor agonist aripiprazole. Worm and fly models of NGLY1 deficiency validate therapeutic rationales for activation of NRF2 and anti-inflammatory pathways based on results in mice and human cell models, and suggest a novel therapeutic rationale for boosting catecholamine levels and/or signaling in the brain. Summary: Using worm and fly models of an ultra-rare congenital disorder of glycosylation, we performed repurposing screens and identified the FDA-approved drug aripiprazole as a clinical candidate.
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Affiliation(s)
- Sangeetha Iyer
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
| | - Joshua D Mast
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
| | - Hillary Tsang
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
| | | | - Nina DiPrimio
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
| | | | - Feba S Sam
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
| | - Zachary Parton
- Perlara PBC, 2625 Alcatraz Ave, #435, Berkeley, CA 94705, USA
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Mao Q, Wang D, Li Y, Kohler M, Wilson J, Parton Z, Shmaltsuyeva B, Gursel D, Rademakers R, Weintraub S, Mesulam MM, Xia H, Bigio EH. Disease and Region Specificity of Granulin Immunopositivities in Alzheimer Disease and Frontotemporal Lobar Degeneration. J Neuropathol Exp Neurol 2017; 76:957-968. [PMID: 29044416 DOI: 10.1093/jnen/nlx085] [Citation(s) in RCA: 19] [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] [Indexed: 12/11/2022] Open
Abstract
Heterozygous loss-of-function mutations in GRN, the progranulin gene, which result in progranulin (PGRN) protein haploinsufficiency, are a major cause of frontotemporal lobar degeneration with TDP-43 proteinopathy (FTLD-TDP). PGRN is composed of seven and a half repeats of a highly conserved granulin motif that is cleaved to produce the granulin peptides A-G and paragranulin. To better understand the role of PGRN and granulin (Grn) peptides in the pathogenesis of neurodegeneration, we evaluated PGRN/Grn in brains of patients with Alzheimer disease, FTLD-TDP type A with or without GRN mutations, and normal individuals, using a panel of monoclonal antibodies against Grn peptides A-G. In the neocortex, Grn peptide-specific immunostains were observed, for example, membranous Grn E immunopositivity in pyramidal neurons, and Grn C immunopositivity in ramified microglia. In the hippocampus, Grn immunopositivity in the CA1 and CA2 regions showed disease-specific changes in both neurons and microglia. Most interestingly, in FTLD-TDP type A with GRN mutations, there is a 60% decrease in the density of Grn-positive microglia in the hippocampal CA1, suggesting that haploinsufficiency of the GRN mutations also extends to PGRN expression in microglia. This study provides important insights into future studies of the pathogenesis and treatment of FTLD-TDP.
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Affiliation(s)
- Qinwen Mao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Dongyang Wang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Yanqing Li
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Missia Kohler
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Jayson Wilson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Zachary Parton
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Bella Shmaltsuyeva
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Demirkan Gursel
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Rosa Rademakers
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Sandra Weintraub
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Marek-Marsel Mesulam
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Haibin Xia
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, P.R. China; The Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pathology Core Facility, Robert H. Lurie Comprehensive Cancer Center, Northwestern University School of Medicine, Chicago, Illinois; Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
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