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Nishide M, Le Marquand K, Davis MR, Halmágyi GM, Fellner A, Narayanan RK, Kennerson ML, Reddel SW, Worgan L, Panegyres PK, Kumar KR. Two New Families and a Literature Review of ELOVL4-Associated Spinocerebellar Ataxia Type 34. Cerebellum 2024; 23:268-277. [PMID: 36696030 PMCID: PMC10864522 DOI: 10.1007/s12311-023-01522-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Autosomal dominant variants in ELOVL4 cause spinocerebellar ataxia type 34 (SCA34; ATX-ELOVL4), classically associated with a skin condition known as erythrokeratoderma. Here, we report a large Italian-Maltese-Australian family with spinocerebellar ataxia. Notably, while there were dermatological manifestations (eczema), erythrokeratoderma was not present. Using a next-generation sequencing panel, we identified a previously reported ELOVL4 variant, NM_022726.4: c.698C > T p.(Thr233Met). The variant was initially classified as a variant of uncertain significance; however, through segregation studies, we reclassified the variant as likely pathogenic. We next identified an individual from another family (Algerian-Maltese-Australian) with the same ELOVL4 variant with spinocerebellar ataxia but without dermatological manifestations. We subsequently performed the first dedicated literature review of ELOVL4-associated ataxia to gain further insights into genotype-phenotype relationships. We identified a total of 60 reported cases of SCA34 to date. The majority had gait ataxia (88.3%), limb ataxia (76.7%), dysarthria (63.3%), and nystagmus (58.3%). Of note, skin lesions related to erythrokeratoderma were seen in a minority of cases (33.3%). Other extracerebellar manifestations included pyramidal tract signs, autonomic disturbances, retinitis pigmentosa, and cognitive impairment. For brain MRI data, cerebellar atrophy was seen in all cases (100%), whereas the hot cross bun sign (typically associated with multiple system atrophy type C) was seen in 32.4% of cases. Our family study and literature review highlight the variable phenotypic spectrum of SCA34. Importantly, it shows that erythrokeratoderma is not found in most cases and that, while a dermatological assessment may be helpful in these patients, SCA34 diagnosis should be considered irrespective of dermatological manifestations.
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Affiliation(s)
- Masahiro Nishide
- Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Kathleen Le Marquand
- Clinical Genetics Service, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Mark R Davis
- Department of Diagnostic Genomics, Path West Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia
| | - Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Camperdown and the University of Sydney, Sydney, NSW, 2050, Australia
| | - Avi Fellner
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
- Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Hospital, 4941492, Petah Tikva, Israel
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, 4941492, Petah Tikva, Israel
| | - Ramesh K Narayanan
- Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - Marina L Kennerson
- Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, NSW, 2139, Australia
- Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Stephen W Reddel
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Lisa Worgan
- Clinical Genetics Service, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, WA, 6005, Australia
- School of Medicine, The University of Western Australia, Nedlands, WA, 6008, Australia
| | - Kishore R Kumar
- Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia.
- Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
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Ozaki K, Irioka T, Uchihara T, Yamada A, Nakamura A, Majima T, Igarashi S, Shintaku H, Yakeishi M, Tsuura Y, Okazaki Y, Ishikawa K, Yokota T. Neuropathology of SCA34 showing widespread oligodendroglial pathology with vacuolar white matter degeneration: a case study. Acta Neuropathol Commun 2021; 9:172. [PMID: 34689836 PMCID: PMC8543940 DOI: 10.1186/s40478-021-01272-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/10/2021] [Indexed: 12/19/2022] Open
Abstract
Spinocerebellar ataxia type 34 (SCA34) is an autosomal dominant inherited ataxia due to mutations in ELOVL4, which encodes one of the very long-chain fatty acid elongases. SCA38, another spinocerebellar ataxia, is caused by mutations in ELOVL5, a gene encoding another elongase. However, there have been no previous studies describing the neuropathology of either SCA34 or 38. This report describes the neuropathological findings of an 83-year-old man with SCA34 carrying a pathological ELOVL4 mutation (NM_022726, c.736T>G, p.W246G). Macroscopic findings include atrophies in the pontine base, cerebellum, and cerebral cortices. Microscopically, marked neuronal and pontocerebellar fiber loss was observed in the pontine base. In addition, in the pontine base, accumulation of CD68-positive macrophages laden with periodic acid-Schiff (PAS)-positive material was observed. Many vacuolar lesions were found in the white matter of the cerebral hemispheres and, to a lesser extent, in the brainstem and spinal cord white matter. Immunohistological examination and ultrastructural observations with an electron microscope suggest that these vacuolar lesions are remnants of degenerated oligodendrocytes. Electron microscopy also revealed myelin sheath destruction. Unexpectedly, aggregation of the four-repeat tau was observed in a spatial pattern reminiscent of progressive supranuclear palsy. The tau lesions included glial fibrillary tangles resembling tuft-shaped astrocytes and neurofibrillary tangles and pretangles. This is the first report to illustrate that a heterozygous missense mutation in ELOVL4 leads to neuronal loss accompanied by macrophages laden with PAS-positive material in the pontine base and oligodendroglial degeneration leading to widespread vacuoles in the white matter in SCA34.
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