101
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Hartley MD, Kirkemo LL, Banerji T, Scanlan TS. A Thyroid Hormone-Based Strategy for Correcting the Biochemical Abnormality in X-Linked Adrenoleukodystrophy. Endocrinology 2017; 158:1328-1338. [PMID: 28200172 PMCID: PMC5460829 DOI: 10.1210/en.2016-1842] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 02/05/2023]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a rare, genetic disorder characterized by adrenal insufficiency and central nervous system (CNS) demyelination. All patients with X-ALD have the biochemical abnormality of elevated blood and tissue levels of very long chain fatty acids (VLCFAs), saturated fatty acids with 24 to 26 carbons. X-ALD results from loss of function mutations in the gene encoding the peroxisomal transporter ABCD1, which is responsible for uptake of VLCFAs into peroxisomes for degradation by oxidation. One proposed therapeutic strategy for genetic complementation of ABCD1 is pharmacologic upregulation of ABCD2, a gene encoding a homologous peroxisomal transporter. Here, we show that thyroid hormone or sobetirome, a clinical-stage selective thyroid hormone receptor agonist, increases cerebral Abcd2 and lowers VLCFAs in blood, peripheral organs, and brains of mice with defective Abcd1. These results support an approach to treating X-ALD that involves a thyromimetic agent that reactivates VLCFA disposal both in the periphery and the CNS.
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Affiliation(s)
- Meredith D. Hartley
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Lisa L. Kirkemo
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Tapasree Banerji
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Thomas S. Scanlan
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
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102
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Takashima S, Toyoshi K, Itoh T, Kajiwara N, Honda A, Ohba A, Takemoto S, Yoshida S, Shimozawa N. Detection of unusual very-long-chain fatty acid and ether lipid derivatives in the fibroblasts and plasma of patients with peroxisomal diseases using liquid chromatography-mass spectrometry. Mol Genet Metab 2017; 120:255-268. [PMID: 28089346 DOI: 10.1016/j.ymgme.2016.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
Metabolic changes occur in patients with peroxisomal diseases owing to impairments in the genes involved in peroxisome function. For diagnostic purposes, saturated very-long-chain fatty acids (VLCFAs) such as C24:0 and C26:0, phytanic acid, pristanic acid, and plasmalogens are often measured as metabolic hallmarks. As the direct pathology of peroxisomal disease is yet to be fully elucidated, we sought to explore the fatty acid species that accumulate in patients with peroxisomal diseases. We developed a method for detecting a range of fatty acids implicated in peroxisomal diseases such as Zellweger syndrome (ZS) and X-linked adrenoleukodystrophy (X-ALD). To this end, we employed an ultra-performance liquid chromatography-mass spectrometry (LC-MS) coupled with negatively charged electrospray ionization. Fatty acids from patients and control subjects were extracted from total lipids by acid-hydrolysis and compared. In accordance with previous results, the amounts of VLCFAs, phytanic acid, and pristanic acid differed between the two groups. We identified extremely long and highly polyunsaturated VLCFAs (ultra-VLC-PUFAs) such as C44:12 in ZS samples. Moreover, three unknown molecules were prominent in control samples but scarcely detectable in ZS samples. LC-MS/MS analysis identified these as 1-alkyl-sn-glycerol 3-phosphates derived from ether lipids containing fatty alcohols such as C16:0, C18:0, or C18:1. Our method provides an approach to observing a wide range of lipid-derived fatty acids and related molecules in order to understand the metabolic changes involved in peroxisomal diseases. This technique can therefore be used in identifying metabolic markers and potential clinical targets for future treatment.
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Affiliation(s)
- Shigeo Takashima
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan.
| | - Kayoko Toyoshi
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
| | - Takahiro Itoh
- Department of Biomolecular Science, Faculty of Engineering, Gifu University, Japan
| | - Naomi Kajiwara
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
| | - Ayako Honda
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
| | - Akiko Ohba
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
| | - Shoko Takemoto
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
| | - Satoshi Yoshida
- Department of Biomolecular Science, Faculty of Engineering, Gifu University, Japan
| | - Nobuyuki Shimozawa
- Division of Genomics Research, Life Science Research Center, Gifu University, Japan
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103
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Breen DP, Stinton V, De Silva RN. A hill walker with long chains. Pract Neurol 2017; 17:71-73. [DOI: 10.1136/practneurol-2016-001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 11/04/2022]
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104
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Affiliation(s)
| | - Maria Daniela D'Agostino
- McGill University Department of Human Genetics and McGill University Health Center, Department of Medical Genetics, Montreal, QC, Canada
| | - Nancy Braverman
- McGill University Department of Human Genetics and Pediatrics, and The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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105
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Jang J, Park S, Jin Hur H, Cho HJ, Hwang I, Pyo Kang Y, Im I, Lee H, Lee E, Yang W, Kang HC, Won Kwon S, Yu JW, Kim DW. 25-hydroxycholesterol contributes to cerebral inflammation of X-linked adrenoleukodystrophy through activation of the NLRP3 inflammasome. Nat Commun 2016; 7:13129. [PMID: 27779191 PMCID: PMC5093305 DOI: 10.1038/ncomms13129] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/06/2016] [Indexed: 12/16/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD), caused by an ABCD1 mutation, is a progressive neurodegenerative disorder associated with the accumulation of very long-chain fatty acids (VLCFA). Cerebral inflammatory demyelination is the major feature of childhood cerebral ALD (CCALD), the most severe form of ALD, but its underlying mechanism remains poorly understood. Here, we identify the aberrant production of cholesterol 25-hydroxylase (CH25H) and 25-hydroxycholesterol (25-HC) in the cellular context of CCALD based on the analysis of ALD patient-derived induced pluripotent stem cells and ex vivo fibroblasts. Intriguingly, 25-HC, but not VLCFA, promotes robust NLRP3 inflammasome assembly and activation via potassium efflux-, mitochondrial reactive oxygen species (ROS)- and liver X receptor (LXR)-mediated pathways. Furthermore, stereotaxic injection of 25-HC into the corpus callosum of mouse brains induces microglial recruitment, interleukin-1β production, and oligodendrocyte cell death in an NLRP3 inflammasome-dependent manner. Collectively, our results indicate that 25-HC mediates the neuroinflammation of X-ALD via activation of the NLRP3 inflammasome. The mechanism underlying neuroinflammation in X-linked adrenoleukodystrophy (ALD) is poorly understood. Here authors identify aberrant production of 25-hydroxycholesterol (25-HC) in ALD patient-derived cells, and show that 25-HC mediates neuroinflammation via activating the NLRP3 inflammasome.
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Affiliation(s)
- Jiho Jang
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sangjun Park
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye Jin Hur
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hyun-Ju Cho
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Inhwa Hwang
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yun Pyo Kang
- College of Pharmacy, Seoul National University, Seoul 08826, Korea
| | - Isak Im
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hyunji Lee
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eunju Lee
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Wonsuk Yang
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Seoul 03722, Korea
| | - Sung Won Kwon
- College of Pharmacy, Seoul National University, Seoul 08826, Korea
| | - Je-Wook Yu
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong-Wook Kim
- Department of Physiology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
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106
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Neumann J, Rose-Sperling D, Hellmich UA. Diverse relations between ABC transporters and lipids: An overview. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2016; 1859:605-618. [PMID: 27693344 DOI: 10.1016/j.bbamem.2016.09.023] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/19/2022]
Abstract
It was first discovered in 1992 that P-glycoprotein (Pgp, ABCB1), an ATP binding cassette (ABC) transporter, can transport phospholipids such as phosphatidylcholine, -ethanolamine and -serine as well as glucosylceramide and glycosphingolipids. Subsequently, many other ABC transporters were identified to act as lipid transporters. For substrate transport by ABC transporters, typically a classic, alternating access model with an ATP-dependent conformational switch between a high and a low affinity substrate binding site is evoked. Transport of small hydrophilic substrates can easily be imagined this way, as the molecule can in principle enter and exit the transporter in the same orientation. Lipids on the other hand need to undergo a 180° degree turn as they translocate from one membrane leaflet to the other. Lipids and lipidated molecules are highly diverse, so there may be various ways how to achieve their flipping and flopping. Nonetheless, an increase in biophysical, biochemical and structural data is beginning to shed some light on specific aspects of lipid transport by ABC transporters. In addition, there is now abundant evidence that lipids affect ABC transporter conformation, dynamics as well as transport and ATPase activity in general. In this review, we will discuss different ways in which lipids and ABC transporters interact and how lipid translocation may be achieved with a focus on the techniques used to investigate these processes. This article is part of a Special Issue entitled: Lipid order/lipid defects and lipid-control of protein activity edited by Dirk Schneider.
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Affiliation(s)
- Jennifer Neumann
- Institute of Pharmacy and Biochemistry, Johannes Gutenberg University Mainz, Johann-Joachim-Becher-Weg 30, 55128 Mainz, Germany
| | - Dania Rose-Sperling
- Institute of Pharmacy and Biochemistry, Johannes Gutenberg University Mainz, Johann-Joachim-Becher-Weg 30, 55128 Mainz, Germany
| | - Ute A Hellmich
- Institute of Pharmacy and Biochemistry, Johannes Gutenberg University Mainz, Johann-Joachim-Becher-Weg 30, 55128 Mainz, Germany.
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107
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ABC Transporter Subfamily D: Distinct Differences in Behavior between ABCD1-3 and ABCD4 in Subcellular Localization, Function, and Human Disease. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6786245. [PMID: 27766264 PMCID: PMC5059523 DOI: 10.1155/2016/6786245] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
Abstract
ATP-binding cassette (ABC) transporters are one of the largest families of membrane-bound proteins and transport a wide variety of substrates across both extra- and intracellular membranes. They play a critical role in maintaining cellular homeostasis. To date, four ABC transporters belonging to subfamily D have been identified. ABCD1-3 and ABCD4 are localized to peroxisomes and lysosomes, respectively. ABCD1 and ABCD2 are involved in the transport of long and very long chain fatty acids (VLCFA) or their CoA-derivatives into peroxisomes with different substrate specificities, while ABCD3 is involved in the transport of branched chain acyl-CoA into peroxisomes. On the other hand, ABCD4 is deduced to take part in the transport of vitamin B12 from lysosomes into the cytosol. It is well known that the dysfunction of ABCD1 results in X-linked adrenoleukodystrophy, a severe neurodegenerative disease. Recently, it is reported that ABCD3 and ABCD4 are responsible for hepatosplenomegaly and vitamin B12 deficiency, respectively. In this review, the targeting mechanism and physiological functions of the ABCD transporters are summarized along with the related disease.
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108
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정을식, 강훈철, 고아라. X-linked adrenoleukodystrophy; Recent Advances in Classification, Diagnosis and Management. ACTA ACUST UNITED AC 2016. [DOI: 10.26815/jkcns.2016.24.3.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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109
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Abstract
Gene therapy has recently shown great promise as an effective treatment for a number of metabolic diseases caused by genetic defects in both animal models and human clinical trials. Most of the current success has been achieved using a viral mediated gene addition approach, but gene-editing technology has progressed rapidly and gene modification is being actively pursued in clinical trials. This review focuses on viral mediated gene addition approaches, because most of the current clinical trials utilize this approach to treat metabolic diseases.
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Affiliation(s)
- Randy J Chandler
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles P Venditti
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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110
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Dunkl V, Rau I, Wunderlich G, Fink GR, Lehmann HC. Oligosymptomatic adrenomyeloneuropathy due to a novel mutation in the ABCD1 start codon. J Neurol Sci 2016; 367:81-2. [PMID: 27423567 DOI: 10.1016/j.jns.2016.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/13/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Veronika Dunkl
- Department of Neurology, University Hospital of Cologne, Germany.
| | - Isabella Rau
- Department of Genetics, University of Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, 52425 Juelich, Germany.
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Germany.
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111
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Howard R, Chataway J, Edwards M, Heales S, Lachmann R, Leff A, Murphy E. Toxic, Metabolic and Physical Insults to the Nervous System and Inherited Disorders of Metabolism. Neurology 2016. [DOI: 10.1002/9781118486160.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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112
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Lee JY, Petratos S. Thyroid Hormone Signaling in Oligodendrocytes: from Extracellular Transport to Intracellular Signal. Mol Neurobiol 2016; 53:6568-6583. [PMID: 27427390 DOI: 10.1007/s12035-016-0013-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/10/2016] [Indexed: 01/24/2023]
Abstract
Thyroid hormone plays an important role in central nervous system (CNS) development, including the myelination of variable axonal calibers. It is well-established that thyroid hormone is required for the terminal differentiation of oligodendrocyte precursor cells (OPCs) into myelinating oligodendrocytes by inducing rapid cell-cycle arrest and constant transcription of pro-differentiation genes. This is well supported by the hypomyelinating phenotypes exhibited by patients with congenital hypothyroidism, cretinism. During development, myelinating oligodendrocytes only appear after the formation of neural circuits, indicating that the timing of oligodendrocyte differentiation is important. Since fetal and post-natal serum thyroid hormone levels peak at the stage of active myelination, it is suspected that the timing of oligodendrocyte development is finely controlled by thyroid hormone. The essential machinery for thyroid hormone signaling such as deiodinase activity (utilized by cells to auto-regulate the level of thyroid hormone), and nuclear thyroid hormone receptors (for gene transcription) are expressed on oligodendrocytes. In this review, we discuss the known and potential thyroid hormone signaling pathways that may regulate oligodendrocyte development and CNS myelination. Moreover, we evaluate the potential of targeting thyroid hormone signaling for white matter injury or disease.
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Affiliation(s)
- Jae Young Lee
- Department of Medicine, Central Clinical School, Monash University, Prahran, Victoria, 3004, Australia.,ToolGen, Inc., #1204, Byucksan Digital Valley 6-cha, Seoul, South Korea
| | - Steven Petratos
- Department of Medicine, Central Clinical School, Monash University, Prahran, Victoria, 3004, Australia.
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113
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Kemper AR, Brosco J, Comeau AM, Green NS, Grosse SD, Jones E, Kwon JM, Lam WKK, Ojodu J, Prosser LA, Tanksley S. Newborn screening for X-linked adrenoleukodystrophy: evidence summary and advisory committee recommendation. Genet Med 2016; 19:121-126. [PMID: 27337030 DOI: 10.1038/gim.2016.68] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/15/2016] [Indexed: 11/09/2022] Open
Abstract
The secretary of the US Department of Health and Human Services in February 2016 recommended that X-linked adrenoleukodystrophy (X-ALD) be added to the recommended uniform screening panel for state newborn screening programs. This decision was informed by data presented on the accuracy of screening from New York, the only state that currently offers X-ALD newborn screening, and published and unpublished data showing health benefits of earlier treatment (hematopoietic stem cell transplantation and adrenal hormone replacement therapy) for the childhood cerebral form of X-ALD. X-ALD newborn screening also identifies individuals with later-onset disease, but poor genotype-phenotype correlation makes predicting health outcomes difficult and might increase the risk of unnecessary treatment. Few data are available regarding the harms of screening and presymptomatic identification. Significant challenges exist for implementing comprehensive X-ALD newborn screening, including incorporation of the test, coordinating follow-up diagnostic and treatment care, and coordination of extended family testing after case identification.Genet Med 19 1, 121-126.
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Affiliation(s)
- Alex R Kemper
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jeffrey Brosco
- Department of Pediatrics, University of Miami, Coral Gables, Florida, USA
| | - Anne Marie Comeau
- Department of Pediatrics, University of Massachusetts Medical School, Jamaica Plain, Massachusetts, USA
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Jones
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Jennifer M Kwon
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Wendy K K Lam
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Lisa A Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Tanksley
- Texas Department of State Health Services, Austin, Texas, USA
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114
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Kallabi F, Ben Salah G, Ben Chehida A, Tabebi M, Felhi R, Ben Turkia H, Tebib N, Keskes L, Kamoun H. A de-novo large deletion of 2.8 kb produced in the ABCD1 gene causing adrenoleukodystrophy disease. Biochem Cell Biol 2016; 94:265-9. [PMID: 27248780 DOI: 10.1139/bcb-2015-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a neurodegenerative disorder caused by mutations in the ABCD1 gene, which encodes an ATP-binding cassette transporter protein, ALDP. The disease is characterized by increased concentrations of very long chain fatty acids (VLCFAs) in plasma, adrenal, testicular, and nerve tissues. For this study, our objective was to conduct clinical, molecular, and genetic studies of a Tunisian patient with X-ALD. The diagnosis was based on clinical indications, biochemical analyses, typical brain-scan patterns, and molecular biology; the molecular analyses were based on PCR, long-range PCR, and sequencing. The molecular analysis by long-range PCR and direct sequencing of the ABCD1 gene showed the presence of a de-novo 2794 bp deletion covering the whole of exon 2. Using bioinformatics tools, we demonstrate that the large deletion is located in a region rich with Alu sequences. Furthermore, we suggest that the AluJb sequence could be the cause of the large deletion of intron 1, exon 2, and intron 2, and the creation of a premature stop codon within exon 3. This report is the first report in which we demonstrate the breakpoints and the size of a large deletion in a Tunisian with X-ALD.
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Affiliation(s)
- Fakhri Kallabi
- a Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, Road Majida Boulila, 3029 Sfax, Tunisia
| | | | | | - Mouna Tabebi
- a Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, Road Majida Boulila, 3029 Sfax, Tunisia
| | - Rahma Felhi
- a Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, Road Majida Boulila, 3029 Sfax, Tunisia
| | | | - Neji Tebib
- c Service of Pediatrics, Rabta Hospital of Tunis, Tunisia
| | - Leila Keskes
- a Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, Road Majida Boulila, 3029 Sfax, Tunisia
| | - Hassen Kamoun
- a Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, Road Majida Boulila, 3029 Sfax, Tunisia.,d Service of Medical Genetics, Hedi Chaker Hospital of Sfax, Tunisia
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115
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Kemp K, Redondo J, Hares K, Rice C, Scolding N, Wilkins A. Oxidative injury in multiple sclerosis cerebellar grey matter. Brain Res 2016; 1642:452-460. [PMID: 27086975 DOI: 10.1016/j.brainres.2016.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/16/2023]
Abstract
Cerebellar dysfunction is a significant contributor to disability in multiple sclerosis (MS). Both white matter (WM) and grey matter (GM) injury occurs within MS cerebellum and, within GM, demyelination, inflammatory cell infiltration and neuronal injury contribute to on-going pathology. The precise nature of cerebellar GM injury is, however, unknown. Oxidative stress pathways with ultimate lipid peroxidation and cell membrane injury occur extensively in MS and the purpose of this study was to investigate these processes in MS cerebellar GM. Post-mortem human cerebellar GM from MS and control subjects was analysed immunohistochemically, followed by semi-quantitative analysis of markers of cellular injury, lipid peroxidation and anti-oxidant enzyme expression. We have shown evidence for reduction in myelin and neuronal markers in MS GM, coupled to an increase in expression of a microglial marker. We also show that the lipid peroxidation product 4-hydroxynonenal co-localises with myelin and its levels negatively correlate to myelin basic protein levels. Furthermore, superoxide dismutase (SOD1 and 2) enzymes, localised within cerebellar neurons, are up-regulated, yet the activation of subsequent enzymes responsible for the detoxification of hydrogen peroxide, catalase and glutathione peroxidase are relatively deficient. These studies provide evidence for oxidative injury in MS cerebellar GM and further help define disease mechanisms within the MS brain.
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Affiliation(s)
- Kevin Kemp
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK.
| | - Juliana Redondo
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - Kelly Hares
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - Claire Rice
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - Neil Scolding
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - Alastair Wilkins
- Multiple Sclerosis and Stem Cell Group, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
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116
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Yin PT, Han E, Lee KB. Engineering Stem Cells for Biomedical Applications. Adv Healthc Mater 2016; 5:10-55. [PMID: 25772134 PMCID: PMC5810416 DOI: 10.1002/adhm.201400842] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/14/2015] [Indexed: 12/19/2022]
Abstract
Stem cells are characterized by a number of useful properties, including their ability to migrate, differentiate, and secrete a variety of therapeutic molecules such as immunomodulatory factors. As such, numerous pre-clinical and clinical studies have utilized stem cell-based therapies and demonstrated their tremendous potential for the treatment of various human diseases and disorders. Recently, efforts have focused on engineering stem cells in order to further enhance their innate abilities as well as to confer them with new functionalities, which can then be used in various biomedical applications. These engineered stem cells can take on a number of forms. For instance, engineered stem cells encompass the genetic modification of stem cells as well as the use of stem cells for gene delivery, nanoparticle loading and delivery, and even small molecule drug delivery. The present Review gives an in-depth account of the current status of engineered stem cells, including potential cell sources, the most common methods used to engineer stem cells, and the utilization of engineered stem cells in various biomedical applications, with a particular focus on tissue regeneration, the treatment of immunodeficiency diseases, and cancer.
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Affiliation(s)
- Perry T Yin
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, 599 Taylor Road, Piscataway, NJ, 08854, USA
| | - Edward Han
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Ki-Bum Lee
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, 599 Taylor Road, Piscataway, NJ, 08854, USA
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, 610 Taylor Road, Piscataway, NJ, 08854, USA
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Ombrone D, Giocaliere E, Forni G, Malvagia S, la Marca G. Expanded newborn screening by mass spectrometry: New tests, future perspectives. MASS SPECTROMETRY REVIEWS 2016; 35:71-84. [PMID: 25952022 DOI: 10.1002/mas.21463] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/09/2015] [Indexed: 05/02/2023]
Abstract
Tandem mass spectrometry (MS/MS) has become a leading technology used in clinical chemistry and has shown to be particularly sensitive and specific when used in newborn screening (NBS) tests. The success of tandem mass spectrometry is due to important advances in hardware, software and clinical applications during the last 25 years. MS/MS permits a very rapid measurement of many metabolites in different biological specimens by using filter paper spots or directly on biological fluids. Its use in NBS give us the chance to identify possible treatable metabolic disorders even when asymptomatic and the benefits gained by this type of screening is now recognized worldwide. Today the use of MS/MS for second-tier tests and confirmatory testing is promising especially in the early detection of new disorders such as some lysosomal storage disorders, ADA and PNP SCIDs, X-adrenoleucodistrophy (X-ALD), Wilson disease, guanidinoacetate methyltransferase deficiency (GAMT), and Duchenne muscular dystrophy. The new challenge for the future will be reducing the false positive rate by using second-tier tests, avoiding false negative results by using new specific biomarkers and introducing new treatable disorders in NBS programs.
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Affiliation(s)
- Daniela Ombrone
- Newborn screening, Clinical Chemistry and Pharmacology Lab, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, 50139, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, Florence, 50139, Italy
| | - Elisa Giocaliere
- Newborn screening, Clinical Chemistry and Pharmacology Lab, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, 50139, Italy
| | - Giulia Forni
- Newborn screening, Clinical Chemistry and Pharmacology Lab, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, 50139, Italy
| | - Sabrina Malvagia
- Newborn screening, Clinical Chemistry and Pharmacology Lab, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, 50139, Italy
| | - Giancarlo la Marca
- Newborn screening, Clinical Chemistry and Pharmacology Lab, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, 50139, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, Florence, 50139, Italy
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Jiang MY, Cai YN, Liang CL, Peng MZ, Sheng HY, Fan LP, Lin RZ, Jiang H, Huang Y, Liu L. Clinical, biochemical, neuroimaging and molecular findings of X-linked Adrenoleukodystrophy patients in South China. Metab Brain Dis 2015; 30:1439-44. [PMID: 26260157 DOI: 10.1007/s11011-015-9717-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/28/2015] [Indexed: 12/18/2022]
Abstract
X-linked adrenoleukodystrophy is a common X-linked recessive peroxisomal disorder caused by the mutations in the ABCD1 gene. In this study, we analyzed 19 male patients and 9 female carriers with X-linked adrenoleukodystrophy in South China. By sequencing the ABCD1 gene, 13 different mutations were identified, including 7 novel mutations, and 6 known mutations, and 1 reported polymorphism. Mutation c.1180delG was demonstrated to be de novo mutation. 26.3 % (5/19) patients carried the deletion c.1415_16delAG, which may be the mutational hot spot in South China population. In addition, 73.7 % (14/19) patients were type of childhood cerebral adrenoleukodystrophy, 26.3 %(5/19) were in Addison only. Half of the childhood cerebral adrenoleukodystrophy patients had the adrenocortical insufficiency preceded the onset of neurological symptoms. Furthermore, 5 of 19 cases underwent hematopoietic stem cell transplantation. Our data showed that hematopoietic stem cell transplantation performed at an advanced stage of the cerebral X- linked adrenoleukodystrophy would accelerate the progression of the disease. Good clinical outcome achieved when hematopoietic stem cell transplantation performed at the very early stage of the disease.
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Affiliation(s)
- Min-yan Jiang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Yan-na Cai
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Cui-li Liang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Min-zhi Peng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Hui-ying Sheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Li-ping Fan
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Rui-zhu Lin
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Hua Jiang
- Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Yonglan Huang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China.
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Chu SS, Ye J, Zhang HW, Han LS, Qiu WJ, Gao XL, Gu XF. Eight novel mutations in the ABCD1 gene and clinical characteristics of 25 Chinese patients with X-linked adrenoleukodystrophy. World J Pediatr 2015; 11:366-73. [PMID: 26454440 DOI: 10.1007/s12519-015-0044-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is a fatal neurodegenerative disease caused by mutations in the adenosine triphosphate-binding cassette D1 (ABCD1) gene. This study aimed to retrospectively investigate the clinical characteristics of 25 patients with X-ALD including members of large pedigrees, to analyze ABCD1 gene mutations, the effect of gene novel variants on ALD protein (ALDP) structure and function, and to expand gene mutation spectrum of Chinese patients. METHODS Twenty-five male patients diagnosed with X-ALD were enrolled in this study. The clinical characteristics of the patients were retrospectively summarized by reviewing medical records or telephone consultation. ABCD1 gene mutations were analyzed. The pathogenicity of novel missense variants was analyzed using cobalt constraint-based multiple protein alignment tool, polymorphism phenotyping, sorting intolerant from tolerant, Align-Grantham variation and Grantham deviation, and Swiss-Program Database Viewer 4.04 software, respectively. RESULTS Childhood cerebral form ALD (CCALD) is the most common phenotype (64%) in the 25 patients with X-ALD. The progressive deterioration of neurological and cognitive functions is the main clinical feature. The demyelination of the brain white matter and elevated plasma very long chain fatty acids (VLCFAs) were found in all patients. Different phenotypes were also presented within family members of the patients. Twenty-two different mutations including 8 novel mutations in the ABCD1 gene were identified in the 25 patients. Of the mutations, 63.6% were missense mutations and 34.8% located in exon 1. The amino acid residues of three novel missense mutations in eight species were highly conserved, and were predicted to be "probably" damaging to ALDP function. The other five novel mutations were splice, nonsense, deletion or duplication mutations. CONCLUSIONS CCALD is the most common phenotype (64%) in our patients with X-ALD. Eight novel mutations in the ABCD1 gene identified are disease-causing mutations. Brain magnetic resonance imaging and plasma VLCFA determination should be performed for the patients who present with progressive deterioration of neurological development.
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Affiliation(s)
- Shan-Shan Chu
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ye
- , Shanghai, China. .,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hui-Wen Zhang
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian-Shu Han
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Juan Qiu
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Lan Gao
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Fan Gu
- , Shanghai, China.,Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Splicing defects in ABCD1 gene leading to both exon skipping and partial intron retention in X-linked adrenoleukodystrophy Tunisian patient. Neurosci Res 2015; 97:7-12. [DOI: 10.1016/j.neures.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022]
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121
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Nowak J, Löbel U, Wölfl M, Schlegel PG, Warmuth-Metz M. MRI demyelination pattern and clinical course in a child with cerebral X-linked adrenoleukodystrophy (X-ALD). Acta Radiol Open 2015; 4:2047981615573655. [PMID: 25848550 PMCID: PMC4385045 DOI: 10.1177/2047981615573655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/07/2014] [Accepted: 01/28/2015] [Indexed: 12/02/2022] Open
Abstract
The clinical spectrum in boys with X-linked adrenoleukodystrophy (X-ALD) ranges from isolated adrenocortical insufficiency and slowly progressive myelopathy to devastating cerebral demyelination. In the individual case, the disease course still remains unpredictable. Research findings suggest an important role of brain magnetic resonance imaging (MRI) lesion patterns as prognostic markers for X-ALD. Hence, familiarity with imaging features of childhood X-ALD in combination with clinical manifestation is required in order to stratify affected patients for therapy. We report on MRI findings and clinical course of cerebral X-ALD in a young boy with a rare subtype of white matter demyelination.
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Affiliation(s)
- Johannes Nowak
- Departments of Radiology and Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
| | - Ulrike Löbel
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Wölfl
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | | | - Monika Warmuth-Metz
- Departments of Radiology and Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
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122
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Bladder and Bowel Dysfunction Is Common in Both Men and Women with Mutation of the ABCD1 Gene for X-Linked Adrenoleukodystrophy. JIMD Rep 2015; 22:77-83. [PMID: 25763509 DOI: 10.1007/8904_2015_414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is a disorder caused by mutations in the ABCD1 gene. The commonest phenotype of X-ALD is adrenomyeloneuropathy (AMN), which is characterised by involvement of the spinal cord and peripheral nerves. The aim of this study was to evaluate bladder and bowel symptoms in men with AMN and female X-ALD carriers. METHODS In this cross-sectional study, patients with confirmed mutation of the ABCD1 gene attending a tertiary care service were approached about bladder and bowel complaints and completed the Urinary Symptom Profile (USP), Qualiveen Short Form (SF-Qualiveen), International Prostate Symptom Score (IPSS) and Neurogenic Bowel Dysfunction (NBD) questionnaires. Neurological disability was assessed using the Expanded Disability Status Scale (EDSS). RESULTS Forty-eight patients participated, 19 males (mean EDSS score (n = 16) 5.0 (95% CI ± 1.03)) and 29 females (mean EDSS score (n = 25) 3.2 (95% CI ± 0.98)). Overactive bladder (OAB) symptoms were reported in both males (100%, n = 19) and females (86.2%, n = 25). There was no significant gender difference in severity of OAB symptoms (P = 0.35) and impact on quality of life (P = 0.13). Furthermore, there was no significant difference in OAB severity when symptoms were compared between female carriers and a cohort of women (n = 17) with spinal cord damage due to multiple sclerosis (P = 0.27). Twenty-one percent (n = 4) of males and 10% (n = 3) of females had moderate to severe bowel dysfunction. CONCLUSIONS Bladder and bowel complaints are common in both men with AMN and female carriers. They have a significant impact on the quality of life yet are under-reported and under-treated. Though having an X-linked pattern of inheritance, female carriers may experience overactive bladder symptoms which are as severe as in male patients and are likely to be neurological in origin.
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123
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Pfeifenbring S, von Baumgarten L, Schüller U, Rosewich H, Thal DR, Wirtz CR, Hecht M, Terpolilli NA, Brück W. Biopsy findings of symptomatic cerebral X-linked adrenoleucodystrophy and histological differentiation from multiple sclerosis. Neuropathol Appl Neurobiol 2015; 40:658-61. [PMID: 24117509 DOI: 10.1111/nan.12089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sabine Pfeifenbring
- Department of Neuropathology, University Medical Centre, Georg August University, Göttingen, Germany
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Ohkuma Y, Hayashi T, Yoshimine S, Tsuneoka H, Terao Y, Akiyama M, Ida H, Ohashi T, Okumura A, Ebihara N, Murakami A, Shimozawa N. Retinal Ganglion Cell Loss in X-linked Adrenoleukodystrophy with an ABCD1 Mutation (Gly266Arg). Neuroophthalmology 2014; 38:331-335. [PMID: 27928321 DOI: 10.3109/01658107.2014.950430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/19/2014] [Accepted: 07/19/2014] [Indexed: 12/27/2022] Open
Abstract
The authors here report a single case of a 10-year-old male patient who presented with severe vision loss associated with progressive demyelination. The patient was diagnosed with X-linked childhood cerebral adrenoleukodystrophy (ALD). Genetic analysis demonstrated a missense mutation (Gly266Arg) in exon 1 of the ABCD1 gene. His corrected visual acuity confirmed the absolute lack of light perception in both eyes. Funduscopy revealed severe pallor of the optic disc in both eyes. Spectral-domain optical coherence tomography showed thinning of the retinal ganglion cell and inner plexiform layers (GCL and IPL). Thinning of the GCL and IPL may be due to transneuronal retrograde degeneration of ganglion cells secondary to optic tract demyelination.
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Affiliation(s)
| | | | | | | | - Yoko Terao
- Department of Pediatrics, The Jikei University School of Medicine Tokyo Japan
| | - Masaharu Akiyama
- Department of Pediatrics, The Jikei University School of Medicine Tokyo Japan
| | - Hiroyuki Ida
- Department of Pediatrics, The Jikei University School of Medicine Tokyo Japan
| | - Toya Ohashi
- Department of Pediatrics, The Jikei University School of Medicine Tokyo Japan
| | | | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University School of Medicine Tokyo Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University School of Medicine Tokyo Japan
| | - Nobuyuki Shimozawa
- Division of Genomics Research, Life Science Research Center, Gifu University Yanagido Japan
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Zhang Y, Liu Y, Li Y, Duan Y, Zhang K, Wang J, Dai Y. Exome sequencing identifies mutations in ABCD1 and DACH2 in two brothers with a distinct phenotype. BMC MEDICAL GENETICS 2014; 15:105. [PMID: 25234129 PMCID: PMC4355004 DOI: 10.1186/s12881-014-0105-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/05/2014] [Indexed: 11/18/2022]
Abstract
Background We report on two brothers with a distinct syndromic phenotype and explore the potential pathogenic cause. Methods Cytogenetic tests and exome sequencing were performed on the two brothers and their parents. Variants detected by exome sequencing were validated by Sanger sequencing. Results The main phenotype of the two brothers included congenital language disorder, growth retardation, intellectual disability, difficulty in standing and walking, and urinary and fecal incontinence. To the best of our knowledge, no similar phenotype has been reported previously. No abnormalities were detected by G-banding chromosome analysis or array comparative genomic hybridization. However, exome sequencing revealed novel mutations in the ATP-binding cassette, sub-family D member 1 (ABCD1) and Dachshund homolog 2 (DACH2) genes in both brothers. The ABCD1 mutation was a missense mutation c.1126G > C in exon 3 leading to a p.E376Q substitution. The DACH2 mutation was also a missense mutation c.1069A > T in exon 6, leading to a p.S357C substitution. The mother was an asymptomatic heterozygous carrier. Plasma levels of very-long-chain fatty acids were increased in both brothers, suggesting a diagnosis of adrenoleukodystrophy (ALD); however, their phenotype was not compatible with any reported forms of ALD. DACH2 plays an important role in the regulation of brain and limb development, suggesting that this mutation may be involved in the phenotype of the two brothers. Conclusion The distinct phenotype demonstrated by these two brothers might represent a new form of ALD or a new syndrome. The combination of mutations in ABCD1 and DACH2 provides a plausible mechanism for this phenotype.
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Affiliation(s)
- Yanliang Zhang
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Yunnan Province, 650032, P R China.
| | - Yanhui Liu
- Prepotency Center, Dongguan Maternal and Child Health Hospital, Guangdong Province, 523000, P R China.
| | - Ya Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Yunnan Province, 650032, P R China.
| | - Yong Duan
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Yunnan Province, 650032, P R China.
| | - Keyun Zhang
- Radiology Department, Dongguan Guanghua Hospital of Tongji Medical College, Guangdong Province, 523000, P R China.
| | - Junwang Wang
- Radiology Department, Dongguan Guanghua Hospital of Tongji Medical College, Guangdong Province, 523000, P R China.
| | - Yong Dai
- The Clinical Medical Research Center, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong Province, 518020, P R China.
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Durmaz A, Atik T, Onay H, Canda EE, Uçar SK, Bademkıran F, Coker M, Coğulu Ö, Özkınay F. Molecular analysis in X-linked adrenoleukodystrophy patients: identification of a novel mutation. Metab Brain Dis 2014; 29:809-12. [PMID: 24788897 DOI: 10.1007/s11011-014-9552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
X linked adrenoleukodystrophy (X-ALD) is a neurodegenerative disease characterized by progressive demyelination of the central nervous system, adrenocortical insufficiency and elevated levels of very long chain fatty acids (VLCFAs). It is caused by mutations in ABCD1 gene located at Xq28. More than 1,300 mutations have been identified to date which is unique to each patient. In this study we report the mutational analysis of 2 X-ALD patients (1 male and 1 female) showing variable clinical spectrum. The mutation analysis of the female patient revealed IVS5-6delC (c.1489-6delC) and p. P543L variations in compound heterozygous state. The male patient was found to be hemizygous for a novel mutation, p. R104P. In conclusion, while defining a novel mutation, the cases presented herein may contribute to the mutation and clinical spectrum of X-ALD.
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Affiliation(s)
- Asude Durmaz
- Department of Medical Genetics, Ege University Medical Faculty, Izmir, Turkey,
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127
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Pathologic role of glial nitric oxide in adult and pediatric neuroinflammatory diseases. Neurosci Biobehav Rev 2014; 45:168-82. [DOI: 10.1016/j.neubiorev.2014.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 01/22/2023]
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128
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Leite CC, Lucato LT, Santos GT, Kok F, Brandão AR, Castillo M. Imaging of adult leukodystrophies. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:625-32. [DOI: 10.1590/0004-282x20140095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/27/2014] [Indexed: 11/21/2022]
Abstract
Leukodystrophies are genetically determined white matter disorders. Even though leukodystrophies essentially affect children in early infancy and childhood, these disorders may affect adults. In adults, leukodystrophies may present a distinct clinical and imaging presentation other than those found in childhood. Clinical awareness of late-onset leukodystrophies should be increased as new therapies emerge. MRI is a useful tool to evaluate white matter disorders and some characteristics findings can help the diagnosis of leukodystrophies. This review article briefly describes the imaging characteristics of the most common adult leukodystrophies.
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Affiliation(s)
- Claudia Costa Leite
- Universidade de São Paulo, Brazil; University of North Carolina, United States
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129
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Ahmed RM, Murphy E, Davagnanam I, Parton M, Schott JM, Mummery CJ, Rohrer JD, Lachmann RH, Houlden H, Fox NC, Chataway J. A practical approach to diagnosing adult onset leukodystrophies. J Neurol Neurosurg Psychiatry 2014; 85:770-81. [PMID: 24357685 DOI: 10.1136/jnnp-2013-305888] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R M Ahmed
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - E Murphy
- The Charles Dent Metabolic Unit, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - I Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery and Brain Repair and Rehabilitation unit UCL Institute of Neurology, London, UK
| | - M Parton
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - C J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - R H Lachmann
- The Charles Dent Metabolic Unit, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - H Houlden
- Department of Molecular Neurosciences, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - N C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
| | - J Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, National Hospital for Neurology & Neurosurgery and UCL Institute of Neurology, London, UK
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Jang J, Quan Z, Yum YJ, Song HS, Paek S, Kang HC. Induced pluripotent stem cells for modeling of pediatric neurological disorders. Biotechnol J 2014; 9:871-81. [PMID: 24838856 DOI: 10.1002/biot.201400010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/29/2014] [Accepted: 05/15/2014] [Indexed: 12/14/2022]
Abstract
The pathophysiological mechanisms underlying childhood neurological disorders have remained obscure due to a lack of suitable disease models reflecting human pathogenesis. Using induced pluripotent stem cell (iPSC) technology, various neurological disorders can now be extensively modeled. Specifically, iPSC technology has aided the study and treatment of early-onset pediatric neurodegenerative diseases such as Rett syndrome, Down syndrome, Angelman syndrome. Prader-Willi syndrome, Friedreich's ataxia, spinal muscular atrophy (SMA), fragile X syndrome, X-linked adrenoleukodystrophy (ALD), and SCN1A gene-related epilepsies. In this paper, we provide an overview of various gene delivery systems for generating iPSCs, the current state of modeling early-onset neurological disorders and the ultimate application of these in vitro models in cell therapy through the correction of disease-specific mutations.
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Affiliation(s)
- Jiho Jang
- Department of Physiology, Yonsei University College of Medicine, Seoul, Korea
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131
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Multiple endocrine disorders associated with adrenomyeloneuropathy and a novel mutation of the ABCD1 gene. Pediatr Neurol 2014; 50:622-4. [PMID: 24685009 DOI: 10.1016/j.pediatrneurol.2014.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION X-linked adrenomyeloneuropathy (X-AMN) is a genetic disorder that primarily affects the adrenal cortex and the nervous system. The disease shows a wide range of phenotypic expression, age of onset, and rate of progression. PATIENT DESCRIPTION We present a thalassemic 23-year-old man with X-AMN and multiple endocrine disorders. At age 2 years, he was diagnosed with thalassaemia intermedia, and he was receiving occasional blood transfusions and maintaining an adequate hemoglobin level without signs of extramedullar hematopoiesis or hemosiderosis. During adolescence, he was diagnosed with growth hormone deficiency, primary hypothyroidism, and primary adrenal insufficiency. In his early 20s he demonstrated progressive tetraparesis, and the diagnosis of X-AMN was confirmed by DNA analysis of the ABCD1 gene. CONCLUSION This patient expands the phenotype X-AMN by adding growth hormone deficiency and hypothyroidism.
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Morató L, Bertini E, Verrigni D, Ardissone A, Ruiz M, Ferrer I, Uziel G, Pujol A. Mitochondrial dysfunction in central nervous system white matter disorders. Glia 2014; 62:1878-94. [DOI: 10.1002/glia.22670] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Laia Morató
- Neurometabolic Diseases Laboratory; Bellvitge Biomedical Research Institute (IDIBELL); L'Hospitalet de Llobregat Barcelona Spain
- Center for Biomedical Research on Rare Diseases (CIBERER); ISCIII Spain
| | - Enrico Bertini
- Unit for Neuromuscular and Neurodegenerative Diseases, Laboratory of Molecular Medicine, Bambino Gesù Children's Hospital; IRCCS Rome Italy
| | - Daniela Verrigni
- Unit for Neuromuscular and Neurodegenerative Diseases, Laboratory of Molecular Medicine, Bambino Gesù Children's Hospital; IRCCS Rome Italy
| | - Anna Ardissone
- Department of Child Neurology The Foundation “Carlo Besta” Neurological Institute (IRCCS); Milan Italy
| | - Montse Ruiz
- Neurometabolic Diseases Laboratory; Bellvitge Biomedical Research Institute (IDIBELL); L'Hospitalet de Llobregat Barcelona Spain
- Center for Biomedical Research on Rare Diseases (CIBERER); ISCIII Spain
| | - Isidre Ferrer
- Institute of Neuropathology, University of Barcelona, L'Hospitalet de Llobregat; Barcelona Spain
- Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED); ISCIII Spain
| | - Graziella Uziel
- Department of Child Neurology The Foundation “Carlo Besta” Neurological Institute (IRCCS); Milan Italy
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory; Bellvitge Biomedical Research Institute (IDIBELL); L'Hospitalet de Llobregat Barcelona Spain
- Center for Biomedical Research on Rare Diseases (CIBERER); ISCIII Spain
- Catalan Institution of Research and Advanced Studies (ICREA); Barcelona Spain
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133
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Barrette B, Nave KA, Edgar JM. Molecular triggers of neuroinflammation in mouse models of demyelinating diseases. Biol Chem 2014; 394:1571-81. [PMID: 23959664 DOI: 10.1515/hsz-2013-0219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/15/2013] [Indexed: 12/20/2022]
Abstract
Myelinating cells wrap axons with multi-layered myelin sheaths for rapid impulse propagation. Dysfunctions of oligodendrocytes or Schwann cells are often associated with neuroinflammation, as observed in animal models of leukodystrophies and peripheral neuropathies, respectively. The neuroinflammatory response modulates the pathological changes, including demyelination and axonal injury, but also remyelination and repair. Here we discuss different immune mechanisms as well as factors released or exposed by myelinating glia in disease conditions. The spectrum of inflammatory mediators varies with different myelin disorders and has a major impact on the beneficial or detrimental role of immune cells in keeping nervous system integrity.
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134
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Park HJ, Shin HY, Kang HC, Choi BO, Suh BC, Kim HJ, Choi YC, Lee PH, Kim SM. Clinical and genetic aspects in twelve Korean patients with adrenomyeloneuropathy. Yonsei Med J 2014; 55:676-82. [PMID: 24719134 PMCID: PMC3990087 DOI: 10.3349/ymj.2014.55.3.676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/13/2013] [Accepted: 10/03/2013] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study was designed to investigate the characteristics of Korean adrenomyeloneuropathy (AMN) patients. MATERIALS AND METHODS We retrospectively selected 12 Korean AMN patients diagnosed by clinical analysis and increased plasma content of very long chain fatty acids. RESULTS All 12 patients were men. Patient ages at symptom onset ranged from 18 to 55 years. Family history was positive in two patients. The phenotype distributions consisted of AMN without cerebral involvement in seven patients, AMN with cerebral involvement in two patients, and the spinocerebellar phenotype in three patients. Nerve conduction studies revealed abnormalities in four patients and visual evoked tests revealed abnormalities in three patients. Somatosensory evoked potential tests revealed central conduction defects in all of the tested patients. Spinal MRI showed diffuse cord atrophy or subtle signal changes in all 12 patients. Brain MRI findings were abnormal in six of the nine tested patients. These brain abnormalities reflected the clinical phenotypes. Mutational analysis identified nine different ABCD1 mutations in 10 of 11 tested patients. Among them, nine have been previously reported and shown to be associated with various phenotypes; one was a novel mutation. CONCLUSION In conclusion, the present study is the first to report on the clinical and mutational spectrum of Korean AMN patients, and confirms various clinical presentations and the usefulness of brain MRI scan.
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Affiliation(s)
- Hyung Jun Park
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bum Chun Suh
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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135
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Chen X, Chen Z, Huang D, Liu X, Gui Q, Yu S. Adult cerebral adrenoleukodystrophy and Addison's disease in a female carrier. Gene 2014; 544:248-51. [PMID: 24768737 DOI: 10.1016/j.gene.2014.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/10/2014] [Accepted: 04/24/2014] [Indexed: 12/24/2022]
Abstract
We described a 38-year-old woman of rapidly progressive dementia with white matter encephalopathy and death. She had Addison's disease but the adrenal glands were hyperplastic. Brain magnetic resonance imaging revealed diffuse white matter lesion predominantly in the frontal lobe with band-like contrast enhancement. l-Methyl-11C-methionine positron emission tomography revealed accumulation of tracer in bilateral frontal lobes. Stereotactic biopsy demonstrated demyelination changes. A number of urinary organic acids were elevated. Adrenoleukodystrophy was diagnosed by elevated plasma very long chain fatty acid and ABCD1 gene mutation (C1544C/T). Adrenoleukodystrophy should be considered as a differential diagnosis in women with rapidly progressive white matter encephalopathy.
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Affiliation(s)
- Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dehui Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Qiuping Gui
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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136
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Müller vom Hagen J, Karle KN, Schüle R, Krägeloh-Mann I, Schöls L. Leukodystrophies underlying cryptic spastic paraparesis: frequency and phenotype in 76 patients. Eur J Neurol 2014; 21:983-8. [DOI: 10.1111/ene.12423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J. Müller vom Hagen
- Department of Neurodegenerative Diseases; Hertie-Institute for Clinical Brain Research; University of Tübingen; Tübingen Germany
- German Centre for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - K. N. Karle
- Department of Neurodegenerative Diseases; Hertie-Institute for Clinical Brain Research; University of Tübingen; Tübingen Germany
- German Centre for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - R. Schüle
- Department of Neurodegenerative Diseases; Hertie-Institute for Clinical Brain Research; University of Tübingen; Tübingen Germany
- German Centre for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - I. Krägeloh-Mann
- German Centre for Neurodegenerative Diseases (DZNE); Tübingen Germany
- Department of Neuropediatrics; University of Tübingen; Tübingen Germany
| | - L. Schöls
- Department of Neurodegenerative Diseases; Hertie-Institute for Clinical Brain Research; University of Tübingen; Tübingen Germany
- German Centre for Neurodegenerative Diseases (DZNE); Tübingen Germany
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Langberg JM, Froehlich TE, Loren REA, Martin JE, Epstein JN. Assessing children with ADHD in primary care settings. Expert Rev Neurother 2014; 8:627-41. [DOI: 10.1586/14737175.8.4.627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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138
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Haavik J, Halmøy A, Lundervold AJ, Fasmer OB. Clinical assessment and diagnosis of adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2014; 10:1569-80. [DOI: 10.1586/ern.10.149] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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139
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Karapanou O, Vlassopoulou B, Tzanela M, Papadopoulos D, Angelidakis P, Michelakakis H, Ioannidis G, Mihalatos M, Kamakari S, Tsagarakis S. X-linked adrenoleukodystrophy: are signs of hypogonadism always due to testicular failure? Hormones (Athens) 2014; 13:146-52. [PMID: 24722136 DOI: 10.1007/bf03401330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present the clinical and hormonal findings of a young male with X-linked adrenoleukodystrophy (X-ALD), with special emphasis on the biochemical and clinical pattern of hypogonadism. A patient, with primary adrenal insufficiency since the age of 5 years, developed progressive neurological symptoms at the age of 29. Diagnosis of X-ALD was established by elevated serum very long chain fatty acids (VLCFAs) and genetic testing. His sexual body hair was sparse. Hormonal investigations revealed normal testosterone and inappropriately elevated LH levels. Androgen receptor gene analysis was negative for mutations or polymorphic variants associated with decreased receptor activity. Signs of hypogonadism in patients with confirmed X-ALD are not exclusively due to primary testicular failure. Tissue specific androgen resistance represents an alternative possibility. Since no loss-of-function mutations were detected in the androgen receptor, it is speculated that the patient's androgen resistance could be part of a functional defect mediated through VLCFA accumulation at the testosterone receptor and/or post-receptor levels.
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Affiliation(s)
- Olga Karapanou
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Barbara Vlassopoulou
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Marinella Tzanela
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | | | | | - Helen Michelakakis
- Department of Metabolic Diseases, Institute of Child's Health, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George Ioannidis
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
| | - Markos Mihalatos
- BioGenomica SA, Center for Genetic Analysis and Research; Athens, Greece
| | - Smaragda Kamakari
- BioGenomica SA, Center for Genetic Analysis and Research; Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology Diabetes and Metabolism, "Evangelismos" Hospital, Athens, Greece
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Theda C, Gibbons K, Defor TE, Donohue PK, Golden WC, Kline AD, Gulamali-Majid F, Panny SR, Hubbard WC, Jones RO, Liu AK, Moser AB, Raymond GV. Newborn screening for X-linked adrenoleukodystrophy: further evidence high throughput screening is feasible. Mol Genet Metab 2014; 111:55-7. [PMID: 24268529 PMCID: PMC3935823 DOI: 10.1016/j.ymgme.2013.10.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022]
Abstract
X-linked adrenoleukodystrophy (ALD) is characterized by adrenal insufficiency and neurologic involvement with onset at variable ages. Plasma very long chain fatty acids are elevated in ALD; even in asymptomatic patients. We demonstrated previously that liquid chromatography tandem mass spectrometry measuring C26:0 lysophosphatidylcholine reliably identifies affected males. We prospectively applied this method to 4689 newborn blood spot samples; no false positives were observed. We show that high throughput neonatal screening for ALD is methodologically feasible.
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Affiliation(s)
- Christiane Theda
- Royal Women's Hospital, Neonatal Services, 20 Flemington Road, Parkville VIC 3052, Australia; The University of Melbourne and the Murdoch Childrens Research Institute, Melbourne, Australia; Frederick Memorial Hospital, 400 W 7th Street, Frederick, MD 21701, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Katy Gibbons
- Neurogenetics, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA
| | - Todd E Defor
- Department of Biostatistics and Informatics Core, University of Minnesota Medical School, 420 Delaware Street, SE, Minneapolis, MN 55455, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, USA; Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - W Christopher Golden
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Antonie D Kline
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, 6701 N Charles Street, Baltimore, MD 21204, USA
| | - Fizza Gulamali-Majid
- Maryland Department of Health and Mental Hygiene, 201 W Preston Street, Room 1A6, Baltimore, MD 21201, USA
| | - Susan R Panny
- Maryland Department of Health and Mental Hygiene, 201 W Preston Street, Room 1A6, Baltimore, MD 21201, USA
| | - Walter C Hubbard
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Osler 527, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Richard O Jones
- Neurogenetics, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA
| | - Anita K Liu
- Neurogenetics, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA
| | - Ann B Moser
- Neurogenetics, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA
| | - Gerald V Raymond
- Neurogenetics, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, USA; University of Minnesota, 12-150 Phillips Wangensteen Building, MMC-295, 516 Delaware Street, SE, Minneapolis, MN 55455, USA
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Abstract
Multiple sclerosis (MS) patients are classified as either having relapsing onset or progressive onset disease, also known as primary progressive MS (PPMS). Relative to relapsing onset patients, PPMS patients are older at disease onset, are equally likely to be men or women, and have more rapid accumulation of disability that does not respond well to treatments used in relapsing onset MS. Although estimates vary, 5-15% of all MS patients have a PPMS disease course. Genetic variance is a proposed determinant of MS disease course. If distinct genes associated with PPMS were identified study of these genes might lead to an understanding of the biology underlying disease progression and neural degeneration that are the hallmarks of PPMS. These genes and their biological pathways might also represent therapeutic targets. This chapter systematically reviews the PPMS genetic literature. Despite the intuitively appealing notion that differences between PPMS and relapsing onset MS are due to genetics, definite differences associated with these phenotypes at the major histocompatibility complex or elsewhere in the genome have not been found. Recent large-scale genome wide screens identified multiple genes associated with MS susceptibility outside the MHC. The genetic variants identified thus far make only weak individual contributions to MS susceptibility. If the genetic effects that contribute to the differences between PPMS and relapsing MS are similar in magnitude to those that distinguish MS from healthy controls then, given the relative scarcity of the PPMS phenotype, very large datasets will be needed to identify PPMS associated genes. International collaborative efforts could provide the means to identify such genes. Alternately, it is possible that factors other than genetics underlie the differences between these clinical phenotypes.
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Affiliation(s)
- Bruce A C Cree
- Department of Neurology, University of California, San Francisco, USA.
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142
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Weber FD, Wiesinger C, Forss-Petter S, Regelsberger G, Einwich A, Weber WHA, Köhler W, Stockinger H, Berger J. X-linked adrenoleukodystrophy: very long-chain fatty acid metabolism is severely impaired in monocytes but not in lymphocytes. Hum Mol Genet 2013; 23:2542-50. [PMID: 24363066 PMCID: PMC3990157 DOI: 10.1093/hmg/ddt645] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a fatal neurodegenerative disease caused by mutations in the ABCD1 gene, encoding a member of the peroxisomal ABC transporter family. The ABCD1 protein transports CoA-activated very long-chain fatty acids (VLCFAs) into peroxisomes for degradation via β-oxidation. In the severest form, X-ALD patients suffer from inflammatory demyelination of the brain. As the extent of the metabolic defect in the main immune cells is unknown, we explored their phenotypes concerning mRNA expression pattern of the three peroxisomal ABC transporters, VLCFA accumulation and peroxisomal β-oxidation. In controls, ABCD1 expression was high in monocytes, intermediate in B cells and low in T cells; ABCD2 expression was extremely low in monocytes, intermediate in B cells and highest in T cells; ABCD3 mRNA was equally distributed. In X-ALD patients, the expression patterns remained unaltered; accordingly, monocytes, which lack compensatory VLCFA transport by ABCD2, displayed the severest biochemical phenotype with a 6-fold accumulation of C26:0 and a striking 70% reduction in peroxisomal β-oxidation activity. In contrast, VLCFA metabolism was close to control values in B cells and T cells, supporting the hypothesis that sufficient ABCD2 is present to compensate for ABCD1 deficiency. Thus, the vulnerability of the main immune cell types is highly variable in X-ALD. Based on these results, we propose that in X-ALD the halt of inflammation after allogeneic hematopoietic stem cell transplantation relies particularly on the replacement of the monocyte lineage. Additionally, these findings support the concept that ABCD2 is a target for pharmacological induction as an alternative therapeutic strategy.
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Affiliation(s)
- Franziska D Weber
- Center for Brain Research, Medical University of Vienna, Spitalgasse 4, Vienna A-1090, Austria
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Berger J, Forss-Petter S, Eichler FS. Pathophysiology of X-linked adrenoleukodystrophy. Biochimie 2013; 98:135-42. [PMID: 24316281 PMCID: PMC3988840 DOI: 10.1016/j.biochi.2013.11.023] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/22/2013] [Indexed: 12/26/2022]
Abstract
Currently the molecular basis for the clinical heterogeneity of X-linked adrenoleukodystrophy (X-ALD) is poorly understood. The genetic bases for all different phenotypic variants of X-ALD are mutations in the gene encoding the peroxisomal ATP-binding cassette (ABC) transporter, ABCD1 (formerly adrenoleukodystrophy protein, ALDP). ABCD1 transports CoA-activated very long-chain fatty acids from the cytosol into the peroxisome for degradation. The phenotypic variability is remarkable ranging from cerebral inflammatory demyelination of childhood onset, leading to death within a few years, to adults remaining pre-symptomatic through more than five decades. There is no general genotype–phenotype correlation in X-ALD. The default manifestation of mutations in ABCD1 is adrenomyeloneuropathy, a slowly progressive dying-back axonopathy affecting both ascending and descending spinal cord tracts as well as in some cases, a peripheral neuropathy. In about 60% of male X-ALD patients, either in childhood (35–40%) or in adulthood (20%), an initial, clinically silent, myelin destabilization results in conversion to a devastating, rapidly progressive form of cerebral inflammatory demyelination. Here, ABCD1 remains a susceptibility gene, necessary but not sufficient for inflammatory demyelination to occur. Although the accumulation of very long-chain fatty acids appears to be essential for the pathomechanism of all phenotypes, the molecular mechanisms underlying these phenotypes are fundamentally different. Cell autonomous processes such as oxidative stress and energy shortage in axons as well as non-cell autonomous processes involving axon–glial interactions seem pertinent to the dying-back axonopathy. Various dynamic mechanisms may underlie the initiation of inflammation, the altered immune reactivity, the propagation of inflammation, as well as the mechanisms leading to the arrest of inflammation after hematopoietic stem cell transplantation. An improved understanding of the molecular mechanisms involved in these events is required for the development of urgently needed therapeutics. Adrenomyeloneuropathy (AMN) is proposed to be the core syndrome of X-ALD. The cerebral inflammatory demyelinating form of X-ALD is independent of AMN. The same genetic basis but fundamentally different pathomechanisms lead to AMN and cerebral ALD. Genetic, epigenetic and environmental factors modulate onset and severity of AMN and cerebral ALD.
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Affiliation(s)
- J Berger
- Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria.
| | - S Forss-Petter
- Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria
| | - F S Eichler
- Department for Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street ACC 708, Boston, MA 02114, USA
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Horn MA, Erichsen MM, Wolff ASB, Månsson JE, Husebye ES, Tallaksen CME, Skjeldal OH. Screening for X-linked adrenoleukodystrophy among adult men with Addison's disease. Clin Endocrinol (Oxf) 2013; 79:316-20. [PMID: 23346902 DOI: 10.1111/cen.12159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/23/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES X-linked adrenoleukodystrophy is an important cause of Addison's disease in boys, but less is known about its contribution to Addison's disease in adult men. After surveying all known cases of X-linked adrenoleukodystrophy in Norway in a separate study, we aimed to look for any missed cases among the population of adult men with nonautoimmune Addison's disease. STUDY DESIGN Among 153 adult men identified in a National Registry for Addison's Disease (75% of identified male cases of Addison's disease in Norway), those with negative indices for 21-hydroxylase autoantibodies were selected. Additionally, cases with low autoantibody indices (48-200) were selected. Sera from subjects included were analysed for levels of very long-chain fatty acids, which are diagnostic for X-linked adrenoleukodystrophy in men. RESULTS Eighteen subjects had negative indices and 17 had low indices for 21-hydroxylase autoantibodies. None of those with low indices and only one of those with negative indices were found to have X-linked adrenoleukodystrophy; this subject had already been diagnosed because of the neurological symptoms. Cases of Addison's disease proved to be caused by X-linked adrenoleukodystrophy constitute 1·5% of all adult male cases in Norway; the proportion among nonautoimmune cases was 15%. CONCLUSIONS We found X-linked adrenoleukodystrophy to be an uncommon cause of Addison's disease in adult men. However, this aetiological diagnosis has far-reaching consequences both for the patient and for his extended family. We therefore recommend that all adult men with nonautoimmune Addison's disease be analysed for levels of very long-chain fatty acids.
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Affiliation(s)
- Morten A Horn
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
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145
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Petrillo S, Piemonte F, Pastore A, Tozzi G, Aiello C, Pujol A, Cappa M, Bertini E. Glutathione imbalance in patients with X-linked adrenoleukodystrophy. Mol Genet Metab 2013; 109:366-70. [PMID: 23768953 PMCID: PMC3732387 DOI: 10.1016/j.ymgme.2013.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/13/2013] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is a genetic disorder of X-linked inheritance caused by a mutation in the ABCD1 gene which determines an accumulation of long-chain fatty acids in plasma and tissues. Recent evidence shows that oxidative stress may be a hallmark in the pathogenesis of X-ALD and glutathione plays an important role in the defense against free radicals. In this study we have analyzed glutathione homeostasis in lymphocytes of 14 patients with X-ALD and evaluated the balance between oxidized and reduced forms of glutathione, in order to define the role of this crucial redox marker in this condition. METHODS Lymphocytes, plasma and erythrocytes were obtained from the whole blood of 14 subjects with X-ALD and in 30 healthy subjects. Total, reduced and protein-bound glutathione levels were measured in lymphocytes by HPLC analysis. Erythrocyte free glutathione and antioxidant enzyme activities, plasma thiols and carbonyl content were determined by spectrophotometric assays. RESULTS A significant decrease of total and reduced glutathione was found in lymphocytes of patients, associated to high levels of all oxidized glutathione forms. A decline of free glutathione was particularly significant in erythrocytes. The increased oxidative stress in X-ALD was additionally confirmed by the decrease of plasma thiols and the high level of carbonyls. CONCLUSION Our results strongly support a role for oxidative stress in the pathophysiology of X-ALD and strengthen the importance of the balance among glutathione forms as a hallmark and a potential biomarker of the disease.
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Affiliation(s)
- Sara Petrillo
- Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiorella Piemonte
- Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Pastore
- Laboratory of Metabolomics and Proteomics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Tozzi
- Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Aiello
- Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurora Pujol
- Catalan Institution of Research and Advanced Studies (ICREA), Barcelona, Spain
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Spain
- Institut de Neuropatologia, Bellvitge Biomedical Research Institute (IDIBELL), Hospital Universitari de Bellvitge, Universitat de Barcelona, Spain
| | - Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Correspondence to: M. Cappa, Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio, 4-00165 Roma, Italy. Fax: + 39 06/6859 2024.
| | - Enrico Bertini
- Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Correspondence to: E. Bertini, Unit for Neuromuscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio, 4-00165 Roma, Italy. Fax: + 39 06/6859 2024.
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146
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Tsutsui S, Stys PK. Metabolic injury to axons and myelin. Exp Neurol 2013; 246:26-34. [DOI: 10.1016/j.expneurol.2012.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/20/2012] [Accepted: 04/23/2012] [Indexed: 12/31/2022]
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147
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Clinical manifest x-linked recessive adrenoleukodystrophy in a female. Case Rep Neurol Med 2013; 2013:491790. [PMID: 23864971 PMCID: PMC3705873 DOI: 10.1155/2013/491790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022] Open
Abstract
Adrenoleukodystrophy (ALD) is a rare X-linked inherited leukodystrophy with a reduced capacity for degradation of very long chain fatty acids (VLCFAs). The intracellular accumulation of VLCFA leads to demyelination in the central nervous system (CNS) and cell destruction in the adrenal glands. ALD primarily affects males; however, females may develop milder symptoms that may be difficult to recognize. The present report describes a 35-year-old female who experienced a feeling of heaviness in the upper and lower limbs, pain in both knees, and difficulty climbing stairs, running, and jumping. Clinical examination revealed decreased sensitivity in the feet, particularly to touch. Deep tendon reflexes in the lower limbs were brisk, and Babinski's sign was present bilaterally. Multiple sclerosis (MS) was excluded, and all clinical and biochemical tests were normal. After two years of progressing symptoms, the patient was reevaluated and plasma levels of VLCFA were found to be elevated. Seven years prior to this finding, the patient had been found to be heterozygous for the missense mutation c.1679C> T, p.Pro560Leu on the ABCD1 gene (ATP-Binding Cassette subfamily D1). In conclusion, the patient's symptoms could be attributed to ALD. The present case underlines the importance of reevaluating family history in women presenting with vague neurological symptoms.
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148
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Ragot K, Mackrill JJ, Zarrouk A, Nury T, Aires V, Jacquin A, Athias A, Barros JPPD, Véjux A, Riedinger JM, Delmas D, Lizard G. Absence of correlation between oxysterol accumulation in lipid raft microdomains, calcium increase, and apoptosis induction on 158N murine oligodendrocytes. Biochem Pharmacol 2013; 86:67-79. [DOI: 10.1016/j.bcp.2013.02.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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149
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Launay N, Ruiz M, Fourcade S, Schlüter A, Guilera C, Ferrer I, Knecht E, Pujol A. Oxidative stress regulates the ubiquitin-proteasome system and immunoproteasome functioning in a mouse model of X-adrenoleukodystrophy. Brain 2013; 136:891-904. [PMID: 23436506 DOI: 10.1093/brain/aws370] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Oxidative damage is a pivotal aetiopathogenic factor in X-linked adrenoleukodystrophy. This is a neurometabolic disease characterized by the accumulation of very-long-chain fatty acids owing to the loss of function of the peroxisomal transporter Abcd1. Here, we used the X-linked adrenoleukodystrophy mouse model and patient's fibroblasts to detect malfunctioning of the ubiquitin-proteasome system resulting from the accumulation of oxidatively modified proteins, some involved in bioenergetic metabolism. Furthermore, the immunoproteasome machinery appears upregulated in response to oxidative stress, in the absence of overt inflammation. i-Proteasomes are recruited to mitochondria when fibroblasts are exposed to an excess of very-long-chain fatty acids in response to oxidative stress. Antioxidant treatment regulates proteasome expression, prevents i-proteasome induction and translocation of i-proteasomes to mitochondria. Our findings support a key role of i-proteasomes in quality control in mitochondria during oxidative damage in X-linked adrenoleukodystrophy, and perhaps in other neurodegenerative conditions with similar pathogeneses.
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Affiliation(s)
- Nathalie Launay
- Neurometabolic Diseases Laboratory, Institute of Neuropathology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
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150
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Niu YF, Ni W, Wu ZY. ABCD1 mutations and phenotype distribution in Chinese patients with X-linked adrenoleukodystrophy. Gene 2013; 522:117-20. [PMID: 23566833 DOI: 10.1016/j.gene.2013.03.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/31/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a neurodegenerative disorder resulting from mutations within the ABCD1 gene. Adrenomyeloneuropathy (AMN) and childhood cerebral ALD (CCALD) are most common phenotypes in the Western ALD patients. Here we performed mutation analysis of ABCD1 in 10 Chinese ALD families and identified 8 mutations, including one novel deletion (c.1477_1488+11del23) and 7 known mutations. Mutations c.1772G>A and c.1816T>C were first reported in the Chinese patients. Mutations c.1661G>A and c.1679C>T were demonstrated to be de novo mutations. The dinucleotide deletion 1415_16delAG, described as a mutational hotspot in different ethnic groups, was identified in two families. In addition, we performed a retrospective nation-wide mutation study of X-linked ALD in China based on a literature review. The retrospective study further confirmed the hypothesis that exon 6 is a potential mutation cluster region in the Asian populations. Furthermore, it suggested that CCALD is the most common phenotype in China.
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Affiliation(s)
- Yan-Fang Niu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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