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Aughey G, Cali E, Maroofian R, Zaki MS, Pagnamenta AT, Rahman F, Menzies L, Shafique A, Suri M, Roze E, Aguennouz M, Ghizlane Z, Saadi SM, Ali Z, Abdulllah U, Cheema HA, Anjum MN, Morel G, McFarland R, Altunoglu U, Kraus V, Shoukier M, Murphy D, Flemming K, Yttervik H, Rhouda H, Lesca G, Murtaza BN, Rehman MU, Consortium GE, Seo GH, Beetz C, Kayserili H, Krioulie Y, Chung WK, Naz S, Maqbool S, Gleeson J, Baig SM, Efthymiou S, Taylor JC, Severino M, Jepson JE, Houlden H. Clinical and neurogenetic characterisation of autosomal recessive RBL2-associated progressive neurodevelopmental disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.03.24306631. [PMID: 38746364 PMCID: PMC11092723 DOI: 10.1101/2024.05.03.24306631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Retinoblastoma (RB) proteins are highly conserved transcriptional regulators that play important roles during development by regulating cell-cycle gene expression. RBL2 dysfunction has been linked to a severe neurodevelopmental disorder. However, to date, clinical features have only been described in six individuals carrying five biallelic predicted loss of function (pLOF) variants. To define the phenotypic effects of RBL2 mutations in detail, we identified and clinically characterized a cohort of 28 patients from 18 families carrying LOF variants in RBL2 , including fourteen new variants that substantially broaden the molecular spectrum. The clinical presentation of affected individuals is characterized by a range of neurological and developmental abnormalities. Global developmental delay and intellectual disability were uniformly observed, ranging from moderate to profound and involving lack of acquisition of key motor and speech milestones in most patients. Frequent features included postnatal microcephaly, infantile hypotonia, aggressive behaviour, stereotypic movements and non-specific dysmorphic features. Common neuroimaging features were cerebral atrophy, white matter volume loss, corpus callosum hypoplasia and cerebellar atrophy. In parallel, we used the fruit fly, Drosophila melanogaster , to investigate how disruption of the conserved RBL2 orthologueue Rbf impacts nervous system function and development. We found that Drosophila Rbf LOF mutants recapitulate several features of patients harboring RBL2 variants, including alterations in the head and brain morphology reminiscent of microcephaly, and perturbed locomotor behaviour. Surprisingly, in addition to its known role in controlling tissue growth during development, we find that continued Rbf expression is also required in fully differentiated post-mitotic neurons for normal locomotion in Drosophila , and that adult-stage neuronal re-expression of Rbf is sufficient to rescue Rbf mutant locomotor defects. Taken together, this study provides a clinical and experimental basis to understand genotype-phenotype correlations in an RBL2 -linked neurodevelopmental disorder and suggests that restoring RBL2 expression through gene therapy approaches may ameliorate aspects of RBL2 LOF patient symptoms.
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Accogli A, Zaki MS, Al-Owain M, Otaif MY, Jackson A, Argilli E, Chandler KE, De Goede CGEL, Cora T, Alvi JR, Eslahi A, Asl Mohajeri MS, Ashtiani S, Au PYB, Scocchia A, Alakurtti K, Pagnamenta AT, Toosi MB, Karimiani EG, Mojarrad M, Arab F, Duymuş F, Scantlebury MH, Yeşil G, Rosenfeld JA, Türkyılmaz A, Sağer SG, Sultan T, Ashrafzadeh F, Zahra T, Rahman F, Maqbool S, Abdel-Hamid MS, Issa MY, Efthymiou S, Bauer P, Zifarelli G, Salpietro V, Al-Hassnan Z, Banka S, Sherr EH, Gleeson JG, Striano P, Houlden H, Severino M, Maroofian R. Lunapark deficiency leads to an autosomal recessive neurodevelopmental phenotype with a degenerative course, epilepsy and distinct brain anomalies. Brain Commun 2023; 5:fcad222. [PMID: 37794925 PMCID: PMC10546953 DOI: 10.1093/braincomms/fcad222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
LNPK encodes a conserved membrane protein that stabilizes the junctions of the tubular endoplasmic reticulum network playing crucial roles in diverse biological functions. Recently, homozygous variants in LNPK were shown to cause a neurodevelopmental disorder (OMIM#618090) in four patients displaying developmental delay, epilepsy and nonspecific brain malformations including corpus callosum hypoplasia and variable impairment of cerebellum. We sought to delineate the molecular and phenotypic spectrum of LNPK-related disorder. Exome or genome sequencing was carried out in 11 families. Thorough clinical and neuroradiological evaluation was performed for all the affected individuals, including review of previously reported patients. We identified 12 distinct homozygous loss-of-function variants in 16 individuals presenting with moderate to profound developmental delay, cognitive impairment, regression, refractory epilepsy and a recognizable neuroimaging pattern consisting of corpus callosum hypoplasia and signal alterations of the forceps minor ('ear-of-the-lynx' sign), variably associated with substantia nigra signal alterations, mild brain atrophy, short midbrain and cerebellar hypoplasia/atrophy. In summary, we define the core phenotype of LNPK-related disorder and expand the list of neurological disorders presenting with the 'ear-of-the-lynx' sign suggesting a possible common underlying mechanism related to endoplasmic reticulum-phagy dysfunction.
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Affiliation(s)
- Andrea Accogli
- Division of Medical Genetics, Department of Specialized Medicine, McGill University, Montreal H3G 1A4, Canada
- Department of Human Genetics, McGill University, Montreal, QC H3A 0C7, Canada
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt
| | - Mohammed Al-Owain
- Department of Medical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Mansour Y Otaif
- Department of Pediatric, Neurology Section, Abha Maternity and Childern Hospital, Abha 62521, Saudi Arabia
| | - Adam Jackson
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Emanuela Argilli
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kate E Chandler
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Christian G E L De Goede
- Department of Paediatric Neurology, Clinical Research Facility, Lancashire Teaching Hospital NHS Trust, Preston PR2 9HT, UK
| | - Tülün Cora
- Department of Medical Genetics, Selcuk University School of Medicine, Konya 42100, Turkey
| | - Javeria Raza Alvi
- Department of Pediatric Neurology, Institute of Child Health, Children's Hospital, Lahore 54590, Pakistan
| | - Atieh Eslahi
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9137-86177, Iran
| | - Mahsa Sadat Asl Mohajeri
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran
| | - Setareh Ashtiani
- Alberta Children’s Hospital Research Institute, Department of Medical Genetics, University of Calgary, Alberta T2N 4Z6, Canada
| | - P Y Billie Au
- Alberta Children’s Hospital Research Institute, Department of Medical Genetics, University of Calgary, Alberta T2N 4Z6, Canada
| | | | | | - Alistair T Pagnamenta
- NIHR Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Mehran Beiraghi Toosi
- Pediatric Neurology Department, Mashhad University of Medical Sciences, Mashhad 913791-6847, Iran
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad 91375-33116, Iran
| | - Ehsan Ghayoor Karimiani
- Molecular and Clinical Sciences Institute, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad 91869-51591, Iran
| | - Majid Mojarrad
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9137-86177, Iran
- Genetic Center of Khorasan Razavi, Mashhad 91877-53831, Iran
| | - Fatemeh Arab
- Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran
| | - Fahrettin Duymuş
- Department of Medical Genetics, Selcuk University School of Medicine, Konya 42100, Turkey
- Department of Medical Genetics, Konya City Hospital, Konya 42020, Turkey
| | - Morris H Scantlebury
- Departments of Pediatrics and Clinical Neuroscience, University of Calgary; Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute & Owerko Center, University of Calgary, Alberta T2N 4N1, Canada
| | - Gözde Yeşil
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul 34093, Turkey
| | - Jill Anne Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Baylor Genetics Laboratories, Houston, TX 77021, USA
| | - Ayberk Türkyılmaz
- Department of Medical Genetics, Karadeniz Technical University Faculty of Medicine, Trabzon 61080, Turkey
| | - Safiye Güneş Sağer
- Clinics of Pediatric Neurology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul 34890, Turkey
| | - Tipu Sultan
- Department of Pediatric Neurology, Institute of Child Health, Children's Hospital, Lahore 54590, Pakistan
| | - Farah Ashrafzadeh
- Pediatric Neurology Department, Mashhad University of Medical Sciences, Mashhad 913791-6847, Iran
| | - Tatheer Zahra
- Department of Developmental-Behavioral Pediatrics, University of Child Health Sciences, The Children’s Hospital, Lahore 54590, Pakistan
| | - Fatima Rahman
- Department of Developmental-Behavioral Pediatrics, University of Child Health Sciences, The Children’s Hospital, Lahore 54590, Pakistan
| | - Shazia Maqbool
- Department of Developmental-Behavioral Pediatrics, University of Child Health Sciences, The Children’s Hospital, Lahore 54590, Pakistan
| | - Mohamed S Abdel-Hamid
- Medical Molecular Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt
| | - Mahmoud Y Issa
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | | | | | - Vincenzo Salpietro
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila 67100, Italy
| | - Zuhair Al-Hassnan
- Department of Medical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Siddharth Banka
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Elliot H Sherr
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joseph G Gleeson
- Department of Neurosciences, University of California, San Diego, La Jolla 92093, USA
- Rady Children’s Institute for Genomic Medicine, San Diego 92123, USA
| | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa 16132, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto ‘Giannina Gaslini’, Genoa 16147, Italy
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | | | - Reza Maroofian
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Monfrini E, Pesini A, Biella F, Sobreira CFR, Emmanuele V, Brescia G, Lopez LC, Tadesse S, Hirano M, Comi GP, Quinzii CM, Di Fonzo A. Whole-Exome Sequencing Study of Fibroblasts Derived From Patients With Cerebellar Ataxia Referred to Investigate CoQ10 Deficiency. NEUROLOGY GENETICS 2023; 9:e200058. [PMID: 37090936 PMCID: PMC10117701 DOI: 10.1212/nxg.0000000000200058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/04/2023] [Indexed: 03/17/2023]
Abstract
Background and ObjectivesCoenzyme Q10(CoQ10)–deficient cerebellar ataxia can be due to pathogenic variants in genes encoding for CoQ10biosynthetic proteins or associated with defects in protein unrelated to its biosynthesis. Diagnosis is crucial because patients may respond favorably to CoQ10supplementation. The aim of this study was to identify through whole-exome sequencing (WES) the pathogenic variants, and assess CoQ10levels, in fibroblasts from patients with undiagnosed cerebellar ataxia referred to investigate CoQ10deficiency.MethodsWES was performed on genomic DNA extracted from 16 patients. Sequencing data were filtered using a virtual panel of genes associated with CoQ10deficiency and/or cerebellar ataxia. CoQ10levels were measured by high-performance liquid chromatography in 14 patient-derived fibroblasts.ResultsA definite genetic etiology was identified in 8 samples of 16 (diagnostic yield = 50%). The identified genetic causes were pathogenic variants of the genesCOQ8A(ADCK3) (n = 3 samples),ATP1A3(n = 2),PLA2G6(n = 1),SPG7(n = 1), andMFSD8(n = 1). Five novel mutations were found (COQ8An = 3,PLA2G6n = 1, andMFSD8n = 1). CoQ10levels were significantly decreased in 3/14 fibroblast samples (21.4%), 1 carrying compound heterozygousCOQ8Apathogenic variants, 1 harboring a homozygous pathogenicSPG7variant, and 1 with an unknown molecular defect.DiscussionThis work confirms the importance ofCOQ8Agene mutations as a frequent genetic cause of cerebellar ataxia and CoQ10deficiency and suggestsSPG7mutations as a novel cause of secondary CoQ10deficiency.
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Affiliation(s)
- Edoardo Monfrini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Alba Pesini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Fabio Biella
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Claudia F R Sobreira
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Valentina Emmanuele
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Gloria Brescia
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Luis Carlos Lopez
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Saba Tadesse
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Michio Hirano
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Giacomo P Comi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Catarina Maria Quinzii
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
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