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Shirakaki S, Roshmi RR, Yokota T. Genetic Approaches for the Treatment of Giant Axonal Neuropathy. J Pers Med 2022; 13:jpm13010091. [PMID: 36675752 PMCID: PMC9865904 DOI: 10.3390/jpm13010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Giant axonal neuropathy (GAN) is a pediatric, hereditary, neurodegenerative disorder that affects both the central and peripheral nervous systems. It is caused by mutations in the GAN gene, which codes for the gigaxonin protein. Gigaxonin plays a role in intermediate filament (IF) turnover hence loss of function of this protein leads to IF aggregates in various types of cells. These aggregates can lead to abnormal cellular function that manifests as a diverse set of symptoms in persons with GAN including nerve degeneration, cognitive issues, skin diseases, vision loss, and muscle weakness. GAN has no cure at this time. Currently, an adeno-associated virus (AAV) 9-mediated gene replacement therapy is being tested in a phase I clinical trial for the treatment of GAN. This review paper aims to provide an overview of giant axonal neuropathy and the current efforts at developing a treatment for this devastating disease.
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Bharucha-Goebel DX, Norato G, Saade D, Paredes E, Biancavilla V, Donkervoort S, Kaur R, Lehky T, Fink M, Armao D, Gray SJ, Waite M, Debs S, Averion G, Hu Y, Zein WM, Foley AR, Jain M, Bönnemann CG. Giant axonal neuropathy: cross sectional analysis of a large natural history cohort. Brain 2021; 144:3239-3250. [PMID: 34114613 DOI: 10.1093/brain/awab179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/14/2022] Open
Abstract
Giant axonal neuropathy (GAN) is an ultra-rare autosomal recessive, progressive neurodegenerative disease with early childhood onset that presents as a prominent sensorimotor neuropathy and commonly progresses to affect both the peripheral nervous system and central nervous system. The disease is caused by biallelic mutations in the GAN gene located on 16q23.2, leading to loss of functional gigaxonin, a substrate specific ubiquitin ligase adapter protein necessary for the regulation of intermediate filament turnover. Here, we report on cross-sectional data from the first study visit of a prospectively collected natural history study of 45 individuals, age range 3-21 years with genetically confirmed giant axonal neuropathy to describe and cross-correlate baseline clinical and functional cohort characteristics. We review causative variants distributed throughout the GAN gene in this cohort and identify a recurrent founder mutation in individuals with giant axonal neuropathy of Mexican descent as well as cases of recurrent uniparental isodisomy. Through cross correlation analysis of measures of strength, motor function, and electrophysiologic markers of disease severity, we identified the Motor Function Measure 32 (MFM-32) to have the strongest correlation across measures and age in individuals with giant axonal neuropathy. We analysed the Motor Function Measure 32 scores as they correspond to age and ambulatory status. Importantly, we identified and characterized a sub cohort of individuals with a milder form of giant axonal neuropathy and with a presentation similar to Charcot-Marie-Tooth disease. Such a clinical presentation is distinct from the classic presentation of giant axonal neuropathy, and we demonstrate how the two groups diverge in performance on the Motor Function Measure 32 and other functional motor scales. We further present data on the first systematic clinical analysis of autonomic impairment in giant axonal neuropathy as performed on a subset of the natural history cohort. Our cohort of individuals with genetically confirmed giant axonal neuropathy is the largest reported to date and highlights the clinical heterogeneity and the unique phenotypic and functional characteristics of giant axonal neuropathy in relation to disease state. The present work is designed to serve as a foundation for a prospective natural history study and functions in concert with the ongoing gene therapy trial for children with giant axonal neuropathy.
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Affiliation(s)
- Diana X Bharucha-Goebel
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA.,Children's National Hospital, Division of Neurology, Washington DC, USA
| | - Gina Norato
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Clinical Trials Unit, Bethesda, MD 20892, USA
| | - Dimah Saade
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Eduardo Paredes
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Victoria Biancavilla
- National Institutes of Health, Rehabilitation Medicine Department, Bethesda, MD, USA
| | - Sandra Donkervoort
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Rupleen Kaur
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Tanya Lehky
- National Institutes of Health, EMG Section, Bethesda, MD 20892, USA
| | - Margaret Fink
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Diane Armao
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.,Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Steven J Gray
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Melissa Waite
- National Institutes of Health, Rehabilitation Medicine Department, Bethesda, MD, USA
| | - Sarah Debs
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Gilberto Averion
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Ying Hu
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Wadih M Zein
- National Institutes of Health, National Eye Institute, Bethesda, MD 20892, USA
| | - A Reghan Foley
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
| | - Minal Jain
- National Institutes of Health, Rehabilitation Medicine Department, Bethesda, MD, USA
| | - Carsten G Bönnemann
- National Institutes of Health, Neuromuscular and Neurogenetic Disorders of Childhood Section, Bethesda, MD 20892, USA
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Hardcastle N, Boulis NM, Federici T. AAV gene delivery to the spinal cord: serotypes, methods, candidate diseases, and clinical trials. Expert Opin Biol Ther 2017; 18:293-307. [PMID: 29249183 DOI: 10.1080/14712598.2018.1416089] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Adeno-associated viral (AAV) vector-mediated gene delivery to the spinal cord has finally entered the pathway towards regulatory approval. Phase 1 clinical trials using AAV gene therapy for pediatric disorders - spinal muscular atrophy (SMA) and giant axonal neuropathy (GAN) - are now underway. AREAS COVERED This review addresses the latest progress in the field of AAV gene delivery to the spinal cord, particularly focusing on the most prominent AAV serotypes and delivery methodologies to the spinal cord. Candidate diseases and scaling up experiments in large animals are also discussed. EXPERT OPINION Intravenous (IV) and intrathecal (IT) deliveries seem to undoubtedly be the preferred routes of administration for diffuse spinal cord delivery of therapeutic AAV vectors that can cross the blood-brain barrier (BBB) and correct inherited genetic disorders. Conversely, intraparenchymal delivery is still an undervalued but very viable approach for segmental therapy in afflictions such as ALS or Pompe Disease as a means to prevent respiratory dysfunction.
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Affiliation(s)
- Nathan Hardcastle
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
| | - Nicholas M Boulis
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
| | - Thais Federici
- a Department of Neurosurgery , Emory University , Atlanta , GA , USA
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Takaku S, Niimi N, Kadoya T, Yako H, Tsukamoto M, Sakumi K, Nakabeppu Y, Horie H, Sango K. Galectin-1 and galectin-3 as key molecules for peripheral nerve degeneration and regeneration. AIMS MOLECULAR SCIENCE 2016. [DOI: 10.3934/molsci.2016.3.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Johnson-Kerner BL, Garcia Diaz A, Ekins S, Wichterle H. Kelch Domain of Gigaxonin Interacts with Intermediate Filament Proteins Affected in Giant Axonal Neuropathy. PLoS One 2015; 10:e0140157. [PMID: 26460568 PMCID: PMC4604155 DOI: 10.1371/journal.pone.0140157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022] Open
Abstract
Patients with giant axonal neuropathy (GAN) show progressive loss of motor and sensory function starting in childhood and typically live for less than 30 years. GAN is caused by autosomal recessive mutations leading to low levels of gigaxonin (GIG), a ubiquitously-expressed BTB/Kelch cytoplasmic protein believed to be an E3 ligase substrate adaptor. GAN pathology is characterized by aggregates of intermediate filaments (IFs) in multiple tissues. To delineate the molecular pathway between GIG deficiency and IF pathology, we undertook a proteomic screen to identify the normal binding partners of GIG. Prominent among them were several classes of IFs, including the neurofilament subunits whose accumulation leads to the axonal swellings for which GAN is named. We showed these interactions were dependent on the Kelch domain of GIG. Furthermore, we identified the E3 ligase MYCBP2 and the heat shock proteins HSP90AA1/AB1 as interactors with the BTB domain that may result in the ubiquitination and subsequent degradation of intermediate filaments. Our open-ended proteomic screen provides support to GIG’s role as an adaptor protein, linking IF proteins through its Kelch domain to the ubiquitin pathway proteins via its BTB domain, and points to future approaches for reversing the phenotype in human patients.
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Affiliation(s)
- Bethany L. Johnson-Kerner
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, New York, United States of America
- Center for Motor Neuron Biology and Disease, Columbia University Medical Center, New York, New York, United States of America
- Departments of Pathology and Cell Biology, Neurology, and Neuroscience, Columbia University Medical Center, New York, New York, United States of America
- Columbia Stem Cell Initiative, Columbia University Medical Center, New York, New York, United States of America
| | - Alejandro Garcia Diaz
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, New York, United States of America
- Center for Motor Neuron Biology and Disease, Columbia University Medical Center, New York, New York, United States of America
| | - Sean Ekins
- Collaborations in Chemistry, Fuquay-Varina, North Carolina, United States of America
| | - Hynek Wichterle
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, New York, United States of America
- Center for Motor Neuron Biology and Disease, Columbia University Medical Center, New York, New York, United States of America
- Departments of Pathology and Cell Biology, Neurology, and Neuroscience, Columbia University Medical Center, New York, New York, United States of America
- Columbia Stem Cell Initiative, Columbia University Medical Center, New York, New York, United States of America
- * E-mail:
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Johnson-Kerner BL, Ahmad FS, Diaz AG, Greene JP, Gray SJ, Samulski RJ, Chung WK, Van Coster R, Maertens P, Noggle SA, Henderson CE, Wichterle H. Intermediate filament protein accumulation in motor neurons derived from giant axonal neuropathy iPSCs rescued by restoration of gigaxonin. Hum Mol Genet 2014; 24:1420-31. [PMID: 25398950 DOI: 10.1093/hmg/ddu556] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Giant axonal neuropathy (GAN) is a progressive neurodegenerative disease caused by autosomal recessive mutations in the GAN gene resulting in a loss of a ubiquitously expressed protein, gigaxonin. Gene replacement therapy is a promising strategy for treatment of the disease; however, the effectiveness and safety of gigaxonin reintroduction have not been tested in human GAN nerve cells. Here we report the derivation of induced pluripotent stem cells (iPSCs) from three GAN patients with different GAN mutations. Motor neurons differentiated from GAN iPSCs exhibit accumulation of neurofilament (NF-L) and peripherin (PRPH) protein and formation of PRPH aggregates, the key pathological phenotypes observed in patients. Introduction of gigaxonin either using a lentiviral vector or as a stable transgene resulted in normalization of NEFL and PRPH levels in GAN neurons and disappearance of PRPH aggregates. Importantly, overexpression of gigaxonin had no adverse effect on survival of GAN neurons, supporting the feasibility of gene replacement therapy. Our findings demonstrate that GAN iPSCs provide a novel model for studying human GAN neuropathologies and for the development and testing of new therapies in relevant cell types.
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Affiliation(s)
- Bethany L Johnson-Kerner
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, NY 10032, USA, Center for Motor Neuron Biology and Disease, Departments of Pathology and Cell Biology, Neurology, and Neuroscience, Columbia Stem Cell Initiative
| | | | - Alejandro Garcia Diaz
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, NY 10032, USA
| | - John Palmer Greene
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, NY 10032, USA
| | - Steven J Gray
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard Jude Samulski
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Rudy Van Coster
- Department of Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Paul Maertens
- Departments of Pediatric Neurology, University of South Alabama, Mobile, AL, USA
| | | | - Christopher E Henderson
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, NY 10032, USA, Center for Motor Neuron Biology and Disease, Departments of Pathology and Cell Biology, Neurology, and Neuroscience, Columbia Stem Cell Initiative, Department of Rehabilitation and Regenerative Medicine
| | - Hynek Wichterle
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research, New York, NY 10032, USA, Center for Motor Neuron Biology and Disease, Departments of Pathology and Cell Biology, Neurology, and Neuroscience, Columbia Stem Cell Initiative,
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Johnson-Kerner BL, Roth L, Greene JP, Wichterle H, Sproule DM. Giant axonal neuropathy: An updated perspective on its pathology and pathogenesis. Muscle Nerve 2014; 50:467-76. [DOI: 10.1002/mus.24321] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Bethany L. Johnson-Kerner
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Lisa Roth
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - J. Palmer Greene
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Hynek Wichterle
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Douglas M. Sproule
- Division of Pediatric Neurosciences, Department of Neurology; SMA Clinical Research Center, Columbia University Medical Center; Harkness Pavilion, HP-519, 180 Fort Washington Avenue New York New York 10032-3791 USA
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Wang L, Zhao D, Wang Z, Zhang W, Lv H, Liu X, Meng L, Yuan Y. Heterogeneity of axonal pathology in chinese patients with giant axonal neuropathy. Muscle Nerve 2014; 50:200-5. [PMID: 24273072 DOI: 10.1002/mus.24130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/01/2013] [Accepted: 11/19/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Lu Wang
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Danhua Zhao
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Zhaoxia Wang
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Wei Zhang
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - He Lv
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Xiao Liu
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Lingchao Meng
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Yun Yuan
- Department of Neurology; Peking University First Hospital; 8 Xishiku Street, Xicheng District Beijing 100034 China
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Integrative biological analysis for neuropsychopharmacology. Neuropsychopharmacology 2014; 39:5-23. [PMID: 23800968 PMCID: PMC3857644 DOI: 10.1038/npp.2013.156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 01/24/2023]
Abstract
Although advances in psychotherapy have been made in recent years, drug discovery for brain diseases such as schizophrenia and mood disorders has stagnated. The need for new biomarkers and validated therapeutic targets in the field of neuropsychopharmacology is widely unmet. The brain is the most complex part of human anatomy from the standpoint of number and types of cells, their interconnections, and circuitry. To better meet patient needs, improved methods to approach brain studies by understanding functional networks that interact with the genome are being developed. The integrated biological approaches--proteomics, transcriptomics, metabolomics, and glycomics--have a strong record in several areas of biomedicine, including neurochemistry and neuro-oncology. Published applications of an integrated approach to projects of neurological, psychiatric, and pharmacological natures are still few but show promise to provide deep biological knowledge derived from cells, animal models, and clinical materials. Future studies that yield insights based on integrated analyses promise to deliver new therapeutic targets and biomarkers for personalized medicine.
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Mussche S, Devreese B, Nagabhushan Kalburgi S, Bachaboina L, Fox JC, Shih HJ, Van Coster R, Samulski RJ, Gray SJ. Restoration of cytoskeleton homeostasis after gigaxonin gene transfer for giant axonal neuropathy. Hum Gene Ther 2013; 24:209-19. [PMID: 23316953 DOI: 10.1089/hum.2012.107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Giant axonal neuropathy (GAN) is caused by loss of function of the gigaxonin protein. On a cellular level GAN is characterized by intermediate filament (IF) aggregation, leading to a progressive and fatal peripheral neuropathy in humans. This study sought to determine if re-introduction of the GAN gene into GAN-deficient cells and mice would restore proper cytoskeleton IF homeostasis. Treatment of primary skin fibroblast cultures from three different GAN patients with an adeno-associated virus type 2 (AAV2) vector containing a normal human GAN transgene significantly reduced the number of cells displaying vimentin IF aggregates. A proteomic analysis of these treated cells was also performed, wherein the abundance of 32 of 780 identified proteins significantly changed in response to gigaxonin gene transfer. While 29 of these responding proteins have not been directly described in association with gigaxonin, three were previously identified as being disregulated in GAN and were now shifted toward normal levels. To assess the potential application of this approach in vivo and eventually in humans, GAN mice received an intracisternal injection of an AAV9/GAN vector to globally deliver the GAN gene to the brainstem and spinal cord. The treated mice showed a nearly complete clearance of peripherin IF accumulations at 3 weeks post-injection. These studies demonstrate that gigaxonin gene transfer can reverse the cellular IF aggregate pathology associated with GAN.
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Affiliation(s)
- Silke Mussche
- Department of Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent 9000, Belgium
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Wood J, Sames L, Moore A, Ekins S. Multifaceted roles of ultra-rare and rare disease patients/parents in drug discovery. Drug Discov Today 2013; 18:1043-51. [PMID: 23968993 DOI: 10.1016/j.drudis.2013.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/29/2013] [Accepted: 08/07/2013] [Indexed: 01/10/2023]
Abstract
Individual parents and patients are increasingly doing more to fund, discover and develop treatments for rare and ultra-rare diseases that afflict their children, themselves or their friends. They are performing roles in business development that would be classed as entrepreneurial; and their organizational roles in driving the science in some cases are equivalent to those of principal investigators. These roles are in addition to their usual positioning as advocates. Through their efforts and those of the collaborative networks that they have developed, they could be positioned to disrupt the usual course of drug discovery. This can be illustrated using three different ultra-rare disease parent/patient advocate groups and the diseases for which they are developing treatments. This represents an alternative model for pharmaceutical research.
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Affiliation(s)
- Jill Wood
- Jonah's Just Begun, P.O. Box 150057, Brooklyn, NY 11215, USA; Phoenix Nest, P.O. Box 150057, Brooklyn, NY 11215, USA
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