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Ferreira DT, Shen BQ, Mwirigi JM, Shiers S, Sankaranarayanan I, Kotamarti M, Inturi NN, Mazhar K, Ubogu EE, Thomas G, Lalli T, Wukich D, Price TJ. Deciphering the molecular landscape of human peripheral nerves: implications for diabetic peripheral neuropathy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.15.599167. [PMID: 38915676 PMCID: PMC11195245 DOI: 10.1101/2024.06.15.599167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a prevalent complication of diabetes mellitus that is caused by metabolic toxicity to peripheral axons. We aimed to gain deep mechanistic insight into the disease process using bulk and spatial RNA sequencing on tibial and sural nerves recovered from lower leg amputations in a mostly diabetic population. First, our approach comparing mixed sensory and motor tibial and purely sensory sural nerves shows key pathway differences in affected nerves, with distinct immunological features observed in sural nerves. Second, spatial transcriptomics analysis of sural nerves reveals substantial shifts in endothelial and immune cell types associated with severe axonal loss. We also find clear evidence of neuronal gene transcript changes, like PRPH, in nerves with axonal loss suggesting perturbed RNA transport into distal sensory axons. This motivated further investigation into neuronal mRNA localization in peripheral nerve axons generating clear evidence of robust localization of mRNAs such as SCN9A and TRPV1 in human sensory axons. Our work gives new insight into the altered cellular and transcriptomic profiles in human nerves in DPN and highlights the importance of sensory axon mRNA transport as an unappreciated potential contributor to peripheral nerve degeneration.
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Affiliation(s)
- Diana Tavares Ferreira
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Breanna Q Shen
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Juliet M Mwirigi
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Stephanie Shiers
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Ishwarya Sankaranarayanan
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Miriam Kotamarti
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Nikhil N Inturi
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Khadijah Mazhar
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
| | - Eroboghene E Ubogu
- Department of Neurology, Division of Neuromuscular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Geneva Thomas
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trapper Lalli
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dane Wukich
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain Studies; University of Texas at Dallas, Richardson, TX, USA
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Roberts LJ, Szmulewicz DJ. A patient with neuropathy and ataxia: what do I have to consider? Curr Opin Neurol 2023; 36:382-387. [PMID: 37639448 DOI: 10.1097/wco.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW An increasing number of peripheral neuro(no)pathies are identified as involving other components of the neurological system, particularly those that further impair balance. Here we aim to outline an evidence-based approach to the diagnosis of patients who present with a somatosensory disorder which also involves at least one other area of neurological impairment such as the vestibular, auditory, or cerebellar systems. RECENT FINDINGS Detailed objective investigation of patients who present with sensory impairment, particularly where the degree of imbalance is greater than would be expected, aids the accurate diagnosis of genetic, autoimmune, metabolic, and toxic neurological disease. SUMMARY Diagnosis and management of complex somatosensory disorders benefit from investigation which extends beyond the presenting sensory impairment.
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Affiliation(s)
- Leslie J Roberts
- Neurophysiology Department, Department of Neurology & Neurological Research, St Vincent's Hospital, Department of Medicine, the University of Melbourne
| | - David J Szmulewicz
- Balance Disorders and Ataxia Service, Eye and Ear Hospital
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, Australia
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Johnson D, Santos E, Kim K, Ponzini MD, McLennan YA, Schneider A, Tassone F, Hagerman RJ. Increased Pain Symptomatology Among Females vs. Males With Fragile X-Associated Tremor/Ataxia Syndrome. Front Psychiatry 2021; 12:762915. [PMID: 35126193 PMCID: PMC8811376 DOI: 10.3389/fpsyt.2021.762915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Individuals with the fragile X premutation report symptoms of chronic pain from multiple systems, have increased incidence of comorbid conditions where pain is a prominent feature, and pathophysiology that supports disrupted pain regulation, inflammation, and energy imbalance. Less is known about how pain manifests for the subpopulation of carriers that develop the motor and cognitive changes of fragile X-associated tremor and ataxia syndrome (FXTAS), and how pain may differ between men and women. We gathered data collected from 104 males and females with FXTAS related to chronic pain, comorbid conditions related to pain, and medications used for pain control to further explore the types of pain experienced and to better characterize how individuals with the fragile X premutation experience pain sensation across genders. We found that women experience significantly more pain symptoms than men, particularly allodynia (20 vs. 2.0%, p = 0.008), peripheral neuropathy pain (43.9 vs. 25.4%, p = 0.0488), migraine (43.9 vs. 14.5%, p = 0.0008), fibromyalgia (26.8 vs. 0%, p = 0.0071) and back pain (48.5 vs. 23.4%, p = 0.008). We found onset of peripheral neuropathy predicts the onset of ataxia (β = 0.63 ± 0.25, p = 0.019) and tremor (β = 0.56 ± 0.17, p = 0.004) across gender. Women also report significantly more anxiety (82.9 vs. 39.7%, p < 0.001), which has implications for ideal pain treatment. These pain symptoms need to be recognized in the medical history and treated appropriately, with consideration for overlapping comorbidities.
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Affiliation(s)
- Devon Johnson
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Ellery Santos
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Kyoungmi Kim
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Matthew D Ponzini
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Yingratana A McLennan
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
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Mariano V, Domínguez-Iturza N, Neukomm LJ, Bagni C. Maintenance mechanisms of circuit-integrated axons. Curr Opin Neurobiol 2018; 53:162-173. [PMID: 30241058 DOI: 10.1016/j.conb.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Adult, circuit-integrated neurons must be maintained and supported for the life span of their host. The attenuation of either maintenance or plasticity leads to impaired circuit function and ultimately to neurodegenerative disorders. Over the last few years, significant discoveries of molecular mechanisms were made that mediate the formation and maintenance of axons. Here, we highlight intrinsic and extrinsic mechanisms that ensure the health and survival of axons. We also briefly discuss examples of mutations associated with impaired axonal maintenance identified in specific neurological conditions. A better understanding of these mechanisms will therefore help to define targets for therapeutic interventions.
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Affiliation(s)
- Vittoria Mariano
- Department of Fundamental Neurosciences, University of Lausanne, Switzerland; Department of Neurosciences KU Leuven, VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Nuria Domínguez-Iturza
- Department of Fundamental Neurosciences, University of Lausanne, Switzerland; Department of Neurosciences KU Leuven, VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Lukas J Neukomm
- Department of Fundamental Neurosciences, University of Lausanne, Switzerland.
| | - Claudia Bagni
- Department of Fundamental Neurosciences, University of Lausanne, Switzerland; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
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Characterization and Early Detection of Balance Deficits in Fragile X Premutation Carriers With and Without Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). THE CEREBELLUM 2016; 14:650-62. [PMID: 25763861 DOI: 10.1007/s12311-015-0659-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" size 55-200 CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Core motor features include cerebellar gait ataxia and kinetic tremor, resulting in progressive mobility disability. There are no published studies characterizing balance deficits in FMR1 premutation carriers with and without FXTAS using a battery of quantitative measures to test the sensory integration underlying postural control, automatic postural reflexes, and dynamic postural stability limits. Computerized dynamic posturography (CDP) and two performance-based balance measures were administered in 44 premutation carriers, 21 with FXTAS and 23 without FXTAS, and 42 healthy controls to compare balance and functional mobility between these groups. Relationships between FMR1 molecular variables, age, and sex and CDP scores were explored. FXTAS subjects demonstrated significantly lower scores on the sensory organization test (with greatest reductions in the vestibular control of balance), longer response latencies to balance perturbations, and reduced stability limits compared to controls. Premutation carriers without FXTAS also demonstrated significantly delayed response latencies and disrupted sensory weighting for balance control. Advancing age, male sex, increased CGG repeat size, and reduced X activation of the normal allele in premutation carrier women predicted balance dysfunction. These postural control deficits in carriers with and without FXTAS implicate dysfunctional cerebellar neural networks and may provide valuable outcome markers for tailored rehabilitative interventions. Our findings suggest that CDP may provide sensitive measures for early detection of postural control impairments in at-risk carriers and better characterize balance dysfunction and progression in FXTAS.
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Lorefice L, Tranquilli S, Fenu G, Murru MR, Frau J, Rolesu M, Coghe GC, Marrosu F, Marrosu MG, Cocco E. A genetic study of the FMR1 gene in a Sardinian multiple sclerosis population. Neurol Sci 2015; 36:2213-20. [PMID: 26194536 DOI: 10.1007/s10072-015-2339-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/13/2015] [Indexed: 02/04/2023]
Abstract
Multiple sclerosis (MS) is a complex autoimmune disease originated from the interplay between genetic and environmental factors. An overlap of clinical and neuroradiological parameters has been described between MS and an adult-onset neurodegenerative disorder, the fragile-X-associated tremor/ataxia syndrome (FXTAS). This syndrome is caused by a trinucleotide premutation expansion of a CGG sequence in the 55-200 repeat range, which is located in the fragile-X mental retardation 1 (FMR1) gene. Female premutation carriers have an increased propensity for immune-mediated disorders. Recently, a case of co-occurrence of MS and FXTAS was reported. Assuming that the premutation expansion may play a role in the MS susceptibility, we evaluated its frequency in a cohort of MS patients from Sardinia, an island characterized by a very high frequency of MS. Nuclear DNA was extracted by standard methods, purified with bisulfite treatment and then amplified twice by PCR with specific primers. Microsatellite analysis was performed and emizogotic subjects were sequenced. Clinical data of patients were also collected. Only 1/755 MS patients exhibited the premutation expansion with a heterozygosis pattern (30/58). No pathogenic repeat expansions (>200 repeats) were found in the entire cohort. Repeats labeled as the gray zone (45-60 repeats) were observed in 15/755 patients. No specific clinical features concerning disease course, disease activity, and disability were reported for these patients. Our results do not support a possible role for premutation or gray zone alleles in MS Sardinian patients. Further studies are needed to better understand the relationship between FXTAS and MS.
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Affiliation(s)
- L Lorefice
- Department of Public Health and Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari, Ospedale "Binaghi", via Is Guadazzonis, 2, 09126, Cagliari, Italy.
| | - S Tranquilli
- Department of Medical Sciences, Institute of Neurology, University of Cagliari, Cagliari, Italy
| | - G Fenu
- Department of Public Health and Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari, Ospedale "Binaghi", via Is Guadazzonis, 2, 09126, Cagliari, Italy
| | - M R Murru
- ASL8-Department of Medical Sciences, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - J Frau
- Department of Public Health and Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari, Ospedale "Binaghi", via Is Guadazzonis, 2, 09126, Cagliari, Italy
| | - M Rolesu
- ASL8-Department of Medical Sciences, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - G C Coghe
- Department of Public Health and Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari, Ospedale "Binaghi", via Is Guadazzonis, 2, 09126, Cagliari, Italy
| | - F Marrosu
- Department of Medical Sciences, Institute of Neurology, University of Cagliari, Cagliari, Italy
| | - M G Marrosu
- Department of Medical Sciences, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - E Cocco
- Department of Public Health and Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari, Ospedale "Binaghi", via Is Guadazzonis, 2, 09126, Cagliari, Italy
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