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Karimzadeh P, Ebrahimi M, Etemad K, Ahmad Abadi F, Hosseini Nezhad Z. GM1 and GM2-Gangliosidosis: Clinical Features, Neuroimaging Findings and Electroencephalography. IRANIAN JOURNAL OF CHILD NEUROLOGY 2024; 18:127-140. [PMID: 38617391 PMCID: PMC11015724 DOI: 10.22037/ijcn.v18i2.40751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 12/30/2023] [Indexed: 04/16/2024]
Abstract
Abstract Gangliosidosis is one of the hereditary metabolic diseases caused by the accumulation of Gangliosid in the central nervous system, leading to severe and progressive neurological deficits. Regarding phenotype, GM1 and GM2-Gangliosidosis are divided into Infantile, Juvenile, and Adult. Materials & Methods In this study, thirty-seven patients with GM1 and GM2-Gangliosidosis were referred to the neurology department of Mofid Children's Hospital in Tehran, Iran, whose disease was confirmed from September 2019 to December 2021. This study assessed age, sex, and developmental status before the onset of the disease, clinical manifestations, brain imaging, and electroencephalography. Results 97.20% of patients were the result of family marriage. Approximately 80% of juvenile patients were developmentally normal before the onset of the disease. Developmental delay was more common among infantile GM1-Gangliosidosis than infantile GM2-Gangliosidosis, but in total, more than 50% of GM1&GM2-Gangliosidosis patients had reached their developmental milestone before the onset of the disease. With the onset of disease symptoms, 100% of patients regressed in terms of movement, 97.20% of them mentally, and 75% of them had seizures during the disease. The most common clinical findings were cherry-red spot, Mongolian spot, macrocephaly, organomegaly, hyperacusis, and scoliosis. The most common brain imaging findings included bilateral thalamus involvement, brain atrophy, PVL, and delayed myelination. The most common finding in electroencephalography was background low voltage with abnormal sharp waves. Conclusion This study concluded that most of the patients are the result of family marriage, and most of the juvenile patients are developmentally normal before the onset of the disease. In addition, more than 50% of infantile patients reach their developmental milestones before the onset of the disease. The most common clinical findings of these patients are seizures, cherry-red spot, macrocephaly, hyperacusis, Mongolian spot, and bilateral involvement of the thalamus.
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Affiliation(s)
- Parvaneh Karimzadeh
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masomeh Ebrahimi
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Korosh Etemad
- Department of Epidemiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Ahmad Abadi
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini Nezhad
- Department of Pediatrics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Sheth J, Nair A, Bhavsar R, Godbole K, Datar C, Nampoothiri S, Panigrahi I, Shah H, Bajaj S, Tayade N, Bhardwaj N, Sheth H. Lysosomal storage disorders identified in adult population from India: Experience of a tertiary genetic centre and review of literature. JIMD Rep 2024; 65:85-101. [PMID: 38444573 PMCID: PMC10910243 DOI: 10.1002/jmd2.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 03/07/2024] Open
Abstract
Lysosomal storage disorders (LSDs) in adults have milder phenotype and variable age at presentation. Several studies have described the phenotype, genotype and treatment outcomes for adult-onset LSDs like Gaucher, Fabry, Pompe disease and others. We describe the first systematic study on the occurrence of LSDs in an adult population from India. It describes, the key clinical signs seen in these patients and those from literature review that can aid in early detection. Of 2102 biochemically diagnosed LSDs cases, 32 adult patients were identified with LSDs. Based on the clinical suspicion, screening test and enzyme study was carried out. Twenty-two patients were subjected to a genetic study to identify the causative variant in a respective gene. Of the 32 adult patients, we observed a maximum percentage of 37.5% (n = 12) cases with Gaucher disease, followed by 13% (n = 4) with Fabry disease. We found 10% of cases with MPS IVA and MPS I, and 9% cases with Pompe. Single case of adult mucolipidosis III and two cases each of Type 1 Sialidosis, Niemann-Pick disease B and metachromatic leukodystrophy were identified. We observed two common variants p.Leu483Pro and p.Ala487Thr in the GBA1 gene in 23% of Indian patients with adult Gaucher disease. No common variants were observed in other aforementioned LSDs. Study identified 50% of Fabry patients and 4% of Gaucher patients diagnosed at our centre to be adults. The prevalence of adult Pompe patients was low (3.4%) as compared to 80% reported in the Caucasian population. Adult LSDs such as, MPS III, GM1/GM2 gangliosidosis and Krabbe disease were not identified in our cohort.
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Affiliation(s)
- Jayesh Sheth
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Aadhira Nair
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Riddhi Bhavsar
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Koumudi Godbole
- Department of Clinical GeneticsDeenanath Mangeshkar Hospital & Research CentrePuneIndia
| | - Chaitanya Datar
- Department of Clincial GeneticsBharati Hospital and Research CentrePuneIndia
| | | | - Inusha Panigrahi
- Department of PediatricsPostgraduate Institute of Medical Education and Research, PGIMERChandigarhIndia
| | - Heli Shah
- Department of PediatricsSmt. NHL Municipal Medical CollegeAhmedabadIndia
| | | | - Naresh Tayade
- Department of PediatricsDr. Panjabrao Deshmukh Memorial Medical CollegeAmravatiIndia
| | | | - Harsh Sheth
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
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D'Souza P, Farmer C, Johnston J, Han ST, Adams D, Hartman AL, Zein W, Huryn LA, Solomon B, King K, Jordan C, Myles J, Nicoli ER, Rothermel CE, Algarin YM, Huang R, Quimby R, Zainab M, Bowden S, Crowell A, Buckley A, Brewer C, Regier D, Brooks B, Baker E, Vézina G, Thurm A, Tifft CJ. GM1 Gangliosidosis Type II: Results of a 10-Year Prospective Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.04.24300778. [PMID: 38313286 PMCID: PMC10836125 DOI: 10.1101/2024.01.04.24300778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Purpose GM1 gangliosidosis (GM1) is an ultra-rare lysosomal storage disease caused by pathogenic variants in galactosidase beta 1 (GLB1; NM_000404), primarily characterized by neurodegeneration, often in children. There are no approved treatments for GM1, but clinical trials using gene therapy (NCT03952637, NCT04713475) and small molecule substrate inhibitors (NCT04221451) are ongoing. Understanding the natural history of GM1 is essential for timely diagnosis, facilitating better supportive care, and contextualizing the results of therapeutic trials. Methods Forty-one individuals with type II GM1 (n=17 late infantile and n=24 juvenile onset) participated in a single-site prospective observational study. Here, we describe the results of extensive multisystem assessment batteries, including clinical labs, neuroimaging, physiological exams, and behavioral assessments. Results Classification of 37 distinct variants in this cohort was performed according to ACMG criteria and resulted in the upgrade of six and the submission of four new variants to pathogenic or likely pathogenic. In contrast to type I infantile, children with type II disease exhibited normal or near normal hearing and did not have cherry red maculae or significant hepatosplenomegaly. Some older children with juvenile onset developed thickened aortic and/or mitral valves with regurgitation. Serial MRIs demonstrated progressive brain atrophy that were more pronounced in those with late infantile onset. MR spectroscopy showed worsening elevation of myo-inositol and deficit of N-acetyl aspartate that were strongly correlated with scores on the Vineland Adaptive Behavior Scale and progress more rapidly in late infantile than juvenile onset disease. Conclusion The comprehensive serial phenotyping of type II GM1 patients expands the understanding of disease progression and clarifies some common misconceptions about type II patients. Findings from this 10-year endeavor are a pivotal step toward more timely diagnosis and better supportive care for patients. The wealth of data amassed through this effort will serve as a robust comparator for ongoing and future therapeutic trials.
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Affiliation(s)
- Precilla D'Souza
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Cristan Farmer
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, 10 Center Drive, Bethesda MD USA
| | - Jean Johnston
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Sangwoo T Han
- Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - David Adams
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Adam L Hartman
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, 6001 Executive Blvd, Rockville, MD, USA
| | - Wadih Zein
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, 10 Center Drive, Bethesda MD, USA
| | - Laryssa A Huryn
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, 10 Center Drive, Bethesda MD, USA
| | - Beth Solomon
- Speech Language Pathology Section, Rehabilitation Medicine Department, Warren Grant Magnuson Clinical Research Center, 10 Center Drive Bethesda MD USA
| | - Kelly King
- Neurotology Branch, Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, 10 Center Drive, Bethesda, MD USA
| | - Christopher Jordan
- Inova Children's Cardiology, 8260 Willow Oaks Corporate Drive; suite 400; Fairfax, VA, 22031
| | - Jennifer Myles
- Nutrition Department, Warren Grant Magnuson Clinical Research Center, 10 Center Drive Bethesda MD USA
| | - Elena-Raluca Nicoli
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Caroline E Rothermel
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Yoliann Mojica Algarin
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Reyna Huang
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Rachel Quimby
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Mosufa Zainab
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Sarah Bowden
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Anna Crowell
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
| | - Ashura Buckley
- Sleep and Neurodevelopment Service, National Institute of Mental Health, 10 Center Drive, Bethesda MD USA
| | - Carmen Brewer
- Neurotology Branch, Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, 10 Center Drive, Bethesda, MD USA
| | - Deborah Regier
- Genetics and Metabolism, Children's National Hospital, 111 Michigan Avenue NW, Washington DC USA
| | - Brian Brooks
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, 10 Center Drive, Bethesda MD, USA
| | - Eva Baker
- Department of Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Research Center, 10 Center Drive, Bethesda, MD, USA
| | - Gilbert Vézina
- Program in Neuroradiology, Children's National Hospital, 111 Michigan Avenue NW, Washington DC USA; Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington DC USA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, 10 Center Drive, Bethesda MD USA
| | - Cynthia J Tifft
- Office of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, 10 Center Drive, Bethesda MD USA
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Stockler‐Ipsiroglu S, Yazdanpanah N, Yazdanpanah M, Moisa Popurs M, Yuskiv N, Schmitz Ferreira Santos ML, Ae Kim C, Fischinger Moura de Souza C, Marques Lourenço C, Steiner CE, Federhen A, Giugliani L, Bastos Pereira DM, Durán‐Carabali LE, Giugliani R. Morquio-like dysostosis multiplex presenting with neuronopathic features is a distinct GLB1-related phenotype. JIMD Rep 2021; 60:23-31. [PMID: 34258138 PMCID: PMC8260481 DOI: 10.1002/jmd2.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Morquio B disease (MBD) is a distinct GLB1-related dysostosis multiplex presenting a mild phenocopy of GALNS-related Morquio A disease. Previously reported cases from European countries carry the W273L variant on at least one GLB1 allele and exhibit a pure skeletal phenotype (pure MBD). Only a minority of MBD cases have been described with additional neuronopathic findings (MBD plus). OBJECTIVES AND METHODS With the aim to further describe patterns of MBD-related dysostosis multiplex, we analyzed clinical, biochemical, and genetic features in 17 cases with GLB1-related dysostosis multiplex living and diagnosed in Brazil. RESULTS About 14 of the 17 individuals had three or more skeletal findings characteristic of Morquio syndrome. Two had no additional neuronopathic features (pure MBD) and 12 exhibited additional neuronopathic features (MBD plus). Three of the 17 cases had mild dysostosis without distinct features of MBD. Seven of the 12 MBD plus patients had signs of spinal cord compression (SCC), as a result of progressive spinal vertebral dysostosis. There was an age-dependent increase in the number of skeletal findings and in the severity of growth impairment. GLB1 mutation analysis was completed in 10 of the 14 MBD patients. T500A occurred in compound heterozygosity in 8 of the 19 alleles. CONCLUSION Our study extends the phenotypic spectrum of GLB1-related conditions by describing a cohort of patients with MBD and GM1-gangliosidosis (MBD plus). Targeting the progressive nature of the skeletal manifestations in the development of new therapies for GLB1-related conditions is warranted.
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Affiliation(s)
- Sylvia Stockler‐Ipsiroglu
- Department of PediatricsUniversity of British ColumbiaVancouverCanada
- Division of Biochemical GeneticsBC Children's HospitalVancouverCanada
- BC Children's Hospital Research InstituteVancouverCanada
| | - Nahid Yazdanpanah
- Department of PediatricsUniversity of British ColumbiaVancouverCanada
| | | | - Marioara Moisa Popurs
- Department of PediatricsUniversity of British ColumbiaVancouverCanada
- Division of Biochemical GeneticsBC Children's HospitalVancouverCanada
| | - Nataliya Yuskiv
- Department of PediatricsUniversity of British ColumbiaVancouverCanada
- Division of Biochemical GeneticsBC Children's HospitalVancouverCanada
| | | | - Chong Ae Kim
- Instituto da Criança, Faculdade de Medicina, USPSão PauloBrazil
| | | | | | | | | | | | | | | | - Roberto Giugliani
- Serviço de Genética Médica, HCPAPorto AlegreBrazil
- Departamento de GenéticaUFRGSPorto AlegreBrazil
- Programa de Pós‐Graduação em Genética e Biologia Molecular, UFRGSPorto AlegreBrazil
- INAGEMPPorto AlegreBrazil
- DR BRASIL, HCPAPorto AlegreBrazil
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5
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Kingma SDK, Ceulemans B, Kenis S, Jonckheere AI. Are GMI gangliosidosis and Morquio type B two different disorders or part of one phenotypic spectrum? JIMD Rep 2021; 59:90-103. [PMID: 33977034 PMCID: PMC8100397 DOI: 10.1002/jmd2.12204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
Monosialotetrahexosylganglioside (GMI) gangliosidosis and Morquio type B (MorB) are two lysosomal storage disorders (LSDs) caused by the same enzyme deficiency, β-galactosidase (βgal). GMI gangliosidosis, associated with GMI ganglioside accumulation, is a neurodegenerative condition characterized by psychomotor regression, visceromegaly, cherry red spot, and facial and skeletal abnormalities. MorB is characterized by prominent and severe skeletal deformities due to keratan sulfate (KS) accumulation. There are only a few reports on intermediate phenotypes between GMI gangliosidosis and MorB. The presentation of two new patients with this rare intermediate phenotype motivated us to review the literature, to study differences and similarities between GMI gangliosidosis and MorB, and to speculate about the possible mechanisms that may contribute to the differences in clinical presentation. In conclusion, we hypothesize that GMI gangliosidosis and MorB are part of one phenotypic spectrum of the same disease and that the classification of LSDs might need to be revised.
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Affiliation(s)
- Sandra D. K. Kingma
- Centre for Metabolic DiseasesUniversity Hospital Antwerp, University of AntwerpEdegem, AntwerpBelgium
- Department of Pediatric NeurologyAntwerp University Hospital, University of AntwerpEdegem, AntwerpBelgium
| | - Berten Ceulemans
- Department of Pediatric NeurologyAntwerp University Hospital, University of AntwerpEdegem, AntwerpBelgium
| | - Sandra Kenis
- Department of Pediatric NeurologyAntwerp University Hospital, University of AntwerpEdegem, AntwerpBelgium
| | - An I. Jonckheere
- Centre for Metabolic DiseasesUniversity Hospital Antwerp, University of AntwerpEdegem, AntwerpBelgium
- Department of Pediatric NeurologyAntwerp University Hospital, University of AntwerpEdegem, AntwerpBelgium
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Percival BC, Latour YL, Tifft CJ, Grootveld M. Rapid Identification of New Biomarkers for the Classification of GM1 Type 2 Gangliosidosis Using an Unbiased 1H NMR-Linked Metabolomics Strategy. Cells 2021; 10:572. [PMID: 33807817 PMCID: PMC7998791 DOI: 10.3390/cells10030572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
Biomarkers currently available for the diagnosis, prognosis, and therapeutic monitoring of GM1 gangliosidosis type 2 (GM1T2) disease are mainly limited to those discovered in targeted proteomic-based studies. In order to identify and establish new, predominantly low-molecular-mass biomarkers for this disorder, we employed an untargeted, multi-analyte approach involving high-resolution 1H NMR analysis coupled to a range of multivariate analysis and computational intelligence technique (CIT) strategies to explore biomolecular distinctions between blood plasma samples collected from GM1T2 and healthy control (HC) participants (n = 10 and 28, respectively). The relationship of these differences to metabolic mechanisms underlying the pathogenesis of GM1T2 disorder was also investigated. 1H NMR-linked metabolomics analyses revealed significant GM1T2-mediated dysregulations in ≥13 blood plasma metabolites (corrected p < 0.04), and these included significant upregulations in 7 amino acids, and downregulations in lipoprotein-associated triacylglycerols and alanine. Indeed, results acquired demonstrated a profound distinctiveness between the GM1T2 and HC profiles. Additionally, employment of a genome-scale network model of human metabolism provided evidence that perturbations to propanoate, ethanol, amino-sugar, aspartate, seleno-amino acid, glutathione and alanine metabolism, fatty acid biosynthesis, and most especially branched-chain amino acid degradation (p = 10-12-10-5) were the most important topologically-highlighted dysregulated pathways contributing towards GM1T2 disease pathology. Quantitative metabolite set enrichment analysis revealed that pathological locations associated with these dysfunctions were in the order fibroblasts > Golgi apparatus > mitochondria > spleen ≈ skeletal muscle ≈ muscle in general. In conclusion, results acquired demonstrated marked metabolic imbalances and alterations to energy demand, which are consistent with GM1T2 disease pathogenesis mechanisms.
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Affiliation(s)
- Benita C. Percival
- Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester LE1 9BH, UK;
| | - Yvonne L. Latour
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN 37232-0252, USA;
| | - Cynthia J. Tifft
- Deputy Clinical Director, National Human Genome Research Institute, Director, National Institutes of Health, Bethesda, MD 20892-1205, USA;
| | - Martin Grootveld
- Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester LE1 9BH, UK;
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7
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King KE, Kim S, Whitley CB, Jarnes-Utz JR. The juvenile gangliosidoses: A timeline of clinical change. Mol Genet Metab Rep 2020; 25:100676. [PMID: 33240792 PMCID: PMC7674119 DOI: 10.1016/j.ymgmr.2020.100676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background The gangliosidoses are rare inherited diseases that result in pathologic accumulation of gangliosides in the central nervous system and other tissues, leading to severe and progressive neurological impairment and early death in the childhood forms. No treatments are currently approved for the gangliosidoses, and development of treatments is impaired by limited understanding of the natural history of these diseases. Objective The objective of this study is to improve understanding of the juvenile gangliosidoses phenotypes and the late-infantile phenotypic subtype. Methods Through a prospective natural history study of subjects with juvenile GM1- and GM2-gangliosidosis, a timeline of clinical changes was developed for the classic juvenile phenotypes and the late-infantile phenotypes and results of serial neurodevelopmental testing was analyzed. Results Several candidate ‘outcome measures’ were identified: changes in ambulation and verbalization skills, the communication domain from neurodevelopmental testing and the caregiver-reported socialization domain. Conclusions The most common symptoms leading caregivers to seek a genetic diagnosis were changes in ambulation and verbalization.
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Affiliation(s)
- Kelly E King
- Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA
| | - Sarah Kim
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA.,Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA
| | - Chester B Whitley
- Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA.,Gene Therapy Center, University of Minnesota, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA.,Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA
| | - Jeanine R Jarnes-Utz
- Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA.,Gene Therapy Center, University of Minnesota, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA.,Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA
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8
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Luu AR, Wong C, Agrawal V, Wise N, Handyside B, Lo MJ, Pacheco G, Felix JB, Giaramita A, d'Azzo A, Vincelette J, Bullens S, Bunting S, Christianson TM, Hague CM, LeBowitz JH, Yogalingam G. Intermittent enzyme replacement therapy with recombinant human β-galactosidase prevents neuraminidase 1 deficiency. J Biol Chem 2020; 295:13556-13569. [PMID: 32727849 DOI: 10.1074/jbc.ra119.010794] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Mutations in the galactosidase β 1 (GLB1) gene cause lysosomal β-galactosidase (β-Gal) deficiency and clinical onset of the neurodegenerative lysosomal storage disease, GM1 gangliosidosis. β-Gal and neuraminidase 1 (NEU1) form a multienzyme complex in lysosomes along with the molecular chaperone, protective protein cathepsin A (PPCA). NEU1 is deficient in the neurodegenerative lysosomal storage disease sialidosis, and its targeting to and stability in lysosomes strictly depend on PPCA. In contrast, β-Gal only partially depends on PPCA, prompting us to investigate the role that β-Gal plays in the multienzyme complex. Here, we demonstrate that β-Gal negatively regulates NEU1 levels in lysosomes by competitively displacing this labile sialidase from PPCA. Chronic cellular uptake of purified recombinant human β-Gal (rhβ-Gal) or chronic lentiviral-mediated GLB1 overexpression in GM1 gangliosidosis patient fibroblasts coincides with profound secondary NEU1 deficiency. A regimen of intermittent enzyme replacement therapy dosing with rhβ-Gal, followed by enzyme withdrawal, is sufficient to augment β-Gal activity levels in GM1 gangliosidosis patient fibroblasts without promoting NEU1 deficiency. In the absence of β-Gal, NEU1 levels are elevated in the GM1 gangliosidosis mouse brain, which are restored to normal levels following weekly intracerebroventricular dosing with rhβ-Gal. Collectively, our results highlight the need to carefully titrate the dose and dosing frequency of β-Gal augmentation therapy for GM1 gangliosidosis. They further suggest that intermittent intracerebroventricular enzyme replacement therapy dosing with rhβ-Gal is a tunable approach that can safely augment β-Gal levels while maintaining NEU1 at physiological levels in the GM1 gangliosidosis brain.
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Affiliation(s)
- Amanda R Luu
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Cara Wong
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Vishal Agrawal
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Nathan Wise
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Britta Handyside
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Melanie J Lo
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Glenn Pacheco
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Jessica B Felix
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | | | - Alessandra d'Azzo
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jon Vincelette
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Sherry Bullens
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | - Stuart Bunting
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | | | - Charles M Hague
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA
| | | | - Gouri Yogalingam
- Research Department, BioMarin Pharmaceutical, Inc., Novato, California, USA.
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9
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Ilyas M, Efthymiou S, Salpietro V, Noureen N, Zafar F, Rauf S, Mir A, Houlden H. Novel variants underlying autosomal recessive intellectual disability in Pakistani consanguineous families. BMC MEDICAL GENETICS 2020; 21:59. [PMID: 32209057 PMCID: PMC7092478 DOI: 10.1186/s12881-020-00998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/16/2020] [Indexed: 12/24/2022]
Abstract
Background Intellectual disability (ID) is both a clinically diverse and genetically heterogeneous group of disorder, with an onset of cognitive impairment before the age of 18 years. ID is characterized by significant limitations in intellectual functioning and adaptive behaviour. The identification of genetic variants causing ID and neurodevelopmental disorders using whole-exome sequencing (WES) has proven to be successful. So far more than 1222 primary and 1127 candidate genes are associated with ID. Methods To determine pathogenic variants causative of ID in three unrelated consanguineous Pakistani families, we used a combination of WES, homozygosity-by-descent mapping, de-deoxy sequencing and bioinformatics analysis. Results Rare pathogenic single nucleotide variants identified by WES which passed our filtering strategy were confirmed by traditional Sanger sequencing and segregation analysis. Novel and deleterious variants in VPS53, GLB1, and MLC1, genes previously associated with variable neurodevelopmental anomalies, were found to segregate with the disease in the three families. Conclusions This study expands our knowledge on the molecular basis of ID as well as the clinical heterogeneity associated to different rare genetic causes of neurodevelopmental disorders. This genetic study could also provide additional knowledge to help genetic assessment as well as clinical and social management of ID in Pakistani families.
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Affiliation(s)
- Muhammad Ilyas
- Department of Biological Sciences, International Islamic University Islamabad, Islamabad, 44000, Pakistan
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Nuzhat Noureen
- Department of Pediatric Neurology, Children's Hospital and Institute of Child Health, Multan, 60000, Pakistan
| | - Faisal Zafar
- Department of Pediatric Neurology, Children's Hospital and Institute of Child Health, Multan, 60000, Pakistan
| | - Sobiah Rauf
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asif Mir
- Department of Biological Sciences, International Islamic University Islamabad, Islamabad, 44000, Pakistan.
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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10
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Arash-Kaps L, Komlosi K, Seegräber M, Diederich S, Paschke E, Amraoui Y, Beblo S, Dieckmann A, Smitka M, Hennermann JB. The Clinical and Molecular Spectrum of GM1 Gangliosidosis. J Pediatr 2019; 215:152-157.e3. [PMID: 31761138 DOI: 10.1016/j.jpeds.2019.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/23/2019] [Accepted: 08/07/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the clinical presentation of patients with GM1 gangliosidosis and to determine whether specific clinical or biochemical signs could lead to a prompt diagnosis. STUDY DESIGN We retrospectively analyzed clinical, biochemical, and genetic data of 22 patients with GM1 gangliosidosis from 5 metabolic centers in Germany and Austria. RESULTS Eight patients were classified as infantile, 11 as late-infantile, and 3 as juvenile form. Delay of diagnosis was 6 ± 2.6 months in the infantile, 2.6 ± 3.79 years in the late-infantile, and 14 ± 3.48 years in the juvenile form. Coarse facial features, cherry red spots, and visceromegaly occurred only in patients with the infantile form. Patients with the late-infantile and juvenile forms presented with variable neurologic symptoms. Seventeen patients presented with dystonia and 14 with dysphagia. Laboratory analysis revealed an increased ASAT concentration (13/20), chitotriosidase activity (12/15), and pathologic urinary oligosaccharides (10/19). Genotype analyses revealed 23 causative or likely causative mutations in 19 patients, 7 of them being novel variants. In the majority, a clear genotype-phenotype correlation was found. CONCLUSIONS Diagnosis of GM1 gangliosidosis often is delayed, especially in patients with milder forms of the disease. GM1 gangliosidosis should be considered in patients with progressive neurodegeneration and spastic-dystonic movement disorders, even in the absence of visceral symptoms or cherry red spots. ASAT serum concentrations and chitotriosidase activity may be of value in screening for GM1 gangliosidosis.
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Affiliation(s)
- Laila Arash-Kaps
- Villa Metabolica, Department of Pediatric and University Medical Center Mainz, Germany
| | - Katalin Komlosi
- Adolescent Medicine, and Institute of Human Genetics, University Medical Center Mainz, Germany
| | - Marlene Seegräber
- Villa Metabolica, Department of Pediatric and University Medical Center Mainz, Germany
| | - Stefan Diederich
- Adolescent Medicine, and Institute of Human Genetics, University Medical Center Mainz, Germany
| | | | - Yasmina Amraoui
- Villa Metabolica, Department of Pediatric and University Medical Center Mainz, Germany
| | - Skadi Beblo
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Leipzig
| | - Andrea Dieckmann
- Center for Inborn Metabolic Disorders, Department of Neuropediatrics, Jena University Hospital, Jena
| | - Martin Smitka
- Neuropediatric Department, Carl Gustav Carus University Children's Hospital Dresden, Germany
| | - Julia B Hennermann
- Villa Metabolica, Department of Pediatric and University Medical Center Mainz, Germany
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11
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Tonin R, Caciotti A, Procopio E, Fischetto R, Deodato F, Mancardi MM, Di Rocco M, Ardissone A, Salviati A, Marangi A, Strisciuglio P, Mangone G, Casini A, Ricci S, Fiumara A, Parini R, Pavone FS, Guerrini R, Calamai M, Morrone A. Pre-diagnosing and managing patients with GM1 gangliosidosis and related disorders by the evaluation of GM1 ganglioside content. Sci Rep 2019; 9:17684. [PMID: 31776384 PMCID: PMC6881353 DOI: 10.1038/s41598-019-53995-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/26/2019] [Indexed: 01/03/2023] Open
Abstract
GM1 ganglioside, a monosialic glycosphingolipid and a crucial component of plasma membranes, accumulates in lysosomal storage disorders, primarily in GM1 gangliosidosis. The development of biomarkers for simplifying diagnosis, monitoring disease progression and evaluating drug therapies is an important objective in research into neurodegenerative lysosomal disorders. With this in mind, we established fluorescent imaging and flow-cytometric methods to track changes in GM1 ganglioside levels in patients with GM1 gangliosidosis and in control cells. We also evaluated GM1 ganglioside content in patients’ cells treated with the commercially available Miglustat, a substrate inhibitor potentially suitable for the treatment of late-onset GM1 gangliosidosis. The flow-cytometric method proved to be sensitive, unbiased, and rapid in determining variations in GM1 ganglioside content in human lymphocytes derived from small amounts of fresh blood. We detected a strong correlation between GM1 ganglioside content and the clinical severity of GM1 gangliosidosis. We confirm the ability of Miglustat to act as a substrate reduction agent in the patients’ treated cells. As well as being suitable for diagnosing and managing patients with GM1 gangliosidosis this method could be useful in the diagnosis and management of other lysosomal diseases, such as galactosialidosis, Type C Niemann-Pick, and any other disease with pathologic variations of GM1 ganglioside.
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Affiliation(s)
- Rodolfo Tonin
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Anna Caciotti
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Elena Procopio
- Metabolic Unit, Meyer Children's Hospital, Florence, Italy
| | - Rita Fischetto
- Divisione Malattie Metaboliche-Genetica Medica, Ospedale Regionale Pediatrico Giovanni XXIII, Bari, Italy
| | - Federica Deodato
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Maja Di Rocco
- Unit of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anna Ardissone
- Divisione Neuropsichiatria Infantile, Fondazione IRCCS Istituto Nazionale Neurologico C. Besta, Milan, Italy
| | | | | | - Pietro Strisciuglio
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Giusi Mangone
- Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Arianna Casini
- Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Silvia Ricci
- Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Agata Fiumara
- Malattie Metaboliche e Sindromi Malformative Congenite, P.O. Gaspare Rodolico, Catania, Italy
| | - Rossella Parini
- UOS Malattie Metaboliche Rare, Clinica Pediatrica, Ospedale San Gerardo, Monza, Italy
| | | | - Renzo Guerrini
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Martino Calamai
- European Laboratory for Non-linear Spectroscopy (LENS), University of Florence, Florence, Italy.,National Institute of Optics, National Research Council of Italy (CNR), Florence, Italy
| | - Amelia Morrone
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy. .,Metabolic Unit, Meyer Children's Hospital, Florence, Italy.
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12
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Chen JC, Luu AR, Wise N, Angelis RD, Agrawal V, Mangini L, Vincelette J, Handyside B, Sterling H, Lo MJ, Wong H, Galicia N, Pacheco G, Van Vleet J, Giaramita A, Fong S, Roy SM, Hague C, Lawrence R, Bullens S, Christianson TM, d'Azzo A, Crawford BE, Bunting S, LeBowitz JH, Yogalingam G. Intracerebroventricular enzyme replacement therapy with β-galactosidase reverses brain pathologies due to GM1 gangliosidosis in mice. J Biol Chem 2019; 295:13532-13555. [PMID: 31481471 PMCID: PMC7521651 DOI: 10.1074/jbc.ra119.009811] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Indexed: 01/16/2023] Open
Abstract
Autosomal recessive mutations in the galactosidase β1 (GLB1) gene cause lysosomal β-gal deficiency, resulting in accumulation of galactose-containing substrates and onset of the progressive and fatal neurodegenerative lysosomal storage disease, GM1 gangliosidosis. Here, an enzyme replacement therapy (ERT) approach in fibroblasts from GM1 gangliosidosis patients with recombinant human β-gal (rhβ-gal) produced in Chinese hamster ovary cells enabled direct and precise rhβ-gal delivery to acidified lysosomes. A single, low dose (3 nm) of rhβ-gal was sufficient for normalizing β-gal activity and mediating substrate clearance for several weeks. We found that rhβ-gal uptake by the fibroblasts is dose-dependent and saturable and can be competitively inhibited by mannose 6-phosphate, suggesting cation-independent, mannose 6-phosphate receptor–mediated endocytosis from the cell surface. A single intracerebroventricularly (ICV) administered dose of rhβ-gal (100 μg) resulted in broad bilateral biodistribution of rhβ-gal to critical regions of pathology in a mouse model of GM1 gangliosidosis. Weekly ICV dosing of rhβ-gal for 8 weeks substantially reduced brain levels of ganglioside and oligosaccharide substrates and reversed well-established secondary neuropathology. Of note, unlike with the ERT approach, chronic lentivirus-mediated GLB1 overexpression in the GM1 gangliosidosis patient fibroblasts caused accumulation of a prelysosomal pool of β-gal, resulting in activation of the unfolded protein response and endoplasmic reticulum stress. This outcome was unsurprising in light of our in vitro biophysical findings for rhβ-gal, which include pH-dependent and concentration-dependent stability and dynamic self-association. Collectively, our results highlight that ICV-ERT is an effective therapeutic intervention for managing GM1 gangliosidosis potentially more safely than with gene therapy approaches.
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Affiliation(s)
- Joseph C Chen
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Amanda R Luu
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Nathan Wise
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Rolando De Angelis
- Process Sciences, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Vishal Agrawal
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Linley Mangini
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Jon Vincelette
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Britta Handyside
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Harry Sterling
- Process Sciences, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Melanie J Lo
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Hio Wong
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Nicole Galicia
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Glenn Pacheco
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Jeremy Van Vleet
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | | | - Sylvia Fong
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Sushmita M Roy
- Process Sciences, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Chuck Hague
- Process Sciences, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Roger Lawrence
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Sherry Bullens
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | | | - Alessandra d'Azzo
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, Tennessee 38105
| | - Brett E Crawford
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | - Stuart Bunting
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949
| | | | - Gouri Yogalingam
- Research, BioMarin Pharmaceutical, Inc., Novato, California 94949.
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13
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Giugliani L, Steiner CE, Kim CA, Lourenço CM, Santos MLSF, de Souza CFM, Brusius‐Facchin AC, Baldo G, Riegel M, Giugliani R. Clinical findings in Brazilian patients with adult GM1 gangliosidosis. JIMD Rep 2019; 49:96-106. [PMID: 31497487 PMCID: PMC6718113 DOI: 10.1002/jmd2.12067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/12/2019] [Accepted: 06/24/2019] [Indexed: 11/20/2022] Open
Abstract
GM1 gangliosidosis is a lysosomal storage disorder caused by β-galactosidase deficiency. To date, prospective studies for GM1 gangliosidosis are not available, and only a few have focused on the adult form. This retrospective cross-sectional study focused on clinical findings in Brazilian patients with the adult form of GM1 gangliosidosis collected over 2 years. Ten subjects were included in the study. Eight were males and two females, with median age at diagnosis of 11.5 years (IQR, 4-34 years). Short stature and weight below normal were seen in five out of the six patients with data available. Radiological findings revealed that the most frequent skeletal abnormalities were beaked vertebrae, followed by hip dysplasia, and platyspondyly. Neurological examination revealed that dystonia and swallowing problems were the most frequently reported. None of the patients presented hyperkinesia, truncal hypertonia, Parkinsonism, or spinal cord compression. Clinical evaluation revealed impairment in activities of cognitive/intellectual development and behavioral/psychiatric disorders in all nine subjects with data available. Language/speech impairment (dysarthria) was found in 8/9 patients, fine motor and gross motor impairments were reported in 7/9 and 5/9 patients, respectively. Impairment of cognition and daily life activities were seen in 7/9 individuals. Our findings failed to clearly identify typical early or late alterations presented in GM1 gangliosidosis patients, which confirms that it is a very heterogeneous condition with wide phenotypic variability. This should be taken into account in the evaluation of future therapies for this challenging condition.
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Affiliation(s)
- Luciana Giugliani
- National Institute of Population Medical Genetics (INAGEMP)Porto AlegreBrazil
| | | | - Chong Ae Kim
- Instituto da CriançaHospital das Clínicas, FM, USPSão PauloBrazil
| | | | | | | | | | - Guilherme Baldo
- Gene Therapy Center, HCPAPorto AlegreBrazil
- Department of PhysiologyUFRGSPorto AlegreBrazil
- Post‐Graduate Program in PhysiologyUFRGSPorto AlegreBrazil
| | - Mariluce Riegel
- Medical Genetics Service, HCPAPorto AlegreBrazil
- Post‐Graduate Program in Genetics and Molecular BiologyUFRGSPorto AlegreBrazil
| | - Roberto Giugliani
- National Institute of Population Medical Genetics (INAGEMP)Porto AlegreBrazil
- Medical Genetics Service, HCPAPorto AlegreBrazil
- Post‐Graduate Program in Genetics and Molecular BiologyUFRGSPorto AlegreBrazil
- Department of GeneticsUFRGSPorto AlegreBrazil
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14
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Genotype-phenotype correlation of gangliosidosis mutations using in silico tools and homology modeling. Mol Genet Metab Rep 2019; 20:100495. [PMID: 31367523 PMCID: PMC6646740 DOI: 10.1016/j.ymgmr.2019.100495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/01/2019] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
Gangliosidoses, including GM1-gangliosidosis and GM2-gangliosidosis (Tay-Sachs disease and Sandhoff disease), are lysosomal disorders resulting from enzyme deficiencies and accumulation of gangliosides. Phenotypes of gangliosidoses range from infantile, late-infantile, juvenile, and to the adult form. The genotype-phenotype correlation is essential for prognosis and clinical care planning for patients with a gangliosidosis condition. Previously, we have developed a method to establish the genotype-phenotype correlation of another lysosomal disease, mucopolysaccharidosis type I, with in silico tools. This same method was applied to analyze the genotype and phenotype of 38 patients diagnosed with a gangliosidosis disease in the United States. Out of 40 mutations identified, 3 were novel, including p.Tyr192His and p.Phe556Ser of the GLB1 gene and p.Gly461Val of the HEXA gene. Furthermore, the mutant protein structure of all missense mutations was constructed by homology modeling. A systemic structural analysis of these models revealed the specific mechanisms of how each mutation may lead to the disease. In summary, the method developed in this study holds promise as a tool that can be broadly applicable to other lysosomal diseases and monogenic diseases.
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15
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Maegawa GH. Lysosomal Leukodystrophies Lysosomal Storage Diseases Associated With White Matter Abnormalities. J Child Neurol 2019; 34:339-358. [PMID: 30757954 PMCID: PMC6459700 DOI: 10.1177/0883073819828587] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The leukodystrophies are a group of genetic metabolic diseases characterized by an abnormal development or progressive degeneration of the myelin sheath. The myelin is a complex sheath composed of several macromolecules covering axons as an insulator. Each of the leukodystrophies is caused by mutations in genes encoding enzymes that are involved in myelin production and maintenance. The lysosomal storage diseases are inborn disorders of compartmentalized cellular organelles with broad clinical manifestations secondary to the progressive accumulation of undegraded macromolecules within lysosomes and related organelles. The more than 60 different lysosomal storage diseases are rare diseases; however, collectively, the incidence of lysosomal storage diseases ranges just over 1 in 2500 live births. The majority of lysosomal storage diseases are associated with neurologic manifestations including developmental delay, seizures, acroparesthesia, motor weakness, and extrapyramidal signs. These inborn organelle disorders show wide clinical variability affecting individuals from all age groups. In addition, several of neurologic, also known as neuronopathic, lysosomal storage diseases are associated with some level of white matter disease, which often triggers the diagnostic investigation. Most lysosomal storage diseases are autosomal recessively inherited and few are X-linked, with females being at risk of presenting with mild, but clinically relevant neurologic manifestations. Biochemical assays are the basis of the diagnosis and are usually confirmed by molecular genetic testing. Novel therapies have emerged. However, most affected patients with lysosomal storage diseases have only supportive management to rely on. A better understanding of the mechanisms resulting in the leukodystrophy will certainly result in innovative and efficacious disease-modifying therapies.
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Affiliation(s)
- Gustavo H.B. Maegawa
- University of Florida, Department of Pediatrics/Genetics
& Metabolism, Gainesville, FL 32608, USA
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16
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Pereira DM, Valentão P, Andrade PB. Tuning protein folding in lysosomal storage diseases: the chemistry behind pharmacological chaperones. Chem Sci 2018; 9:1740-1752. [PMID: 29719681 PMCID: PMC5896381 DOI: 10.1039/c7sc04712f] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
Misfolding of proteins is the basis of several proteinopathies. Chemical and pharmacological chaperones are small molecules capable of inducing the correct conformation of proteins, thus being of interest for human therapeutics. The most recent developments in medicinal chemistry and in the drug development of pharmacological chaperones are discussed, with focus on lysosomal storage diseases.
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Affiliation(s)
- David M Pereira
- REQUIMTE/LAQV , Laboratório de Farmacognosia , Departamento de Química , Faculdade de Farmácia , Universidade do Porto , Rua de Jorge Viterbo Ferreira 228 , 4050-313 Porto , Portugal .
| | - Patrícia Valentão
- REQUIMTE/LAQV , Laboratório de Farmacognosia , Departamento de Química , Faculdade de Farmácia , Universidade do Porto , Rua de Jorge Viterbo Ferreira 228 , 4050-313 Porto , Portugal .
| | - Paula B Andrade
- REQUIMTE/LAQV , Laboratório de Farmacognosia , Departamento de Química , Faculdade de Farmácia , Universidade do Porto , Rua de Jorge Viterbo Ferreira 228 , 4050-313 Porto , Portugal .
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17
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Nestrasil I, Ahmed A, Utz JM, Rudser K, Whitley CB, Jarnes-Utz JR. Distinct progression patterns of brain disease in infantile and juvenile gangliosidoses: Volumetric quantitative MRI study. Mol Genet Metab 2018; 123:97-104. [PMID: 29352662 PMCID: PMC5832355 DOI: 10.1016/j.ymgme.2017.12.432] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND GM1-gangliosidosis and GM2-gangliosidosis (Tay-Sachs disease and Sandhoff disease) are unrelenting heritable neurodegenerative conditions of lysosomal ganglioside accumulation. Although progressive brain atrophy is characteristic, longitudinal quantification of specific brain structures has not been systematically studied. OBJECTIVES The goal of this longitudinal study has been to quantify and track brain MRI volume changes, including specific structure volume changes, at different times in disease progression of childhood gangliosidoses, and to explore quantitative brain MRI volumetry (qMRI) as a non-invasive marker of disease progression for future treatment trials. METHODS Brain qMRI studies were performed in 14 patients with gangliosidoses (9 infantile, 5 juvenile) yearly. Cerebellar cortex and white matter, caudate, putamen, corpus callosum, ventricles, total brain, and intracranial volumes were measured, as well as total brain volume. Age-matched controls were available for the patients with the juvenile phenotype. RESULTS The infantile phenotype of all gangliosidoses showed a consistent pattern of macrocephaly and rapidly increasing intracranial MRI volume with both (a) brain tissue volume (cerebral cortex and other smaller structures) and (b) ventricular volume (P<0.01 for all). In contrast to apparent enlargement of the total brain volume, and chiefly the enlarged cerebral cortex, a subset of smaller brain substructures generally decreased in size: the corpus callosum, caudate and putamen became smaller with time. The volume of cerebellar cortex also decreased in patients with infantile GM1-gangliosidosis and juvenile GM1- and GM2-gangliosidosis; however, infantile GM2-gangliosidosis cerebellar cortex was the exception, increasing in size. Elevated intracranial pressure (estimated by lumbar spinal pressure) was a common finding in infantile disease and showed continued increases as the disease progressed, yet lacked MRI signs of hydrocephalus except for increasing ventricular size. Notably, in patients with juvenile gangliosidosis, macrocephaly and elevated intracranial pressure were absent and total brain volume decreased with time compared to controls (P=0.004). CONCLUSIONS The disease course of infantile versus juvenile gangliosidoses is clearly distinguished by the rate of brain disease progression as characterized by qMRI. Assessments by qMRI represent a robust non-invasive method for monitoring CNS changes in the clinical course of gangliosidoses and is ideally suited to monitor effects of novel CNS-directed therapies in future clinical trials.
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Affiliation(s)
- Igor Nestrasil
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Josephine M Utz
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Chester B Whitley
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Advanced Therapies Department, University of Minnesota, Fairview, Minneapolis, MN, USA; Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Jeanine R Jarnes-Utz
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Advanced Therapies Department, University of Minnesota, Fairview, Minneapolis, MN, USA; Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
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18
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Karimzadeh P, Naderi S, Modarresi F, Dastsooz H, Nemati H, Farokhashtiani T, Shamsian BS, Inaloo S, Faghihi MA. Case reports of juvenile GM1 gangliosidosisis type II caused by mutation in GLB1 gene. BMC MEDICAL GENETICS 2017; 18:73. [PMID: 28716012 PMCID: PMC5513107 DOI: 10.1186/s12881-017-0417-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 05/06/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Type II or juvenile GM1-gangliosidosis is an autosomal recessive lysosomal storage disorder, which is clinically distinct from infantile form of the disease by the lack of characteristic cherry-red spot and hepatosplenomegaly. The disease is characterized by slowly progressive neurodegeneration and mild skeletal changes. Due to the later age of onset and uncharacteristic presentation, diagnosis is frequently puzzled with other ataxic and purely neurological disorders. Up to now, 3-4 types of GM1-gangliosidosis have been reported and among them type I is the most common phenotype with the age of onset around 6 months. Various forms of GM1-gangliosidosis are caused by GLB1 gene mutations but severity of the disease and age of onset are directly related to the position and the nature of deleterious mutations. However, due to its unique genetic cause and overlapping clinical features, some researchers believe that GM1 gangliosidosis represents an overlapped disease spectrum instead of four distinct types. CASE PRESENTATION Here, we report a less frequent type of autosomal recessive GM1 gangliosidosis with perplexing clinical presentation in three families in the southwest part of Iran, who are unrelated but all from "Lurs" ethnic background. To identify disease-causing mutations, Whole Exome Sequencing (WES) utilizing next generation sequencing was performed. Four patients from three families were investigated with the age of onset around 3 years old. Clinical presentations were ataxia, gate disturbances and dystonia leading to wheelchair-dependent disability, regression of intellectual abilities, and general developmental regression. They all were born in consanguineous families with no previous documented similar disease in their parents. A homozygote missense mutation in GLB1 gene (c. 601 G > A, p.R201C) was found in all patients. Using Sanger sequencing this identified mutation was confirmed in the proband, their parents, grandparents, and extended family members, confirming its autosomal recessive pattern of inheritance. CONCLUSIONS Our study identified a rare pathogenic missense mutation in GLB1 gene in patients with complex neurodevelopmental findings, which can extend the list of differential diagnoses for childhood ataxia in Iranian patients.
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Affiliation(s)
- Parvaneh Karimzadeh
- Pediatric Neurology Department, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Samaneh Naderi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Modarresi
- Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Hassan Dastsooz
- Comprehensive Medical Genetic Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nemati
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Tayebeh Farokhashtiani
- Pediatric Neurology Department, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Bibi Shahin Shamsian
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroor Inaloo
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Faghihi
- Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA.
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Jarnes Utz JR, Kim S, King K, Ziegler R, Schema L, Redtree ES, Whitley CB. Infantile gangliosidoses: Mapping a timeline of clinical changes. Mol Genet Metab 2017; 121:170-179. [PMID: 28476546 PMCID: PMC5727905 DOI: 10.1016/j.ymgme.2017.04.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Infantile gangliosidoses include GM1 gangliosidosis and GM2 gangliosidosis (Tay-Sachs disease, Sandhoff disease). To date, natural history studies in infantile GM2 (iGM2) have been retrospective and conducted through surveys. Compared to iGM2, there is even less natural history information available on infantile GM1 disease (iGM1). There are no approved treatments for infantile gangliosidoses. Substrate reduction therapy using miglustat has been tried, but is limited by gastrointestinal side effects. Development of effective treatments will require identification of meaningful outcomes in the setting of rapidly progressive and fatal diseases. OBJECTIVES This study aimed to establish a timeline of clinical changes occurring in infantile gangliosidoses, prospectively, to: 1) characterize the natural history of these diseases; 2) improve planning of clinical care; and 3) identify meaningful future treatment outcome measures. METHODS Patients were evaluated prospectively through ongoing clinical care. RESULTS Twenty-three patients were evaluated: 8 infantile GM1, 9 infantile Tay-Sachs disease, 6 infantile Sandhoff disease. Common patterns of clinical change included: hypotonia before 6months of age; severe motor skill impairment within first year of life; seizures; dysphagia and feeding-tube placement before 18months of age. Neurodevelopmental testing scores reached the floor of the testing scale by 20 to 28months of age. Vertebral beaking, kyphosis, and scoliosis were unique to patients with infantile GM1. Chest physiotherapy was associated with increased survival in iGM1 (p=0.0056). Miglustat combined with a low-carbohydrate ketogenic diet (the Syner-G regimen) in patients who received a feeding-tube was associated with increased survival in infantile GM1 (p=0.025). CONCLUSIONS This is the first prospective study of the natural history of infantile gangliosidoses and the very first natural history of infantile GM1. The homogeneity of the infantile gangliosidoses phenotype as demonstrated by the clinical events timeline in this study provides promising secondary outcome measure candidates. This study indicates that overall survival is a meaningful primary outcome measure for future clinical trials due to reliable timing and early occurrence of this event. Combination therapy approaches, instead of monotherapy approaches, will likely be the best way to optimize clinical outcomes. Combination therapy approaches include palliative therapies (e.g., chest physiotherapy) along with treatments that address the underlying disease pathology (e.g. miglustat or future gene therapies).
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Affiliation(s)
- Jeanine R Jarnes Utz
- University of Minnesota, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA; University of Minnesota, Department of Pediatrics, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA; University of Minnesota, Department of Experimental and Clinical Pharmacology, College of Pharmacy, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA; Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA.
| | - Sarah Kim
- University of Minnesota, College of Pharmacy, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA
| | - Kelly King
- University of Minnesota, Department of Pediatrics, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA
| | - Richard Ziegler
- University of Minnesota, Department of Pediatrics, 2450 Riverside Avenue, Minneapolis, MN 55454-1450, USA
| | - Lynn Schema
- Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA; University of Minnesota, Department of Pediatrics, Medical School, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA
| | - Evelyn S Redtree
- Gene Therapy Center, University of Minnesota, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA
| | - Chester B Whitley
- University of Minnesota, Department of Experimental and Clinical Pharmacology, College of Pharmacy, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA; Advanced Therapies Program, University of Minnesota (UMMC) and Fairview Hospitals, Minneapolis, MN 55454, USA; University of Minnesota, College of Pharmacy, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA; Gene Therapy Center, University of Minnesota, 420 Delaware St SE, MMC 391, Minneapolis, MN 55455-0341, USA; University of Minnesota, Department of Pediatrics, Medical School, 420 Delaware St SE, MMC 446, Minneapolis, MN 55455-0341, USA
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Baptista MB, Scherrer DZ, Bonadia LC, Steiner CE. Molecular Analysis of 9 Unrelated Families Presenting With Juvenile and Chronic GM1 Gangliosidosis. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816643098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Marcella B. Baptista
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Daniel Z. Scherrer
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Luciana C. Bonadia
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos E. Steiner
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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