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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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Yousef M, Bharucha-Goebel D, Saade D, Averion G, Bönnemann CG, Quezado ZMN. Anesthetic Management of Children and Adolescents With Giant Axonal Neuropathy: A Large Case Series. A A Pract 2021; 15:e01539. [PMID: 34695041 DOI: 10.1213/xaa.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Giant axonal neuropathy (GAN) is a rare autosomal recessive neurodegenerative disorder caused by mutations in the GAN gene, which encodes for gigaxonin, a protein involved in intermediate filament processing in neural cells and fibroblasts. We report on 14 GAN patients who underwent 77 anesthetics during the conduct of an intrathecal gene transfer clinical trial from April 2015 to August 2020. We observed only a few nonsignificant perianesthetic complications. Our data expand the knowledge regarding safety of anesthesia for patients with this rare and potentially fatal disease and highlights the tolerability of shorter procedural sedation and anesthesia.
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Affiliation(s)
- Muhammad Yousef
- From the Pediatric Anesthesia and Critical Care Section, Department of Perioperative Medicine, National Institutes of Health Clinical Center
| | - Diana Bharucha-Goebel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Maryland.,Division of Neurology, Children's National Hospital, Washington, DC
| | - Dimah Saade
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Gilberto Averion
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurologic Diseases and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Zenaide M N Quezado
- From the Pediatric Anesthesia and Critical Care Section, Department of Perioperative Medicine, National Institutes of Health Clinical Center
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3
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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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Armao D, Bouldin TW, Bailey RM, Gray SJ. Extensive rod and cone photoreceptor-cell degeneration in rat models of giant axonal neuropathy: implications for gene therapy of human disease. Ophthalmic Genet 2021; 42:600-603. [PMID: 33955818 DOI: 10.1080/13816810.2021.1923036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Giant axonal neuropathy (GAN; ORPHA: 643; OMIM# 256850) is a rare, hereditary, pediatric neurodegenerative disorder associated with intracellular accumulations of intermediate filaments (IFs). Validation of therapeutic efficacy and viral vector delivery systems with GAN knockout (KO) mouse models has provided the springboard for the development of a viral vector being delivered intrathecally in an ongoing Phase I gene therapy clinical trial for the treatment of children with GAN (https://clinicaltrials.gov/ct2/show/NCT02362438).Purpose: To characterize the ocular pathologic phenotype of newly developed GAN rat models.Materials and Methods: Microscopic examination of eyes at various timepoints.Results: We noted the unexpected finding of progressive and extensive degeneration of rod and cone photoreceptor (PR) cells in the retinas of GAN rat models.Conclusion: This PR-cell loss in rat models of GAN raises the possibility that PR-cell loss may contribute to the visual impairment observed in human GAN. The intrathecal viral vector employed in the ongoing Phase I gene therapy clinical trial for the treatment of children with GAN was not specifically designed to address PR-cell degeneration. If GAN-associated PR-cell loss is present and clinically significant in humans, then future treatment protocols for GAN may need to include a gene transfer approach or combinatorial treatment strategy that also targets retinal PR cells.
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Affiliation(s)
- Diane Armao
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rachel M Bailey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Viral Vector Facility Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven J Gray
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Viral Vector Facility Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Bailey RM, Rozenberg A, Gray SJ. Comparison of high-dose intracisterna magna and lumbar puncture intrathecal delivery of AAV9 in mice to treat neuropathies. Brain Res 2020; 1739:146832. [PMID: 32289279 DOI: 10.1016/j.brainres.2020.146832] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Gene therapy clinical trials for neurological disorders are ongoing using intrathecal injection of adeno-associated virus (AAV) vector directly into the cerebral spinal fluid. Preliminary findings from these trials and results from extensive animal studies provides compelling data supporting the safety and benefit of intrathecal delivery of AAV vectors for inherited neurological disorders. Intrathecal delivery can be achieved by a lumbar puncture (LP) or intracisterna magna (ICM) injection, although ICM is not commonly used in clinical practice due to increased procedural risk. Few studies directly compared these delivery methods and there are limited reports on transduction of the PNS. To further test the utility of ICM or LP delivery for neuropathies, we performed a head to head comparison of AAV serotype 9 (AAV9) vectors expressing GFP injected into the cisterna magna or lumbar subarachnoid space in mice. We report that an intrathecal gene delivery of AAV9 in mice leads to stable transduction of neurons and glia in the brain and spinal cord and has a widespread distribution that includes components of the PNS. Vector expression was notably higher in select brain and PNS regions following ICM injection, while higher amounts of vector was found in the lower spinal cord and peripheral organs following LP injection. These findings support that intrathecal AAV9 delivery is a translationally relevant delivery method for inherited neuropathies.
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Affiliation(s)
- Rachel M Bailey
- Gene Therapy Center, University of North Carolina at Chapel Hill, United States; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States; Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Alejandra Rozenberg
- Gene Therapy Center, University of North Carolina at Chapel Hill, United States
| | - Steven J Gray
- Gene Therapy Center, University of North Carolina at Chapel Hill, United States; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, NC, United States; Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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Chen PH, Hu J, Wu J, Huynh DT, Smith TJ, Pan S, Bisnett BJ, Smith AB, Lu A, Condon BM, Chi JT, Boyce M. Gigaxonin glycosylation regulates intermediate filament turnover and may impact giant axonal neuropathy etiology or treatment. JCI Insight 2019; 5:127751. [PMID: 31944090 DOI: 10.1172/jci.insight.127751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Gigaxonin (also known as KLHL16) is an E3 ligase adaptor protein that promotes the ubiquitination and degradation of intermediate filament (IF) proteins. Mutations in human gigaxonin cause the fatal neurodegenerative disease giant axonal neuropathy (GAN), in which IF proteins accumulate and aggregate in axons throughout the nervous system, impairing neuronal function and viability. Despite this pathophysiological significance, the upstream regulation and downstream effects of normal and aberrant gigaxonin function remain incompletely understood. Here, we report that gigaxonin is modified by <italic>O</italic>-linked β-<italic>N</italic>-acetylglucosamine (O-GlcNAc), a prevalent form of intracellular glycosylation, in a nutrient- and growth factor–dependent manner. MS analyses of human gigaxonin revealed 9 candidate sites of O-GlcNAcylation, 2 of which — serine 272 and threonine 277 — are required for its ability to mediate IF turnover in gigaxonin-deficient human cell models that we created. Taken together, the results suggest that nutrient-responsive gigaxonin O-GlcNAcylation forms a regulatory link between metabolism and IF proteostasis. Our work may have significant implications for understanding the nongenetic modifiers of GAN phenotypes and for the optimization of gene therapy for this disease.
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Affiliation(s)
- Po-Han Chen
- Department of Biochemistry.,Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jianli Wu
- Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Samuel Pan
- Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Alexander B Smith
- Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Annie Lu
- Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jen-Tsan Chi
- Department of Molecular Genetics and Microbiology, and.,Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, North Carolina, USA
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Armao D, Bouldin TW, Bailey RM, Hooper JE, Bharucha DX, Gray SJ. Advancing the pathologic phenotype of giant axonal neuropathy: early involvement of the ocular lens. Orphanet J Rare Dis 2019; 14:27. [PMID: 30709364 PMCID: PMC6359799 DOI: 10.1186/s13023-018-0957-5] [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: 08/17/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022] Open
Abstract
Giant axonal neuropathy (GAN; ORPHA: 643; OMIM# 256850) is a rare, hereditary, pediatric neurodegenerative disorder associated with intracellular accumulations of intermediate filaments (IFs). GAN knockout (KO) mouse models mirror the IF dysregulation and widespread nervous system pathology seen in human GAN. Validation of therapeutic efficacy and viral vector delivery systems with these GAN KO models has provided the springboard for the development of a viral vector being delivered intrathecally in an ongoing Phase I gene therapy clinical trial for the treatment of children with GAN (https://clinicaltrials.gov/ct2/show/NCT02362438). During the course of a comprehensive pathologic characterization of the GAN KO mouse, we discovered the very early and unexpected involvement of the ocular lens. Light microscopy revealed the presence of intracytoplasmic inclusion bodies within lens epithelial cells. The inclusion bodies showed strong immunohistochemical positivity for glial fibrillary acidic protein (GFAP). We confirmed that intracytoplasmic inclusion bodies are also present within lens epithelial cells in human GAN. These IF inclusion bodies in lens epithelial cells are unique to GAN. Similar IF inclusion bodies in lens epithelial cells have not been reported previously in experimental animal models or human diseases. Since current paradigms in drug discovery and drug repurposing for IF-associated disorders are often hindered by lack of validated targets, our findings suggest that lens epithelial cells in the GAN KO mouse may provide a potential target, in vivo and in vitro, for evaluating drug efficacy and alternative therapeutic approaches in promoting the clearance of IF inclusions in GAN and other diseases characterized by intracellular IF accumulations.
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Affiliation(s)
- Diane Armao
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Rachel M Bailey
- Gene Therapy Center, University of North Carolina at Chapel Hill Chapel Hill, Chapel Hill, NC, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jody E Hooper
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Diana X Bharucha
- Department of Neurology and Pediatrics, Children's National Health System, Washington, DC, USA.,National Institutes of Health NINDS/ Neurogenetics Branch, Bethesda, MD, USA
| | - Steven J Gray
- Gene Therapy Center, University of North Carolina at Chapel Hill Chapel Hill, Chapel Hill, NC, USA. .,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. .,Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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