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Grønbæk-Thygesen M, Hartmann-Petersen R. Cellular and molecular mechanisms of aspartoacylase and its role in Canavan disease. Cell Biosci 2024; 14:45. [PMID: 38582917 PMCID: PMC10998430 DOI: 10.1186/s13578-024-01224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/24/2024] [Indexed: 04/08/2024] Open
Abstract
Canavan disease is an autosomal recessive and lethal neurological disorder, characterized by the spongy degeneration of the white matter in the brain. The disease is caused by a deficiency of the cytosolic aspartoacylase (ASPA) enzyme, which catalyzes the hydrolysis of N-acetyl-aspartate (NAA), an abundant brain metabolite, into aspartate and acetate. On the physiological level, the mechanism of pathogenicity remains somewhat obscure, with multiple, not mutually exclusive, suggested hypotheses. At the molecular level, recent studies have shown that most disease linked ASPA gene variants lead to a structural destabilization and subsequent proteasomal degradation of the ASPA protein variants, and accordingly Canavan disease should in general be considered a protein misfolding disorder. Here, we comprehensively summarize the molecular and cell biology of ASPA, with a particular focus on disease-linked gene variants and the pathophysiology of Canavan disease. We highlight the importance of high-throughput technologies and computational prediction tools for making genotype-phenotype predictions as we await the results of ongoing trials with gene therapy for Canavan disease.
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Affiliation(s)
- Martin Grønbæk-Thygesen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
| | - Rasmus Hartmann-Petersen
- The Linderstrøm-Lang Centre for Protein Science, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200N, Copenhagen, Denmark.
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2
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Irilouzadian R, Goudarzi A, Hesami H, Sarmadian R, Biglari HN, Gilani A. An unusual case of a toddler with Canavan disease with frequent
intractable seizures: A case report and review of the literature. SAGE Open Med Case Rep 2023; 11:2050313X231160885. [PMID: 36968992 PMCID: PMC10034305 DOI: 10.1177/2050313x231160885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/10/2023] [Indexed: 03/24/2023] Open
Abstract
Canavan disease is a rare fetal inherited leukodystrophy, caused by accumulation
of N-acetyl-aspartate in the brain. Here, we report a child presented with
frequent intractable seizures and visual impairment. A 14-month-old female
infant with a complaint of the absence of neck holding and generalized
tonic-clonic seizures was referred to our hospital. Macrocephaly, setting sun
eyes, tremor, and hypotonia were observed. Funduscopy showed optic atrophy. Our
patient’s flash visual evoked potential showed blindness. Her brain magnetic
resonance imaging showed diffuse white matter in subcortical, basal ganglia, and
dorsal pons. Electroencephalography showed diffuse slow and sharp waves. The
genetic study detected a hemizygous mutation in the aspartoacylase gene. Our
patient was diagnosed with Canavan disease and began anticonvulsant treatment.
However, seizures were not under control. Then, her medications were
discontinued, and clobazam and primidone were administered. In conclusion,
starting clobazam and primidone may help prevent frequently intractable seizures
in Canavan disease patients.
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Affiliation(s)
- Rana Irilouzadian
- Burn Research Center, Iran University
of Medical Sciences, Tehran, Iran
| | - Ali Goudarzi
- Iranian Center of Neurological
Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran,
Iran
| | - Hamed Hesami
- School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Roham Sarmadian
- Infectious Diseases Research Center,
Arak University of Medical Sciences, Arak, Iran
| | - Habibe Nejad Biglari
- Neurosciences Research Center, Kerman
University of Medical Sciences, Kerman, Iran
| | - Abolfazl Gilani
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
- Abolfazl Gilani, Sina Trauma and Surgery
Research Center, Building 7, Sina Hospital, Hassan-Abad Sq, Tehran 11365-3876,
Iran.
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Benson MD, Plemel DJA, Freund PR, Lewis JR, Sass JO, Bähr L, Gemperle-Britschgi C, Ferreira P, MacDonald IM. Severe retinal degeneration in a patient with Canavan disease. Ophthalmic Genet 2020; 42:75-78. [PMID: 32975148 DOI: 10.1080/13816810.2020.1827441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Canavan disease is an autosomal recessive, neurodegenerative disorder caused by mutations in ASPA, a gene encoding the enzyme aspartoacylase. Patients present with macrocephaly, developmental delay, hypotonia, vision impairment and accumulation of N-acetylaspartic acid. Progressive white matter changes occur in the central nervous system. The disorder is often fatal in early childhood, but milder forms exist. Materials and methods: Case report. Results: We present the case of a 31-year-old male with mild/juvenile Canavan disease who had severe vision loss due to a retinal degeneration resembling retinitis pigmentosa. Prior to this case, vision loss in Canavan disease had been attributed to optic atrophy based on fundoscopic evidence of optic nerve pallor. Investigations for an alternative cause for our patient's retinal degeneration were non-revealing. Conclusion: We wonder if retinal degeneration may not have been previously recognized as a feature of Canavan disease. We highlight findings from animal models of Canavan disease to further support the association between Canavan disease and retinal degeneration.
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Affiliation(s)
- Matthew D Benson
- Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
| | - David J A Plemel
- Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
| | - Paul R Freund
- Department of Ophthalmology and Visual Sciences, Dalhousie University , Halifax, Canada
| | - James R Lewis
- Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
| | - Jörn Oliver Sass
- Research Group Inborn Errors of Metabolism, Department of Natural Science & Institute for Functional Gene Analytics (IFGA), Bonn-Rhein Sieg University of Applied Sciences , Rheinbach, Germany
| | - Luzy Bähr
- Clinical Chemistry & Biochemistry and Children's Research Center, University Children's Hospital , Zürich, Switzerland
| | - Corinne Gemperle-Britschgi
- Clinical Chemistry & Biochemistry and Children's Research Center, University Children's Hospital , Zürich, Switzerland
| | - Patrick Ferreira
- Division of Medical Genetics, Alberta Children's Hospital , Calgary, Canada
| | - Ian M MacDonald
- Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
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4
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Çakar NE, Aksu Uzunhan T. A case of juvenile Canavan disease with distinct pons involvement. Brain Dev 2020; 42:222-225. [PMID: 31839386 DOI: 10.1016/j.braindev.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/03/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Canavan disease is a genetic neurodegenerative leukodystrophy that results in the spongy degeneration of the white matter. Its key clinical features in the infantile form are developmental delay, visual problems and macrocephaly. Congenital and juvenile forms have also been described. PATIENT DESCRIPTION We report on a 13-year-old boy who is a high school student in a public school. He was diagnosed with juvenile Canavan disease, presenting with intentional tremor as the only clinical finding. RESULTS Magnetic resonance imaging revealed mainly the involvement of the caudate nucleus and pons extending to the mesencephalon and also the putamen and the thalamus, with no apparent signal increase in the cerebral white matter. A homozygous p.Gly274Arg (c.820A>G) missense mutation was identified. CONCLUSION Juvenile Canavan disease with mainly pons involvement has not been published before. Pons, caudate nucleus and basal ganglia involvement without any white matter being involved could be expected in juvenile Canavan disease as a rare form of the disease.
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Affiliation(s)
- Nafiye Emel Çakar
- University of Health Sciences, Okmeydanı Training and Research Hospital, Division of Paediatric Metabolism, Turkey
| | - Tuğçe Aksu Uzunhan
- University of Health Sciences, Okmeydanı Training and Research Hospital, Division of Pediatric Neurology, Turkey.
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Kimiskidis VK, Papaliagkas V, Papagiannopoulos S, Zafeiriou D, Kazis D, Tsatsali-Foroglou E, Kouvatsou Z, Kapina V, Koutsonikolas D, Anogianakis G, Geroukis T, Bostantjopoulou S. Investigation of the motor system in two siblings with Canavan's disease: a combined transcranial magnetic stimulation (TMS) - diffusion tensor imaging (DTI) study. Metab Brain Dis 2017; 32:307-310. [PMID: 28130616 DOI: 10.1007/s11011-017-9955-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/18/2017] [Indexed: 12/11/2022]
Abstract
Canavan's disease (CD) is a hereditary leukodystrophy caused by mutations in the aspartoacylase gene (ASPA), leading to spongiform degeneration of the white matter and severe impairment of psychomotor development. We present the cases of two non-Jewish sisters with CD that have a milder and protracted clinical course compared to typical CD. MRI imaging revealed bilateral high-signal-intensity areas in the thalami and the internal capsule and MR spectroscopy showed typical findings for CD (a marked increase in N-acetylaspartate (NAA) levels). FA values of the right and left corticospinal tracts at the level of the posterior limb of the internal capsule, and the centrum semiovale were found to be significantly reduced compared to healthy controls. From a neurophysiological point of view, the peripheral motor system was normal. In contrast, cortical stimulation at maximal intensity failed to elicit facilitated or resting MEPs and silent periods (SPs) in upper and lower limbs, providing evidence for significant upper motor pathway dysfunction.
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Affiliation(s)
- V K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Thessaloniki, Greece.
| | - S Papagiannopoulos
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - D Zafeiriou
- First Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Kazis
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Z Kouvatsou
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - V Kapina
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - D Koutsonikolas
- Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Anogianakis
- Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Geroukis
- Department of Radiology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - S Bostantjopoulou
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
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Mendes MI, Smith DE, Pop A, Lennertz P, Fernandez Ojeda MR, Kanhai WA, van Dooren SJ, Anikster Y, Barić I, Boelen C, Campistol J, de Boer L, Kariminejad A, Kayserili H, Roubertie A, Verbruggen KT, Vianey-Saban C, Williams M, Salomons GS. Clinically Distinct Phenotypes of Canavan Disease Correlate with Residual Aspartoacylase Enzyme Activity. Hum Mutat 2017; 38:524-531. [PMID: 28101991 PMCID: PMC5412892 DOI: 10.1002/humu.23181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Abstract
We describe 14 patients with 12 novel missense mutations in ASPA, the gene causing Canavan disease (CD). We developed a method to study the effect of these 12 variants on the function of aspartoacylase—the hydrolysis of N‐acetyl‐l‐aspartic acid (NAA) to aspartate and acetate. The wild‐type ASPA open reading frame (ORF) and the ORFs containing each of the variants were transfected into HEK293 cells. Enzyme activity was determined by incubating cell lysates with NAA and measuring the released aspartic acid by LC–MS/MS. Clinical data were obtained for 11 patients by means of questionnaires. Four patients presented with a non‐typical clinical picture or with the milder form of CD, whereas seven presented with severe CD. The mutations found in the mild patients corresponded to the variants with the highest residual enzyme activities, suggesting that this assay can help evaluate unknown variants found in patients with atypical presentation. We have detected a correlation between clinical presentation, enzyme activity, and genotype for CD.
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Affiliation(s)
- Marisa I Mendes
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Desirée Ec Smith
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Ana Pop
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pascal Lennertz
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Matilde R Fernandez Ojeda
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Warsha A Kanhai
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Silvy Jm van Dooren
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yair Anikster
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ivo Barić
- Department of Pediatrics, University Hospital Center Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Caroline Boelen
- Department of Pediatrics, Admiraal De Ruyter Ziekenhuis, Goes, Zeeland, The Netherlands
| | - Jaime Campistol
- Neurology Department, CIBERER ISCIII, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Lonneke de Boer
- Department of pediatrics, metabolic diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hulya Kayserili
- Medical Genetics Department, Koç University School of Medicine (KUSOM), Istanbul, Turkey
| | - Agathe Roubertie
- Département de Neuropédiatrie, Hopital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France.,INSERM U1051, Institut des Neurosciences de Montpellier, Montpellier, France
| | - Krijn T Verbruggen
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christine Vianey-Saban
- Centre de Biologie et de Pathologie Est CHU de Lyon, Service Maladies Héréditaires du Métabolisme et Dépistage Néonatal, Lyon, France
| | - Monique Williams
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Gajja S Salomons
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Merrill ST, Nelson GR, Longo N, Bonkowsky JL. Cytotoxic edema and diffusion restriction as an early pathoradiologic marker in canavan disease: case report and review of the literature. Orphanet J Rare Dis 2016; 11:169. [PMID: 27927234 PMCID: PMC5142413 DOI: 10.1186/s13023-016-0549-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/29/2016] [Indexed: 12/27/2022] Open
Abstract
Background Canavan disease is a devastating autosomal recessive leukodystrophy leading to spongiform degeneration of the white matter. There is no cure or treatment for Canavan disease, and disease progression is poorly understood. Results We report a new presentation of a patient found to have Canavan disease; brain magnetic resonance imaging (MRI) revealed white matter cytotoxic edema, indicative of an acute active destructive process. We performed a comprehensive review of published cases of Canavan disease reporting brain MRI findings, and found that cytotoxic brain edema is frequently reported in early Canavan disease. Conclusions Our results and the literature review support the notion of an acute phase in Canavan disease progression. These findings suggest that there is a window available for therapeutic intervention and support the need for early identification of patients with Canavan disease.
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Affiliation(s)
- Steven T Merrill
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Gary R Nelson
- Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way/Williams Building, 84108, Salt Lake City, UT, USA
| | - Joshua L Bonkowsky
- Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way/Williams Building, 84108, Salt Lake City, UT, USA.
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