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Wallenius J, Kafantari E, Jhaveri E, Gorcenco S, Ameur A, Karremo C, Dobloug S, Karrman K, de Koning T, Ilinca A, Landqvist Waldö M, Arvidsson A, Persson S, Englund E, Ehrencrona H, Puschmann A. Exonic trinucleotide repeat expansions in ZFHX3 cause spinocerebellar ataxia type 4: A poly-glycine disease. Am J Hum Genet 2024; 111:82-95. [PMID: 38035881 PMCID: PMC10806739 DOI: 10.1016/j.ajhg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023] Open
Abstract
Autosomal-dominant ataxia with sensory and autonomic neuropathy is a highly specific combined phenotype that we described in two Swedish kindreds in 2014; its genetic cause had remained unknown. Here, we report the discovery of exonic GGC trinucleotide repeat expansions, encoding poly-glycine, in zinc finger homeobox 3 (ZFHX3) in these families. The expansions were identified in whole-genome datasets within genomic segments that all affected family members shared. Non-expanded alleles carried one or more interruptions within the repeat. We also found ZFHX3 repeat expansions in three additional families, all from the region of Skåne in southern Sweden. Individuals with expanded repeats developed balance and gait disturbances at 15 to 60 years of age and had sensory neuropathy and slow saccades. Anticipation was observed in all families and correlated with different repeat lengths determined through long-read sequencing in two family members. The most severely affected individuals had marked autonomic dysfunction, with severe orthostatism as the most disabling clinical feature. Neuropathology revealed p62-positive intracytoplasmic and intranuclear inclusions in neurons of the central and enteric nervous system, as well as alpha-synuclein positivity. ZFHX3 is located within the 16q22 locus, to which spinocerebellar ataxia type 4 (SCA4) repeatedly had been mapped; the clinical phenotype in our families corresponded well with the unique phenotype described in SCA4, and the original SCA4 kindred originated from Sweden. ZFHX3 has known functions in neuronal development and differentiation n both the central and peripheral nervous system. Our findings demonstrate that SCA4 is caused by repeat expansions in ZFHX3.
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Affiliation(s)
- Joel Wallenius
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Efthymia Kafantari
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Emma Jhaveri
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Sorina Gorcenco
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Adam Ameur
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, 751 23 Uppsala, Sweden
| | - Christin Karremo
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Sigurd Dobloug
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden; Department of Neurology, Helsingborg General Hospital, 252 23 Helsingborg, Sweden
| | - Kristina Karrman
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, 221 85 Lund, Sweden
| | - Tom de Koning
- Pediatrics, Department of Clinical Sciences Lund, Lund University, 221 84 Lund, Sweden
| | - Andreea Ilinca
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Maria Landqvist Waldö
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, 221 84 Lund, Sweden
| | - Andreas Arvidsson
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Staffan Persson
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Elisabet Englund
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, 221 85 Lund, Sweden; Pathology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden
| | - Hans Ehrencrona
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, 221 85 Lund, Sweden
| | - Andreas Puschmann
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, 222 42 Lund, Sweden; SciLifeLab National Research Infrastructure, Lund University, 221 84 Lund, Sweden.
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Lindsay E, Storey E. Cognitive Changes in the Spinocerebellar Ataxias Due to Expanded Polyglutamine Tracts: A Survey of the Literature. Brain Sci 2017; 7:brainsci7070083. [PMID: 28708110 PMCID: PMC5532596 DOI: 10.3390/brainsci7070083] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022] Open
Abstract
The dominantly-inherited ataxias characterised by expanded polyglutamine tracts—spinocere bellar ataxias (SCAs) 1, 2, 3, 6, 7, 17, dentatorubral pallidoluysian atrophy (DRPLA) and, in part, SCA 8—have all been shown to result in various degrees of cognitive impairment. We survey the literature on the cognitive consequences of each disorder, attempting correlation with their published neuropathological, magnetic resonance imaging (MRI) and clinical features. We suggest several psychometric instruments for assessment of executive function, whose results are unlikely to be confounded by visual, articulatory or upper limb motor difficulties. Finally, and with acknowledgement of the inadequacies of the literature to date, we advance a tentative classification of these disorders into three groups, based on the reported severity of their cognitive impairments, and correlated with their neuropathological topography and MRI findings: group 1—SCAs 6 and 8—mild dysexecutive syndrome based on disruption of cerebello-cortical circuitry; group 2—SCAs 1, 2, 3, and 7—more extensive deficits based largely on disruption of striatocortical in addition to cerebello-cerebral circuitry; and group 3—SCA 17 and DRPLA—in which cognitive impairment severe enough to cause a dementia syndrome is a frequent feature.
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Affiliation(s)
- Evelyn Lindsay
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Commercial Road, Melbourne, VIC 3004, Australia.
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Commercial Road, Melbourne, VIC 3004, Australia.
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Hekman KE, Gomez CM. The autosomal dominant spinocerebellar ataxias: emerging mechanistic themes suggest pervasive Purkinje cell vulnerability. J Neurol Neurosurg Psychiatry 2015; 86:554-61. [PMID: 25136055 PMCID: PMC6718294 DOI: 10.1136/jnnp-2014-308421] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/27/2014] [Indexed: 01/05/2023]
Abstract
The spinocerebellar ataxias are a genetically heterogeneous group of disorders with clinically overlapping phenotypes arising from Purkinje cell degeneration, cerebellar atrophy and varying degrees of degeneration of other grey matter regions. For 22 of the 32 subtypes, a genetic cause has been identified. While recurring themes are emerging, there is no clear correlation between the clinical phenotype or penetrance, the type of genetic defect or the category of the disease mechanism, or the neuronal types involved beyond Purkinje cells. These phenomena suggest that cerebellar Purkinje cells may be a uniquely vulnerable neuronal cell type, more susceptible to a wider variety of genetic/cellular insults than most other neuron types.
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Affiliation(s)
- Katherine E Hekman
- Department of Vascular Surgery, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
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