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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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Amanat M, Nemeth CL, Fine AS, Leung DG, Fatemi A. Antisense Oligonucleotide Therapy for the Nervous System: From Bench to Bedside with Emphasis on Pediatric Neurology. Pharmaceutics 2022; 14:2389. [PMID: 36365206 PMCID: PMC9695718 DOI: 10.3390/pharmaceutics14112389] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 09/05/2023] Open
Abstract
Antisense oligonucleotides (ASOs) are disease-modifying agents affecting protein-coding and noncoding ribonucleic acids. Depending on the chemical modification and the location of hybridization, ASOs are able to reduce the level of toxic proteins, increase the level of functional protein, or modify the structure of impaired protein to improve function. There are multiple challenges in delivering ASOs to their site of action. Chemical modifications in the phosphodiester bond, nucleotide sugar, and nucleobase can increase structural thermodynamic stability and prevent ASO degradation. Furthermore, different particles, including viral vectors, conjugated peptides, conjugated antibodies, and nanocarriers, may improve ASO delivery. To date, six ASOs have been approved by the US Food and Drug Administration (FDA) in three neurological disorders: spinal muscular atrophy, Duchenne muscular dystrophy, and polyneuropathy caused by hereditary transthyretin amyloidosis. Ongoing preclinical and clinical studies are assessing the safety and efficacy of ASOs in multiple genetic and acquired neurological conditions. The current review provides an update on underlying mechanisms, design, chemical modifications, and delivery of ASOs. The administration of FDA-approved ASOs in neurological disorders is described, and current evidence on the safety and efficacy of ASOs in other neurological conditions, including pediatric neurological disorders, is reviewed.
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Affiliation(s)
- Man Amanat
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Christina L. Nemeth
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Amena Smith Fine
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Doris G. Leung
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Ali Fatemi
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Wei H, Moffett JR, Amanat M, Fatemi A, Tsukamoto T, Namboodiri AM, Slusher BS. The pathogenesis of, and pharmacological treatment for, Canavan disease. Drug Discov Today 2022; 27:2467-2483. [DOI: 10.1016/j.drudis.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022]
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Whitehead MT, Lai LM, Blüml S. Clinical 1H MRS in childhood neurometabolic diseases — part 2: MRS signatures. Neuroradiology 2022; 64:1111-1126. [DOI: 10.1007/s00234-022-02918-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/10/2022] [Indexed: 12/23/2022]
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Shukla A, Kaur P, Narayanan DL, do Rosario MC, Kadavigere R, Girisha KM. Genetic disorders with central nervous system white matter abnormalities: An update. Clin Genet 2021; 99:119-132. [PMID: 33047326 PMCID: PMC9951823 DOI: 10.1111/cge.13863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022]
Abstract
Several genetic disorders have variable degree of central nervous system white matter abnormalities. We retrieved and reviewed 422 genetic conditions with prominent and consistent involvement of white matter from the literature. We herein describe the current definitions, classification systems, clinical spectrum, neuroimaging findings, genomics, and molecular mechanisms of these conditions. Though diagnosis for most of these disorders relies mainly on genomic tests, specifically exome sequencing, we collate several clinical and neuroimaging findings still relevant in diagnosis of clinically recognizable disorders. We also review the current understanding of pathophysiology and therapeutics of these disorders.
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Affiliation(s)
- Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Parneet Kaur
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Michelle C do Rosario
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Katta Mohan Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Pleasure D, Guo F, Chechneva O, Bannerman P, McDonough J, Burns T, Wang Y, Hull V. Pathophysiology and Treatment of Canavan Disease. Neurochem Res 2020; 45:561-565. [PMID: 30535831 PMCID: PMC11131954 DOI: 10.1007/s11064-018-2693-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 01/28/2023]
Affiliation(s)
- David Pleasure
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA.
- , C/o Shriners Hospital, 2425 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Fuzheng Guo
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
| | - Olga Chechneva
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
| | - Peter Bannerman
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
| | - Jennifer McDonough
- Department of Biological Sciences, School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - Travis Burns
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
| | - Yan Wang
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
| | - Vanessa Hull
- Institute for Pediatric Regenerative Research, Shriners Hospitals for Children Northern California and UC Davis School of Medicine, 2425 Stockton Blvd, 95817, Sacramento, CA, USA
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Pronin AV, Gogoleva IV, Torshin IY, Gromovа OA. [Neurotrophic effects of lithium stimulate the reduction of ischemic and neurodegenerative brain damage]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:99-108. [PMID: 27166488 DOI: 10.17116/jnevro20161162199-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For over 60 years, high doses of lithium (hundreds of milligrams of elemental lithium) have being used to treat bipolar disorder. However, only during the past 20 years the relevant basic and clinical studies have shown that neuroprotective and neurotrophic effects of lithium are possible in much smaller doses ( hundreds of micrograms of elemental lithium). These data indicate a significant potential for the clinical applications of lithium-based drugs in modern neurology for the purposes of prevention and treatment of neurodegenerative and ischemic pathologies. Pharmacological and molecular biology studies indicated that the inhibition of glycogen synthase kinase-syntentase-3 (GSK-3) and induction of brain-derived neurotrophic factors are the main mechanisms of neurotropic actions of lithium. Also, by inhibiting the NMDA receptors, lithium regulates the calcium homeostasis and inhibits the activation of calcium-dependent apotosis. These and other molecular mechanisms of lithium action protect neurons from ischemia and neurodegeneration thus contributing to a significant reduction of neurological deficit in various models of stroke and neurodegenerative diseases.
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Affiliation(s)
- A V Pronin
- Ivanovo State Medical Academy, Ivanovo, Russian Satellite Center, Trace Elements Institute for UNESCO, Moscow
| | - I V Gogoleva
- Ivanovo State Medical Academy, Ivanovo, Russian Satellite Center, Trace Elements Institute for UNESCO, Moscow
| | - I Yu Torshin
- Ivanovo State Medical Academy, Ivanovo, Russian Satellite Center, Trace Elements Institute for UNESCO, Moscow
| | - O A Gromovа
- Ivanovo State Medical Academy, Ivanovo, Russian Satellite Center, Trace Elements Institute for UNESCO, Moscow
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Szulc A, Wiedlocha M, Waszkiewicz N, Galińska-Skok B, Marcinowicz P, Gierus J, Mosiolek A. Proton magnetic resonance spectroscopy changes after lithium treatment. Systematic review. Psychiatry Res Neuroimaging 2018; 273:1-8. [PMID: 29414126 DOI: 10.1016/j.pscychresns.2018.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/10/2017] [Accepted: 01/12/2018] [Indexed: 01/03/2023]
Abstract
1H MRS is widely used in the research of mental disorders. It enables evaluation of concentration or ratios of several metabolites, which play important roles in brain metabolism: N-acetylaspartate (NAA), choline containing compounds, myo-inositol and glutamate, glutamine and GABA (together as Glx complex or separately). Specifically in bipolar disorder brain metabolite abnormalities include mostly NAA reduces and Glx increases in different brain regions. Bipolar disorder is associated with impairment in neurotrophic and cellular plasticity, resilience pathways and in neuroprotective processes. Lithium, which is commonly used in BD treatment, modulates neurotransmitter release, reduces oxidative stress and apoptosis, induces angiogenesis, neurogenesis and neurotrophic response. Thus brain metabolite abnormalities may elucidate the mechanisms of this processes. In the present article we systematically reviewed 26 studies - the majority of them investigated bipolar disorder ( 7 follow-up and all 11 cross-sectional studies). Moreover we dispute whether the influence of lithium on brain metabolites in bipolar disorder could explain the background of its potential neuroprotective action. The results of our literature review do not equivocally confirm Lithium's influence the metabolite changes in the brain. The majority of the follow-up studies do not support the initially assumed influence of Lithium on the increase of NAA level in various brain structures. The results of studies are inconclusive with regard to levels of Glx or Glu and Lithium intake, rather point a lack of relationship. The above results were reviewed according to the most recent theories in the field accounting for the impact of lithium (1)HMRS measures.
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Affiliation(s)
- Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | | | | | - Beata Galińska-Skok
- Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland
| | - Piotr Marcinowicz
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Jacek Gierus
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Anna Mosiolek
- Department of Psychiatry, Medical University of Warsaw, Pruszkow, Poland; Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland
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Elevated Choline-Containing Compound Levels in Rapid Cycling Bipolar Disorder. Neuropsychopharmacology 2017; 42:2252-2258. [PMID: 28220797 PMCID: PMC5603812 DOI: 10.1038/npp.2017.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 12/16/2022]
Abstract
Previous studies have found increased levels of choline-containing compounds (ie, glycerophosphocholine plus phosphocholine (GPC+PC)) in bipolar disorder using in vivo proton magnetic resonance spectroscopy (1H MRS), especially in bipolar I disorder (BD-I). Increased levels of GPC+PC suggest alterations in the membrane phospholipids metabolism in bipolar disorder. Rapid cycling (RC) bipolar disorder is considered as a severe course of bipolar disorder, but it is unclear whether rapid cycling bipolar disorder is linked to highly altered membrane phospholipid metabolism. The purpose of this study was to investigate whether the regional extent of elevated GPC+PC were greater in BD-I patients with rapid cycling compared to BD-I patients without rapid cycling and healthy controls. Using a multi-voxel 1H MRS approach at 3 Tesla with high spatial resolution and absolute quantification, GPC+PC levels from the anterior cingulate cortex (ACC), caudate and putamen of 16 RC BD-I, 34 non-RC BD-I and 44 healthy controls were assessed. We found significantly elevated GPC+PC levels in ACC, putamen and caudate of RC BD-I patients compared to healthy controls (P<0.005) and in ACC compared to non-RC BD-I patients (P<0.05). These results suggest greater alteration of membrane phospholipid metabolisms in rapid cycling BD-I compared to non-rapid-cycling BD-I.
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Jurdáková H, Górová R, Addová G, Behúlová D, Ostrovský I. The state of treatment approach and diagnostics in Canavan disease with focus on the determination of N-acetylasparic acid. CHEMICAL PAPERS 2017. [DOI: 10.1007/s11696-016-0033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Roscoe RB, Elliott C, Zarros A, Baillie GS. Non-genetic therapeutic approaches to Canavan disease. J Neurol Sci 2016; 366:116-124. [DOI: 10.1016/j.jns.2016.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/11/2016] [Accepted: 05/09/2016] [Indexed: 01/30/2023]
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In Vivo NMR Studies of the Brain with Hereditary or Acquired Metabolic Disorders. Neurochem Res 2015; 40:2647-85. [PMID: 26610379 DOI: 10.1007/s11064-015-1772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 01/09/2023]
Abstract
Metabolic disorders, whether hereditary or acquired, affect the brain, and abnormalities of the brain are related to cellular integrity; particularly in regard to neurons and astrocytes as well as interactions between them. Metabolic disturbances lead to alterations in cellular function as well as microscopic and macroscopic structural changes in the brain with diabetes, the most typical example of metabolic disorders, and a number of hereditary metabolic disorders. Alternatively, cellular dysfunction and degeneration of the brain lead to metabolic disturbances in hereditary neurological disorders with neurodegeneration. Nuclear magnetic resonance (NMR) techniques allow us to assess a range of pathophysiological changes of the brain in vivo. For example, magnetic resonance spectroscopy detects alterations in brain metabolism and energetics. Physiological magnetic resonance imaging (MRI) detects accompanying changes in cerebral blood flow related to neurovascular coupling. Diffusion and T1/T2-weighted MRI detect microscopic and macroscopic changes of the brain structure. This review summarizes current NMR findings of functional, physiological and biochemical alterations within a number of hereditary and acquired metabolic disorders in both animal models and humans. The global view of the impact of these metabolic disorders on the brain may be useful in identifying the unique and/or general patterns of abnormalities in the living brain related to the pathophysiology of the diseases, and identifying future fields of inquiry.
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LaPash Daniels CM, Paffenroth E, Austin EV, Glebov K, Lewis D, Walter J, Messing A. Lithium Decreases Glial Fibrillary Acidic Protein in a Mouse Model of Alexander Disease. PLoS One 2015; 10:e0138132. [PMID: 26378915 PMCID: PMC4574949 DOI: 10.1371/journal.pone.0138132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022] Open
Abstract
Alexander disease is a fatal neurodegenerative disease caused by mutations in the astrocyte intermediate filament glial fibrillary acidic protein (GFAP). The disease is characterized by elevated levels of GFAP and the formation of protein aggregates, known as Rosenthal fibers, within astrocytes. Lithium has previously been shown to decrease protein aggregates by increasing the autophagy pathway for protein degradation. In addition, lithium has also been reported to decrease activation of the transcription factor STAT3, which is a regulator of GFAP transcription and astrogliogenesis. Here we tested whether lithium treatment would decrease levels of GFAP in a mouse model of Alexander disease. Mice with the Gfap-R236H point mutation were fed lithium food pellets for 4 to 8 weeks. Four weeks of treatment with LiCl at 0.5% in food pellets decreased GFAP protein and transcripts in several brain regions, although with mild side effects and some mortality. Extending the duration of treatment to 8 weeks resulted in higher mortality, and again with a decrease in GFAP in the surviving animals. Indicators of autophagy, such as LC3, were not increased, suggesting that lithium may decrease levels of GFAP through other pathways. Lithium reduced the levels of phosphorylated STAT3, suggesting this as one pathway mediating the effects on GFAP. In conclusion, lithium has the potential to decrease GFAP levels in Alexander disease, but with a narrow therapeutic window separating efficacy and toxicity.
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Affiliation(s)
| | - Elizabeth Paffenroth
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Elizabeth V. Austin
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | | | - Diana Lewis
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jochen Walter
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Albee Messing
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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Kantor B, McCown T, Leone P, Gray SJ. Clinical applications involving CNS gene transfer. ADVANCES IN GENETICS 2015; 87:71-124. [PMID: 25311921 DOI: 10.1016/b978-0-12-800149-3.00002-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diseases of the central nervous system (CNS) have traditionally been the most difficult to treat by traditional pharmacological methods, due mostly to the blood-brain barrier and the difficulties associated with repeated drug administration targeting the CNS. Viral vector gene transfer represents a way to permanently provide a therapeutic protein within the nervous system after a single administration, whether this be a gene replacement strategy for an inherited disorder or a disease-modifying protein for a disease such as Parkinson's. Gene therapy approaches for CNS disorders has evolved considerably over the last two decades. Although a breakthrough treatment has remained elusive, current strategies are now considerably safer and potentially much more effective. This chapter will explore the past, current, and future status of CNS gene therapy, focusing on clinical trials utilizing adeno-associated virus and lentiviral vectors.
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Affiliation(s)
- Boris Kantor
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina, Columbia, SC, USA
| | - Thomas McCown
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paola Leone
- Department of Cell Biology, Rowan University, Camden, NJ, USA
| | - Steven J Gray
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ahmed SS, Gao G. Making the White Matter Matters: Progress in Understanding Canavan's Disease and Therapeutic Interventions Through Eight Decades. JIMD Rep 2015; 19:11-22. [PMID: 25604619 DOI: 10.1007/8904_2014_356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/24/2022] Open
Abstract
Canavan's disease (CD) is a fatal autosomal recessive pediatric leukodystrophy in which patients show severe neurodegeneration and typically die by the age of 10, though life expectancy in patients can be highly variable. Currently, there is no effective treatment for CD; however, gene therapy seems to be a feasible approach to combat the disease. Being a monogenic defect, the disease provides an excellent model system to develop gene therapy approaches that can be extended to other monogenic leukodystrophies and neurodegenerative diseases. CD results from mutations in a single gene aspartoacylase which hydrolyses N-acetyl aspartic acid (NAA) which accumulates in its absences. Since CD is one of the few diseases that show high NAA levels, it can also be used to study the enigmatic biological role of NAA. The disease was first described in 1931, and this review traces the progress made in the past 8 decades to understand the disease by enumerating current hypotheses and ongoing palliative measures to alleviate patient symptoms in the context of the latest advances in the field.
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Affiliation(s)
- Seemin S Ahmed
- University of Massachusetts Medical School, 368 Plantation Street, ASC6, Worcester, MA, 01605, USA
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Hoshino H, Kubota M. Canavan disease: clinical features and recent advances in research. Pediatr Int 2014; 56:477-83. [PMID: 24977939 DOI: 10.1111/ped.12422] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 12/19/2022]
Abstract
Canavan disease (CD) is a genetic neurodegenerative leukodystrophy that results in the spongy degeneration of white matter in the brain. CD is characterized by mutations in the gene encoding aspartoacylase (ASPA), the substrate enzyme that hydrolyzes N-acetylaspartic acid (NAA) to acetate and aspartate. Elevated NAA and subsequent deficiency in acetate associated with this disease cause progressive neurological symptoms, such as macrocephaly, visuocognitive dysfunction, and psychomotor delay. The prevalence of CD is higher among Ashkenazi Jewish people, and several types of mutations have been reported in the gene coding ASPA. Highly elevated NAA is more specific to CD than other leukodystrophies, and an examination of urinary NAA concentration is useful for diagnosing CD. Many researchers are now examining the mechanisms responsible for white matter degeneration or dysmyelination in CD using mouse models, and several persuasive hypotheses have been suggested for the pathophysiology of CD. One is that NAA serves as a water pump; consequently, a disorder in NAA catabolism leads to astrocytic edema. Another hypothesis is that the hydrolyzation of NAA in oligodendrocytes is essential for myelin synthesis through the supply of acetate. Although there is currently no curative therapy for CD, dietary supplements are candidates that may retard the progression of the symptoms associated with CD. Furthermore, gene therapies using viral vectors have been investigated using rat models. These therapies have been found to be tolerable with no severe long-term adverse effects, reduce the elevated NAA in the brain, and may be applied to humans in the future.
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Affiliation(s)
- Hideki Hoshino
- Department of Pediatrics, University of Tokyo, Tokyo, Japan; Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
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Francis JS, Markov V, Leone P. Dietary triheptanoin rescues oligodendrocyte loss, dysmyelination and motor function in the nur7 mouse model of Canavan disease. J Inherit Metab Dis 2014; 37:369-81. [PMID: 24288037 DOI: 10.1007/s10545-013-9663-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/24/2013] [Accepted: 11/11/2013] [Indexed: 12/11/2022]
Abstract
The inherited pediatric leukodystrophy Canavan disease is characterized by dysmyelination and severe spongiform degeneration, and is currently refractory to treatment. A definitive understanding of core disease mechanisms is lacking, but pathology is believed to result at least in part compromised fatty acid synthesis during myelination. Recent evidence generated in an animal model suggests that the breakdown of N-acetylaspartate metabolism in CD results in a heightened coupling of fatty acid synthesis to oligodendrocyte oxidative metabolism during the early stages of myelination, thereby causing acute oxidative stress. We present here the results of a dietary intervention designed to support oxidative integrity during developmental myelination in the nur7 mouse model of Canavan disease. Provision of the odd carbon triglyceride triheptanoin to neonatal nur7 mice reduced oxidative stress, promoted long-term oligodendrocyte survival, and increased myelin in the brain. Improvements in oligodendrocyte survival and myelination were associated with a highly significant reduction in spongiform degeneration and improved motor function in triheptanoin treated mice. Initiation of triheptanoin treatment in older animals resulted in markedly more modest effects on these same pathological indices, indicating a window of therapeutic intervention that corresponds with developmental myelination. These results support the targeting of oxidative integrity at early stages of Canavan disease, and provide a foundation for the clinical development of a non-invasive dietary triheptanoin treatment regimen.
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Affiliation(s)
- Jeremy S Francis
- Cell and Gene Therapy Center, Department of Cell Biology, Rowan University School of Osteopathic Medicine, 40 East Laurel Rd, Stratford, NJ, USA,
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Meffre D, Grenier J, Bernard S, Courtin F, Dudev T, Shackleford G, Jafarian-Tehrani M, Massaad C. Wnt and lithium: a common destiny in the therapy of nervous system pathologies? Cell Mol Life Sci 2014; 71:1123-48. [PMID: 23749084 PMCID: PMC11113114 DOI: 10.1007/s00018-013-1378-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 02/07/2023]
Abstract
Wnt signaling is required for neurogenesis, the fate of neural progenitors, the formation of neuronal circuits during development, neuron positioning and polarization, axon and dendrite development and finally for synaptogenesis. This signaling pathway is also implicated in the generation and differentiation of glial cells. In this review, we describe the mechanisms of action of Wnt signaling pathways and their implication in the development and correct functioning of the nervous system. We also illustrate how a dysregulated Wnt pathway could lead to psychiatric, neurodegenerative and demyelinating pathologies. Lithium, used for the treatment of bipolar disease, inhibits GSK3β, a central enzyme of the Wnt/β-catenin pathway. Thus, lithium could, to some extent, mimic Wnt pathway. We highlight the possible dialogue between lithium therapy and modulation of Wnt pathway in the treatment of the diseases of the nervous system.
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Affiliation(s)
- Delphine Meffre
- UMR 8194 CNRS, University Paris Descartes, 45 rue des Saints-Pères, 75270 Paris Cedex 6, France
| | - Julien Grenier
- UMR 8194 CNRS, University Paris Descartes, 45 rue des Saints-Pères, 75270 Paris Cedex 6, France
| | - Sophie Bernard
- UMR 8194 CNRS, University Paris Descartes, 45 rue des Saints-Pères, 75270 Paris Cedex 6, France
| | - Françoise Courtin
- UMR 8194 CNRS, University Paris Descartes, 45 rue des Saints-Pères, 75270 Paris Cedex 6, France
| | - Todor Dudev
- Institute of Biomedical Sciences, Academia Sinica, 11529 Taipei, Taiwan, R.O.C
- Faculty of Chemistry and Pharmacy, University of Sofia, 1 James Bourchier Avenue, 1164 Sofia, Bulgaria
| | | | | | - Charbel Massaad
- UMR 8194 CNRS, University Paris Descartes, 45 rue des Saints-Pères, 75270 Paris Cedex 6, France
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Clarner T, Wieczorek N, Krauspe B, Jansen K, Beyer C, Kipp M. Astroglial redistribution of aquaporin 4 during spongy degeneration in a Canavan disease mouse model. J Mol Neurosci 2013; 53:22-30. [PMID: 24272958 DOI: 10.1007/s12031-013-0184-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023]
Abstract
Canavan disease is a spongiform leukodystrophy caused by an autosomal recessive mutation in the aspartoacylase gene. Deficiency of oligodendroglial aspartoacylase activity and a subsequent increase of its substrate N-acetylaspartate are the etiologic factors for the disease. N-acetylaspartate acts as a molecular water pump. Therefore, an osmotic-hydrostatic mechanism is thought to be involved in the development of the Canavan disease phenotype. Astrocytes express water transporters and are critically involved in regulating and maintaining water homeostasis in the brain. We used the ASPA(Nur7/Nur7) mouse model of Canavan disease to investigate whether a disturbance of water homeostasis might be involved in the disease's progression. Animals showed an age-dependent impairment of motor performance and spongy degeneration in various brain regions, among the basal ganglia, brain stem, and cerebellar white matter. Astrocyte activation was prominent in regions which displayed less tissue damage, such as the corpus callosum, cortex, mesencephalon, and stratum Purkinje of cerebellar lobe IV. Immunohistochemistry revealed alterations in the cellular distribution of the water channel aquaporin 4 in astrocytes of ASPA(Nur7/Nur7) mice. In control animals, aquaporin 4 was located exclusively in the astrocytic end feet. In contrast, in ASPA(Nur7/Nur7) mice, aquaporin 4 was located throughout the cytoplasm. These results indicate that astroglial regulation of water homeostasis might be involved in the partial prevention of spongy degeneration. These observations highlight aquaporin 4 as a potential therapeutic target for Canavan disease.
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Affiliation(s)
- Tim Clarner
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany,
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Glicksman S, Borgen C, Blackstein M, Gordon A, Hanon I, Kusin D, Leibowitz B, Halle J. A thematic review of scientific and family interests in Canavan Disease: where are the developmentalists? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:815-825. [PMID: 22676184 DOI: 10.1111/j.1365-2788.2012.01576.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Canavan Disease is a degenerative neurological condition resulting in a spongy deterioration of the brain. Much research has been conducted by the medical community regarding this condition, but little research can be found in the psychological literature. METHOD A review of the scientific literature related to Canavan Disease using the Psychinfo and PubMed databases was conducted covering a 5-year span from 2006 through 2011. Concurrently, a review of parent initiated topics found on the most popular Canavan Disease Internet discussion board was conducted for comparison purposes. RESULTS When comparing the topics discussed and information sought among parents with the themes noted in the extant scientific literature, researchers found an exceedingly small overlap between the two communities of interest. In the scientific literature, published research on Canavan Disease focused on three areas: the biochemistry of Canavan Disease, diagnosis and genetic counselling, and clinical therapeutic approaches in Canavan Disease. Of the 42 unique topics raised on a popular Internet discussion board, however, only three (7%) fell into the category of diagnosis and genetic counselling, none (0%) fell into the category of the biochemistry of Canavan Disease, and four fell into the category of clinical therapeutic approaches in Canavan Disease (10%). Of the four posts addressing clinical therapeutic approaches to Canavan Disease, only one post truly overlapped with the topics addressed by the scientific community. Worded differently, while these three categories comprise 100% of the extant scientific literature regarding Canavan Disease, they comprise only 17% of the parent-raised topics. The remaining 83% of parent-raised topics addressed concerns not currently being focusing upon by the scientific community, namely, non-medical practical issues, information regarding specific characteristics of Canavan Disease, non-medical developmental and quality of life issues, and day-to-day developmental and medical concerns. CONCLUSION By comparing the extant literature on Canavan Disease with the topics of interest raised by parents and caregivers, it seems clear that there is a significant 'underlap' of topics raised by these two communities of interest, one that may reflect a lack of sensitivity on the part of the scientific community to meet the needs of this population of knowledge seekers. It is the suggestion of these authors that developmental psychology may be the appropriate scientific field within which to address this need and fill this gap in the current literature.
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Maaloul I, Fourati H, Wali M, Chabchoub I, Kamoun T, Mnif Z, Kaabachi N, Hachicha M. [Megalencephaly with dystonia revealing Canavan disease]. Arch Pediatr 2013; 20:783-6. [PMID: 23727372 DOI: 10.1016/j.arcped.2013.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 03/22/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
Canavan disease, or N-acetyl aspartic aciduria, is an autosomal recessive leukodystrophy characterized by spongy degeneration of the brain. The disease results from the accumulation of N-acetyl aspartic acid in the brain, due to aspartoacylase deficiency. We report the case of a 6-month-old girl who presented with megalencephaly, peripheral hypertonia, and a developmental delay noticeable after 4 months of age. Magnetic resonance imaging of the brain with spectroscopy was suggestive of Canavan disease, which was confirmed by chromatography of urinary organic acids.
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Affiliation(s)
- I Maaloul
- Service de pédiatrie générale, hôpital Hédi-Chaker, avenue Majida-Boulila, 3029 Sfax, Tunisie.
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Baslow M, Guilfoyle D. Canavan disease, a rare early-onset human spongiform leukodystrophy: Insights into its genesis and possible clinical interventions. Biochimie 2013; 95:946-56. [DOI: 10.1016/j.biochi.2012.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/27/2012] [Indexed: 01/14/2023]
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Bergeron M, Clémençon B, Hediger M, Markovich D. SLC13 family of Na+-coupled di- and tri-carboxylate/sulfate transporters. Mol Aspects Med 2013; 34:299-312. [DOI: 10.1016/j.mam.2012.12.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/16/2012] [Indexed: 12/22/2022]
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Solsona MDE, Fernández LL, Boquet EM, Andrés JLP. Lithium citrate as treatment of Canavan disease. Clin Neuropharmacol 2012; 35:150-1. [PMID: 22592512 DOI: 10.1097/wnf.0b013e3182515c9d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Canavan disease is a rare autosomal recessive leukodystrophy characterized by abnormal accumulation of N-acetyl aspartate (NAA) in brain white matter. Currently, there is no cure for this disease, and management of patients consists mainly of treating symptoms. We describe a 3-month-old girl who was hospitalized for poor head control and decreased muscle tone. A battery of laboratory and genetic (homozygous mutation p.C218X) analysis revealed the presence of Canavan disease. Lithium citrate was initiated at a dosage of 45 mg/kg per day after diagnosis. Periodic controls of thyroid and liver function, and lithium levels in blood showed that this drug was sure and well tolerated. After 1 year of treatment, NAA levels decreased by approximately 20% in the brain region, urinary NAA levels showed a reduction of 80%, and patient improved alertness and visual tracking but continued with no heat support, axial hypotonia, and spastic diplegia. In our patient, the results obtained after drug administration are important with respect to the decrease in NAA and more discreet in clinical improvement. However, given the absence of adverse effects and limited treatment options, lithium citrate may be a good alternative to stop the progression of the disease and improve the quality of life of patients.
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Abstract
Leukodystrophies comprise a broad group of progressive, inherited disorders affecting mainly myelin. They often present after a variable period of normalcy with a variety of neurologic problems. Though the ultimate diagnosis is not found in many patients with leukodystrophies, distinctive features unique to them aid in diagnosis, treatment and prognostication. The clinical characteristics, etiologies, diagnostic testing and treatment options are reviewed in detail for some of the major leukodystrophies: X-linked adrenoleukodystrophy, Krabbe disease, metachromatic leukodystrophy, Pelizaeus-Merzbacher disease, Alexander disease, Canavan disease, megalencephalic leukoencephalopathy with subcortical cysts and vanishing white matter disease.
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Affiliation(s)
- Seth J Perlman
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
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Schober H, Luetschg J, Hoeliner I, Kalb S, Simma B. Canavan disease: a novel mutation. Pediatr Neurol 2011; 45:256-8. [PMID: 21907889 DOI: 10.1016/j.pediatrneurol.2011.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022]
Abstract
Canavan disease, an autosomal recessive inherited leukodystrophy caused by an aspartoacylase deficiency, is common among children of Ashkenazi Jewish descent. We report on a non-Jewish female infant who presented at age 6 months with progressive macrocephaly and developmental delay. A sequence analysis of the aspartoacylase gene revealed compound heterozygosity for a known mutation and for the mutation c.432G>A in exon 2, which has not yet been described in Canavan disease.
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Affiliation(s)
- Harald Schober
- Department of Pediatrics, Academic Teaching Hospital, Feldkirch, Austria.
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Mersmann N, Tkachev D, Jelinek R, Röth PT, Möbius W, Ruhwedel T, Rühle S, Weber-Fahr W, Sartorius A, Klugmann M. Aspartoacylase-lacZ knockin mice: an engineered model of Canavan disease. PLoS One 2011; 6:e20336. [PMID: 21625469 PMCID: PMC3098885 DOI: 10.1371/journal.pone.0020336] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/26/2011] [Indexed: 11/19/2022] Open
Abstract
Canavan Disease (CD) is a recessive leukodystrophy caused by loss of function mutations in the gene encoding aspartoacylase (ASPA), an oligodendrocyte-enriched enzyme that hydrolyses N-acetylaspartate (NAA) to acetate and aspartate. The neurological phenotypes of different rodent models of CD vary considerably. Here we report on a novel targeted aspa mouse mutant expressing the bacterial β-Galactosidase (lacZ) gene under the control of the aspa regulatory elements. X-Gal staining in known ASPA expression domains confirms the integrity of the modified locus in heterozygous aspa lacZ-knockin (aspalacZ/+) mice. In addition, abundant ASPA expression was detected in Schwann cells. Homozygous (aspalacZ/lacZ) mutants are ASPA-deficient, show CD-like histopathology and moderate neurological impairment with behavioural deficits that are more pronounced in aspalacZ/lacZ males than females. Non-invasive ultrahigh field proton magnetic resonance spectroscopy revealed increased levels of NAA, myo-inositol and taurine in the aspalacZ/lacZ brain. Spongy degeneration was prominent in hippocampus, thalamus, brain stem, and cerebellum, whereas white matter of optic nerve and corpus callosum was spared. Intracellular vacuolisation in astrocytes coincides with axonal swellings in cerebellum and brain stem of aspalacZ/lacZ mutants indicating that astroglia may act as an osmolyte buffer in the aspa-deficient CNS. In summary, the aspalacZ mouse is an accurate model of CD and an important tool to identify novel aspects of its complex pathology.
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Affiliation(s)
- Nadine Mersmann
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Dmitri Tkachev
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ruth Jelinek
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Thomas Röth
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
| | - Torben Ruhwedel
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
| | - Sabine Rühle
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Wolfgang Weber-Fahr
- Neuroimaging Department, Central Institute of Mental Health, Mannheim, Mannheim, Germany
| | - Alexander Sartorius
- Neuroimaging Department, Central Institute of Mental Health, Mannheim, Mannheim, Germany
| | - Matthias Klugmann
- Institute of Physiological Chemistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
- Translational Neuroscience Facility, Department of Physiology, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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