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Holroyd KB, Berkowitz AL. Metabolic and Toxic Myelopathies. Continuum (Minneap Minn) 2024; 30:199-223. [PMID: 38330479 DOI: 10.1212/con.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article reviews the clinical presentation, diagnostic evaluation, and treatment of metabolic and toxic myelopathies resulting from nutritional deficiencies, environmental and dietary toxins, drugs of abuse, systemic medical illnesses, and oncologic treatments. LATEST DEVELOPMENTS Increased use of bariatric surgery for obesity has led to higher incidences of deficiencies in nutrients such as vitamin B12 and copper, which can cause subacute combined degeneration. Myelopathies secondary to dietary toxins including konzo and lathyrism are likely to become more prevalent in the setting of climate change leading to drought and flooding. Although modern advances in radiation therapy techniques have reduced the incidence of radiation myelopathy, patients with cancer are living longer due to improved treatments and may require reirradiation that can increase the risk of this condition. Immune checkpoint inhibitors are increasingly used for the treatment of cancer and are associated with a wide variety of immune-mediated neurologic syndromes including myelitis. ESSENTIAL POINTS Metabolic and toxic causes should be considered in the diagnosis of myelopathy in patients with particular clinical syndromes, risk factors, and neuroimaging findings. Some of these conditions may be reversible if identified and treated early, requiring careful history, examination, and laboratory and radiologic evaluation for prompt diagnosis.
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Gomez MA, Berkoff KC, Gill BK, Iavarone AT, Lieberman SE, Ma JM, Schultink A, Karavolias NG, Wyman SK, Chauhan RD, Taylor NJ, Staskawicz BJ, Cho MJ, Rokhsar DS, Lyons JB. CRISPR-Cas9-mediated knockout of CYP79D1 and CYP79D2 in cassava attenuates toxic cyanogen production. FRONTIERS IN PLANT SCIENCE 2023; 13:1079254. [PMID: 37007603 PMCID: PMC10064795 DOI: 10.3389/fpls.2022.1079254] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/21/2022] [Indexed: 05/31/2023]
Abstract
Cassava (Manihot esculenta) is a starchy root crop that supports over a billion people in tropical and subtropical regions of the world. This staple, however, produces the neurotoxin cyanide and requires processing for safe consumption. Excessive consumption of insufficiently processed cassava, in combination with protein-poor diets, can have neurodegenerative impacts. This problem is further exacerbated by drought conditions which increase this toxin in the plant. To reduce cyanide levels in cassava, we used CRISPR-mediated mutagenesis to disrupt the cytochrome P450 genes CYP79D1 and CYP79D2 whose protein products catalyze the first step in cyanogenic glucoside biosynthesis. Knockout of both genes eliminated cyanide in leaves and storage roots of cassava accession 60444; the West African, farmer-preferred cultivar TME 419; and the improved variety TMS 91/02324. Although knockout of CYP79D2 alone resulted in significant reduction of cyanide, mutagenesis of CYP79D1 did not, indicating these paralogs have diverged in their function. The congruence of results across accessions indicates that our approach could readily be extended to other preferred or improved cultivars. This work demonstrates cassava genome editing for enhanced food safety and reduced processing burden, against the backdrop of a changing climate.
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Affiliation(s)
- Michael A. Gomez
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Kodiak C. Berkoff
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Molecular & Cell Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Baljeet K. Gill
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Anthony T. Iavarone
- California Institute for Quantitative Biosciences (QB3), University of California, Berkeley, Berkeley, CA, United States
| | - Samantha E. Lieberman
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Plant & Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Jessica M. Ma
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Plant & Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Alex Schultink
- Department of Plant & Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Nicholas G. Karavolias
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Plant & Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Stacia K. Wyman
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
| | | | - Nigel J. Taylor
- Donald Danforth Plant Science Center, St. Louis, MO, United States
| | - Brian J. Staskawicz
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Plant & Microbial Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Myeong-Je Cho
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Daniel S. Rokhsar
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Molecular & Cell Biology, University of California, Berkeley, Berkeley, CA, United States
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Molecular Genetics Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Chan-Zuckerberg BioHub, San Francisco, CA, United States
| | - Jessica B. Lyons
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Molecular & Cell Biology, University of California, Berkeley, Berkeley, CA, United States
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Kocher K, Bhattacharya S, Bramble MS, Okitundu-Luwa D, Ngoyi DM, Tshala-Katumbay D, Vilain E. DNA methylation patterns associated with konzo in Sub-Saharan Africa. Clin Epigenetics 2022; 14:179. [PMID: 36536449 PMCID: PMC9764695 DOI: 10.1186/s13148-022-01372-x] [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: 04/15/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Konzo, a disease characterized by sudden, irreversible spastic paraparesis, affecting up to 10% of the population in some regions of Sub-Saharan Africa during outbreaks, is strongly associated with dietary exposure to cyanogenic bitter cassava. The molecular mechanisms underlying the development of konzo remain largely unknown. Here, through an analysis of 16 individuals with konzo and matched healthy controls from the same outbreak zones, we identified 117 differentially methylated loci involved in numerous biological processes that may identify cyanogenic-sensitive regions of the genome, providing the first study of epigenomic alterations associated with a clinical phenotype of konzo.
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Affiliation(s)
- Kristen Kocher
- grid.253615.60000 0004 1936 9510Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037 USA ,grid.239560.b0000 0004 0482 1586Department of Genetic Medicine Research, Children’s Research Institute, Childrens National Hospital, Washington, DC 20010 USA
| | - Surajit Bhattacharya
- grid.239560.b0000 0004 0482 1586Department of Genetic Medicine Research, Children’s Research Institute, Childrens National Hospital, Washington, DC 20010 USA
| | - Matthew S. Bramble
- grid.253615.60000 0004 1936 9510Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037 USA ,grid.239560.b0000 0004 0482 1586Department of Genetic Medicine Research, Children’s Research Institute, Childrens National Hospital, Washington, DC 20010 USA
| | - Daniel Okitundu-Luwa
- grid.9783.50000 0000 9927 0991Department of Neurology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Dieudonne Mumba Ngoyi
- grid.452637.10000 0004 0580 7727National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Desire Tshala-Katumbay
- grid.9783.50000 0000 9927 0991Department of Neurology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo ,grid.452637.10000 0004 0580 7727National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo ,grid.5288.70000 0000 9758 5690Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR 97239 USA
| | - Eric Vilain
- grid.253615.60000 0004 1936 9510Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037 USA ,grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA 92697 USA
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Impact of Seasonal Variation and Processing Methods on the Cassava-Derived Dietary Cyanide Poisoning, Nutritional Status, and Konzo Appearance in South-Kivu, Eastern D.R. Congo. Processes (Basel) 2022. [DOI: 10.3390/pr10020337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed at evaluating the impact of seasons on the nutritional status and on dietary cassava-related cyanide exposure in Burhinyi and Idjwi, two areas in the eastern Democratic Republic of the Congo, witnessing similarly high cassava-derived cyanide poisoning but differently affected by konzo and malnutrition. Cyanide content in cassava roots and flour, and urinary thiocyanate levels (uSCN) of 54 subjects (40 from Burhinyi and 14 from Idjwi, aged 28.7 (12.1) years, 63% women) were measured during the rainy season (RS) and dry season (DS), using picrate paper kits A and D1. Local processing methods proved to be efficient in removing cyanogenic compounds in fresh cassava roots during the RS. However, the cyanide content in flour samples significantly increased during DS, with ~50% of samples containing unsafe levels (>10 ppm) of cyanide content. Strikingly, the uSCN (µmol/L), from being comparably high in RS (~172.0), slightly decreased during DS in Burhinyi (~103.2; p = 0,3547), but not in Idjwi (~172; p = 0,1113). Furthermore, serum proteins and albumin levels significantly decreased during the DS, witnessing a worsening of nutritional status, in Burhinyi but not in Idjwi. The consumption of bitter cassava roots (OR = 5.43, p = 0.0144) and skipping heap fermentation (OR = 16.67, p = 0.0021) were independently associated with very high uSCN levels during the DS. Thus, restoring the traditional processing methods, and complying with them in either season should ensure the safe consumption of cassava.
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Baguma M, Malembaka EB, Bahizire E, Mudumbi GZ, Shamamba DB, Matabaro AN, Rigo JM, Njamnshi AK, Chabwine JN. Revisiting Konzo Risk Factors in Three Areas Differently Affected by Spastic Paraparesis in Eastern Democratic Republic of the Congo Discloses a Prominent Role of the Nutritional Status-A Comparative Cross-Sectional Study. Nutrients 2021; 13:2628. [PMID: 34444788 PMCID: PMC8399762 DOI: 10.3390/nu13082628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
This comparative cross-sectional study aimed to better understand the respective contributions of protein malnutrition and cassava-derived cyanide poisoning in the development of konzo. We compared data on nutritional status and cyanide exposure of school-age adolescent konzo-diseased patients to those of non-konzo subjects of similar age from three areas in the Eastern Democratic Republic of the Congo. Our results show that konzo patients had a high prevalence of both wasting (54.5%) and stunting (72.7%), as well as of cyanide poisoning (81.8%). Controls from Burhinyi and those from Idjwi showed a similar profile with a low prevalence of wasting (3.3% and 6.5%, respectively) and intermediate prevalence of stunting (26.7% and 23.9%, respectively). They both had a high prevalence of cyanide poisoning (50.0% and 63.0%, respectively), similar to konzo-patients. On the other hand, controls from Bukavu showed the lowest prevalence of both risk factors, namely chronic malnutrition (12.1%) and cyanide poisoning (27.6%). In conclusion, cassava-derived cyanide poisoning does not necessarily coexist with konzo outbreaks. The only factor differentiating konzo patients from healthy individuals exposed to cyanide poisoning appeared to be their worse nutritional status. This further suggests that, besides the known role of cyanide poisoning in the pathogenesis of konzo, malnutrition may be a key factor for the disease occurrence.
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Affiliation(s)
- Marius Baguma
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (E.B.M.); (E.B.); (J.N.C.)
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu 285, Democratic Republic of the Congo
- Biomedical Research Institute (BIOMED), Faculty of Health and Life Sciences, UHasselt—Hasselt University, 3590 Diepenbeek, Belgium;
- Center for Tropical Diseases & Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (E.B.M.); (E.B.); (J.N.C.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, W6030, Baltimore, MD 21205, USA
| | - Esto Bahizire
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (E.B.M.); (E.B.); (J.N.C.)
- Center for Tropical Diseases & Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo
- Center for Research in Natural Sciences of Lwiro, Bukavu 285, Democratic Republic of the Congo
- Department of Medical Microbiology, University of Nairobi, Nairobi 00100, Kenya
| | - Germain Zabaday Mudumbi
- Department of Pediatrics, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu 285, Democratic Republic of the Congo;
| | - Dieudonné Bahati Shamamba
- Plant Pathology Laboratory, Faculty of Agronomy, Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo;
| | - Alain-Narcisse Matabaro
- Department of Medical Biology, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu 285, Democratic Republic of the Congo;
| | - Jean-Michel Rigo
- Biomedical Research Institute (BIOMED), Faculty of Health and Life Sciences, UHasselt—Hasselt University, 3590 Diepenbeek, Belgium;
| | - Alfred Kongnyu Njamnshi
- Department of Internal Medicine and Specialties/Neuroscience, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé P.O. Box 25625, Cameroon;
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon
- Brain Research Africa Initiative (BRAIN), Thônex, 1226 Geneva, Switzerland
| | - Joelle Nsimire Chabwine
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (E.B.M.); (E.B.); (J.N.C.)
- Neurology Unit, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
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