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Ketata I, Ellouz E. From pathological mechanisms in Krabbe disease to cutting-edge therapy: A comprehensive review. Neuropathology 2024; 44:255-277. [PMID: 38444347 DOI: 10.1111/neup.12967] [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: 01/11/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Since its initial documentation by Knud Krabbe in 1916, numerous studies have scrutinized the characteristics of Krabbe disease (KD) until the identification of the mutation in the GALC gene. In alignment with that, we investigated the natural history of KD spanning eight decades to gain a deeper understanding of the evolutionary trajectory of its mechanisms. Through our comprehensive analysis, we unearthed additional novel elements in molecular biology involving the micropathological mechanism of the disease. This review offers an updated perspective on the metabolic disorder that defines KD. Recently, extracellular vesicles (EVs), autophagy impairment, and α-synuclein have emerged as pivotal players in the neuropathological processes. EVs might serve as a cellular mechanism to avoid or alleviate the detrimental impacts of excessive toxic psychosine levels, and extracting EVs could contribute to synapse dysfunction. Autophagy impairment was found to be independent of psychosine and reliant on AKT and B-cell lymphoma 2. Additionally, α-synuclein has been recognized for inducing cellular death and dysfunction in common biological pathways. Our objective is to assess the effectiveness of advanced therapies in addressing this particular condition. While hematopoietic stem cells have been a primary treatment, its administration proves challenging, particularly in the presymptomatic phase. In this review, we have compiled information from over 10 therapy trials, comparing them based on their benefits and disadvantage.
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Affiliation(s)
- Imen Ketata
- Neurology Department, University Hospital of Gabes, Gabes, Tunisia
- Sfax University, Sfax Faculty of Medicine, Sfax, Tunisia
| | - Emna Ellouz
- Neurology Department, University Hospital of Gabes, Gabes, Tunisia
- Sfax University, Sfax Faculty of Medicine, Sfax, Tunisia
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Tonazzini I, Cerri C, Del Grosso A, Antonini S, Allegra M, Caleo M, Cecchini M. Visual System Impairment in a Mouse Model of Krabbe Disease: The Twitcher Mouse. Biomolecules 2020; 11:biom11010007. [PMID: 33374753 PMCID: PMC7824544 DOI: 10.3390/biom11010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/14/2022] Open
Abstract
Krabbe disease (KD, or globoid cell leukodystrophy; OMIM #245200) is an inherited neurodegenerative condition belonging to the class of the lysosomal storage disorders. It is caused by genetic alterations in the gene encoding for the enzyme galactosylceramidase, which is responsible for cleaving the glycosydic linkage of galatosylsphingosine (psychosine or PSY), a highly cytotoxic molecule. Here, we describe morphological and functional alterations in the visual system of the Twitcher (TWI) mouse, the most used animal model of Krabbe disease. We report in vivo electrophysiological recordings showing defective basic functional properties of the TWI primary visual cortex. In particular, we demonstrate a reduced visual acuity and contrast sensitivity, and a delayed visual response. Specific neuropathological alterations are present in the TWI visual cortex, with reduced myelination, increased astrogliosis and microglia activation, and around the whole brain. Finally, we quantify PSY content in the brain and optic nerves by high-pressure liquid chromatography-mass spectrometry methods. An increasing PSY accumulation with time, the characteristic hallmark of KD, is found in both districts. These results represent the first complete characterization of the TWI visual system. Our data set a baseline for an easy testing of potential therapies for this district, which is also dramatically affected in KD patients.
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Affiliation(s)
- Ilaria Tonazzini
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, 56127 Pisa, Italy; (I.T.); (A.D.G.); (S.A.)
| | - Chiara Cerri
- Istituto Neuroscienze-CNR, Via G. Moruzzi 1, 56124 Pisa, Italy; (C.C.); (M.A.); (M.C.)
- Department of Pharmacy, University of Pisa, Via Bonanno Pisano 6, 56126 Pisa, Italy
| | - Ambra Del Grosso
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, 56127 Pisa, Italy; (I.T.); (A.D.G.); (S.A.)
| | - Sara Antonini
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, 56127 Pisa, Italy; (I.T.); (A.D.G.); (S.A.)
| | - Manuela Allegra
- Istituto Neuroscienze-CNR, Via G. Moruzzi 1, 56124 Pisa, Italy; (C.C.); (M.A.); (M.C.)
- Department of Neuroscience, Institut Pasteur, 25 Rue du Dr Roux, 75015 Paris, France
| | - Matteo Caleo
- Istituto Neuroscienze-CNR, Via G. Moruzzi 1, 56124 Pisa, Italy; (C.C.); (M.A.); (M.C.)
- Department of Biomedical Sciences, University of Padua, Viale G. Colombo 3, 35131 Padua, Italy
| | - Marco Cecchini
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, 56127 Pisa, Italy; (I.T.); (A.D.G.); (S.A.)
- Correspondence:
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Chugani HT. Positron Emission Tomography in Pediatric Neurodegenerative Disorders. Pediatr Neurol 2019; 100:12-25. [PMID: 31416725 DOI: 10.1016/j.pediatrneurol.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Abstract
Application of molecular neuroimaging using positron emission tomographic techniques to assess pediatric neurodegenerative disorders has been limited, unlike in adults where positron emission tomography has contributed to clinical diagnosis, monitoring of neurodegenerative disease progression, and assessment of novel therapeutic approaches. Yet, there is a huge unexplored potential of molecular imaging to improve our understanding of the pathophysiology of neurodegenerative disorders in children and provide radiological biomarkers that can be applied clinically. The obstacles in performing PET scans on children include sedation, radiation exposure, and access but, as will be illustrated, these barriers can be easily overcome. This review summarizes findings from PET studies that have been performed over the past three decades on children with various neurodegenerative disorders, including the neuronal ceroid lipofuscinoses, juvenile Huntington disease, Wilson disease, Niemann-Pick disease type C, Dravet syndrome, dystonia, mitochondrial disorders, inborn errors of metabolism, lysosomal storage diseases, dysmyelinating disorders, Rett syndrome, neurotransmitter disorders, glucose transporter Glut 1 deficiency, and Lesch-Nyhan disease. Because positron emission tomographic scans have often been clinically useful and have contributed to the management of these disorders, we suggest that the time has come for glucose metabolism positron emission tomographic scans to be reimbursed by insurance carriers for children with neurodegenerative disorders, and not restricted only to epilepsy surgery evaluation.
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Affiliation(s)
- Harry T Chugani
- Department of Neurology, NYU School of Medicine, New York, New York.
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Finnsson J, Lubberink M, Savitcheva I, Fällmar D, Melberg A, Kumlien E, Raininko R. Glucose metabolism in the brain in LMNB1-related autosomal dominant leukodystrophy. Acta Neurol Scand 2019; 139:135-142. [PMID: 30192380 PMCID: PMC6585974 DOI: 10.1111/ane.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/02/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE LMNB1-related autosomal dominant leukodystrophy is caused by an overexpression of the protein lamin B1, usually due to a duplication of the LMNB1 gene. Symptoms start in 5th to 6th decade. This slowly progressive disease terminates with death. We studied brain glucose metabolism in this disease using 18 F-fluorodeoxyglucose positron emission tomography (PET). METHODS We examined 8 patients, aged 48-64 years, in varying stages of clinical symptomatology. Two patients were investigated with quantitative PET on clinical indications after which six more patients were recruited. Absolute glucose metabolism was analyzed with the PVElab software in 6 patients and 18 healthy controls. A semiquantitative analysis using the CortexID software was performed in seven investigations, relating local metabolism levels to global glucose metabolism. RESULTS The clinical quantitative PET revealed low global glucose metabolism, with the most marked reduction in the cerebellum. In the PVElab analysis, patients presented low mean glucose metabolism in the cerebellum, brainstem and global grey matter. In the semiquantitative analysis, 2 patients showed a decreased metabolism in the cerebellum and 4 patients a relatively higher metabolism in parts of the temporal lobes. Since none of the patients showed an increased metabolism in the quantitative analysis, we interpret these increases as "pseudo-increases" related to a globally reduced metabolism. CONCLUSIONS Global reduction of grey matter glucose metabolism in this white matter disease most likely depends on a combination of cortical afferent dysfunction and, in later stages, neuronal loss. The lowest metabolism in the cerebellum is consistent with histopathological findings and prominent cerebellar symptoms.
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Affiliation(s)
| | | | - Irina Savitcheva
- Nuclear Medicine and PETUppsala UniversityUppsalaSweden
- Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | | | - Atle Melberg
- Neuroscience, NeurologyUppsala UniversityUppsalaSweden
| | - Eva Kumlien
- Neuroscience, NeurologyUppsala UniversityUppsalaSweden
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Abstract
The autosomal recessive inherited Krabbe disease (KD) is a devastating pediatric lysosomal storage disorder affecting white matter of the brain. It is caused by mutations in the gene coding for the lysosomal enzyme galactocerebrosidase. While most patients present with symptoms within the first 6 months of life, others present later in life throughout adulthood. The early infantile form of KD (EIKD) is frequent in the Muslim Arab population in Israel, with a very high prevalence of approximately 1/100 to 1/150 live births. The homozygous variant c.1582G > A (p.D528N) was found to be responsible for EIKD in Palestinian Arab patients. KD was reported in different Arab countries with much lower frequency. While most Arab patients presented with EIKD, late infantile and late onset KD forms were also reported. Most Arab patients presented with variable symptoms ranging from EIKD to late onset KD, with variable clinical findings. Based on literature studies, this review focuses on the clinical and molecular findings of KD patients with Arab ancestry, and highlights the need for developing universal genetic screening programs to overcome the under-reported status of KD prevalence in Arabia. This is expected to improve the prognosis of the disease and promote targeted molecular diagnostics to the Arab patients.
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Affiliation(s)
- Hatem Zayed
- Department of Health Sciences, Biomedical Program, Qatar University, Doha, Qatar
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Smith BR, Santos MB, Marshall MS, Cantuti-Castelvetri L, Lopez-Rosas A, Li G, van Breemen R, Claycomb KI, Gallea JI, Celej SM, Crocker S, Givogri MI, Bongarzone ER. Neuronal inclusions of α-synuclein contribute to the pathogenesis of Krabbe disease. J Pathol 2014; 232:509-21. [PMID: 24415155 PMCID: PMC3977150 DOI: 10.1002/path.4328] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/26/2013] [Accepted: 12/29/2013] [Indexed: 11/11/2022]
Abstract
Demyelination is a major contributor to the general decay of neural functions in children with Krabbe disease. However, recent reports have indicated a significant involvement of neurons and axons in the neuropathology of the disease. In this study, we have investigated the nature of cellular inclusions in the Krabbe brain. Brain samples from the twitcher mouse model for Krabbe disease and from patients affected with the infantile and late-onset forms of the disease were examined for the presence of neuronal inclusions. Our experiments demonstrated the presence of cytoplasmic aggregates of thioflavin-S-reactive material in both human and murine mutant brains. Most of these inclusions were associated with neurons. A few inclusions were detected to be associated with microglia and none were associated with astrocytes or oligodendrocytes. Thioflavin-S-reactive inclusions increased in abundance, paralleling the development of neurological symptoms, and distributed throughout the twitcher brain in areas of major involvement in cognition and motor functions. Electron microscopy confirmed the presence of aggregates of stereotypic β-sheet folded proteinaceous material. Immunochemical analyses identified the presence of aggregated forms of α-synuclein and ubiquitin, proteins involved in the formation of Lewy bodies in Parkinson's disease and other neurodegenerative conditions. In vitro assays demonstrated that psychosine, the neurotoxic sphingolipid accumulated in Krabbe disease, accelerated the fibrillization of α-synuclein. This study demonstrates the occurrence of neuronal deposits of fibrillized proteins including α-synuclein, identifying Krabbe disease as a new α-synucleinopathy.
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Affiliation(s)
- Benjamin R. Smith
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Marta B. Santos
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Michael S. Marshall
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Ludovico Cantuti-Castelvetri
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Aurora Lopez-Rosas
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Guanan Li
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Richard van Breemen
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Kumiko I. Claycomb
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT
| | - Jose I. Gallea
- Departamento de Quimica Biologica, CIQUIBIC, CONICET, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Soledad M. Celej
- Departamento de Quimica Biologica, CIQUIBIC, CONICET, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Stephen Crocker
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT
| | - Maria I. Givogri
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Ernesto R. Bongarzone
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
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Abstract
Factors that place constraints on radio-chemists who are seeking to design and develop radiopharmaceuticals for PET imaging studies include the short half-lives of 11C and 18F, minimum radiochemical yield and specific activity requirements, and high radiation fields that are associated with multi-Curie quantities of PET radionuclides. Nevertheless, during the past 20 years, considerable progress has been made in the development and application of a variety of PET radiotracers for a range of imaging studies in human subjects. We have highlighted a few areas of radiochemistry that focused on PET radiotracers that are described in this issue. Although the number of PET radiotracers synthesized is in the hundreds [6], much work remains to develop specific and useful PET radiotracers for a host of new and exciting noninvasive imaging applications.
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Affiliation(s)
- N Scott Mason
- Positron Emission Tomography Facility, Department of Radiology, University of Pittsburgh, B-938, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
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