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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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Wang P, Du X, Shen Q, Jiang W, Shen C, Wang H, Zhou S, Wang Y, Qian X, Zhai X. Unrelated umbilical cord blood transplantation for children with hereditary leukodystrophy: A retrospective study. Front Neurol 2022; 13:999919. [PMID: 36247778 PMCID: PMC9561100 DOI: 10.3389/fneur.2022.999919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the efficiency of unrelated umbilical cord blood transplantation (UCBT) in the treatment of hereditary leukodystrophy following busulfan- and cyclophosphamide-based myeloablative chemotherapy. Methods A retrospective study was performed in patients with hereditary leukodystrophy who underwent UCBT after myeloablative chemotherapy between April 2015 and March 2020. Results The study cohort included 12 pediatric patients (ten males), nine with cerebral adrenoleukodystrophy (ALD) and three with juvenile globoid cell leukodystrophy (GLD). All received HLA-matched or partially mismatched unrelated UCBT. There were no cases of graft rejection. Median neutrophil engraftment time was 20 days [12–33 days] and median platelet engraftment time was 29 days [14–65 days]. Median follow-up was 36 months [1–86 months], and the overall survival rate for patients with cerebral ALD and juvenile GLD after UCBT was 77.8% (7/9) and 100% (3/3), respectively. In patients with ALD, although lipid profiles (serum very-long-chain fatty acid) were improved post-UCBT, six patients demonstrated worse neurologic function score and performance status post-UCBT, and six patients had higher Loes scores at last follow-up compared with baseline. In patients with juvenile GLD, all patients showed stable neurologic function score and performance status despite the Loes score of one patient increased slightly after transplantation. Conclusion In patients with cerebral ALD, patients with no or mild neurological symptoms can benefit from UCBT, while UCBT cannot reverse advanced disease. In patients with juvenile GLD, UCBT is safe and contributes to stabilize neurological function.
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Affiliation(s)
- Ping Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaonan Du
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Quanli Shen
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, China
| | - Wenjin Jiang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Chen Shen
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Hongsheng Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaowen Qian
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
- Xiaowen Qian
| | - Xiaowen Zhai
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
- *Correspondence: Xiaowen Zhai
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Wu G, Li Z, Li J, Li X, Wang M, Zhang J, Liu G, Zhang P. A neglected neurodegenerative disease: Adult-onset globoid cell leukodystrophy. Front Neurosci 2022; 16:998275. [PMID: 36161165 PMCID: PMC9490374 DOI: 10.3389/fnins.2022.998275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Globoid cell leukodystrophy (GLD), or Krabbe disease (KD) is a rare neurodegenerative disease, and adult-onset GLD is more even neglected by clinicians. This review provides detailed discussions of the serum enzymes, genes, clinical manifestations, neuroimaging features, and therapies of GLD, with particular emphasis on the characteristics of adult-onset GLD, in an attempt to provide clinicians with in-depth insights into this disease.
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Affiliation(s)
- Guode Wu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhenhua Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Manxia Wang,
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Pengfei Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
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Zaccariotto E, Cachón-González MB, Wang B, Lim S, Hirth B, Park H, Fezoui M, Sardi SP, Mason P, Barker RH, Cox TM. A novel brain-penetrant oral UGT8 inhibitor decreases in vivo galactosphingolipid biosynthesis in murine Krabbe disease. Biomed Pharmacother 2022; 149:112808. [PMID: 35290889 DOI: 10.1016/j.biopha.2022.112808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Krabbe disease is a rare, inherited neurodegenerative disease due to impaired lysosomal β-galactosylceramidase (GALC) activity and formation of neurotoxic β-galactosylsphingosine ('psychosine'). We investigated substrate reduction therapy with a novel brain-penetrant inhibitor of galactosylceramide biosynthesis, RA 5557, in twitcher mice that lack GALC activity and model Krabbe disease. This thienopyridine derivative selectively inhibits uridine diphosphate-galactose glycosyltransferase 8 (UGT8), the final step in the generation of galactosylceramides which are precursors of sulphatide and, in the pathological lysosome, the immediate source of psychosine. Administration of RA 5557, reduced pathologically elevated psychosine concentrations (72-86%) in the midbrain and cerebral cortex in twitcher mice: the inhibitor decreased galactosylceramides by about 70% in midbrain and cerebral cortex in mutant and wild type animals. Exposure to the inhibitor significantly decreased several characteristic inflammatory response markers without causing apparent toxicity to myelin-producing cells in wild type and mutant mice; transcript abundance of oligodendrocyte markers MBP (myelin basic protein) and murine UGT8 was unchanged. Administration of the inhibitor before conception and during several breeding cycles to mice did not impair fertility and gave rise to healthy offspring. Nevertheless, given the unchanged lifespan, it appears that GALC has critical functions in the nervous system beyond the hydrolysis of galactosylceramide and galactosylsphingosine. Our findings support further therapeutic exploration of orally active UGT8 inhibitors in Krabbe disease and related galactosphingolipid disorders. The potent thienopyridine derivative with effective target engagement here studied appears to have an acceptable safety profile in vivo; judicious dose optimization will be needed to ensure efficacious clinical translation.
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Affiliation(s)
- Eva Zaccariotto
- Department of Medicine, University of Cambridge, Cambridge, UK.
| | | | - Bing Wang
- Early Development, Sanofi R&D, Waltham, MA, United States
| | - Sungtaek Lim
- Integrated Drug Discovery, Sanofi R&D, Waltham, MA, United States
| | - Bradford Hirth
- Integrated Drug Discovery, Sanofi R&D, Waltham, MA, United States
| | - Hyejung Park
- Early Development, Sanofi R&D, Waltham, MA, United States
| | - Malika Fezoui
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - S Pablo Sardi
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Paul Mason
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Robert H Barker
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK.
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A novel compound heterozygous mutation in GALC associated with adult-onset Krabbe disease: case report and literature review. Neurogenetics 2022; 23:157-165. [PMID: 35013804 DOI: 10.1007/s10048-021-00682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
Krabbe disease (KD) is a rare autosomal recessive lipid storage leukodystrophy. It is caused by deficient enzyme activity resulting from mutations of the β-galactocerebrosidase (GALC) gene. KD is distinguished into subtypes based on the age of onset; these are early infantile, late infantile, juvenile, and adult-onset. We report a case of a 47-year-old Caucasian man with a 2-year history of muscle atrophy and weakness in both hands associated with pyramidal signs and mild spasticity in the lower limbs. An extensive work-up led this motor neuron disease-like disorder to be diagnosed as adult-onset KD. The patient was found to be compound heterozygous for two GALC mutations (p.G286D and p.Y490N). These two rare missense mutations have previously been reported with other heterozygous mutations. However, their co-occurrence in a KD patient is novel. From the perspective of this case, we review the current literature on compound heterozygous mutations in adult-onset KD and their phenotypic variability.
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Thompson-Stone R, Ream MA, Gelb M, Matern D, Orsini JJ, Levy PA, Rubin JP, Wenger DA, Burton BK, Escolar ML, Kurtzberg J. Consensus recommendations for the classification and long-term follow up of infants who screen positive for Krabbe Disease. Mol Genet Metab 2021; 134:53-59. [PMID: 33832819 DOI: 10.1016/j.ymgme.2021.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide updated evidence and consensus-based recommendations for the classification of individuals who screen positive for Krabbe Disease (KD) and recommendations for long-term follow-up for those who are at risk for late onset Krabbe Disease (LOKD). METHODS KD experts (KD NBS Council) met between July 2017 and June 2020 to develop consensus-based classification and follow-up recommendations. The resulting newly proposed recommendations were assessed in a historical cohort of 47 newborns from New York State who were originally classified at moderate or high risk for LOKD. RESULTS Infants identified by newborn screening with possible KD should enter one of three clinical follow-up pathways (Early infantile KD, at-risk for LOKD, or unaffected), based on galactocerebrosidase (GALC) activity, psychosine concentration, and GALC genotype. Patients considered at-risk for LOKD based on low GALC activity and an intermediate psychosine concentration are further split into a high-risk or low-risk follow-up pathway based on genotype. Review of the historical New York State cohort found that the updated follow-up recommendations would reduce follow up testing by 88%. CONCLUSION The KD NBS Council has presented updated consensus recommendations for efficient and effective classification and follow-up of NBS positive patients with a focus on long-term follow-up of those at-risk for LOKD.
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Affiliation(s)
- Robert Thompson-Stone
- University of Rochester, Golisano Children's Hospital, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Margie A Ream
- Nationwide Children's Hospital Division of Neurology, 700 Children's Dr., Columbus, OH 43205, USA
| | - Michael Gelb
- Departments of Chemistry and Biochemistry, University of Washington, Campus Box 351700, 36 Bagley Hall, Seattle, WA 98195, USA
| | - Dietrich Matern
- Biochemical Genetics Laboratory, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Joseph J Orsini
- Laboratory of Human Genetics, Wadsworth Center, New York State Dept. of Health, Albany, NY, USA
| | - Paul A Levy
- Children's Hospital at Montefiore, Einstein-Montefiore, Pediatric Genetic Medicine, 3411 Wayne Avenue, 9(th) Floor, Bronx, NY 10467, USA
| | - Jennifer P Rubin
- Department of Pediatric Neurology, Northwestern Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - David A Wenger
- Department of Neurology, Sidney Kimmel College of Medicine, Thomas Jefferson University, 1020 Locust St, Room 346, Philadelphia, PA 19107, USA
| | - Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Feinberg School of Medicine of Northwestern University, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Maria L Escolar
- Department of Pediatrics, University of Pittsburgh Medical Center, Plaza Suite 407, 4401 Penn Ave, Pittsburgh, PA 15224, USA
| | - Joanne Kurtzberg
- Marcus Center for Cellular Cures, Duke University School of Medicine, 2400 Pratt Street, Room 9026, Durham, NC 27705, USA
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Corre CS, Matern D, Pellegrino JE, Saavedra-Matiz CA, Orsini JJ, Thompson-Stone R. Low Psychosine in Krabbe Disease with Onset in Late Infancy: A Case Report. Int J Neonatal Screen 2021; 7:ijns7020028. [PMID: 34071213 PMCID: PMC8162352 DOI: 10.3390/ijns7020028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Krabbe disease (KD) is a rare inherited neurodegenerative disorder caused by a deficiency in galactocerebrosidase enzyme activity, which can present in early infancy, requiring an urgent referral for hematopoietic stem cell transplantation, or later in life. Newborn screening (NBS) for KD requires identification and risk-stratification of patients based on laboratory values to predict disease onset in early infancy or later in life. The biomarker psychosine plays a key role in NBS algorithms to ascertain probability of early-onset disease. This report describes a patient who was screened positive for KD in New York State, had a likely pathogenic genotype, and showed markedly reduced enzyme activity but surprisingly low psychosine levels. The patient ultimately developed KD in late infancy, an outcome not clearly predicted by existing NBS algorithms. It remains critical that psychosine levels be evaluated alongside genotype, enzyme activity levels, and the patient's evolving clinical presentation, ideally in consultation with experts in KD, in order to guide diagnosis and plans for monitoring.
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Affiliation(s)
- Camille S. Corre
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA;
| | - Dietrich Matern
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Joan E. Pellegrino
- Inherited Metabolic Specialty Center, Department of Pediatrics, Upstate Medical University, Syracuse, NY 13010, USA;
| | - Carlos A. Saavedra-Matiz
- NY State Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY 13010, USA; (C.A.S.-M.); (J.J.O.)
| | - Joseph J. Orsini
- NY State Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY 13010, USA; (C.A.S.-M.); (J.J.O.)
| | - Robert Thompson-Stone
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA;
- Correspondence:
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Zuccoli G, Kim A, Poe M, Escolar ML. Spontaneous Third Ventriculostomy in Krabbe Disease. Pediatr Neurol 2020; 108:99-105. [PMID: 32197817 PMCID: PMC7263959 DOI: 10.1016/j.pediatrneurol.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Spontaneous third ventriculostomies have been reported in relation to obstructive hydrocephalus and increased intracranial pressure and are most commonly seen as disruption of the floor of the third ventricle. Hydrocephalus has been reported in patients with Krabbe disease; however, it is clinically difficult to monitor for hydrocephalus in patients with Krabbe disease as symptoms of increased intracranial pressure may overlap with symptoms of Krabbe disease. We describe a case series of spontaneous third ventriculostomy and hydrocephalus, likely in response to increased intracranial pressure, in patients with infantile Krabbe disease. METHODS Brain magnetic resonance images of patients with infantile Krabbe disease were retrospectively analyzed to assess for ventricular size and presence of spontaneous third ventriculostomies. A brain atlas was used to standardize the calculation of ventricular size. Mid-sagittal, T2-weighted images around the third ventricle were assessed for spontaneous third ventriculostomies. Developmental outcomes were measured with a series of standardized and validated tests. RESULTS Seventy-five patients with infantile Krabbe disease were evaluated. Twelve cases of spontaneous third ventriculostomies were identified. Head circumference (SE = 8.07; P < 0.001) and average ventricular volume were greater (left: SE = 1.47, P < 0.001) in patients with spontaneous third ventriculostomies when compared with patients without spontaneous third ventriculostomies. Patients with spontaneous third ventriculostomies also had more delayed development in adaptive (difference = 0.2, P < 0.01), gross motor (difference = 0.0, P < 0.01), and fine motor (difference = 0.1, P < 0.001) function. CONCLUSIONS Spontaneous third ventriculostomies, likely in the context of increased intracranial pressure, were identified in patients with Krabbe disease. Although difficult to assess, our study highlights the importance of monitoring for increased intracranial pressure, which can result in spontaneous third ventriculostomies, in patients with infantile Krabbe disease.
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Affiliation(s)
- Giulio Zuccoli
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aram Kim
- Division of Child Neurology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michele Poe
- Program for the Study of Neurodevelopment in Rare Disorders, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria L Escolar
- Program for the Study of Neurodevelopment in Rare Disorders, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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D TK, Jain N, Kumar S U, Jena PP, Ramamoorthy S, Priya Doss C G, Zayed H. Molecular dynamics simulations to decipher the structural and functional consequences of pathogenic missense mutations in the galactosylceramidase (GALC) protein causing Krabbe’s disease. J Biomol Struct Dyn 2020; 39:1795-1810. [DOI: 10.1080/07391102.2020.1742790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Thirumal Kumar D
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Nikita Jain
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Udhaya Kumar S
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Prangya Paramita Jena
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Siva Ramamoorthy
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - George Priya Doss C
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health and Sciences, QU Health, Qatar University, Doha, Qatar
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Alderson J, Ghosh PS. Clinical Reasoning: Pes cavus and neuropathy: Think beyond Charcot-Marie-Tooth disease. Neurology 2020; 93:e823-e826. [PMID: 31427497 DOI: 10.1212/wnl.0000000000007976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jillian Alderson
- From the Department of Neurology (J.A), Beth Israel Deaconess Medical Center; and Department of Neurology (P.S.G.), Boston Children's Hospital, MA
| | - Partha S Ghosh
- From the Department of Neurology (J.A), Beth Israel Deaconess Medical Center; and Department of Neurology (P.S.G.), Boston Children's Hospital, MA.
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Zhuang S, Kong L, Li C, Chen L, Zhang T. GALC mutations in Chinese patients with late-onset Krabbe disease: a case report. BMC Neurol 2019; 19:122. [PMID: 31185936 PMCID: PMC6560759 DOI: 10.1186/s12883-019-1345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Krabbe disease (also known as globoid cell leukodystrophy) cause by a deficiency of the enzyme β-galactocerebrosidase (galactosylceramidase, GALC). The deficiency of GALC leads to accumulation of galactosylceramide and psychosine, the latter GALC substrate having a potential role in triggering demyelination. Typically, the disease has an infantile onset, with rapid deterioration in the first few months, leading to death before the age of 2 years. The late onset forms (late-infantile, juvenile, and adult forms) are rare with variable clinical outcomes, presenting spastic paraplegia as the main symptom. CASE PRESENTATION We recruited a family with two affected individuals. The proband (Patient 1), a 25-year-old male, was presented with slow progressive symptoms, including spastic gait disturbance and vision loss since the 5th year of life. His elder sister (Patient 2), became wheelchair-bound and demented at the age of 22 years. Brain magnetic resonance imaging (MRI) showed increased signal intensity in the white matter along with the involvement of the bilateral corticospinal tracts. GALC deficiency was confirmed by biochemical analysis. DNA sequencing revealed two mutations (c.865G > C: p. G289R and c.136G > T: p. D46Y) in GALC. The clinical characteristics, brain MRI, biochemical and molecular findings led to the diagnosis of Krabbe disease. CONCLUSION Clinical and neuroimaged signs, positive enzymatic analysis and molecular data converged to definite diagnosis in this neurodegenerative disease.
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Affiliation(s)
- Shunzhi Zhuang
- Department of Neurology, the First People's Hospital of Huizhou city, 20# Sanxin south Road, Huizhou, 516003, Guangdong Province, China
| | - Lingen Kong
- Department of Neurology, the First People's Hospital of Huizhou city, 20# Sanxin south Road, Huizhou, 516003, Guangdong Province, China
| | - Caiming Li
- Department of Neurology, the First People's Hospital of Huizhou city, 20# Sanxin south Road, Huizhou, 516003, Guangdong Province, China.
| | - Likun Chen
- Department of Neurology, the First People's Hospital of Huizhou city, 20# Sanxin south Road, Huizhou, 516003, Guangdong Province, China
| | - Tingting Zhang
- Department of Neurology, the First People's Hospital of Huizhou city, 20# Sanxin south Road, Huizhou, 516003, Guangdong Province, China
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12
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Moskot M, Bocheńska K, Jakóbkiewicz-Banecka J, Banecki B, Gabig-Cimińska M. Abnormal Sphingolipid World in Inflammation Specific for Lysosomal Storage Diseases and Skin Disorders. Int J Mol Sci 2018; 19:E247. [PMID: 29342918 PMCID: PMC5796195 DOI: 10.3390/ijms19010247] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 02/06/2023] Open
Abstract
Research in recent years has shown that sphingolipids are essential signalling molecules for the proper biological and structural functioning of cells. Long-term studies on the metabolism of sphingolipids have provided evidence for their role in the pathogenesis of a number of diseases. As many inflammatory diseases, such as lysosomal storage disorders and some dermatologic diseases, including psoriasis, atopic dermatitis and ichthyoses, are associated with the altered composition and metabolism of sphingolipids, more studies precisely determining the responsibilities of these compounds for disease states are required to develop novel pharmacological treatment opportunities. It is worth emphasizing that knowledge from the study of inflammatory metabolic diseases and especially the possibility of their treatment may lead to insight into related metabolic pathways, including those involved in the formation of the epidermal barrier and providing new approaches towards workable therapies.
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Affiliation(s)
- Marta Moskot
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Laboratory of Molecular Biology, Kadki 24, 80-822 Gdańsk, Poland.
- Department of Medical Biology and Genetics, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
| | - Katarzyna Bocheńska
- Department of Medical Biology and Genetics, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
| | | | - Bogdan Banecki
- Department of Molecular and Cellular Biology, Intercollegiate Faculty of Biotechnology UG-MUG, Abrahama 58, 80-307 Gdańsk, Poland.
| | - Magdalena Gabig-Cimińska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Laboratory of Molecular Biology, Kadki 24, 80-822 Gdańsk, Poland.
- Department of Medical Biology and Genetics, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
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New in Newborn Screening. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shao YH, Choquet K, La Piana R, Tétreault M, Dicaire MJ, Boycott KM, Majewski J, Brais B. Mutations in GALC cause late-onset Krabbe disease with predominant cerebellar ataxia. Neurogenetics 2016; 17:137-41. [PMID: 26915362 DOI: 10.1007/s10048-016-0476-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/09/2016] [Indexed: 11/25/2022]
Abstract
Mutations in GALC cause Krabbe disease. This autosomal recessive leukodystrophy generally presents in early infancy as a severe disorder, but sometimes manifests as a milder adult-onset disease with spastic paraplegia as the main symptom. We recruited a family with five affected individuals presenting with adult-onset predominant cerebellar ataxia with mild spasticity. Whole exome sequencing (WES) revealed one novel and one previously reported compound heterozygous variants in GALC. Magnetic resonance imaging (MRI) confirmed the presence of typical Krabbe features. Our findings expand the phenotypic spectrum of adult-onset Krabbe disease and demonstrate the usefulness of combining WES and pattern-specific MRI for the diagnosis of neurodegenerative diseases.
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Affiliation(s)
- Yi-Hong Shao
- Neurogenetics of Motion Laboratory, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Karine Choquet
- Neurogenetics of Motion Laboratory, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada
- Department of Human Genetics, McGill University, Montreal, QC, H3A 1B1, Canada
| | - Roberta La Piana
- Neurogenetics of Motion Laboratory, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Martine Tétreault
- Department of Human Genetics, McGill University, Montreal, QC, H3A 1B1, Canada
- McGill University and Genome Quebec Innovation Center, Montreal, QC, Canada
| | - Marie-Josée Dicaire
- Neurogenetics of Motion Laboratory, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC, H3A 1B1, Canada
- McGill University and Genome Quebec Innovation Center, Montreal, QC, Canada
| | - Bernard Brais
- Neurogenetics of Motion Laboratory, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada.
- Department of Human Genetics, McGill University, Montreal, QC, H3A 1B1, Canada.
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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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