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Grass T, Dokuzluoglu Z, Buchner F, Rosignol I, Thomas J, Caldarelli A, Dalinskaya A, Becker J, Rost F, Marass M, Wirth B, Beyer M, Bonaguro L, Rodriguez-Muela N. Isogenic patient-derived organoids reveal early neurodevelopmental defects in spinal muscular atrophy initiation. Cell Rep Med 2024; 5:101659. [PMID: 39067446 PMCID: PMC11384962 DOI: 10.1016/j.xcrm.2024.101659] [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: 07/25/2023] [Revised: 02/26/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024]
Abstract
Whether neurodevelopmental defects underlie postnatal neuronal death in neurodegeneration is an intriguing hypothesis only recently explored. Here, we focus on spinal muscular atrophy (SMA), a neuromuscular disorder caused by reduced survival of motor neuron (SMN) protein levels leading to spinal motor neuron (MN) loss and muscle wasting. Using the first isogenic patient-derived induced pluripotent stem cell (iPSC) model and a spinal cord organoid (SCO) system, we show that SMA SCOs exhibit abnormal morphological development, reduced expression of early neural progenitor markers, and accelerated expression of MN progenitor and MN markers. Longitudinal single-cell RNA sequencing reveals marked defects in neural stem cell specification and fewer MNs, favoring mesodermal progenitors and muscle cells, a bias also seen in early SMA mouse embryos. Surprisingly, SMN2-to-SMN1 conversion does not fully reverse these developmental abnormalities. These suggest that early neurodevelopmental defects may underlie later MN degeneration, indicating that postnatal SMN-increasing interventions might not completely amend SMA pathology in all patients.
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Affiliation(s)
- Tobias Grass
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany.
| | - Zeynep Dokuzluoglu
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany
| | - Felix Buchner
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany
| | - Ines Rosignol
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany; Technische Universität Dresden (TUD), Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Joshua Thomas
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany
| | - Antonio Caldarelli
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany
| | - Anna Dalinskaya
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany
| | - Jutta Becker
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Fabian Rost
- DRESDEN-concept Genome Center, Technology Platform at the Center for Molecular and Cellular Bioengineering, TUD, Dresden, Germany
| | - Michele Marass
- Max Planck Institute for Molecular Cell Biology and Genetics, Dresden, Germany; Center for Systems Biology Dresden, Dresden, Germany
| | - Brunhilde Wirth
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany; Center for Rare Diseases, University Hospital of Cologne, Cologne, Germany
| | - Marc Beyer
- Systems Medicine, DZNE, Bonn, Germany; PRECISE Platform for Single Cell Genomics and Epigenomics, DZNE & University of Bonn and West German Genome Center, Bonn, Germany; Immunogenomics & Neurodegeneration, DZNE, Bonn, Germany
| | - Lorenzo Bonaguro
- Systems Medicine, DZNE, Bonn, Germany; Genomics & Immunoregulation, LIMES Institute, University of Bonn, Bonn, Germany
| | - Natalia Rodriguez-Muela
- German Center for Neurodegenerative Diseases e.V. (DZNE), Dresden, Germany; Technische Universität Dresden (TUD), Center for Regenerative Therapies Dresden, Dresden, Germany; Max Planck Institute for Molecular Cell Biology and Genetics, Dresden, Germany.
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2
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de Albuquerque ALA, Chadanowicz JK, Giudicelli GC, Staub ALP, Weber AC, Silva JMDS, Becker MM, Kowalski TW, Siebert M, Saute JAM. Serum myostatin as a candidate disease severity and progression biomarker of spinal muscular atrophy. Brain Commun 2024; 6:fcae062. [PMID: 38487549 PMCID: PMC10939446 DOI: 10.1093/braincomms/fcae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
The identification of biomarkers for spinal muscular atrophy is crucial for predicting disease progression, severity, and response to new disease-modifying therapies. This study aimed to investigate the role of serum levels of myostatin and follistatin as biomarkers for spinal muscular atrophy, considering muscle atrophy secondary to denervation as the main clinical manifestation of the disease. The study evaluated the differential gene expression of myostatin and follistatin in a lesional model of gastrocnemius denervation in mice, as well as in a meta-analysis of three datasets in transgenic mice models of spinal muscular atrophy, and in two studies involving humans with spinal muscular atrophy. Subsequently, a case-control study involving 27 spinal muscular atrophy patients and 27 controls was conducted, followed by a 12-month cohort study with 25 spinal muscular atrophy cases. Serum levels of myostatin and follistatin were analysed using enzyme-linked immunosorbent assay at a single centre in southern Brazil. Skeletal muscle gene expression of myostatin decreased and of follistatin increased following lesional muscle denervation in mice, consistent with findings in the spinal muscular atrophy transgenic mice meta-analysis and in the iliopsoas muscle of five patients with spinal muscular atrophy type 1. Median serum myostatin levels were significantly lower in spinal muscular atrophy patients (98 pg/mL; 5-157) compared to controls (412 pg/mL; 299-730) (P < 0.001). Lower myostatin levels were associated with greater disease severity based on clinician-rated outcomes (Rho = 0.493-0.812; P < 0.05). After 12 months, there was a further reduction in myostatin levels among spinal muscular atrophy cases (P = 0.021). Follistatin levels did not differ between cases and controls, and no significant changes were observed over time. The follistatin:myostatin ratio was significantly increased in spinal muscular atrophy subjects and inversely correlated with motor severity. Serum myostatin levels show promise as a novel biomarker for evaluating the severity and progression of spinal muscular atrophy. The decrease in myostatin levels and the subsequent favourable environment for muscle growth may be attributed to denervation caused by motor neuron dysfunction.
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Affiliation(s)
- Ana Letícia Amorim de Albuquerque
- Graduate Program in Medicine, Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Clinical Neurogenetics research group, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
| | - Júlia Kersting Chadanowicz
- Clinical Neurogenetics research group, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
| | - Giovanna Câmara Giudicelli
- Bioinformatics core, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
- Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre 91501-970, Brazil
| | - Ana Lucia Portella Staub
- Clinical Neurogenetics research group, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
| | - Arthur Carpeggiani Weber
- Clinical Neurogenetics research group, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
| | | | | | - Thayne Woycinck Kowalski
- Bioinformatics core, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
- Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre 91501-970, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
| | - Marina Siebert
- Unit of Laboratorial Research, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-007, Brazil
- Graduate Program in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Jonas Alex Morales Saute
- Graduate Program in Medicine, Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Clinical Neurogenetics research group, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
- Department of Internal Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
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Kordala AJ, Stoodley J, Ahlskog N, Hanifi M, Garcia Guerra A, Bhomra A, Lim WF, Murray LM, Talbot K, Hammond SM, Wood MJA, Rinaldi C. PRMT inhibitor promotes SMN2 exon 7 inclusion and synergizes with nusinersen to rescue SMA mice. EMBO Mol Med 2023; 15:e17683. [PMID: 37724723 PMCID: PMC10630883 DOI: 10.15252/emmm.202317683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality. The advent of approved treatments for this devastating condition has significantly changed SMA patients' life expectancy and quality of life. Nevertheless, these are not without limitations, and research efforts are underway to develop new approaches for improved and long-lasting benefits for patients. Protein arginine methyltransferases (PRMTs) are emerging as druggable epigenetic targets, with several small-molecule PRMT inhibitors already in clinical trials. From a screen of epigenetic molecules, we have identified MS023, a potent and selective type I PRMT inhibitor able to promote SMN2 exon 7 inclusion in preclinical SMA models. Treatment of SMA mice with MS023 results in amelioration of the disease phenotype, with strong synergistic amplification of the positive effect when delivered in combination with the antisense oligonucleotide nusinersen. Moreover, transcriptomic analysis revealed that MS023 treatment has minimal off-target effects, and the added benefit is mainly due to targeting neuroinflammation. Our study warrants further clinical investigation of PRMT inhibition both as a stand-alone and add-on therapy for SMA.
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Affiliation(s)
- Anna J Kordala
- Department of Physiology Anatomy and GeneticsUniversity of OxfordOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | - Jessica Stoodley
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | - Nina Ahlskog
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | | | - Antonio Garcia Guerra
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | - Amarjit Bhomra
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | - Wooi Fang Lim
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
| | - Lyndsay M Murray
- Centre for Discovery Brain Sciences, College of Medicine and Veterinary MedicineUniversity of EdinburghEdinburghUK
- Euan McDonald Centre for Motor Neuron Disease ResearchUniversity of EdinburghEdinburghUK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, John Radcliffe HospitalUniversity of OxfordOxfordUK
- Kavli Institute for Nanoscience DiscoveryUniversity of OxfordOxfordUK
| | | | - Matthew JA Wood
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
- MDUK Oxford Neuromuscular CentreOxfordUK
| | - Carlo Rinaldi
- Department of PaediatricsUniversity of OxfordOxfordUK
- Institute of Developmental and Regenerative Medicine (IDRM)OxfordUK
- MDUK Oxford Neuromuscular CentreOxfordUK
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Garofalo M, Bonanno S, Marcuzzo S, Pandini C, Scarian E, Dragoni F, Di Gerlando R, Bordoni M, Parravicini S, Gellera C, Masson R, Dosi C, Zanin R, Pansarasa O, Cereda C, Berardinelli A, Gagliardi S. Preliminary insights into RNA in CSF of pediatric SMA patients after 6 months of nusinersen. Biol Direct 2023; 18:57. [PMID: 37705059 PMCID: PMC10498611 DOI: 10.1186/s13062-023-00413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a rare autosomal-recessive neurodegenerative disorder caused by mutations in survival motor neuron 1 (SMN1) gene, and consequent loss of function of SMN protein, which results in progressive loss of lower motor neurons, and muscular wasting. Antisense oligonucleotide (ASO) nusinersen (Spinraza®) modulates the pre-mRNA splicing of the SMN2 gene, allowing rebalance of biologically active SMN. It is administered intrathecally via lumbar puncture after removing an equal amount of cerebrospinal fluid (CSF). Its effect was proven beneficial and approved since 2017 for SMA treatment. Given the direct effect of nusinersen on RNA metabolism, the aim of this project was to evaluate cell-free RNA (cfRNA) in CSF of SMA patients under ASOs treatment for biomarker discovery. METHODS By RNA-sequencing approach, RNA obtained from CSF of pediatric SMA type 2 and 3 patients was processed after 6 months of nusinersen treatment, at fifth intrathecal injection (T6), and compared to baseline (T0). RESULTS We observed the deregulation of cfRNAs in patients at T6 and we were able to classify these RNAs into disease specific, treatment specific and treatment dependent. Moreover, we subdivided patients into "homogeneous" and "heterogeneous" according to their gene expression pattern. The "heterogeneous" group showed peculiar activation of genes coding for ribosomal components, meaning that in these patients a different molecular effect of nusinersen is observable, even if this specific molecular response was not referable to a clinical pattern. CONCLUSIONS This study provides preliminary insights into modulation of gene expression dependent on nusinersen treatment and lays the foundation for biomarkers discovery.
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Affiliation(s)
| | - S Bonanno
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - S Marcuzzo
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - C Pandini
- Department of Biosciences, University of Milan, Milan, Italy
| | - E Scarian
- IRCCS Mondino Foundation, Pavia, Italy
| | - F Dragoni
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - R Di Gerlando
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - M Bordoni
- IRCCS Mondino Foundation, Pavia, Italy
| | - S Parravicini
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Gellera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - R Masson
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - C Dosi
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - R Zanin
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - C Cereda
- Center of Functional Genomics and Rare Diseases, V. Buzzi Children's Hospital, 20154, Milan, Italy
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Maretina MA, Valetdinova KR, Tsyganova NA, Egorova AA, Ovechkina VS, Schiöth HB, Zakian SM, Baranov VS, Kiselev AV. Identification of specific gene methylation patterns during motor neuron differentiation from spinal muscular atrophy patient-derived iPSC. Gene 2022; 811:146109. [PMID: 34871761 DOI: 10.1016/j.gene.2021.146109] [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: 08/12/2020] [Revised: 05/08/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Spinal muscular atrophy is a progressive motor neuron disorder caused by deletions or point mutations in the SMN1 gene. It is not known why motor neurons are particularly sensitive to a decrease in SMN protein levels and what factors besides SMN2 underlie the high clinical heterogeneity of the disease. Here we studied the methylation patterns of genes on sequential stages of motor neuron differentiation from induced pluripotent stem cells derived from the patients with SMA type I and II. The genes involved in the regulation of pluripotency, neural differentiation as well as those associated with spinal muscular atrophy development were included. The results show that the PAX6, HB9, CHAT, ARHGAP22, and SMN2 genes are differently methylated in cells derived from SMA patients compared to the cells of healthy individuals. This study clarifies the specificities of the disease pathogenesis and extends the knowledge of pathways involved in the SMA progression.
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Affiliation(s)
- M A Maretina
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
| | - K R Valetdinova
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 630090 Novsibirsk, Russia
| | - N A Tsyganova
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
| | - A A Egorova
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
| | - V S Ovechkina
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 630090 Novsibirsk, Russia; Novosibirsk State University, 630090 Novosibirsk, Russia
| | - H B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, S-75124 Uppsala, Sweden; Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - S M Zakian
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 630090 Novsibirsk, Russia; Meshalkin National Medical Research Center, Ministry of Healthcare of the Russian Federation, 630055 Novosibirsk, Russia
| | - V S Baranov
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
| | - A V Kiselev
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia.
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Navarrete-Opazo A, Garrison S, Waite M. Molecular Biomarkers for Spinal Muscular Atrophy: A Systematic Review. Neurol Clin Pract 2021; 11:e524-e536. [PMID: 34484951 DOI: 10.1212/cpj.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/05/2020] [Indexed: 11/15/2022]
Abstract
Background There is an unmet need for reliable biomarkers to predict disease severity, prognosis, and treatment effect in patients with spinal muscular atrophy (SMA). The purpose of this review is to evaluate the clinical utility of blood-based biomarkers in patients with SMA. Methods A systematic review of MEDLINE, DARE, PEDro, PsycINFO, Cochrane Database, LILACS, OTSeeker, SpeechBITE, CINAHL, Scopus, Science Direct, clinicaltrial.gov, OpenGrey, and Google Scholar was performed with the last search data of June 30, 2019. Results Survival motor neuron (SMN)-related biomarkers showed an important interpatient and cell variability with a wide overlap between SMA phenotypes and healthy controls. Several plasma protein analytes correlated with motor scores; however, validation studies are needed to rule out false positives. DNA methylation analysis distinguished between patients with mild/moderate SMA and healthy controls. Plasma phosphorylated neurofilament heavy chain (pNF-H) levels increased with disease severity and declined considerably after nusinersen treatment. Conclusion There is no sufficient evidence to support the clinical utility of SMN-related biomarkers to predict disease severity in SMA. pNF-H appears to be a promising biomarker of disease activity and treatment effect in SMA. Further studies should include longitudinal assessments of patients with SMA across functional groups and comparisons with age-matched healthy controls to evaluate the stability of putative biomarkers over time and in response to SMA therapeutics. PROSPERO registration: CRD42019139050.
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Affiliation(s)
| | - Sheldon Garrison
- Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Mindy Waite
- Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
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Pino MG, Rich KA, Kolb SJ. Update on Biomarkers in Spinal Muscular Atrophy. Biomark Insights 2021; 16:11772719211035643. [PMID: 34421296 PMCID: PMC8371741 DOI: 10.1177/11772719211035643] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
The availability of disease modifying therapies for spinal muscular atrophy (SMA) has created an urgent need to identify clinically meaningful biomarkers. Biomarkers present a means to measure and evaluate neurological disease across time. Changes in biomarkers provide insight into disease progression and may reveal biologic, physiologic, or pharmacologic phenomena occurring prior to clinical detection. Efforts to identify biomarkers for SMA, a genetic motor neuron disease characterized by motor neuron degeneration and weakness, have culminated in a number of putative molecular and physiologic markers that evaluate biological media (eg, blood and cerebrospinal fluid [CSF]) or nervous system function. Such biomarkers include SMN2 copy number, SMN mRNA and protein levels, neurofilament proteins (NFs), plasma protein analytes, creatine kinase (CK) and creatinine (Crn), and various electrophysiology and imaging measures. SMN2 copy number inversely correlates with disease severity and is the best predictor of clinical outcome in untreated individuals. SMN mRNA and protein are commonly measured in the blood or CSF of patients receiving SMA therapies, particularly those aimed at increasing SMN protein expression, and provide insight into current disease state. NFs have proven to be robust prognostic, disease progression, and pharmacodynamic markers for SMA infants undergoing treatment, but less so for adolescents and adults. Select plasma proteins are altered in SMA individuals and may track response to therapy. CK and Crn from blood correlate with motor function and disease severity status and are useful for predicting which individuals will respond to therapy. Electrophysiology measures comprise the most reliable means for monitoring motor function throughout disease course and are sensitive enough to detect neuromuscular changes before overt clinical manifestation, making them robust predictive and pharmacodynamic biomarkers. Finally, magnetic resonance imaging and muscle ultrasonography are non-invasive techniques for studying muscle structure and physiology and are useful diagnostic tools, but cannot reliably track disease progression. Importantly, biomarkers can provide information about the underlying mechanisms of disease as well as reveal subclinical disease progression, allowing for more appropriate timing and dosing of therapy for individuals with SMA. Recent therapeutic advancements in SMA have shown promising results, though there is still a great need to identify and understand the impact of biomarkers in modulating disease onset and progression.
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Affiliation(s)
- Megan G Pino
- Department of Neurology, The Ohio State
University Wexner Medical Center, Columbus, OH, USA
| | - Kelly A Rich
- Department of Neurology, The Ohio State
University Wexner Medical Center, Columbus, OH, USA
| | - Stephen J Kolb
- Department of Neurology, The Ohio State
University Wexner Medical Center, Columbus, OH, USA
- Department of Biological Chemistry and
Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH,
USA
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8
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Guiler W, Koehler A, Boykin C, Lu Q. Pharmacological Modulators of Small GTPases of Rho Family in Neurodegenerative Diseases. Front Cell Neurosci 2021; 15:661612. [PMID: 34054432 PMCID: PMC8149604 DOI: 10.3389/fncel.2021.661612] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Classical Rho GTPases, including RhoA, Rac1, and Cdc42, are members of the Ras small GTPase superfamily and play essential roles in a variety of cellular functions. Rho GTPase signaling can be turned on and off by specific GEFs and GAPs, respectively. These features empower Rho GTPases and their upstream and downstream modulators as targets for scientific research and therapeutic intervention. Specifically, significant therapeutic potential exists for targeting Rho GTPases in neurodegenerative diseases due to their widespread cellular activity and alterations in neural tissues. This study will explore the roles of Rho GTPases in neurodegenerative diseases with focus on the applications of pharmacological modulators in recent discoveries. There have been exciting developments of small molecules, nonsteroidal anti-inflammatory drugs (NSAIDs), and natural products and toxins for each classical Rho GTPase category. A brief overview of each category followed by examples in their applications will be provided. The literature on their roles in various diseases [e.g., Alzheimer's disease (AD), Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS), Frontotemporal dementia (FTD), and Multiple sclerosis (MS)] highlights the unique and broad implications targeting Rho GTPases for potential therapeutic intervention. Clearly, there is increasing knowledge of therapeutic promise from the discovery of pharmacological modulators of Rho GTPases for managing and treating these conditions. The progress is also accompanied by the recognition of complex Rho GTPase modulation where targeting its signaling can improve some aspects of pathogenesis while exacerbating others in the same disease model. Future directions should emphasize the importance of elucidating how different Rho GTPases work in concert and how they produce such widespread yet different cellular responses during neurodegenerative disease progression.
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Affiliation(s)
| | | | | | - Qun Lu
- Department of Anatomy and Cell Biology, The Harriet and John Wooten Laboratory for Alzheimer’s and Neurogenerative Diseases Research, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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9
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Sansa A, de la Fuente S, Comella JX, Garcera A, Soler RM. Intracellular pathways involved in cell survival are deregulated in mouse and human spinal muscular atrophy motoneurons. Neurobiol Dis 2021; 155:105366. [PMID: 33845129 DOI: 10.1016/j.nbd.2021.105366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Spinal Muscular Atrophy (SMA) is a severe neuromuscular disorder caused by loss of the Survival Motor Neuron 1 gene (SMN1). Due to this depletion of the survival motor neuron (SMN) protein, the disease is characterized by the degeneration of spinal cord motoneurons (MNs), progressive muscular atrophy, and weakness. Nevertheless, the ultimate cellular and molecular mechanisms leading to cell loss in SMN-reduced MNs are only partially known. We have investigated the activation of apoptotic and neuronal survival pathways in several models of SMA cells. Even though the antiapoptotic proteins FAIM-L and XIAP were increased in SMA MNs, the apoptosis executioner cleaved-caspase-3 was also elevated in these cells, suggesting the activation of the apoptosis process. Analysis of the survival pathway PI3K/Akt showed that Akt phosphorylation was reduced in SMA MNs and pharmacological inhibition of PI3K diminished SMN and Gemin2 at transcriptional level in control MNs. In contrast, ERK phosphorylation was increased in cultured mouse and human SMA MNs. Our observations suggest that apoptosis is activated in SMA MNs and that Akt phosphorylation reduction may control cell degeneration, thereby regulating the transcription of Smn and other genes related to SMN function.
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Affiliation(s)
- Alba Sansa
- Neuronal Signaling Unit, Experimental Medicine Department, Universitat de Lleida-IRBLleida, Rovira Roure, 80, 25198, Lleida, Spain
| | - Sandra de la Fuente
- Neuronal Signaling Unit, Experimental Medicine Department, Universitat de Lleida-IRBLleida, Rovira Roure, 80, 25198, Lleida, Spain
| | - Joan X Comella
- CIBERNED & Cell Signaling and Apoptosis Group, Vall d'Hebron Research Institute (VHIR), 08035, Barcelona, Spain
| | - Ana Garcera
- Neuronal Signaling Unit, Experimental Medicine Department, Universitat de Lleida-IRBLleida, Rovira Roure, 80, 25198, Lleida, Spain
| | - Rosa M Soler
- Neuronal Signaling Unit, Experimental Medicine Department, Universitat de Lleida-IRBLleida, Rovira Roure, 80, 25198, Lleida, Spain..
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10
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Souza PVS, Pinto WBVR, Ricarte A, Badia BML, Seneor DD, Teixeira DT, Caetano L, Gonçalves EA, Chieia MAT, Farias IB, Bertini E, Oliveira ASB. Clinical and radiological profile of patients with spinal muscular atrophy type 4. Eur J Neurol 2020; 28:609-619. [PMID: 33090613 DOI: 10.1111/ene.14587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Spinal muscular atrophy (SMA) is the most important cause of motor neuron disease in childhood, and continues to represent the leading genetic cause of infant death. Adulthood-onset SMA (SMA type 4) is rare, with few isolated cases reported. The objective of the present study was to describe a cohort of patients with SMA type 4. METHODS A cross-sectional study was conducted to characterize clinical, genetic, radiological and neurophysiological features of patients with adulthood-onset SMA. Correlation analysis of functional assessment with genetic, radiological and neurophysiological data was performed. RESULTS Twenty patients with SMA type 4 were identified in a Brazilian cohort of 227 patients with SMA. The most common clinical symptom was limb-girdle muscle weakness, observed in 15 patients (75%). The most frequent neurological findings were absent tendon reflexes in 18 (90%) and fasciculations in nine patients (45%). Sixteen patients (80%) had the homozygous deletion of exon 7 in the SMN1 gene, with 12 patients (60%) showing four copies of the SMN2 gene. The functional scales Hammersmith Functional Motor Scale Expanded, Amyotrophic Lateral Sclerosis Functional Rating Scale Revised, Revised Upper Limb Module and Spinal Muscular Atrophy Functional Rating Scale, as well as the six-minute walk and the Time Up and Go tests showed a correlation with duration of disease. Motor Unit Number Index was correlated both with duration of disease and with performance in functional assessment. Radiological studies exhibited a typical pattern, with involvement of biceps femoris short head and gluteus minimus in all patients. CONCLUSION This study represents the largest cohort of patients with SMA type 4 and provides functional, genetic, radiological and neurophysiological features that can be used as potential biomarkers for the new specific genetic therapies for SMA.
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Affiliation(s)
- P V S Souza
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - W B V R Pinto
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - A Ricarte
- Neurotherapy Rehabilitation Center, São Paulo, SP, Brazil
| | - B M L Badia
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - D D Seneor
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - D T Teixeira
- Neurotherapy Rehabilitation Center, São Paulo, SP, Brazil
| | - L Caetano
- Neurotherapy Rehabilitation Center, São Paulo, SP, Brazil
| | - E A Gonçalves
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - M A T Chieia
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - I B Farias
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - E Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - A S B Oliveira
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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11
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Abstract
Neuromuscular disorders are a heterogeneous group of conditions affecting the neuromuscular system. The aim of this article is to review the major epigenetic findings in motor neuron diseases and major hereditary muscular dystrophies. DNA methylation changes are observed in both hereditary and sporadic forms, and combining DNA methylation analysis with mutational screening holds the potential for better diagnostic and prognostic accuracy. Novel, less toxic and more selective epigenetic drugs are designed and tested in animal and cell culture models of neuromuscular disorders, and non-coding RNAs are being investigated as either disease biomarkers or targets of therapeutic approaches to restore gene expression levels. Overall, neuromuscular disorder epigenetic biomarkers have a strong potential for clinical applications in the near future.
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Affiliation(s)
- Fabio Coppedè
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, 56126 Pisa, Italy
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12
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Smeriglio P, Langard P, Querin G, Biferi MG. The Identification of Novel Biomarkers Is Required to Improve Adult SMA Patient Stratification, Diagnosis and Treatment. J Pers Med 2020; 10:jpm10030075. [PMID: 32751151 PMCID: PMC7564782 DOI: 10.3390/jpm10030075] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Spinal muscular atrophy (SMA) is currently classified into five different subtypes, from the most severe (type 0) to the mildest (type 4) depending on age at onset, best motor function achieved, and copy number of the SMN2 gene. The two recent approved treatments for SMA patients revolutionized their life quality and perspectives. However, upon treatment with Nusinersen, the most widely administered therapy up to date, a high degree of variability in therapeutic response was observed in adult SMA patients. These data, together with the lack of natural history information and the wide spectrum of disease phenotypes, suggest that further efforts are needed to develop precision medicine approaches for all SMA patients. Here, we compile the current methods for functional evaluation of adult SMA patients treated with Nusinersen. We also present an overview of the known molecular changes underpinning disease heterogeneity. We finally highlight the need for novel techniques, i.e., -omics approaches, to capture phenotypic differences and to understand the biological signature in order to revise the disease classification and device personalized treatments.
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Affiliation(s)
- Piera Smeriglio
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Correspondence: (P.S.); (M.G.B.)
| | - Paul Langard
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
| | - Giorgia Querin
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Association Institut de Myologie, Plateforme Essais Cliniques Adultes, 75013 Paris, France
- APHP, Service de Neuromyologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Maria Grazia Biferi
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Correspondence: (P.S.); (M.G.B.)
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13
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Kariyawasam DST, D'Silva A, Lin C, Ryan MM, Farrar MA. Biomarkers and the Development of a Personalized Medicine Approach in Spinal Muscular Atrophy. Front Neurol 2019; 10:898. [PMID: 31481927 PMCID: PMC6709682 DOI: 10.3389/fneur.2019.00898] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
Recent unprecedented advances in treatment for spinal muscular atrophy (SMA) enabled patients to access the first approved disease modifying therapy for the condition. There are however many uncertainties, regarding timing of treatment initiation, response to intervention, treatment effects and long-term outcomes, which are complicated by the evolving phenotypes seen in the post-treatment era for patients with SMA. Biomarkers of disease, with diagnostic, prognostic, predictive, and pharmacodynamic value are thus urgently required, to facilitate a wider understanding in this dynamic landscape. A spectrum of these candidate biomarkers, will be evaluated in this review, including genetic, epigenetic, proteomic, electrophysiological, and imaging measures. Of these, SMN2 appears to be the most significant modifier of phenotype to date, and its use in prognostication shows considerable clinical utility. Longitudinal studies in patients with SMA highlight an emerging role of circulatory markers such as neurofilament, in tracking disease progression and response to treatment. Furthermore, neurophysiological biomarkers such as CMAP and MUNE values show considerable promise in the real word setting, in following the dynamic response and output of the motor unit to therapeutic intervention. The specific value for these possible biomarkers across diagnosis, prognosis, prediction of treatment response, efficacy, and safety will be central to guide future patient-targeted treatments, the design of clinical trials, and understanding of the pathophysiological mechanisms of disease and intervention.
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Affiliation(s)
- Didu S T Kariyawasam
- Department of Neurology, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Arlene D'Silva
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cindy Lin
- Department of Neurophysiology, Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
| | - Monique M Ryan
- Department of Neurology, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, NSW, Australia
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14
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Ruhno C, McGovern VL, Avenarius MR, Snyder PJ, Prior TW, Nery FC, Muhtaseb A, Roggenbuck JS, Kissel JT, Sansone VA, Siranosian JJ, Johnstone AJ, Nwe PH, Zhang RZ, Swoboda KJ, Burghes AHM. Complete sequencing of the SMN2 gene in SMA patients detects SMN gene deletion junctions and variants in SMN2 that modify the SMA phenotype. Hum Genet 2019; 138:241-256. [PMID: 30788592 PMCID: PMC6503527 DOI: 10.1007/s00439-019-01983-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022]
Abstract
Spinal muscular atrophy (SMA) is a progressive motor neuron disease caused by loss or mutation of the survival motor neuron 1 (SMN1) gene and retention of SMN2. We performed targeted capture and sequencing of the SMN2, CFTR, and PLS3 genes in 217 SMA patients. We identified a 6.3 kilobase deletion that occurred in both SMN1 and SMN2 (SMN1/2) and removed exons 7 and 8. The deletion junction was flanked by a 21 bp repeat that occurred 15 times in the SMN1/2 gene. We screened for its presence in 466 individuals with the known SMN1 and SMN2 copy numbers. In individuals with 1 SMN1 and 0 SMN2 copies, the deletion occurred in 63% of cases. We modeled the deletion junction frequency and determined that the deletion occurred in both SMN1 and SMN2. We have identified the first deletion junction where the deletion removes exons 7 and 8 of SMN1/2. As it occurred in SMN1, it is a pathogenic mutation. We called variants in the PLS3 and SMN2 genes, and tested for association with mild or severe exception patients. The variants A-44G, A-549G, and C-1897T in intron 6 of SMN2 were significantly associated with mild exception patients, but no PLS3 variants correlated with severity. The variants occurred in 14 out of 58 of our mild exception patients, indicating that mild exception patients with an intact SMN2 gene and without modifying variants occur. This sample set can be used in the association analysis of candidate genes outside of SMN2 that modify the SMA phenotype.
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Affiliation(s)
- Corey Ruhno
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH, USA
| | - Vicki L McGovern
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH, USA
| | | | - Pamela J Snyder
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Thomas W Prior
- Department of Pathology, Case Western Reserve Medical Center, Cleveland, OH, USA
| | - Flavia C Nery
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Abdurrahman Muhtaseb
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - John T Kissel
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | | | - Jennifer J Siranosian
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alec J Johnstone
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Pann H Nwe
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ren Z Zhang
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn J Swoboda
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Arthur H M Burghes
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, OH, USA.
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15
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Saffari A, Kölker S, Hoffmann GF, Weiler M, Ziegler A. Novel challenges in spinal muscular atrophy - How to screen and whom to treat? Ann Clin Transl Neurol 2018; 6:197-205. [PMID: 30656198 PMCID: PMC6331314 DOI: 10.1002/acn3.689] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/27/2022] Open
Abstract
In recent years, disease‐modifying and life‐prolonging therapies for spinal muscular atrophy (SMA) have been developed. However, patients are currently diagnosed with significant delay and therapies are often administered in advanced stages of motor neuron degeneration, showing limited effects. Methods to identify children in presymptomatic stages are currently evaluated in newborn screening programs. Yet, not all children develop symptoms shortly after birth raising the question whom to treat and when to initiate therapy. Finally, monitoring disease progression becomes essential to individualize management. Here, we review the literature on screening approaches, strategies to predict disease severity, and biomarkers to monitor therapy.
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Affiliation(s)
- Afshin Saffari
- Division of Child Neurology and Metabolic Medicine Center for Child and Adolescent Medicine University Hospital Heidelberg Heidelberg Germany
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine Center for Child and Adolescent Medicine University Hospital Heidelberg Heidelberg Germany
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Medicine Center for Child and Adolescent Medicine University Hospital Heidelberg Heidelberg Germany
| | - Markus Weiler
- Department of Neurology University Hospital Heidelberg Heidelberg Germany
| | - Andreas Ziegler
- Division of Child Neurology and Metabolic Medicine Center for Child and Adolescent Medicine University Hospital Heidelberg Heidelberg Germany
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16
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Maretina M, Egorova A, Baranov V, Kiselev A. DYNC1H1 gene methylation correlates with severity of spinal muscular atrophy. Ann Hum Genet 2018; 83:73-81. [PMID: 30246859 DOI: 10.1111/ahg.12288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022]
Abstract
Methylation profiles of CpG islands within the SLC23A2, CDK2AP1, and DYNC1H1 genes and their association with spinal muscular atrophy (SMA) severity were studied. High clinical heterogeneity of SMA suggests the existence of different factors modifying SMA phenotype with gene methylation as a plausible one. The genes picked up in our earlier genome-wide methylation studies of SMA patients demonstrated obvious differences in their methylation patterns, thus suggesting the likely involvement of their protein products in SMA development. Significantly decreased methylation of CpG islands within exon 37 of the DYNC1H1 gene was observed in patients with a severe SMA manifestation (type I) compared to mildly affected SMA patients (types III-IV). This finding provides new information on peculiarities of methylation in clinically different types of SMA patients and gives a clue for identification of new SMA modifiers.
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Affiliation(s)
- Marianna Maretina
- Laboratory of Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia.,Department of Genetics and Biotechnology, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Anna Egorova
- Laboratory of Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia
| | - Vladislav Baranov
- Laboratory of Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia.,Department of Genetics and Biotechnology, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Anton Kiselev
- Laboratory of Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia
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17
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Maretina MA, Zheleznyakova GY, Lanko KM, Egorova AA, Baranov VS, Kiselev AV. Molecular Factors Involved in Spinal Muscular Atrophy Pathways as Possible Disease-modifying Candidates. Curr Genomics 2018; 19:339-355. [PMID: 30065610 PMCID: PMC6030859 DOI: 10.2174/1389202919666180101154916] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/07/2023] Open
Abstract
Spinal Muscular Atrophy (SMA) is a neuromuscular disorder caused by mutations in the SMN1 gene. Being a monogenic disease, it is characterized by high clinical heterogeneity. Variations in penetrance and severity of symptoms, as well as clinical discrepancies between affected family members can result from modifier genes influence on disease manifestation. SMN2 gene copy number is known to be the main phenotype modifier and there is growing evidence of additional factors contributing to SMA severity. Potential modifiers of spinal muscular atrophy can be found among the wide variety of different factors, such as multiple proteins interacting with SMN or promoting motor neuron survival, epigenetic modifications, transcriptional or splicing factors influencing SMN2 expression. Study of these factors enables to reveal mechanisms underlying SMA pathology and can have pronounced clinical application.
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Affiliation(s)
- Marianna A. Maretina
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya line, 3, Saint Petersburg199034, Russia
- Saint Petersburg State University, Universitetskaya emb. 7/9, 199034Saint Petersburg, Russia
| | - Galina Y. Zheleznyakova
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset, 171 76 Stockholm, Sweden
| | - Kristina M. Lanko
- Saint Petersburg State Institute of Technology, Moskovsky prospect, 26, Saint Petersburg190013, Russia
| | - Anna A. Egorova
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya line, 3, Saint Petersburg199034, Russia
| | - Vladislav S. Baranov
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya line, 3, Saint Petersburg199034, Russia
- Saint Petersburg State University, Universitetskaya emb. 7/9, 199034Saint Petersburg, Russia
| | - Anton V. Kiselev
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya line, 3, Saint Petersburg199034, Russia
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18
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Genome-wide 5-hydroxymethylcytosine patterns in human spermatogenesis are associated with semen quality. Oncotarget 2017; 8:88294-88307. [PMID: 29179435 PMCID: PMC5687605 DOI: 10.18632/oncotarget.18331] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/21/2017] [Indexed: 12/30/2022] Open
Abstract
We performed immunofluorescent analysis of DNA hydroxymethylation and methylation in human testicular spermatogenic cells from azoospermic patients and ejaculated spermatozoa from sperm donors and patients from infertile couples. In contrast to methylation which was present throughout spermatogenesis, hydroxymethylation was either high or almost undetectable in both spermatogenic cells and ejaculated spermatozoa. On testicular cytogenetic preparations, 5-hydroxymethylcytosine was undetectable in mitotic and meiotic chromosomes, and was present exclusively in interphase spermatogonia Ad and in a minor spermatid population. The proportions of hydroxymethylated and non-hydroxymethylated diploid and haploid nuclei were similar among samples, suggesting that the observed alterations of 5-hydroxymethylcytosine patterns in differentiating spermatogenic cells are programmed. In ejaculates, a few spermatozoa had high 5-hydroxymethylcytosine level, while in the other ones hydroxymethylation was almost undetectable. The percentage of highly hydroxymethylated (5-hydroxymethylcytosine-positive) spermatozoa varied strongly among individuals. In patients from infertile couples, it was higher than in sperm donors (P<0.0001) and varied in a wider range: 0.12-21.24% versus 0.02-0.46%. The percentage of highly hydroxymethylated spermatozoa correlated strongly negatively with the indicators of good semen quality – normal morphology (r=-0.567, P<0.0001) and normal head morphology (r=-0.609, P<0.0001) – and strongly positively with the indicator of poor semen quality: sperm DNA fragmentation (r=0.46, P=0.001). Thus, the immunocytochemically detected increase of 5hmC in individual spermatozoa is associated with infertility in a couple and with deterioration of sperm parameters. We hypothesize that this increase is not programmed, but represents an induced abnormality and, therefore, it can be potentially used as a novel indicator of semen quality.
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19
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Schenkel LC, Rodenhiser D, Siu V, McCready E, Ainsworth P, Sadikovic B. Constitutional Epi/Genetic Conditions: Genetic, Epigenetic, and Environmental Factors. J Pediatr Genet 2017; 6:30-41. [PMID: 28180025 PMCID: PMC5288004 DOI: 10.1055/s-0036-1593849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/14/2016] [Indexed: 12/12/2022]
Abstract
There are more than 4,000 phenotypes for which the molecular basis is at least partly known. Though defects in primary DNA structure constitute a major cause of these disorders, epigenetic disruption is emerging as an important alternative mechanism in the etiology of a broad range of congenital and developmental conditions. These include epigenetic defects caused by either localized (in cis) genetic alterations or more distant (in trans) genetic events but can also include environmental effects. Emerging evidence suggests interplay between genetic and environmental factors in the epigenetic etiology of several constitutional "epi/genetic" conditions. This review summarizes our broadening understanding of how epigenetics contributes to pediatric disease by exploring different classes of epigenomic disorders. It further challenges the simplistic dogma of "DNA encodes RNA encodes protein" to best understand the spectrum of factors that can influence genetic traits in a pediatric population.
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Affiliation(s)
- Laila C. Schenkel
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - David Rodenhiser
- Children's Health Research Institute, London, Ontario, Canada
- Department of Biochemistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Victoria Siu
- Children's Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Elizabeth McCready
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter Ainsworth
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Department of Biochemistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
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20
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Cao YY, Qu YJ, He SX, Li Y, Bai JL, Jin YW, Wang H, Song F. Association between SMN2 methylation and disease severity in Chinese children with spinal muscular atrophy. J Zhejiang Univ Sci B 2016; 17:76-82. [PMID: 26739529 DOI: 10.1631/jzus.b1500072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The homozygous loss of the survival motor neuron 1 (SMN1) gene is the primary cause of spinal muscular atrophy (SMA), a neuromuscular degenerative disease. A genetically similar gene, SMN2, which is not functionally equivalent in all SMA patients, modifies the clinical SMA phenotypes. We analyzed the methylation levels of 4 CpG islands (CGIs) in SMN2 in 35 Chinese children with SMA by MassARRAY. We found that three CpG units located in CGI 1 (nucleotides (nt) -871, -735) and CGI 4 (nt +999) are significantly hypomethylated in SMA type III compared with type I or II children after receiving Bonferroni correction. In addition to the differentially methylated CpG unit of nt -871, the methylation level of the nt -290/-288/-285 unit was negatively correlated with the expression of SMN2 full-length transcripts (SMN2-fl). In addition, the methylation level at nt +938 was inversely proportional to the ratio of SMN2-fl and lacking exon 7 transcripts (SMN2-Δ7, fl/Δ7), and was not associated with the SMN2 transcript levels. Thus, we can conclude that SMN2 methylation may regulate the SMA disease phenotype by modulating its transcription.
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Affiliation(s)
- Yan-yan Cao
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yu-jin Qu
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Sheng-xi He
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yan Li
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Jin-Ll Bai
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yu-wei Jin
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Hong Wang
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Fang Song
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing 100020, China
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21
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22
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Zheleznyakova GY, Nilsson EK, Kiselev AV, Maretina MA, Tishchenko LI, Fredriksson R, Baranov VS, Schiöth HB. Methylation levels of SLC23A2 and NCOR2 genes correlate with spinal muscular atrophy severity. PLoS One 2015; 10:e0121964. [PMID: 25821969 PMCID: PMC4378931 DOI: 10.1371/journal.pone.0121964] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/09/2015] [Indexed: 11/19/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a monogenic neurodegenerative disorder subdivided into four different types. Whole genome methylation analysis revealed 40 CpG sites associated with genes that are significantly differentially methylated between SMA patients and healthy individuals of the same age. To investigate the contribution of methylation changes to SMA severity, we compared the methylation level of found CpG sites, designed as "targets", as well as the nearest CpG sites in regulatory regions of ARHGAP22, CDK2AP1, CHML, NCOR2, SLC23A2 and RPL9 in three groups of SMA patients. Of notable interest, compared to type I SMA male patients, the methylation level of a target CpG site and one nearby CpG site belonging to the 5'UTR of SLC23A2 were significantly hypomethylated 19-22% in type III-IV patients. In contrast to type I SMA male patients, type III-IV patients demonstrated a 16% decrease in the methylation levels of a target CpG site, belonging to the 5'UTR of NCOR2. To conclude, this study validates the data of our previous study and confirms significant methylation changes in the SLC23A2 and NCOR2 regulatory regions correlates with SMA severity.
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Affiliation(s)
- Galina Yu. Zheleznyakova
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Faculty of Biology, Saint-Petersburg State University, Saint-Petersburg, Russia
- Laboratory for Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics and Gynecology RAMS, Saint-Petersburg, Russia
- * E-mail:
| | - Emil K. Nilsson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Anton V. Kiselev
- Laboratory for Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics and Gynecology RAMS, Saint-Petersburg, Russia
| | - Marianna A. Maretina
- Faculty of Biology, Saint-Petersburg State University, Saint-Petersburg, Russia
- Laboratory for Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics and Gynecology RAMS, Saint-Petersburg, Russia
| | | | | | - Vladislav S. Baranov
- Faculty of Biology, Saint-Petersburg State University, Saint-Petersburg, Russia
- Laboratory for Prenatal Diagnostics of Inherited Diseases, D.O. Ott Research Institute of Obstetrics and Gynecology RAMS, Saint-Petersburg, Russia
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Valetdinova KR, Medvedev SP, Zakian SM. Model systems of motor neuron diseases as a platform for studying pathogenic mechanisms and searching for therapeutic agents. Acta Naturae 2015; 7:19-36. [PMID: 25926999 PMCID: PMC4410393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Over the past 30 years, many molecular genetic mechanisms underlying motor neuron diseases (MNDs) have been discovered and studied. Among these diseases, amyotrophic lateral sclerosis (ALS), which causes the progressive degeneration and death of central and peripheral motor neurons, and spinal muscular atrophy (SMA), which is one of the inherited diseases that prevail among hereditary diseases in the pattern of child mortality, hold a special place. These diseases, like most nerve, neurodegenerative, and psychiatric diseases, cannot be treated appropriately at present. Artificial model systems, especially those that are based on the use of embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), are of paramount importance in searching for adequate therapeutic agents, as well as for a deep understanding of the MND pathogenesis. This review is mainly focused on the recent advance in the development of and research into cell and animal models of ALS and SMA. The main issues concerning the use of cellular technologies in biomedical applications are also described.
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Affiliation(s)
- K. R. Valetdinova
- Institute of Cytology and Genetics, Prospekt Lavrentyeva, 10, Novosibirsk, 630090, Russia
- Institute of Chemical Biology and Fundamental Medicine, Prospekt Lavrentyeva, 8, Novosibirsk, 630090, Russia
- Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Rechkunovskaya Str., 15, Novosibirsk, 630055, Russia
- Novosibirsk State University, Pirogova Str., 2, Novosibirsk, 630090, Russia
| | - S. P. Medvedev
- Institute of Cytology and Genetics, Prospekt Lavrentyeva, 10, Novosibirsk, 630090, Russia
- Institute of Chemical Biology and Fundamental Medicine, Prospekt Lavrentyeva, 8, Novosibirsk, 630090, Russia
- Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Rechkunovskaya Str., 15, Novosibirsk, 630055, Russia
- Novosibirsk State University, Pirogova Str., 2, Novosibirsk, 630090, Russia
| | - S. M. Zakian
- Institute of Cytology and Genetics, Prospekt Lavrentyeva, 10, Novosibirsk, 630090, Russia
- Institute of Chemical Biology and Fundamental Medicine, Prospekt Lavrentyeva, 8, Novosibirsk, 630090, Russia
- Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Rechkunovskaya Str., 15, Novosibirsk, 630055, Russia
- Novosibirsk State University, Pirogova Str., 2, Novosibirsk, 630090, Russia
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Efimova OA, Pendina AA, Tikhonov AV, Fedorova ID, Krapivin MI, Chiryaeva OG, Shilnikova EM, Bogdanova MA, Kogan IY, Kuznetzova TV, Gzgzyan AM, Ailamazyan EK, Baranov VS. Chromosome hydroxymethylation patterns in human zygotes and cleavage-stage embryos. Reproduction 2014; 149:223-33. [PMID: 25504867 DOI: 10.1530/rep-14-0343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report the sequential changes in 5-hydroxymethylcytosine (5hmC) patterns in the genome of human preimplantation embryos during DNA methylation reprogramming. We have studied chromosome hydroxymethylation and methylation patterns in triploid zygotes and blastomeres of cleavage-stage embryos. Using indirect immunofluorescence, we have analyzed the localization of 5hmC and its co-distribution with 5-methylcytosine (5mC) on the QFH-banded metaphase chromosomes. In zygotes, 5hmC accumulates in both parental chromosome sets, but hydroxymethylation is more intensive in the poorly methylated paternal set. In the maternal set, chromosomes are highly methylated, but contain little 5hmC. Hydroxymethylation is highly region specific in both parental chromosome sets: hydroxymethylated loci correspond to R-bands, but not G-bands, and have well-defined borders, which coincide with the R/G-band boundaries. The centromeric regions and heterochromatin at 1q12, 9q12, 16q11.2, and Yq12 contain little 5mC and no 5hmC. We hypothesize that 5hmC may mark structural/functional genome 'units' corresponding to chromosome bands in the newly formed zygotic genome. In addition, we suggest that the hydroxymethylation of R-bands in zygotes can be treated as a new characteristic distinguishing them from G-bands. At cleavages, chromosomes with asymmetrical hydroxymethylation of sister chromatids appear. They decrease in number during cleavages, whereas totally non-hydroxymethylated chromosomes become numerous. Taken together, our findings suggest that, in the zygotic genome, 5hmC is distributed selectively and its pattern is determined by both parental origin of chromosomes and type of chromosome bands - R, G, or C. At cleavages, chromosome hydroxymethylation pattern is dynamically changed due to passive and non-selective overall loss of 5hmC, which coincides with that of 5mC.
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Affiliation(s)
- Olga A Efimova
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Anna A Pendina
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Pet
| | - Andrei V Tikhonov
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Pet
| | - Irina D Fedorova
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Mikhail I Krapivin
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Olga G Chiryaeva
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Pet
| | - Evgeniia M Shilnikova
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Mariia A Bogdanova
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Igor Yu Kogan
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Tatyana V Kuznetzova
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Alexander M Gzgzyan
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia
| | - Edward K Ailamazyan
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Pet
| | - Vladislav S Baranov
- D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Petersburg, Russia D.O. Ott Research Institute of Obstetrics and GynecologyMendeleevskaya line, 3, 199034 St Petersburg, RussiaSt Petersburg State UniversityUniversitetskaya nab.7/9, 199034 St Petersburg, RussiaCenter for Medical GeneticsTobolskaya ul., 5, 194044 St Petersburg, RussiaSt Petersburg State Pediatric Medical UniversityLitovskaya ul., 2, 194100 St Petersburg, RussiaS.M. Kirov Military Medical AcademyLebedeva ul., 6, 194044 St Petersburg, RussiaN.I. Pirogov National Medical-Surgery CenterSt Petersburg Clinic Complex, nab. Fontanki, 154, 190103 St Petersburg, RussiaI.P. Pavlov First St Petersburg State Medical UniversityL'va Tolstogo ul., 6/8, 197022 St Pet
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