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Chompoopong P, Niu Z, Shouman K, Madigan NN, Sandroni P, Berini SE, Shin AY, Brault JS, Boon AJ, Laughlin RS, Thorland E, Mandrekar J, Klein CJ. Utility of carpal tunnel release and ulnar decompression in CMT1A and HNPP. Muscle Nerve 2022; 66:479-486. [PMID: 35894586 DOI: 10.1002/mus.27687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS Carpal and cubital tunnel syndrome (CTS, CuTS) are common among patients with hereditary neuropathy with liability to pressure-palsies (HNPP) and Charcot-Marie-Tooth-1A (CMT1A), and may impact quality of life. We aimed to evaluate the utility of nerve decompression surgeries in these patients. METHODS Medical records were reviewed for patients with PMP22 mutation confirmed in Mayo Clinic laboratories from January 1999 to December 2020, who had CTS and CuTS and underwent surgical decompression. RESULTS CTS occurred in 53.3% of HNPP and 11.5% of CMT1A, while CuTS was present in 43.3% of HNPP and 5.8% of CMT1A patients. CTS decompression occurred in 10-HNPP and 5-CMT1A patients, and CuTS decompression with/without transposition was performed in 5-HNPP and 1-CMT1A patients. In HNPP, electrodiagnostic studies identified median neuropathy at the wrist in 9/10 patients and ultrasound showed focal enlargements at carpal and cubital tunnels. In CMT1A, median and ulnar sensory responses were all absent, and the nerves were diffusely enlarged. After CTS surgery, pain, sensory loss, and strength improved in 4/5 CMT1A, and 6/10 HNPP patients. Of clinical, electrophysiologic and ultrasound findings, only activity-provoked features significantly correlated with CTS surgical benefit in HNPP patients (odds ratio=117.0:95% CI 1.94>999.99, p=0.01). One CMT1A and one HNPP patient improved with CuTS surgery while 2 HNPP patients worsened. DISCUSSION CTS symptom improvement post-surgery can be seen in CMT1A and (less frequent) in HNPP patients. CuTS surgery commonly worsened course in HNPP. Activity-provoked symptoms in HNPP best informed benefits from CTS surgery.
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Affiliation(s)
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN
| | | | | | | | | | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester, MN
| | - Jeffrey S Brault
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | - Erik Thorland
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN
| | - Jay Mandrekar
- Quantitative health Sciences, Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN
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Moss KR, Bopp TS, Johnson AE, Höke A. New evidence for secondary axonal degeneration in demyelinating neuropathies. Neurosci Lett 2021; 744:135595. [PMID: 33359733 PMCID: PMC7852893 DOI: 10.1016/j.neulet.2020.135595] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/31/2020] [Accepted: 12/19/2020] [Indexed: 12/28/2022]
Abstract
Development of peripheral nervous system (PNS) myelin involves a coordinated series of events between growing axons and the Schwann cell (SC) progenitors that will eventually ensheath them. Myelin sheaths have evolved out of necessity to maintain rapid impulse propagation while accounting for body space constraints. However, myelinating SCs perform additional critical functions that are required to preserve axonal integrity including mitigating energy consumption by establishing the nodal architecture, regulating axon caliber by organizing axonal cytoskeleton networks, providing trophic and potentially metabolic support, possibly supplying genetic translation materials and protecting axons from toxic insults. The intermediate steps between the loss of these functions and the initiation of axon degeneration are unknown but the importance of these processes provides insightful clues. Prevalent demyelinating diseases of the PNS include the inherited neuropathies Charcot-Marie-Tooth Disease, Type 1 (CMT1) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) and the inflammatory diseases Acute Inflammatory Demyelinating Polyneuropathy (AIDP) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Secondary axon degeneration is a common feature of demyelinating neuropathies and this process is often correlated with clinical deficits and long-lasting disability in patients. There is abundant electrophysiological and histological evidence for secondary axon degeneration in patients and rodent models of PNS demyelinating diseases. Fully understanding the involvement of secondary axon degeneration in these diseases is essential for expanding our knowledge of disease pathogenesis and prognosis, which will be essential for developing novel therapeutic strategies.
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Affiliation(s)
- Kathryn R Moss
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Taylor S Bopp
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Anna E Johnson
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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Jouaud M, Mathis S, Richard L, Lia AS, Magy L, Vallat JM. Rodent models with expression of PMP22: Relevance to dysmyelinating CMT and HNPP. J Neurol Sci 2019; 398:79-90. [PMID: 30685714 DOI: 10.1016/j.jns.2019.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/26/2018] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Charcot-Marie-Tooth diseases (CMT) are due to abnormalities of many genes, the most frequent being linked to PMP22 (Peripheral Myelin Protein 22). In the past, only spontaneous genetic anomalies occurring in mouse mutants such as Trembler (Tr) mice were available; more recently, several rodent models have been generated for exploration of the pathophysiological mechanisms underlying these neuropathies. METHODS Based on the personal experience of our team, we describe here the pathological hallmarks of most of these animal models and compare them to the pathological features observed in some CMT patient nerves (CMT types 1A and E; hereditary neuropathy with liability to pressure palsies, HNPP). RESULTS We describe clinical data and detailed pathological analysis mainly by electron microscopy of the sciatic nerves of these animal models conducted in our laboratory; lesions of PMP22 deficient animals (KO and mutated PMP22) and PMP22 overexpressed models are described and compared to ultrastructural anomalies of nerve biopsies from CMT patients due to PMP22 gene anomalies. It is of note that while there are some similarities, there are also significant differences between the lesions in animal models and human cases. Such observations highlight the complex roles played by PMP22 in nerve development. CONCLUSION It should be borne in mind that we require additional correlations between animal models of hereditary neuropathies and CMT patients to rationalize the development of efficient drugs.
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Affiliation(s)
- Maxime Jouaud
- Equipe d'accueil 6309, Maintenance myélinique et Neuropathies périphériques, University of Limoges, 2 rue du Docteur Raymond Marcland, 87000 Limoges, France
| | - Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), place Amélie Raba-Léon, 33000 Bordeaux, France; National Reference Center 'maladies neuromusculaires du Grand Sud-ouest', CHU Bordeaux (Pellegrin University Hospital), place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Laurence Richard
- Department of Neurology, CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France; National Reference Center for 'Rare Peripheral Neuropathies', CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Anne-Sophie Lia
- Equipe d'accueil 6309, Maintenance myélinique et Neuropathies périphériques, University of Limoges, 2 rue du Docteur Raymond Marcland, 87000 Limoges, France; Department of Biochemistry and Molecular Genetics, CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Laurent Magy
- Department of Neurology, CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France; National Reference Center for 'Rare Peripheral Neuropathies', CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Jean-Michel Vallat
- Department of Neurology, CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France; National Reference Center for 'Rare Peripheral Neuropathies', CHU Limoges, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges, France.
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Luigetti M, Del Grande A, Conte A, Lo Monaco M, Bisogni G, Romano A, Zollino M, Rossini PM, Sabatelli M. Clinical, neurophysiological and pathological findings of HNPP patients with 17p12 deletion: A single-centre experience. J Neurol Sci 2014; 341:46-50. [DOI: 10.1016/j.jns.2014.03.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/04/2014] [Accepted: 03/24/2014] [Indexed: 12/14/2022]
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He Y, Wu Q, Xu Z, Wang Q, Wang W, Li D, Liu W, He X. Hereditary Neuropathy with Liability to Pressure Palsy: An Investigation in a Rare and Large Chinese Family. Eur Neurol 2012; 68:322-8. [DOI: 10.1159/000341836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/08/2012] [Indexed: 12/17/2022]
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Pisciotta C, Manganelli F, Dubbioso R, Ruggiero L, Iodice R, Santoro L. Thermosensitive hereditary neuropathy with liability to pressure palsy. Muscle Nerve 2011; 43:448-9. [DOI: 10.1002/mus.21921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Al-Thihli K, Rudkin T, Carson N, Poulin C, Melançon S, Der Kaloustian VM. Compound heterozygous deletions of PMP22 causing severe Charcot-Marie-Tooth disease of the Dejerine-Sottas disease phenotype. Am J Med Genet A 2008; 146A:2412-6. [PMID: 18698610 DOI: 10.1002/ajmg.a.32456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dejerine-Sottas disease (DSD) is a particular phenotype of the Charcot-Marie-Tooth (CMT) disease spectrum that is genetically heterogeneous. It represents a severe form of hypertrophic axonal and demyelinating neuropathy. Although it is predominantly inherited as an autosomal recessive condition, autosomal dominant inheritance has also been described. To date, the autosomal recessive forms of DSD are classified into several CMT type 4 (CMT4) subclasses based on allelic heterogeneity. We present a 7-year-old boy with a severe form of CMT disease consistent with the autosomal recessive phenotype of DSD. He was found to be a compound heterozygote for mutations in the PMP22 gene resulting in homozygous deletion of exons 2 and 3. The maternally inherited allele was the typical 1.5 Mb deletion involving PMP22 seen with hereditary neuropathy with liability to pressure palsy (HNPP). The paternally inherited allele was a deletion of exons 2 and 3. Both parents presented with a typical clinical picture of HNPP. To our knowledge, this is the first patient reported with large deletions involving both PMP22 alleles. Our patient has also developed severe gastroesophageal reflux disease (GERD), a clinical feature not previously reported with CMT or DSD. The correlation of the phenotype and the molecular defects observed in this patient may set a new subcategory in the classification of DSD.
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Affiliation(s)
- Khalid Al-Thihli
- F. Clarke Fraser Clinical Genetics Unit, Division of Medical Genetics, McGill University Health Centre/Montreal Children's Hospital, Montreal, Quebec, Canada
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Bhangoo SK, Ren D, Miller RJ, Chan DM, Ripsch MS, Weiss C, McGinnis C, White FA. CXCR4 chemokine receptor signaling mediates pain hypersensitivity in association with antiretroviral toxic neuropathy. Brain Behav Immun 2007; 21:581-91. [PMID: 17292584 PMCID: PMC2062574 DOI: 10.1016/j.bbi.2006.12.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 12/03/2006] [Accepted: 12/03/2006] [Indexed: 02/07/2023] Open
Abstract
Nucleoside reverse transcriptase inhibitors (NRTIs) are known to produce painful neuropathies and to enhance states of pain hypersensitivity produced by HIV-1 infection. It has also been observed that in some neuropathic pain models, chemokines and their receptors are upregulated, perhaps contributing to the pain state. In order to understand if chemokines are involved in NRTI-mediated sensory neuropathies, we treated rats with the anti-retroviral drug, 2',3'-dideoxycytidine (ddC), which is known to produce an extended period of hyperalgesia and allodynia. Using in situ hybridization, we observed that under normal conditions, CXCR4 chemokine receptors were widely expressed by satellite glia in the dorsal root ganglia (DRG) and Schwann cells in the sciatic nerve. A limited number of DRG neurons also expressed CXCR4 receptors. The chemokine SDF-1/CXCL12 was similarly expressed in glial cells in the DRG and peripheral nerve. Following a single administration of ddC, expression levels of CXCR4 mRNA in glia and neurons and SDF-1 mRNA in glia increased considerably. The functional nature of increased CXCR4 mRNA expression was confirmed by measuring SDF-1 induced [Ca2+]i increases in acutely isolated DRG neurons and glia. In contrast, the expression of the chemokine receptors CCR2 and CCR5 did not change following ddC treatment. Pain hypersensitivity produced by ddC could be inhibited by treatment with the CXCR4 antagonist, AMD3100. Hence, we postulate that NRTIs produce pain hypersensitivity through the upregulation of CXCR4 signaling in the DRG. Increased numbers of CXCR4 receptors would also explain the synergism observed between NRTI treatment and the proalgesic effects of HIV-1 infection.
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MESH Headings
- Analysis of Variance
- Animals
- Chemokine CXCL12
- Chemokines, CXC/genetics
- Chemokines, CXC/immunology
- Chemokines, CXC/metabolism
- Disease Models, Animal
- Female
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/metabolism
- Ganglia, Spinal/pathology
- Ganglia, Spinal/ultrastructure
- Gene Expression Regulation/drug effects
- Neuralgia/chemically induced
- Neuralgia/immunology
- Neuroglia/drug effects
- Neuroglia/metabolism
- Neuroglia/pathology
- Neuroglia/ultrastructure
- Neurons/drug effects
- Neurons/metabolism
- Neurons/pathology
- Neurons/ultrastructure
- Pain Threshold/drug effects
- RNA, Messenger/analysis
- Rats
- Rats, Sprague-Dawley
- Receptors, CXCR4/drug effects
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Reverse Transcriptase Inhibitors/adverse effects
- Reverse Transcriptase Inhibitors/immunology
- Schwann Cells/drug effects
- Schwann Cells/metabolism
- Schwann Cells/pathology
- Schwann Cells/ultrastructure
- Sciatic Nerve/drug effects
- Sciatic Nerve/metabolism
- Sciatic Nerve/pathology
- Sciatic Nerve/ultrastructure
- Statistics, Nonparametric
- Zalcitabine/adverse effects
- Zalcitabine/immunology
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Affiliation(s)
- Sonia K Bhangoo
- Department of Molecular Pharmacology and Structural Biochemistry, Northwestern University, Chicago, IL, USA
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