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Qi X, Zhang J, Sheng Z. Tyrosine hydroxylase deficiency in a child initially misdiagnosed as cerebral palsy combined with epilepsy. Acta Neurol Belg 2024:10.1007/s13760-024-02631-9. [PMID: 39223368 DOI: 10.1007/s13760-024-02631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Xiaoli Qi
- Department of Pediatric Rehabilitation, Jining No.1 People's Hospital, Jining, 272011, China
| | - Jing Zhang
- Department of Pediatric Rehabilitation, Jinhua Maternal and Child Health Care Hospital, Jinhua, 321000, China
| | - Zhiqiang Sheng
- Department of Pediatric Rehabilitation, Jining No.1 People's Hospital, Jining, 272011, China.
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2
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Zhang J, Huang Y, Hu Y, Bai B. Compound heterozygous mutations in three Chinese patients of Segawa syndrome and their treatment outcomes. Int J Dev Neurosci 2024; 84:305-313. [PMID: 38566307 DOI: 10.1002/jdn.10328] [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: 10/19/2023] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Segawa syndrome is a rare autosomal recessive form of dopa-responsive dystonia resulting from TH gene dysfunction. Patients typically exhibit symptoms such as generalized dystonia, rigidity, tremors, infantile Parkinsonism, and pseudo-spastic paraplegia. Levodopa is often an effective treatment. Due to its rarity, high heterogeneity, and poorly understood pathological mutation and phenotype spectrums, as well as genotype-phenotype and genotype-treatment outcome correlations, Segawa syndrome poses diagnostic and therapeutic challenges. In our study, through clinical and molecular analyses of three Chinese Segawa patients, we re-evaluated the pathogenicity of a TH mutation (c.880G>C;p.G294R) previously categorized as "Conflicting classifications of pathogenicity" in ClinVar. Also, we summarized the clinical phenotypes of all reported Segawa syndrome cases until 2023 and compared them with our patients. We identified a novel phenotype, "cafe-au-lait macules," not previously observed in Segawa patients. Additionally, we discussed the correlation between specific genotypes and phenotypes, as well as genotypes and treatment outcomes of our three cases. Our findings aim to enhance the understanding of Segawa syndrome, contributing to improved diagnosis and treatment approaches in the future.
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Affiliation(s)
- Jie Zhang
- State Key Laboratory of Primate Biomedical Research, Kunming University of Science and Technology, Kunming, China
- Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming, China
- Department of Medical Genetics, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, National Health Commission Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Kunming, China
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
- Medical school, Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yaxin Huang
- Department of Medical Genetics, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, National Health Commission Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Kunming, China
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
- Medical school, Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yulei Hu
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Bing Bai
- State Key Laboratory of Primate Biomedical Research, Kunming University of Science and Technology, Kunming, China
- Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming, China
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3
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Alsalloum I, Moskaliuk VS, Rakhov IA, Bazovkina DV, Kulikov AV. The C886T Mutation in the Th Gene Reduces the Activity of Tyrosine Hydroxylase in the Mouse Brain. BIOCHEMISTRY. BIOKHIMIIA 2024; 89:1024-1030. [PMID: 38981698 DOI: 10.1134/s000629792406004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 07/11/2024]
Abstract
Tyrosine hydroxylase (TH) catalyzes hydroxylation of L-tyrosine to L-3,4-dihydroxyphenylalanine, the initial and rate-limiting step in the synthesis of dopamine, noradrenaline, and adrenaline. Mutations in the human TH gene are associated with hereditary motor disorders. The common C886T mutation identified in the mouse Th gene results in the R278H substitution in the enzyme molecule. We investigated the impact of this mutation on the TH activity in the mouse midbrain. The TH activity in the midbrain of Mus musculus castaneus (CAST) mice homozygous for the 886C allele was higher compared to C57BL/6 and DBA/2 mice homozygous for the 886T allele. Notably, this difference in the enzyme activity was not associated with changes in the Th gene mRNA levels and TH protein content. Analysis of the TH activity in the midbrain in mice from the F2 population obtained by crossbreeding of C57BL/6 and CAST mice revealed that the 886C allele is associated with a high TH activity. Moreover, this allele showed complete dominance over the 886T allele. However, the C886T mutation did not affect the levels of TH protein in the midbrain. These findings demonstrate that the C886T mutation is a major genetic factor determining the activity of TH in the midbrain of common laboratory mouse strains. Moreover, it represents the first common spontaneous mutation in the mouse Th gene whose influence on the enzyme activity has been demonstrated. These results will help to understand the role of TH in the development of adaptive and pathological behavior, elucidate molecular mechanisms regulating the activity of TH, and explore pharmacological agents for modulating its function.
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Affiliation(s)
- Ismail Alsalloum
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, 630090, Russia
- Novosibirsk State University, Novosibirsk, 630090, Russia
| | - Vitalii S Moskaliuk
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Ilya A Rakhov
- Novosibirsk State University, Novosibirsk, 630090, Russia
| | - Daria V Bazovkina
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Alexander V Kulikov
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, 630090, Russia.
- Novosibirsk State University, Novosibirsk, 630090, Russia
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4
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Jung-Klawitter S, Richter P, Yuan Y, Welzel K, Kube M, Bähr S, Leibner A, Flory E, Opladen T. Tyrosine hydroxylase variants influence protein expression, cellular localization, stability, enzymatic activity and the physical interaction between tyrosine hydroxylase and GTP cyclohydrolase 1. J Inherit Metab Dis 2024; 47:517-532. [PMID: 38084654 DOI: 10.1002/jimd.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 05/16/2024]
Abstract
Tyrosine hydroxylase (TH) is the rate-limiting enzyme in dopamine biosynthesis catalyzing the tetrahydrobiopterin (BH4)-dependent hydroxylation of tyrosine to L-DOPA. Here, we analyzed 25 TH variants associated with various degrees of dopa-responsive dystonia and evaluate the effect of each variant on protein stability, activity and cellular localization. Furthermore, we investigated the physical interaction between TH and human wildtype (wt) GTP cyclohydrolase 1 (GTPCH) and the effect of variants on this interaction. Our in vitro results classify variants according to their resistance to proteinase K digestion into three groups (stable, intermediate, unstable). Based on their cellular localization, two groups of variants can be identified, variant group one with cytoplasmic distribution and variant group two forming aggregates. These aggregates do not correlate with loss of enzymatic activity but nevertheless might be a good target for molecular chaperones. Unfortunately, no obvious correlation between the half-life of a variant and its enzymatic activity or between solubility, stability and enzymatic activity of a given variant could be found. Excitingly, some variants disrupt the physical interaction between TH and human wildtype GTPCH, thereby interfering with enzymatic activity and offering new druggable targets for therapy. Taken together, our results highlight the importance of an in-depth molecular analysis of each variant in order to be able to classify groups of disease variants and to find specific therapies for each subgroup. Stand-alone in silico analyses predict less precise the effect of specific variants and should be combined with other in vitro analyses in cellular model systems.
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Affiliation(s)
- Sabine Jung-Klawitter
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Petra Richter
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Yuheng Yuan
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Karin Welzel
- Division of Hematology, Cell and Gene Therapy, Paul-Ehrlich-Institute, Langen, Germany
| | - Marie Kube
- Institute of Molecular Biology, Mainz, Germany
| | - Stella Bähr
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Alexander Leibner
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Egbert Flory
- Division of Hematology, Cell and Gene Therapy, Paul-Ehrlich-Institute, Langen, Germany
| | - Thomas Opladen
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
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Atanasoska M, Vazharova R, Stevanović G, Bradinova I, Staykova SY, Balabanski L, Mircheva D, Avdjieva-Tzavella D, Toncheva D. Dopa-responsive dystonia in Bulgarian patients: report of three cases. Eur J Hum Genet 2023:10.1038/s41431-023-01370-4. [PMID: 37165102 DOI: 10.1038/s41431-023-01370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Maya Atanasoska
- GMDL "CellGenetics", Sofia, Bulgaria.
- Department of Genetics, Faculty of Biology, Sofia University St Kliment Ohridski, Sofia, Bulgaria.
| | - Radoslava Vazharova
- GMDL "CellGenetics", Sofia, Bulgaria.
- Department of Biology, Medical genetics and Microbiology, Faculty of Medicine, Sofia University St Kliment Ohridski, Sofia, Bulgaria.
| | - Galina Stevanović
- Clinic of Neurology and Psychiatry for Children and Youth, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Irena Bradinova
- GMDL "CellGenetics", Sofia, Bulgaria
- National Genetic Laboratory, UHOG "Maichin dom" Sofia, Sofia, Bulgaria
| | | | | | | | | | - Draga Toncheva
- GMDL "CellGenetics", Sofia, Bulgaria
- Bulgarian Academy of Science, Sofia, Bulgaria
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Reyes ZMD, Lynch E, Henry J, De Simone LM, Sobotka SA. Diagnosis of autism in a rare case of tyrosine hydroxylase deficiency: a case report. BMC Med Genomics 2023; 16:78. [PMID: 37041529 PMCID: PMC10088295 DOI: 10.1186/s12920-023-01510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Tyrosine hydroxylase deficiency (THD) is a rare movement disorder with broad phenotypic expression caused by bi-allelic mutations in the TH gene, which encode for tyrosine hydroxylase (TH) protein. Some patients with THD have improvement in dystonia with carbidopa-levodopa, a synthetic form of dopamine typically used in Parkinson's disease, and are considered to have dopa-responsive THD. THD has been found in 0.5-1 per million persons, although due to overlapping symptoms with other disorders and the need for genetic testing, prevalence is likely underestimated. Existing literature describes some patients with THD having intellectual disability, but comorbid autism spectrum disorder (ASD) has not been reported. CASE PRESENTATION A nearly 3-year-old boy was referred to pediatric neurology due to hypotonia, delayed motor milestones, and expressive speech delay. Whole exome sequencing confirmed tyrosine hydroxylase deficiency, detecting a novel variant p.S307C first reported here. The child was treated with carbidopa-levodopa with an excellent response, resulting in improved balance, fewer falls, and improved ability to jump, run and climb stairs. He was determined to have dopa-responsive THD. Due to his delays in expressive speech, the boy also had an assessment with a developmental and behavioral pediatrician, who identified a pattern of social pragmatic speech delay, sensory sensitivities, and restricted interests, and determined that he met criteria for a diagnosis of ASD. CONCLUSIONS While ASD can stand alone as a clinical diagnosis, it is also a cardinal feature of other genetically-based neurological disorders. To our knowledge, this is the first case that describes a patient with both disorders. Perhaps THD may be among the genetic disorders linked with ASD.
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Affiliation(s)
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61St Street, Suite 207, Chicago, IL, 60637, USA
| | - Julia Henry
- Section of Pediatric Neurology, Department of Pediatrics, The University of Chicago, Chicago, USA
| | | | - Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61St Street, Suite 207, Chicago, IL, 60637, USA.
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Tristán‐Noguero A, Fernández‐Carasa I, Calatayud C, Bermejo‐Casadesús C, Pons‐Espinal M, Colini Baldeschi A, Campa L, Artigas F, Bortolozzi A, Domingo‐Jiménez R, Ibáñez S, Pineda M, Artuch R, Raya Á, García‐Cazorla À, Consiglio A. iPSC-based modeling of THD recapitulates disease phenotypes and reveals neuronal malformation. EMBO Mol Med 2023; 15:e15847. [PMID: 36740977 PMCID: PMC9994475 DOI: 10.15252/emmm.202215847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/07/2023] Open
Abstract
Tyrosine hydroxylase deficiency (THD) is a rare genetic disorder leading to dopaminergic depletion and early-onset Parkinsonism. Affected children present with either a severe form that does not respond to L-Dopa treatment (THD-B) or a milder L-Dopa responsive form (THD-A). We generated induced pluripotent stem cells (iPSCs) from THD patients that were differentiated into dopaminergic neurons (DAn) and compared with control-DAn from healthy individuals and gene-corrected isogenic controls. Consistent with patients, THD iPSC-DAn displayed lower levels of DA metabolites and reduced TH expression, when compared to controls. Moreover, THD iPSC-DAn showed abnormal morphology, including reduced total neurite length and neurite arborization defects, which were not evident in DAn differentiated from control-iPSC. Treatment of THD-iPSC-DAn with L-Dopa rescued the neuronal defects and disease phenotype only in THDA-DAn. Interestingly, L-Dopa treatment at the stage of neuronal precursors could prevent the alterations in THDB-iPSC-DAn, thus suggesting the existence of a critical developmental window in THD. Our iPSC-based model recapitulates THD disease phenotypes and response to treatment, representing a promising tool for investigating pathogenic mechanisms, drug screening, and personalized management.
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Affiliation(s)
- Alba Tristán‐Noguero
- Neurometabolic Unit and Synaptic Metabolism Lab, Neurology DepartmentInstitut Pediàtric de Recerca, Hospital Sant Joan de DéuBarcelonaSpain
| | - Irene Fernández‐Carasa
- Department of Pathology and Experimental TherapeuticsBellvitge University Hospital‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Institute of Biomedicine of the University of Barcelona (IBUB)BarcelonaSpain
| | - Carles Calatayud
- Department of Pathology and Experimental TherapeuticsBellvitge University Hospital‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Institute of Biomedicine of the University of Barcelona (IBUB)BarcelonaSpain
- Regenerative Medicine ProgramBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Program for Translation of Regenerative Medicine in Catalonia (P‐[CMRC])Hospital Duran i Reynals, Hospitalet de LlobregatBarcelonaSpain
| | - Cristina Bermejo‐Casadesús
- Neurometabolic Unit and Synaptic Metabolism Lab, Neurology DepartmentInstitut Pediàtric de Recerca, Hospital Sant Joan de DéuBarcelonaSpain
| | - Meritxell Pons‐Espinal
- Department of Pathology and Experimental TherapeuticsBellvitge University Hospital‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Institute of Biomedicine of the University of Barcelona (IBUB)BarcelonaSpain
| | - Arianna Colini Baldeschi
- Department of Pathology and Experimental TherapeuticsBellvitge University Hospital‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Institute of Biomedicine of the University of Barcelona (IBUB)BarcelonaSpain
| | - Leticia Campa
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)BarcelonaSpain
- Institut d'Investigacions August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIIIMadridSpain
| | - Francesc Artigas
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)BarcelonaSpain
- Institut d'Investigacions August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIIIMadridSpain
| | - Analia Bortolozzi
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)BarcelonaSpain
- Institut d'Investigacions August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIIIMadridSpain
| | - Rosario Domingo‐Jiménez
- Department of Pediatric NeurologyHospital Virgen de la ArrixacaMurciaSpain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB)MurciaSpain
- Centro de Investigación Biomédica En Red Enfermedades Raras (CIBERER)MadridSpain
| | - Salvador Ibáñez
- Department of Pediatric NeurologyHospital Virgen de la ArrixacaMurciaSpain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB)MurciaSpain
| | - Mercè Pineda
- Fundació Sant Joan de Déu (FSJD), Hospital Sant Joan de Déu (HSJD)BarcelonaSpain
| | - Rafael Artuch
- Centro de Investigación Biomédica En Red Enfermedades Raras (CIBERER)MadridSpain
- Metabolic Unit, Departments of Neurology, Nutrition Biochemistry and GeneticsInstitut Pediàtric de Recerca, Hospital San Joan de DéuBarcelonaSpain
| | - Ángel Raya
- Regenerative Medicine ProgramBellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Program for Translation of Regenerative Medicine in Catalonia (P‐[CMRC])Hospital Duran i Reynals, Hospitalet de LlobregatBarcelonaSpain
- Centre for Networked Biomedical Research on Bioengineering, Biomaterials and Nanomedicine (CIBER‐BBN)MadridSpain
- Institució Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain
| | - Àngels García‐Cazorla
- Neurometabolic Unit and Synaptic Metabolism Lab, Neurology DepartmentInstitut Pediàtric de Recerca, Hospital Sant Joan de DéuBarcelonaSpain
- Centro de Investigación Biomédica En Red Enfermedades Raras (CIBERER)MadridSpain
| | - Antonella Consiglio
- Department of Pathology and Experimental TherapeuticsBellvitge University Hospital‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Institute of Biomedicine of the University of Barcelona (IBUB)BarcelonaSpain
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
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Mastrangelo M, Tolve M, Artiola C, Bove R, Carducci C, Carducci C, Angeloni A, Pisani F, Leuzzi V. Phenotypes and Genotypes of Inherited Disorders of Biogenic Amine Neurotransmitter Metabolism. Genes (Basel) 2023; 14:genes14020263. [PMID: 36833190 PMCID: PMC9957200 DOI: 10.3390/genes14020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Inherited disorders of biogenic amine metabolism are genetically determined conditions resulting in dysfunctions or lack of enzymes involved in the synthesis, degradation, or transport of dopamine, serotonin, adrenaline/noradrenaline, and their metabolites or defects of their cofactor or chaperone biosynthesis. They represent a group of treatable diseases presenting with complex patterns of movement disorders (dystonia, oculogyric crises, severe/hypokinetic syndrome, myoclonic jerks, and tremors) associated with a delay in the emergence of postural reactions, global development delay, and autonomic dysregulation. The earlier the disease manifests, the more severe and widespread the impaired motor functions. Diagnosis mainly depends on measuring neurotransmitter metabolites in cerebrospinal fluid that may address the genetic confirmation. Correlations between the severity of phenotypes and genotypes may vary remarkably among the different diseases. Traditional pharmacological strategies are not disease-modifying in most cases. Gene therapy has provided promising results in patients with DYT-DDC and in vitro models of DYT/PARK-SLC6A3. The rarity of these diseases, combined with limited knowledge of their clinical, biochemical, and molecular genetic features, frequently leads to misdiagnosis or significant diagnostic delays. This review provides updates on these aspects with a final outlook on future perspectives.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
| | - Manuela Tolve
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Artiola
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rossella Bove
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-649972930; Fax: +39-64440232
| | - Vincenzo Leuzzi
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
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