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Di Sarno I, Tozza S, Santorelli FM, Cassano E, Natale G, Dubbioso R, Ruggiero L, Tessa A, Iodice R, Nolano M, Manganelli F. Charcot-Marie-Tooth type 2CC misdiagnosed as Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Neurol Sci 2024; 45:5933-5937. [PMID: 39223423 DOI: 10.1007/s10072-024-07747-7] [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: 06/27/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Charcot-Marie-Tooth (CMT) is a heterogeneous group of genetic neuropathies and is typically characterized by distal muscle weakness, sensory loss, pes cavus and areflexia. Herein we describe a case of CMT2CC presenting with proximal muscle weakness and equivocal electrophysiological features, that was misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP). CASE REPORT A 30-year-old woman complained of proximal muscle weakness with difficulty climbing stairs. Neurological examination showed weakness in lower limb (LL) muscles, that was marked proximally and mild distally, and absence of deep tendon reflexes in the ankles. Nerve conduction studies (NCS) showed sensory-motor neuropathy with non-uniform NC velocity and a partial conduction block (CBs) in peroneal nerve and tibial nerves. Thus, a diagnosis of CIDP was entertained and the patient underwent ineffective treatment with intravenous immunoglobulins. At electrophysiological revaluation CB in peroneal nerve was undetectable as also distal CMAP had decreased whereas the CBs persisted in tibial nerves. Hypothesizing a hereditary neuropathy, we examined the proband's son, who presented mild weakness of distal and proximal muscles at lower limbs. Neurophysiological investigation showed findings consistent with an intermediate-axonal electrophysiological pattern. A targeted-NGS including 136 CMT genes showed the heterozygous frameshift mutation (c.3057dupG; p.K1020fs*43) in the NEFH gene, coding for the neurofilament heavy chain and causing CMT2CC. INTERPRETATION Diagnosis of a genetic neuropathy may be challenging when clinical features are atypical and/or electrophysiological features are misleading. The most common misdiagnosis is CIDP. Our report suggests that also CMT2CC patients with proximal muscle weakness and equivocal electrophysiological features might be misdiagnosed as CIDP.
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Affiliation(s)
- Isabella Di Sarno
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | - Stefano Tozza
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy.
| | | | - Emanuele Cassano
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | - Gemma Natale
- Molecular Medicine, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | | | - Rosa Iodice
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odonstomatological Sciences, University Federico II, Via Sergio Pansini, Naples, 5 - 80131, Italy
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Mousele C, Holden D, Gnanapavan S. Neurofilaments in neurologic disease. Adv Clin Chem 2024; 123:65-128. [PMID: 39181624 DOI: 10.1016/bs.acc.2024.06.010] [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] [Indexed: 08/27/2024]
Abstract
Neurofilaments (NFs), major cytoskeletal constituents of neurons, have emerged as universal biomarkers of neuronal injury. Neuroaxonal damage underlies permanent disability in various neurological conditions. It is crucial to accurately quantify and longitudinally monitor this damage to evaluate disease progression, evaluate treatment effectiveness, contribute to novel treatment development, and offer prognostic insights. Neurofilaments show promise for this purpose, as their levels increase with neuroaxonal damage in both cerebrospinal fluid and blood, independent of specific causal pathways. New assays with high sensitivity allow reliable measurement of neurofilaments in body fluids and open avenues to investigate their role in neurological disorders. This book chapter will delve into the evolving landscape of neurofilaments, starting with their structure and cellular functions within neurons. It will then provide a comprehensive overview of their broad clinical value as biomarkers in diseases affecting the central or peripheral nervous system.
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Kotaich F, Caillol D, Bomont P. Neurofilaments in health and Charcot-Marie-Tooth disease. Front Cell Dev Biol 2023; 11:1275155. [PMID: 38164457 PMCID: PMC10758125 DOI: 10.3389/fcell.2023.1275155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 01/03/2024] Open
Abstract
Neurofilaments (NFs) are the most abundant component of mature neurons, that interconnect with actin and microtubules to form the cytoskeleton. Specifically expressed in the nervous system, NFs present the particularity within the Intermediate Filament family of being formed by four subunits, the neurofilament light (NF-L), medium (NF-M), heavy (NF-H) proteins and α-internexin or peripherin. Here, we review the current knowledge on NF proteins and neurofilaments, from their domain structures and their model of assembly to the dynamics of their transport and degradation along the axon. The formation of the filament and its behaviour are regulated by various determinants, including post-transcriptional (miRNA and RBP proteins) and post-translational (phosphorylation and ubiquitination) modifiers. Altogether, the complex set of modifications enable the neuron to establish a stable but elastic NF array constituting the structural scaffold of the axon, while permitting the local expression of NF proteins and providing the dynamics necessary to fulfil local demands and respond to stimuli and injury. Thus, in addition to their roles in mechano-resistance, radial axonal outgrowth and nerve conduction, NFs control microtubule dynamics, organelle distribution and neurotransmission at the synapse. We discuss how the studies of neurodegenerative diseases with NF aggregation shed light on the biology of NFs. In particular, the NEFL and NEFH genes are mutated in Charcot-Marie-Tooth (CMT) disease, the most common inherited neurological disorder of the peripheral nervous system. The clinical features of the CMT forms (axonal CMT2E, CMT2CC; demyelinating CMT1F; intermediate I-CMT) with symptoms affecting the central nervous system (CNS) will allow us to further investigate the physiological roles of NFs in the brain. Thus, NF-CMT mouse models exhibit various degrees of sensory-motor deficits associated with CNS symptoms. Cellular systems brought findings regarding the dominant effect of NF-L mutants on NF aggregation and transport, although these have been recently challenged. Neurofilament detection without NF-L in recessive CMT is puzzling, calling for a re-examination of the current model in which NF-L is indispensable for NF assembly. Overall, we discuss how the fundamental and translational fields are feeding each-other to increase but also challenge our knowledge of NF biology, and to develop therapeutic avenues for CMT and neurodegenerative diseases with NF aggregation.
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Affiliation(s)
| | | | - Pascale Bomont
- ERC team, NeuroMyoGene Institute-Pathophysiology and Genetics of Neuron and Muscle, Inserm U1315, CNRS UMR5261, University of Lyon 1, Lyon, France
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Truong AT, Luong ATL, Nguyen LH, Nguyen HV, Nguyen DN, Nguyen NTM. A novel single-point mutation of NEFH and biallelic SACS mutation presenting as intermediate form Charcot-Marie-Tooth: A case report in Vietnam. Surg Neurol Int 2022; 13:553. [PMID: 36600740 PMCID: PMC9805609 DOI: 10.25259/sni_803_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background Charcot-Marie-Tooth disease (CMT) is among the most common group of inherited neuromuscular diseases. SACS mutations were demonstrated to cause autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). However, there have been few case reports regarding to NEFH and SACS gene mutation to CMT in Vietnamese patients, and the diagnosis of CMT and ARSACS in the clinical setting still overlapped. Case Description We report two patients presenting with sensorimotor neuropathy without cerebellar ataxia, spasticity and other neurological features, being diagnosed with intermediate form CMT by electrophysiological and clinical examination and neuroimaging. By whole-exome sequencing panel of two affected members, and PCR Sanger on NEFH and SACS genes to confirm the presence of selected variants on their parents, we identified a novel missense variant NEFH c.1925C>T (inherited from the mother) in an autosomal dominant heterozygous state, and two recessive SACS variants (SACS c.13174C>T, causing missense variant, and SACS c.11343del, causing frameshift variant) (inherited one from the mother and another from the father) in these two patients. Clinical and electrophysiological findings on these patients did not match classical ARSACS. To the best of our knowledge, this is the first case report of two affected siblings diagnosed with CMT carrying both a novel NEFH variant and biallelic SACS variants. Conclusion We concluded that this novel NEFH variant is likely benign, and biallelic SACS mutation (c.13174C>T and c.11343del) is likely pathogenic for intermediate form CMT. This study is also expected to emphasize the current knowledge of intermediate form CMT, ARSACS, and the phenotypic spectrum of NEFH-related and SACS-related disorders. We expect to give a new understanding of CMT; however, further research should be conducted to provide a more thorough knowledge of the pathogenesis of CMT in the future.
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Affiliation(s)
- Anh Tuan Truong
- Department of Clinical Medicine, Nam Dinh University of Nursing, Nam Dinh, Vietnam
| | - Anh Thi Lan Luong
- Department of Medical Biology and Genetics, Hanoi Medical University, Hanoi, Vietnam
| | - Linh Hai Nguyen
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam.,Corresponding author: Linh Hai Nguyen, Department of Neurology, Hanoi Medical University, Hanoi, Vietnam.
| | - Huong Van Nguyen
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
| | - Diep Ngoc Nguyen
- Institute of Theoretical and Applied Research (ITAR), School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Ngoc Thi Minh Nguyen
- Department of Medical Biology and Genetics, Hanoi Medical University, Hanoi, Vietnam
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Ando M, Higuchi Y, Okamoto Y, Yuan J, Yoshimura A, Takei J, Taniguchi T, Hiramatsu Y, Sakiyama Y, Hashiguchi A, Matsuura E, Nakagawa H, Sonoda K, Yamashita T, Tamura A, Terasawa H, Mitsui J, Ishiura H, Tsuji S, Takashima H. An NEFH founder mutation causes broad phenotypic spectrum in multiple Japanese families. J Hum Genet 2022; 67:399-403. [DOI: 10.1038/s10038-022-01019-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/28/2021] [Accepted: 01/16/2022] [Indexed: 12/28/2022]
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Pipis M, Cortese A, Polke JM, Poh R, Vandrovcova J, Laura M, Skorupinska M, Jacquier A, Juntas-Morales R, Latour P, Petiot P, Sole G, Fromes Y, Shah S, Blake J, Choi BO, Chung KW, Stojkovic T, Rossor AM, Reilly MM. Charcot-Marie-Tooth disease type 2CC due to NEFH variants causes a progressive, non-length-dependent, motor-predominant phenotype. J Neurol Neurosurg Psychiatry 2022; 93:48-56. [PMID: 34518334 PMCID: PMC8685631 DOI: 10.1136/jnnp-2021-327186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/08/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Neurofilaments are the major scaffolding proteins for the neuronal cytoskeleton, and variants in NEFH have recently been described to cause axonal Charcot-Marie-Tooth disease type 2CC (CMT2CC). METHODS In this large observational study, we present phenotype-genotype correlations on 30 affected and 3 asymptomatic mutation carriers from eight families. RESULTS The majority of patients presented in adulthood with motor-predominant and lower limb-predominant symptoms and the average age of onset was 31.0±15.1 years. A prominent feature was the development of proximal weakness early in the course of the disease. The disease progressed rapidly, unlike other Charcot-Marie-Tooth disease (CMT) subtypes, and half of the patients (53%) needed to use a wheelchair on average 24.1 years after symptom onset. Furthermore, 40% of patients had evidence of early ankle plantarflexion weakness, a feature which is observed in only a handful of CMT subtypes. Neurophysiological studies and MRI of the lower limbs confirmed the presence of a non-length-dependent neuropathy in the majority of patients.All families harboured heterozygous frameshift variants in the last exon of NEFH, resulting in a reading frameshift to an alternate open reading frame and the translation of approximately 42 additional amino acids from the 3' untranslated region (3'-UTR). CONCLUSIONS This phenotype-genotype study highlights the unusual phenotype of CMT2CC, which is more akin to spinal muscular atrophy rather than classic CMT. Furthermore, the study will enable more informative discussions on the natural history of the disease and will aid in NEFH variant interpretation in the context of the disease's unique molecular genetics.
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Affiliation(s)
- Menelaos Pipis
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea Cortese
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - James M Polke
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Roy Poh
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Jana Vandrovcova
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Matilde Laura
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mariola Skorupinska
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Arnaud Jacquier
- Institut NeuroMyoGène, CNRS UMR5310, INSERM U1217, Universite de Lyon, Lyon, France
| | - Raul Juntas-Morales
- Clinique du Motoneurone et Pathologies Neuromusculaires, CHRU de Montpellier, Montpellier, France
| | - Philippe Latour
- Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Philippe Petiot
- Neurologie et Explorations Fonctionnelles Neurologiques, Centre de Référence Maladies Neuromusculaires, Hospices Civils de Lyon, Lyon, France
| | - Guilhem Sole
- Centre de Référence des Maladies Neuromusculaires, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Yves Fromes
- Institut de Myologie, Laboratoire RMN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sachit Shah
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Julian Blake
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Department of Clinical Neurophysiology, Norfolk and Norwich University Hospital, Norfolk, UK
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Wha Chung
- Department of Biological Sciences, Kongju National University, Gongju, South Korea
| | - Tanya Stojkovic
- AP-HP, Reference Center for Neuromuscular Disorders, University Hospital Pitié Salpêtrière, Paris, France
- Centre de Recherche en Myologie, Inserm UMRS974, Sorbonne Universite, Paris, France
| | - Alexander M Rossor
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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Pisciotta C, Pareyson D. CMT2CC associated with NEFH mutations: a predominantly motor neuronopathy. J Neurol Neurosurg Psychiatry 2022; 93:1. [PMID: 34518332 DOI: 10.1136/jnnp-2021-327438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Chiara Pisciotta
- Rare Neurodegenerative and Neurometabolic Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Davide Pareyson
- Rare Neurodegenerative and Neurometabolic Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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First case report of Charcot-Marie-Tooth disease type 2CC with a frameshift mutation of NEFH gene in Greece. Neurol Sci 2021; 42:4377-4379. [PMID: 34275023 DOI: 10.1007/s10072-021-05402-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
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