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Morsy A, Carmona AV, Trippier PC. Patient-Derived Induced Pluripotent Stem Cell Models for Phenotypic Screening in the Neuronal Ceroid Lipofuscinoses. Molecules 2021; 26:molecules26206235. [PMID: 34684815 PMCID: PMC8538546 DOI: 10.3390/molecules26206235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Batten disease or neuronal ceroid lipofuscinosis (NCL) is a group of rare, fatal, inherited neurodegenerative lysosomal storage disorders. Numerous genes (CLN1–CLN8, CLN10–CLN14) were identified in which mutations can lead to NCL; however, the underlying pathophysiology remains elusive. Despite this, the NCLs share some of the same features and symptoms but vary in respect to severity and onset of symptoms by age. Some common symptoms include the progressive loss of vision, mental and motor deterioration, epileptic seizures, premature death, and in the rare adult-onset, dementia. Currently, all forms of NCL are fatal, and no curative treatments are available. Induced pluripotent stem cells (iPSCs) can differentiate into any cell type of the human body. Cells reprogrammed from a patient have the advantage of acquiring disease pathogenesis along with recapitulation of disease-associated phenotypes. They serve as practical model systems to shed new light on disease mechanisms and provide a phenotypic screening platform to enable drug discovery. Herein, we provide an overview of available iPSC models for a number of different NCLs. More specifically, we highlight findings in these models that may spur target identification and drug development.
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Affiliation(s)
- Ahmed Morsy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68106, USA; (A.M.); (A.V.C.)
| | - Angelica V. Carmona
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68106, USA; (A.M.); (A.V.C.)
| | - Paul C. Trippier
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68106, USA; (A.M.); (A.V.C.)
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68106, USA
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE 68106, USA
- Correspondence:
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Jilani A, Matviychuk D, Blaser S, Dyack S, Mathieu J, Prasad AN, Prasad C, Kyriakopoulou L, Mercimek‐Andrews S. High diagnostic yield of direct Sanger sequencing in the diagnosis of neuronal ceroid lipofuscinoses. JIMD Rep 2019; 50:20-30. [PMID: 31741823 PMCID: PMC6850977 DOI: 10.1002/jmd2.12057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/14/2019] [Accepted: 05/23/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Neuronal ceroid lipofuscinoses are neurodegenerative disorders. To investigate the diagnostic yield of direct Sanger sequencing of the CLN genes, we reviewed Molecular Genetics Laboratory Database for molecular genetic test results of the CLN genes from a single clinical molecular diagnostic laboratory. METHODS We reviewed electronic patient charts. We used consent forms and Research Electronic Data Capture questionnaires for the patients from outside of our Institution. We reclassified all variants in the CLN genes. RESULTS Six hundred and ninety three individuals underwent the direct Sanger sequencing of the CLN genes for the diagnosis of neuronal ceroid lipofuscinoses. There were 343 symptomatic patients and 350 family members. Ninety-one symptomatic patients had molecular genetic diagnosis of neuronal ceroid lipofuscinoses including CLN1 (PPT1) (n = 10), CLN2 (TPP1) (n = 33), CLN3 (n = 17), CLN5 (n = 7), CLN6 (n = 10), CLN7 (MFSD8) (n = 10), and CLN8 (n = 4) diseases. The diagnostic yield of direct Sanger sequencing of CLN genes was 27% in symptomatic patients. We report detailed clinical and investigation results of 33 NCL patients. Juvenile onset CLN1 (PPT1) and adult onset CLN6 diseases were nonclassical phenotypes. CONCLUSION In our study, the diagnostic yield of direct Sanger sequencing was close to diagnostic yield of whole exome sequencing. Developmental regression, cognitive decline, visual impairment and cerebral and/or cerebellar atrophy in brain MRI are significant clinical and neuroimaging denominators to include NCL in the differential diagnosis.
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Affiliation(s)
- Abdulhakim Jilani
- Division of Clinical and Metabolic Genetics, Department of PaediatricsUniversity of Toronto, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Diana Matviychuk
- Division of Genome Diagnostics, Department of Paediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Susan Blaser
- Division of Neuroradiology, Department of Medical ImagingUniversity of Toronto, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Sarah Dyack
- Division of Medical Genetics, Department of Pediatrics, IWK Health CentreUniversity of DalhouiseHalifaxNova ScotiaCanada
| | - Jean Mathieu
- Neuromuscular Disease ClinicUniversity of SherbrookeQuebecCanada
| | - Asuri N. Prasad
- Division of Clinical Neurosciences, Department of Paediatrics, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Chitra Prasad
- Division of Medical Genetics Department of Paediatrics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Lianna Kyriakopoulou
- Division of Genome Diagnostics, Department of Paediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Paediatric Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Saadet Mercimek‐Andrews
- Division of Clinical and Metabolic Genetics, Department of PaediatricsUniversity of Toronto, The Hospital for Sick ChildrenTorontoOntarioCanada
- Genetics and Genome Biology Program, Research InstituteThe Hospital for Sick ChildrenTorontoOntarioCanada
- Institute of Medical SciencesUniversity of TorontoTorontoOntarioCanada
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Zlamy M, Hofstätter J, Albrecht U, Baumgartner S, Haberlandt E, Scholl-Bürgi S, Guntersweiler D, Reinehr M, Mihic-Probst D, Karall D. The value of axillary skin electron microscopic analysis in the diagnosis of lysosomal storage disorders. Mod Pathol 2019; 32:755-763. [PMID: 30723298 DOI: 10.1038/s41379-019-0201-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023]
Abstract
Both lysosomal storage diseases and mitochondrial diseases are a group of genetic-inherited metabolic disorders. In an era, where "old fashioned methods" are apparently being replaced by evolving molecular techniques (i.e. exome and whole genome sequencing), the "old fashioned methods" might help to characterise and thus narrow down the potential differential diagnosis. Therefore, we retrospectively evaluated the relevance of electron microscopy of axillary skin for the diagnosis of lysosomal storage or mitochondrial diseases (=inherited metabolic disorders of energy metabolism). Methods and patients: We included 74 patients with developmental delay with regression or neurodegeneration who underwent an axillary skin biopsy for both fibroblast culture and electron microscopy. Because of insufficient skin biopsy quality, for 8 patients no electron microscopy result was obtained. The electron microscopy biopsies revealed abnormalities in 37/66 (56.1%) patients. 29/66 electron microscopy biopsies showed normal results. A definite diagnosis was established in 21/66 (31.8%) patients with a pathological results of axillary skin electron microscopy analysis. In total, in 25/66 (37.8%) of the patients who underwent an axillary skin electron microscopy analysis, a definite diagnosis was finally established. Taking an axillary skin biopsy during anaesthesia or with use of local intradermal lidocaine application is an inexpensive alternative and useful to establish a diagnosis in patients suspected to have a lysosomal storage disease (or inherited metabolic disorder of energy metabolism).
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Affiliation(s)
- Manuela Zlamy
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria.
| | - Justina Hofstätter
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Ursula Albrecht
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Sara Baumgartner
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sabine Scholl-Bürgi
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Doris Guntersweiler
- University Hospital Zürich, Institute of Clinical Pathology, Zürich, Switzerland
| | - Michael Reinehr
- University Hospital Zürich, Institute of Clinical Pathology, Zürich, Switzerland
| | - Daniela Mihic-Probst
- University Hospital Zürich, Institute of Clinical Pathology, Zürich, Switzerland
| | - Daniela Karall
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria.
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Sharma S, Prasad AN. Inborn Errors of Metabolism and Epilepsy: Current Understanding, Diagnosis, and Treatment Approaches. Int J Mol Sci 2017; 18:ijms18071384. [PMID: 28671587 PMCID: PMC5535877 DOI: 10.3390/ijms18071384] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022] Open
Abstract
Inborn errors of metabolism (IEM) are a rare cause of epilepsy, but seizures and epilepsy are frequently encountered in patients with IEM. Since these disorders are related to inherited enzyme deficiencies with resulting effects on metabolic/biochemical pathways, the term “metabolic epilepsy” can be used to include these conditions. These epilepsies can present across the life span, and share features of refractoriness to anti-epileptic drugs, and are often associated with co-morbid developmental delay/regression, intellectual, and behavioral impairments. Some of these disorders are amenable to specific treatment interventions; hence timely and appropriate diagnosis is critical to improve outcomes. In this review, we discuss those disorders in which epilepsy is a dominant feature and present an approach to the clinical recognition, diagnosis, and management of these disorders, with a greater focus on primarily treatable conditions. Finally, we propose a tiered approach that will permit a clinician to systematically investigate, identify, and treat these rare disorders.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi 110001, India.
| | - Asuri N Prasad
- Department of Pediatrics and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Children's Hospital of Western Ontario and London Health Sciences Centre, London, ON N6A5W9, Canada.
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Niemann Pick C: First Case in a Canadian Nakoda Nation Child. Can J Neurol Sci 2014; 41:518-21. [DOI: 10.1017/s0317167100018606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Di-22:6-bis(monoacylglycerol)phosphate: A clinical biomarker of drug-induced phospholipidosis for drug development and safety assessment. Toxicol Appl Pharmacol 2014; 279:467-476. [PMID: 24967688 DOI: 10.1016/j.taap.2014.06.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/06/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
Abstract
The inability to routinely monitor drug-induced phospholipidosis (DIPL) presents a challenge in pharmaceutical drug development and in the clinic. Several nonclinical studies have shown di-docosahexaenoyl (22:6) bis(monoacylglycerol) phosphate (di-22:6-BMP) to be a reliable biomarker of tissue DIPL that can be monitored in the plasma/serum and urine. The aim of this study was to show the relevance of di-22:6-BMP as a DIPL biomarker for drug development and safety assessment in humans. DIPL shares many similarities with the inherited lysosomal storage disorder Niemann-Pick type C (NPC) disease. DIPL and NPC result in similar changes in lysosomal function and cholesterol status that lead to the accumulation of multi-lamellar bodies (myeloid bodies) in cells and tissues. To validate di-22:6-BMP as a biomarker of DIPL for clinical studies, NPC patients and healthy donors were classified by receiver operator curve analysis based on urinary di-22:6-BMP concentrations. By showing 96.7-specificity and 100-sensitivity to identify NPC disease, di-22:6-BMP can be used to assess DIPL in human studies. The mean concentration of di-22:6-BMP in the urine of NPC patients was 51.4-fold (p ≤ 0.05) above the healthy baseline range. Additionally, baseline levels of di-22:6-BMP were assessed in healthy non-medicated laboratory animals (rats, mice, dogs, and monkeys) and human subjects to define normal reference ranges for nonclinical/clinical studies. The baseline ranges of di-22:6-BMP in the plasma, serum, and urine of humans and laboratory animals were species dependent. The results of this study support the role of di-22:6-BMP as a biomarker of DIPL for pharmaceutical drug development and health care settings.
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Thompson MD, Nezarati MM, Gillessen-Kaesbach G, Meinecke P, Mendoza-Londono R, Mendoza R, Mornet E, Brun-Heath I, Squarcioni CP, Legeai-Mallet L, Munnich A, Cole DEC. Hyperphosphatasia with seizures, neurologic deficit, and characteristic facial features: Five new patients with Mabry syndrome. Am J Med Genet A 2010; 152A:1661-9. [PMID: 20578257 DOI: 10.1002/ajmg.a.33438] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Persistent hyperphosphatasia associated with developmental delay and seizures was described in a single family by Mabry et al. 1970 (OMIM 239300), but the nosology of this condition has remained uncertain ever since. We report on five new patients (two siblings, one offspring of consanguineous parents, and two sporadic patients) that help delineate this distinctive disorder and provide evidence in favor of autosomal recessive inheritance. Common to all five new patients is facial dysmorphism, namely hypertelorism, a broad nasal bridge and a tented mouth. All patients have some degree of brachytelephalangy but the phalangeal shortening varies in position and degree. In all, there is a persistent elevation of alkaline phosphatase activity without any evidence for active bone or liver disease. The degree of hyperphosphatasia varies considerably ( approximately 1.3-20 times the upper age-adjusted reference limit) between patients, but is relatively constant over time. In the first family described by Mabry et al. 1970, at least one member was found to have intracellular inclusions on biopsy of some but not all tissues. This was confirmed in three of our patients, but the inclusions are not always observed and the intracellular storage material has not been identified.
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Affiliation(s)
- Miles D Thompson
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Type 2 Gaucher disease: phenotypic variation and genotypic heterogeneity. Blood Cells Mol Dis 2010; 46:75-84. [PMID: 20880730 DOI: 10.1016/j.bcmd.2010.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 08/24/2010] [Indexed: 11/21/2022]
Abstract
Gaucher disease (GD), the most common lysosomal storage disease, results from a deficiency of the lysosomal enzyme glucocerebrosidase. GD has been classified into 3 types, of which type 2 (the acute neuronopathic form) is the most severe, presenting pre- or perinatally, or in the first few months of life. Traditionally, type 2 GD was considered to have the most uniform clinical phenotype when compared to other GD subtypes. However, case studies over time have demonstrated that type 2 GD, like types 1 and 3, manifests with a spectrum of phenotypes. This review includes case reports that illustrate the broad range of clinical presentations encountered in type 2 GD, as well as a discussion of associated manifestations, pathological findings, diagnostic techniques, and a review of current therapies. While type 2 GD is generally associated with severe mutations in the glucocerebrosidase gene, there is also significant genotypic heterogeneity.
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Inherited metabolic disorders involving the eye: a clinico-biochemical perspective. Eye (Lond) 2009; 24:507-18. [PMID: 19798114 DOI: 10.1038/eye.2009.229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The diagnosis of inborn errors of metabolism is challenging for most physicians. Improvements in medical technology and greater knowledge of the human genome are resulting in significant changes in the diagnosis, classification, and treatment of inherited metabolic disorders (IMDs). Many known inborn errors of metabolism will be recognised earlier or treated differently because of these changes. It is important that physicians recognise the clinical signs of IMDs and know when to propose advanced laboratory testing or referral to a higher centre for better patient management. Ocular manifestations occur in various metabolic disorders. Although there is an extensive understanding of many inborn errors of metabolism at the biochemical, molecular, and metabolic levels, little is known about their pathogenesis. In particular, how systemic metabolic disease contributes to ocular defects remains to be elucidated in IMDs. The occurrence of eye abnormalities could be due to direct toxic mechanisms of abnormal metabolic products or accumulation of normal metabolites by errors of synthetic pathways or by deficient energy metabolism. A detailed ophthalmological assessment is essential. Definitive diagnosis and management of patients with IMDs is ideally carried out by a combination of specialists, including an ophthalmologist, paediatrician, biochemist, and medical geneticist. Recent advances in the diagnosis and treatment of IMDs have substantially improved the prognosis for many of these conditions.
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Alroy J, Pfannl R, Ucci A, Lefranc G, Frattini A, Mégarbané A. Electron Microscopic Findings in Skin Biopsies from Patients with Infantile Osteopetrosis and Neuronal Storage Disease. Ultrastruct Pathol 2009; 31:333-8. [DOI: 10.1080/01913120701578098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Alroy J, Ucci AA. Skin biopsy: a useful tool in the diagnosis of lysosomal storage diseases. Ultrastruct Pathol 2007; 30:489-503. [PMID: 17182441 DOI: 10.1080/01913120500520986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this report, the authors summarize their 19-year experience with over 200 biochemically proven cases of lysosomal storage diseases using electron microscopic screening of more than 950 skin biopsies. They found that electron microscopy (EM) is a highly sensitive, efficient, cost-effective, and rapid diagnostic screening tool for evaluation of lysosomal storage diseases in skin biopsies. Although EM is more expensive than a single enzyme assay, it can exclude more than 90% of cases in which lysosomal storage disease is being considered. EM is critical for diagnosis of neuronal ceroid lipofuscinosis and mucolipidosis IV and is the most cost-effective screening tool in patients with previously unrecognized storage diseases.
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Affiliation(s)
- Joseph Alroy
- Department of Pathology, Tufts University School of Medicine and Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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Ceuterick-de Groote C, Martin JJ. Extracerebral biopsy in lysosomal and peroxisomal disorders. Ultrastructural findings. Brain Pathol 2006; 8:121-32. [PMID: 9458171 PMCID: PMC8098575 DOI: 10.1111/j.1750-3639.1998.tb00140.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The lysosomal and peroxisomal disorders are characterized by specific storage affecting mainly the central nervous system with involvement of the peripheral nervous system and visceral organs. Most of these disorders can now be diagnosed by using biochemical and enzymatical assays and by molecular biology techniques, without the need for a brain biopsy used previously. Extraneural tissue biopsies have also been investigated at the ultrastructural level. The study of such tissues is still necessary when the enzymatic or biochemical defect remains unknown and when DNA studies are not informative. The choice of tissue is important. Skin and conjunctival biopsies are less traumatic and are cost-effective diagnostic tools allowing the examination of a great diversity of structures. Skeletal muscle and peripheral nerves are more frequently used for patients with a late-onset or slower course of disease. Rectal biopsy is helpful when neurons require examination in lysosomal diseases, whereas liver is more usually investigated than adrenal or testis in peroxisomal diseases. Bone marrow is most useful for Gaucher's disease while lymphocytes may be examined for all lysosomal disorders as a first diagnostic approach. Chorionic villi still have a diagnostic role in combination of electron microscopy with DNA studies in early pregnancies at-risk for neuronal ceroid lipofuscinosis. Cultured fibroblasts are less informative than other biopsy samples for the morphological evaluation of lysosomal and peroxisomal disorders.
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Affiliation(s)
- C Ceuterick-de Groote
- Laboratory of Neuropathology, Born-Bunge Foundation and University of Antwerp (UIA), Belgium
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Kleta R, Morse RP, Orvisky E, Krasnewich D, Alroy J, Ucci AA, Bernardini I, Wenger DA, Gahl WA. Clinical, biochemical, and molecular diagnosis of a free sialic acid storage disease patient of moderate severity. Mol Genet Metab 2004; 82:137-43. [PMID: 15172001 DOI: 10.1016/j.ymgme.2004.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 11/26/2022]
Abstract
The allelic autosomal recessive lysosomal storage disorders Salla disease and infantile free sialic acid storage disease (ISSD) result from mutations in SLC17A5. This gene codes for sialin, a lysosomal membrane protein that transports the charged sugar, N-acetylneuraminic acid (sialic acid), out of lysosomes. ISSD has a severe phenotype with infantile onset, while the Finnish variant, Salla disease, has a milder phenotype with later onset. Both disorders cause developmental delay, and ISSD is generally fatal in early childhood. We describe a 30-month old non-Finnish, Caucasian child with global developmental delay of postnatal onset, language, and motor skills stagnant at a 3-4 month level, hypotonia, and mild but progressive coarsening of facial features. Urinary excretion of free sialic acid was elevated 4.5 times above control. EM of a skin biopsy revealed enlarged secondary lysosomes consistent with oligosaccharide storage. Free sialic acid in fibroblasts was 3.8+/-0.9 nmol/mg protein (concurrent normal controls, 0.5+/-0.1); differential centrifugation indicated a lysosomal location. Genomic analysis revealed compound heterozygosity for two new SLC17A5 mutations. This child's clinical manifestations of a lysosomal free sialic acid storage disease are consistent with her sialin mutations and biochemical findings. The differential diagnosis of postnatal developmental delay should include free sialic acid storage disorders such as ISSD and Salla disease.
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Affiliation(s)
- Robert Kleta
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Pagano RE. Endocytic trafficking of glycosphingolipids in sphingolipid storage diseases. Philos Trans R Soc Lond B Biol Sci 2003; 358:885-91. [PMID: 12803922 PMCID: PMC1693187 DOI: 10.1098/rstb.2003.1275] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In this review, recent studies of membrane lipid transport in sphingolipid (SL) storage disease (SLSD) fibroblasts are summarized. Several fluorescent glycosphingolipid (GSL) analogues are internalized from the plasma membrane via caveolae and are subsequently transported to the Golgi complex of normal fibroblasts, while in 10 different SLSD cell types, these lipids accumulate in endosomes and lysosomes. Additional studies have shown that cholesterol homeostasis is perturbed in multiple SLSDs secondary to accumulation of endogenous SLs, and that mis-targeting of the GSLs is regulated by cellular cholesterol. Golgi targeting of GSLs internalized via caveolae is dependent on microtubules and phosphoinositide 3-kinase(s) and is inhibited by expression of dominant-negative rab7 and rab9 constructs. Overexpression of wild-type rab7 or rab9 (but not rab11) in Niemann-Pick C fibroblasts results in correction of lipid trafficking defects, including restoration of Golgi targeting of fluorescent lactosylceramide and endogenous GM1 ganglioside (monitored by the transport of fluorescent cholera toxin), and a dramatic reduction in accumulation of intracellular cholesterol. These results suggest an approach for restoring normal lipid trafficking in this, and perhaps other, SLSD cell types, and may provide a basis for future therapy of these diseases.
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Affiliation(s)
- Richard E Pagano
- Department of Biochemistry and Molecular Biology, Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905, USA.
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Shebani E, Johannesson M, Strömberg B, Roomans GM. A patient with type 2 Gaucher's disease with respiratory disease. J Pediatr 2003; 142:209-10. [PMID: 12584549 DOI: 10.1067/mpd.2003.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A 5-month-old boy had respiratory problems and gastroesophageal reflux. Electron microscopy of a tracheal biopsy specimen showed accumulation of lamellar bodies in the columnar cells indicative of lysosomal storage disease. Subsequently, the child had neurologic symptoms and hepatosplenomegaly, and the diagnosis of Gaucher's disease type 2 was made.
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Affiliation(s)
- Eyman Shebani
- Departments of Medical Cell Biology, University of Uppsala, Uppsala, Sweden
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Nyska A, Nold JB, Johnson JD, Abdo K. Lysosomal-storage disorder induced by elmiron following 90-days gavage administration in rats and mice. Toxicol Pathol 2002; 30:178-87. [PMID: 11950161 DOI: 10.1080/019262302753559515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Elmiron, a highly sulfated, semisynthetic pentose polysaccharide with properties similar to heparin, is used for the treatment of interstitial cystitis. Thirteen-week gavage studies were conducted by administering the drug in deionized water to F344/N rats and B6C3F1 mice once daily, 5 days per week for up to 13 consecutive weeks, at doses of 0, 63, 125, 250, 500, and 1,000 mg/kg body weight. No significant drug-related effects were observed in body weight, survival, clinical, and necropsy results. Significant organ weight increases were seen in the liver, lungs, and spleen of both species and the kidneys of rats, mainly in groups treated with 250 mg/kg/day and above. Hematological analysis indicated increases for both species in the white blood cell and lymphocyte counts. Sites of toxicity identified histopathologically were the rectum, liver, mesenteric and mandibular lymph nodes (both sexes), spleen (mice only), and lungs and kidneys (rats only). Lesions consisted mainly of infiltration into multiple tissues of vacuolated histiocytes, which, by histochemical investigation, indicated the presence of neutral and acidic mucins and lipidic material within the vacuoles. Transmission electron microscopy identified these vacuoles as lysosomal structures that exhibited a variety of contents. On the basis of our findings, we propose that Elmiron was absorbed through the focally disrupted rectal mucosa, was deposited in the lamina propria, accumulated within macrophages, and then was distributed by these cells or as a free chemical via the lymphatics and blood, to the various organ sites manifesting histiocytic infiltration. The cytoplasmic membrane-bound structures within macrophages were lysosomes containing membranous material of cellular origin and, perhaps, remnants of the deposited test material, Elmiron.
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Affiliation(s)
- Abraham Nyska
- Laboratory of Experimental Pathology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709, USA.
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Gao H, Boustany RMN, Espinola JA, Cotman SL, Srinidhi L, Antonellis KA, Gillis T, Qin X, Liu S, Donahue LR, Bronson RT, Faust JR, Stout D, Haines JL, Lerner TJ, MacDonald ME. Mutations in a novel CLN6-encoded transmembrane protein cause variant neuronal ceroid lipofuscinosis in man and mouse. Am J Hum Genet 2002; 70:324-35. [PMID: 11791207 PMCID: PMC384912 DOI: 10.1086/338190] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2001] [Accepted: 10/19/2001] [Indexed: 11/03/2022] Open
Abstract
The CLN6 gene that causes variant late-infantile neuronal ceroid lipofuscinosis (vLINCL), a recessively inherited neurodegenerative disease that features blindness, seizures, and cognitive decline, maps to 15q21-23. We have used multiallele markers spanning this approximately 4-Mb candidate interval to reveal a core haplotype, shared in Costa Rican families with vLINCL but not in a Venezuelan kindred, that highlighted a region likely to contain the CLN6 defect. Systematic comparison of genes from the minimal region uncovered a novel candidate, FLJ20561, that exhibited DNA sequence changes specific to the different disease chromosomes: a G-->T transversion in exon 3, introducing a stop codon on the Costa Rican haplotype, and a codon deletion in exon 5, eliminating a conserved tyrosine residue on the Venezuelan chromosome. Furthermore, sequencing of the murine homologue in the nclf mouse, which manifests recessive NCL-like disease, disclosed a third lesion-an extra base pair in exon 4, producing a frameshift truncation on the nclf chromosome. Thus, the novel approximately 36-kD CLN6-gene product augments an intriguing set of unrelated membrane-spanning proteins, whose deficiency causes NCL in mouse and man.
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Affiliation(s)
- Hanlin Gao
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Rose-Mary N. Boustany
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Janice A. Espinola
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Susan L. Cotman
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Lakshmi Srinidhi
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Kristen Auger Antonellis
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Tammy Gillis
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Xuebin Qin
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Shumei Liu
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Leah R. Donahue
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Roderick T. Bronson
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Jerry R. Faust
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Derek Stout
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Jonathan L. Haines
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Terry J. Lerner
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
| | - Marcy E. MacDonald
- Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown; Division of Pediatric Neurology, Duke University Medical Center, Durham, NC; Depratment of Physiology, Tufts University School of Medicine, Boston; The Jackson Laboratory, Bar Harbor, ME; and Program in Human Genetics, Vanderbilt University Medical Center, Nashville
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Warren CD, Alroy J. Morphological, biochemical and molecular biology approaches for the diagnosis of lysosomal storage diseases. J Vet Diagn Invest 2000; 12:483-96. [PMID: 11108447 DOI: 10.1177/104063870001200601] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- C D Warren
- Department of Biomedical Sciences, EK Shriver Center for Mental Retardation, Inc., Waltham, MA 02154, USA
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Abstract
In this review, we summarize our studies of membrane lipid transport in sphingolipid storage disease (SLSD) fibroblasts. We recently showed that several fluorescent SL analogs were internalized from the plasma membrane predominantly to the Golgi complex of normal cells, while in ten different SLSD cell types, these lipids accumulated in endosomes and lysosomes (The Lancet 1999;354: 901-905). Additional studies showed that cholesterol homeostasis is perturbed in multiple SLSDs secondary to SL accumulation and that mistargeting of SL analogs was regulated by cholesterol (Nature Cell Biol 1999;1: 386-388). Based on these findings, we hypothesize that endogenous sphingolipids, which accumulate in SLSD cells due to primary defects in lipid catabolism, result in an altered intracellular distribution of cholesterol, and that this alteration in membrane composition then results in defective sorting and transport of SLs. The importance of SL/cholesterol interactions and potential mechanisms underlying the regulation of lipid transport and targeting are also discussed. These studies suggest a new paradigm for regulation of membrane lipid traffic along the endocytic pathway and could have important implications for future studies of protein trafficking as well as lipid transport. This work may also lead to important future clinical developments (e.g. screening tests for SLSD, new methodology for screening drugs which abrogate lipid storage, and possible therapeutic approaches to SLSD).
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Affiliation(s)
- R E Pagano
- Department of Biochemistry and Molecular Biology, Mayo Clinic and Foundation, 200 First Street, S.W., Rochester, MN 55905, USA.
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Lubensky IA, Schiffmann R, Goldin E, Tsokos M. Lysosomal inclusions in gastric parietal cells in mucolipidosis type IV: a novel cause of achlorhydria and hypergastrinemia. Am J Surg Pathol 1999; 23:1527-31. [PMID: 10584706 DOI: 10.1097/00000478-199912000-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mucolipidosis type IV (ML-IV) is an autosomal recessive lysosomal storage disease that causes severe neurologic abnormalities. The brain disease is characterized by pigmented cytoplasmic granules in neurons and accumulation of lamellated membrane structures in lysosomes. The gastrointestinal disease in ML-IV was not previously recognized. Clinical examination of 20 patients with ML-IV (age range, 2-23 years) at the National Institutes of Health showed hypergastrinemia and constitutive achlorhydria. Endoscopic biopsy specimens from the gastric fundus, body, and antrum and from the duodenum of four such patients (ages 4, 6, 7, and 22 years) were evaluated histologically and by electron microscopy. Histologically, all gastric fundus and body biopsy specimens showed parietal cells in normal numbers. However, a striking cytoplasmic vacuolization of parietal cells was seen on hematoxylin and eosin stain. Electron microscopy showed the parietal cells to be markedly distended by large lysosomes containing lamellar, concentric, and cystic membranous inclusions. Additionally, chronic atrophic gastritis and enterochromaffin-like (ECL) cell hyperplasia were observed. Foveolar and chief cells in stomach and duodenum biopsy specimens were normal. We conclude that the cytoplasmic lysosomal inclusions in gastric parietal cells is a unique histologic feature of gastric biopsy in ML-IV.
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Affiliation(s)
- I A Lubensky
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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21
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Abstract
Among the numerous neurodegenerative diseases in children few may allow morphological diagnosis by extracerebral biopsy. These encompass neurometabolic conditions, foremost lysosomal disorders, but also peroxisomal and mitochondrial diseases marked by disease- or group-specific organelles. Largely, these neurometabolic conditions can also be diagnosed by biochemical and increasingly by molecular genetic techniques. However, there are a few neurodegenerative diseases which do not allow either biochemical or molecular genetic diagnosis and, thus, rely on biopsy of extracerebral tissues, so-called 'essential' biopsies to achieve a diagnosis during the patient's life. Among these few disorders only Lafora disease, as other polyglucosan disorders, may be considered a neurometabolic disease, whereas in the others, neuroaxonal dystrophies, giant axonal neuropathy and neuronal intranuclear inclusion disease no metabolic abnormalities are known, but these disorders share the peripheral nervous system as a common site of their disease-specific morphological lesions. With the progress of molecular genetics and the fact that many neurodegenerative diseases are familial, it is expected that the number of neurodegenerative disorders and the number of patients afflicted with these diseases, currently subject to diagnostic extracerebral biopsies, will be continuously reduced. Thus, it is foreseeable that within the next few years or decades diagnostic electron microscopy and the related knowledge of respective ultrastructural pathology may become outmoded, and, possibly, unknown to future generations of neuropathologists and other members of the neuroscience community.
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Affiliation(s)
- H H Goebel
- Department of Neuropathology, Johannes Gutenberg University, Mainz, Germany.
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