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Walker RH, Barreto M, Bateman JR, Bustamante ML, Chiu G, Feitell S, Frey BM, Guerra P, Guerrero S, Jung HH, Maldonado F, Meyer E, Miranda M, McFarland E, Oates P, Ochoa G, Olsson K, Paucar M, Proschle JA, Sammler EM, Troncoso M, Wu-Wallace R, Young L, Vege S, Westhoff CM, Danek A. The protean presentations of XK disease (McLeod syndrome): a case series with new observations and updates on previously reported families. Front Neurosci 2024; 18:1408105. [PMID: 39315078 PMCID: PMC11417094 DOI: 10.3389/fnins.2024.1408105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
XK disease is a very rare, multi-system disease, which can present with a wide spectrum of symptoms. This disorder can also be identified pre-symptomatically with the incidental detection of serological abnormalities when typing erythrocytes in peripheral blood, or on other routine laboratory testing. Increasing awareness of this disorder and improved access to genetic testing are resulting in increasing identification of affected patients and families. Here we provide updates to some previously-reported families and patients and provide additional clinical details. We also report four new cases with a variety of presentations, one of whom had a novel mutation.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, New York, NY, United States
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | | | - James R Bateman
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - M Leonor Bustamante
- Diagnosis Foundation, Santiago, Chile
- Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, University of Chile, Santiago, Chile
| | - Graham Chiu
- Rheumatologist, Palmerston North, New Zealand
| | - Scott Feitell
- Rochester Regional Health, Sands-Constellation Heart Institute, Rochester, NY, United States
| | - Beat M Frey
- Regional Blood Transfusion Service, Swiss Red Cross, Zurich, Switzerland
| | - Patricio Guerra
- School of Medicine, University San Sebastián, Puerto Montt, Chile
| | | | - Hans H Jung
- Department of Neurology, University Hospital, Zurich, Switzerland
| | | | - Eduardo Meyer
- Regional Blood Transfusion Service, Swiss Red Cross, Zurich, Switzerland
| | - Marcelo Miranda
- Diagnosis Foundation, Santiago, Chile
- Clínica Meds, Lo Barnechea, Chile
| | - Emelie McFarland
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
| | - Patricia Oates
- Rochester Regional Health, Sands-Constellation Heart Institute, Rochester, NY, United States
| | - Gorka Ochoa
- New York Blood Center Enterprises, New York, NY, United States
| | - Karin Olsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Paucar
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Monica Troncoso
- Hospital San Borja Arriaran, University of Chile, Santiago, Chile
| | - Rachel Wu-Wallace
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, United States
| | - Leo Young
- Mental Health Service Line and the Mental Illness Research, Education, and Clinical Center, W.G. (Bill) Hefner Salisbury Veterans Affairs Medical Center, Salisbury, NC, United States
| | - Sunitha Vege
- New York Blood Center Enterprises, New York, NY, United States
| | | | - Adrian Danek
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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2
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Hernández CA, Peikert K, Qiao M, Darras A, de Wilde JRA, Bos J, Leibowitz M, Galea I, Wagner C, Rab MAE, Walker RH, Hermann A, van Beers EJ, van Wijk R, Kaestner L. Osmotic gradient ektacytometry - a novel diagnostic approach for neuroacanthocytosis syndromes. Front Neurosci 2024; 18:1406969. [PMID: 39091345 PMCID: PMC11292800 DOI: 10.3389/fnins.2024.1406969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The unique red blood cell (RBC) properties that characterize the rare neuroacanthocytosis syndromes (NAS) have prompted the exploration of osmotic gradient ektacytometry (Osmoscan) as a diagnostic tool for these disorders. In this exploratory study, we assessed if Osmoscans can discriminate NAS from other neurodegenerative diseases. Methods A comprehensive assessment was conducted using Osmoscan on a diverse group of patients, including healthy controls (n = 9), neuroacanthocytosis syndrome patients (n = 6, 2 VPS13A and 4 XK disease), Parkinson's disease patients (n = 6), Huntington's disease patients (n = 5), and amyotrophic lateral sclerosis patients (n = 4). Concurrently, we collected and analyzed RBC indices and patients' characteristics. Results Statistically significant changes were observed in NAS patients compared to healthy controls and other conditions, specifically in osmolality at minimal elongation index (Omin), maximal elongation index (EImax), the osmolality at half maximal elongation index in the hyperosmotic part of the curve (Ohyper), and the width of the curve close to the osmolality at maximal elongation index (Omax-width). Discussion This study represents an initial exploration of RBC properties from NAS patients using osmotic gradient ektacytometry. While specific parameters exhibited differences, only Ohyper and Omax-width yielded 100% specificity for other neurodegenerative diseases. Moreover, unique correlations between Osmoscan parameters and RBC indices in NAS versus controls were identified, such as osmolality at maximal elongation index (Omax) vs. mean cellular hemoglobin content (MCH) and minimal elongation index (EImin) vs. red blood cell distribution width (RDW). Given the limited sample size, further studies are essential to establish diagnostic guidelines based on these findings.
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Affiliation(s)
- Carolina A. Hernández
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, trecht University, Utrecht, Netherlands
| | - Kevin Peikert
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- United Neuroscience Campus Lund-Rostock (UNC), Rostock, Germany
| | - Min Qiao
- Dynamics of Fluids, Experimental Physics, Saarland University, Saarbrücken, Germany
- Heoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
| | - Alexis Darras
- Dynamics of Fluids, Experimental Physics, Saarland University, Saarbrücken, Germany
| | - Jonathan R. A. de Wilde
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, trecht University, Utrecht, Netherlands
| | - Jennifer Bos
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, trecht University, Utrecht, Netherlands
| | - Maya Leibowitz
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Christian Wagner
- Dynamics of Fluids, Experimental Physics, Saarland University, Saarbrücken, Germany
- Physics and Materials Science Research Unit, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Minke A. E. Rab
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, trecht University, Utrecht, Netherlands
- Department of Hematology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ruth H. Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
- Department of Neurology, Mount Sinai School of Medicine, New York City, NY, United States
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Eduard J. van Beers
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Richard van Wijk
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, trecht University, Utrecht, Netherlands
| | - Lars Kaestner
- Dynamics of Fluids, Experimental Physics, Saarland University, Saarbrücken, Germany
- Heoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
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Alkahtani S, Alkahtane AA, Alarifi S. Physiological and Pathogenesis Significance of Chorein in Health and Disease. Physiol Res 2024; 73:189-203. [PMID: 38710051 PMCID: PMC11081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 05/08/2024] Open
Abstract
This comprehensive review explores the physiological and pathophysiological significance of VPS13A, a protein encoded by the VPS13A gene. The VPS13A gene is associated with Chorea-acanthocytosis (ChAc), a rare hereditary neurodegenerative disorder. The review covers essential aspects, beginning with the genetics of VPS13A, highlighting its role in the pathogenesis of ChAc, and addressing the spectrum of genetic variants involved. It delves into the structure and function of the VPS13A protein, emphasizing its presence in various tissues and its potential involvement in protein trafficking and lipid homeostasis. Molecular functions of VPS13A in the brain tissue and other cell types or tissues with respect to their role in cytoskeletal regulation and autophagy are explored. Finally, it explores the intriguing link between VPS13A mutations, lipid imbalances, and neurodegeneration, shedding light on future research directions. Overall, this review serves as a comprehensive resource for understanding the pivotal role of VPS13A in health and disease, particularly in the context of ChAc. Key words: Chorein , Tumor, Actin, Microfilament, Gene expression, Chorea-acanthocytosis.
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Affiliation(s)
- S Alkahtani
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia.
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Taraconat P, Gineys JP, Isebe D, Nicoud F, Mendez S. Red blood cell rheology during a complete blood count: A proof of concept. PLoS One 2023; 18:e0280952. [PMID: 36706122 PMCID: PMC9882912 DOI: 10.1371/journal.pone.0280952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
Counting and sizing blood cells in hematological analyzers is achieved using the Coulter principle. The cells flow in a micro-aperture in which a strong electrical field is imposed, so that an electrical perturbation, called pulse, is measured each time a cell crosses the orifice. The pulses are expected to contain information on the shape and deformability of Red Blood Cells (RBCs), since recent studies state that RBCs rotate and deform in the micro-orifice. By implementing a dedicated numerical model, the present study sheds light on a variety of cells dynamics, which leads to different associated pulse signatures. Furthermore, simulations provide new insights on how RBCs shapes and mechanical properties affect the measured signals. Those numerical observations are confirmed by experimental assays. Finally, specific features are introduced for assessing the most relevant characteristics from the various pulse signatures and shown to highlight RBCs alterations induced by drugs. In summary, this study paves the way to a characterization of RBC rheology by routine hematological instruments.
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Affiliation(s)
- Pierre Taraconat
- Horiba Medical, Montpellier, France
- Institut Montpellierain Alexander Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
- * E-mail: (PT); (SM)
| | | | | | - Franck Nicoud
- Institut Montpellierain Alexander Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
| | - Simon Mendez
- Institut Montpellierain Alexander Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
- * E-mail: (PT); (SM)
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5
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Darras A, Peikert K, Rabe A, Yaya F, Simionato G, John T, Dasanna AK, Buvalyy S, Geisel J, Hermann A, Fedosov DA, Danek A, Wagner C, Kaestner L. Acanthocyte Sedimentation Rate as a Diagnostic Biomarker for Neuroacanthocytosis Syndromes: Experimental Evidence and Physical Justification. Cells 2021; 10:788. [PMID: 33918219 PMCID: PMC8067274 DOI: 10.3390/cells10040788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 01/28/2023] Open
Abstract
(1) Background: Chorea-acanthocytosis and McLeod syndrome are the core diseases among the group of rare neurodegenerative disorders called neuroacanthocytosis syndromes (NASs). NAS patients have a variable number of irregularly spiky erythrocytes, so-called acanthocytes. Their detection is a crucial but error-prone parameter in the diagnosis of NASs, often leading to misdiagnoses. (2) Methods: We measured the standard Westergren erythrocyte sedimentation rate (ESR) of various blood samples from NAS patients and healthy controls. Furthermore, we manipulated the ESR by swapping the erythrocytes and plasma of different individuals, as well as replacing plasma with dextran. These measurements were complemented by clinical laboratory data and single-cell adhesion force measurements. Additionally, we followed theoretical modeling approaches. (3) Results: We show that the acanthocyte sedimentation rate (ASR) with a two-hour read-out is significantly prolonged in chorea-acanthocytosis and McLeod syndrome without overlap compared to the ESR of the controls. Mechanistically, through modern colloidal physics, we show that acanthocyte aggregation and plasma fibrinogen levels slow down the sedimentation. Moreover, the inverse of ASR correlates with the number of acanthocytes (R2=0.61, p=0.004). (4) Conclusions: The ASR/ESR is a clear, robust and easily obtainable diagnostic marker. Independently of NASs, we also regard this study as a hallmark of the physical view of erythrocyte sedimentation by describing anticoagulated blood in stasis as a percolating gel, allowing the application of colloidal physics theory.
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Affiliation(s)
- Alexis Darras
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
| | - Kevin Peikert
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18051 Rostock, Germany; (K.P.); (A.H.)
- Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Antonia Rabe
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
- Theoretical Medicine and Biosciences, Saarland University, 66424 Homburg, Germany
| | - François Yaya
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
- Laboratoire Interdisciplinaire de Physique, UMR 5588, 38402 Saint Martin d’Hères, France
| | - Greta Simionato
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
- Institute for Clinical and Experimental Surgery, Saarland University, 66424 Homburg, Germany;
| | - Thomas John
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
| | - Anil Kumar Dasanna
- Institute of Biological Information Processing and Institute for Advanced Simulation, Forschungszentrum Jülich, 52425 Jülich, Germany; (A.K.D.); (S.B.); (D.A.F.)
| | - Semen Buvalyy
- Institute of Biological Information Processing and Institute for Advanced Simulation, Forschungszentrum Jülich, 52425 Jülich, Germany; (A.K.D.); (S.B.); (D.A.F.)
| | - Jürgen Geisel
- Institute for Clinical and Experimental Surgery, Saarland University, 66424 Homburg, Germany;
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18051 Rostock, Germany; (K.P.); (A.H.)
- Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, 01062 Dresden, Germany
- DZNE, German Center for Neurodegenerative Diseases, Research Site Rostock/Greifswald, 18051 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, 18051 Rostock, Germany
| | - Dmitry A. Fedosov
- Institute of Biological Information Processing and Institute for Advanced Simulation, Forschungszentrum Jülich, 52425 Jülich, Germany; (A.K.D.); (S.B.); (D.A.F.)
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, 81366 Munich, Germany;
| | - Christian Wagner
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
- Physics and Materials Science Research Unit, University of Luxembourg, 1511 Luxembourg, Luxembourg
| | - Lars Kaestner
- Experimental Physics, Saarland University, 66123 Saarbruecken, Germany; (A.R.); (F.Y.); (G.S.); (T.J.); (C.W.)
- Theoretical Medicine and Biosciences, Saarland University, 66424 Homburg, Germany
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6
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Cloos AS, Daenen LGM, Maja M, Stommen A, Vanderroost J, Van Der Smissen P, Rab M, Westerink J, Mignolet E, Larondelle Y, Terrasi R, Muccioli GG, Dumitru AC, Alsteens D, van Wijk R, Tyteca D. Impaired Cytoskeletal and Membrane Biophysical Properties of Acanthocytes in Hypobetalipoproteinemia - A Case Study. Front Physiol 2021; 12:638027. [PMID: 33708142 PMCID: PMC7940373 DOI: 10.3389/fphys.2021.638027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/25/2021] [Indexed: 12/03/2022] Open
Abstract
Familial hypobetalipoproteinemia is a metabolic disorder mainly caused by mutations in the apolipoprotein B gene. In its homozygous form it can lead without treatment to severe ophthalmological and neurological manifestations. In contrast, the heterozygous form is generally asymptomatic but associated with a low risk of cardiovascular disease. Acanthocytes or thorny red blood cells (RBCs) are described for both forms of the disease. However, those morphological changes are poorly characterized and their potential consequences for RBC functionality are not understood. Thus, in the present study, we asked whether, to what extent and how acanthocytes from a patient with heterozygous familial hypobetalipoproteinemia could exhibit altered RBC functionality. Acanthocytes represented 50% of the total RBC population and contained mitoTracker-positive surface patches, indicating the presence of mitochondrial fragments. While RBC osmotic fragility, calcium content and ATP homeostasis were preserved, a slight decrease of RBC deformability combined with an increase of intracellular free reactive oxygen species were observed. The spectrin cytoskeleton was altered, showing a lower density and an enrichment in patches. At the membrane level, no obvious modification of the RBC membrane fatty acids nor of the cholesterol content were detected but the ceramide species were all increased. Membrane stiffness and curvature were also increased whereas transversal asymmetry was preserved. In contrast, lateral asymmetry was highly impaired showing: (i) increased abundance and decreased functionality of sphingomyelin-enriched domains; (ii) cholesterol enrichment in spicules; and (iii) ceramide enrichment in patches. We propose that oxidative stress induces cytoskeletal alterations, leading to increased membrane stiffness and curvature and impaired lipid lateral distribution in domains and spicules. In addition, ceramide- and spectrin-enriched patches could result from a RBC maturation defect. Altogether, the data indicate that acanthocytes are associated with cytoskeletal and membrane lipid lateral asymmetry alterations, while deformability is only mildly impaired. In addition, familial hypobetalipoproteinemia might also affect RBC precursors leading to disturbed RBC maturation. This study paves the way for the potential use of membrane biophysics and lipid vital imaging as new methods for diagnosis of RBC disorders.
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Affiliation(s)
- Anne-Sophie Cloos
- CELL Unit & PICT Imaging Platform, de Duve Institute, UCLouvain, Brussels, Belgium
| | - Laura G M Daenen
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mauriane Maja
- CELL Unit & PICT Imaging Platform, de Duve Institute, UCLouvain, Brussels, Belgium
| | - Amaury Stommen
- CELL Unit & PICT Imaging Platform, de Duve Institute, UCLouvain, Brussels, Belgium
| | - Juliette Vanderroost
- CELL Unit & PICT Imaging Platform, de Duve Institute, UCLouvain, Brussels, Belgium
| | | | - Minke Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Eric Mignolet
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Yvan Larondelle
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Romano Terrasi
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Giulio G Muccioli
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Andra C Dumitru
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - David Alsteens
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Richard van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Donatienne Tyteca
- CELL Unit & PICT Imaging Platform, de Duve Institute, UCLouvain, Brussels, Belgium
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7
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Werning M, Müllner EW, Mlynek G, Dobretzberger V, Djinovic-Carugo K, Baron DM, Prokisch H, Büchner B, Klopstock T, Salzer U. PKAN neurodegeneration and residual PANK2 activities in patient erythrocytes. Ann Clin Transl Neurol 2020; 7:1340-1351. [PMID: 32705819 PMCID: PMC7448160 DOI: 10.1002/acn3.51127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/14/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Pantothenate kinase 2‐associated neurodegeneration (PKAN) is a rare neurodegenerative disease caused by mutations in the pantothenate kinase 2 (PANK2) gene. PKAN is associated with iron deposition in the basal ganglia and, occasionally, with the occurrence of misshaped erythrocytes (acanthocytes). The aim of this study was to assess residual activity of PANK2 in erythrocytes of PKAN patients and to correlate these data with the type of PANK2 mutations and the progression of neurodegeneration. Methods Residual PANK2 activities in erythrocytes of 14 PKAN patients and 14 related carriers were assessed by a radiometric assay. Clinical data on neurodegeneration included the Barry–Albright Dystonia Scale (BAD‐Scale) besides further general patient features. A molecular visualization and analysis program was used to rationalize the influence of the PKAN causing mutations on a molecular level. Results Erythrocytes of PKAN patients had markedly reduced or no PANK2 activity. However, patients with at least one allele of the c.1583C > T (T528M) or the c.833G > T (R278L) variant exhibited 12–56% of residual PANK2 activity. In line, molecular modeling indicated only minor effects on enzyme structure for these point mutations. On average, these patients with c.1583C > T or c.833G > T variant had lower BAD scores corresponding to lower symptom severity than patients with other PANK2 point mutations. Interpretation Residual erythrocyte PANK2 activity could be a predictor for the progression of neurodegeneration in PKAN patients. Erythrocytes are an interesting patient‐derived cell system with still underestimated diagnostic potential.
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Affiliation(s)
- Maike Werning
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ernst W Müllner
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Georg Mlynek
- Department of Structural and Computational Biology, Max Perutz Labs, University of Vienna, Vienna, Austria
| | - Verena Dobretzberger
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Kristina Djinovic-Carugo
- Department of Structural and Computational Biology, Max Perutz Labs, University of Vienna, Vienna, Austria.,Department of Biochemistry, Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
| | - David M Baron
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Holger Prokisch
- Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Boriana Büchner
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ulrich Salzer
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
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8
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Peikert K, Danek A, Hermann A. Current state of knowledge in Chorea-Acanthocytosis as core Neuroacanthocytosis syndrome. Eur J Med Genet 2018; 61:699-705. [DOI: 10.1016/j.ejmg.2017.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
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9
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Murphy OC, O’Toole O, Hand CK, Ryan AM. Chorea-Acanthocytosis and the Huntington Disease Allele in an Irish Family. Tremor Other Hyperkinet Mov (N Y) 2018; 8:604. [PMID: 30622839 PMCID: PMC6315059 DOI: 10.7916/d8r22j6m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Olwen C. Murphy
- Department of Neurology, National Neuroscience Centre, Cork University Hospital, Cork, IE
- Department of Neurology, Mercy University Hospital, Cork, IE
| | - Orna O’Toole
- Department of Neurology, Mercy University Hospital, Cork, IE
| | | | - Aisling M. Ryan
- Department of Neurology, National Neuroscience Centre, Cork University Hospital, Cork, IE
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Anderson DG, Carmona S, Naidoo K, Coetzer TL, Carr J, Rudnicki DD, Walker RH, Margolis RL, Krause A. Absence of Acanthocytosis in Huntington's Disease-like 2: A Prospective Comparison with Huntington's Disease. Tremor Other Hyperkinet Mov (N Y) 2017; 7:512. [PMID: 29226019 PMCID: PMC5721130 DOI: 10.7916/d81j9pdx] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/15/2017] [Indexed: 12/27/2022] Open
Abstract
Background Huntington's Disease-like 2 (HDL2) is classified as a neuroacanthocytosis; however, this remains unverified. We aim to determine if acanthocytes are present in HDL2 and whether acanthocytes can differentiate HDL2 from Huntington's disease (HD). Methods We prospectively compared 13 HD and 12 HDL2 cases against 21 unaffected controls in Johannesburg. Blood smears were prepared using international standards and reviewed by at least two blinded reviewers. An acanthocytosis rate of greater than 1.2% in the dry smear or greater than 3.7% in the wet smear was designated a priori as the threshold for clinical significance based on previously established standards. Flow cytometry was performed on all but four of the cases. Red cell membrane protein analysis was performed on all participants. Results There were 12 HDL2, 13 HD, and 21 controls enrolled. None of the HD or HDL2 participants had defined acanthocytosis or other morphological abnormalities. None of the HD or HDL2 cases had evidence of an abnormal band 3. Discussion Acanthocytosis was not identified in either HDL2 or HD in our patient population. Our results, based on the first prospective study of acanthocytes in HDL2 or HD, suggest that screening for acanthocytes will not help establish the diagnosis of HD or HDL2, nor differentiate between the two disorders and raises the question if HDL2 should be placed within the neuroacanthocytosis syndromes.
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Affiliation(s)
- David G. Anderson
- Department of Neurology, The University of the Witwatersrand Donald Gordon Medical Center, Johannesburg, South Africa
- Division of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sergio Carmona
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kubendran Naidoo
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Theresa L. Coetzer
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Carr
- Department of Neurology, University of Stellenbosch, Cape Town, South Africa
| | - Dobrila D. Rudnicki
- Office of Special Initiatives, National Center for Advancing Translational Sciences, NIH, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruth H. Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- Department of Neurology, Mount Sinai School of Medicine, New York City, NY, USA
| | - Russell L. Margolis
- Departments of Psychiatry and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda Krause
- Division of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, National Health Laboratory Service, Johannesburg, South Africa
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11
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Bokori-Brown M, Petrov PG, Khafaji MA, Mughal MK, Naylor CE, Shore AC, Gooding KM, Casanova F, Mitchell TJ, Titball RW, Winlove CP. Red Blood Cell Susceptibility to Pneumolysin: CORRELATION WITH MEMBRANE BIOCHEMICAL AND PHYSICAL PROPERTIES. J Biol Chem 2016; 291:10210-27. [PMID: 26984406 DOI: 10.1074/jbc.m115.691899] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Indexed: 12/20/2022] Open
Abstract
This study investigated the effect of the biochemical and biophysical properties of the plasma membrane as well as membrane morphology on the susceptibility of human red blood cells to the cholesterol-dependent cytolysin pneumolysin, a key virulence factor of Streptococcus pneumoniae, using single cell studies. We show a correlation between the physical properties of the membrane (bending rigidity and surface and dipole electrostatic potentials) and the susceptibility of red blood cells to pneumolysin-induced hemolysis. We demonstrate that biochemical modifications of the membrane induced by oxidative stress, lipid scrambling, and artificial cell aging modulate the cell response to the toxin. We provide evidence that the diversity of response to pneumolysin in diabetic red blood cells correlates with levels of glycated hemoglobin and that the mechanical properties of the red blood cell plasma membrane are altered in diabetes. Finally, we show that diabetic red blood cells are more resistant to pneumolysin and the related toxin perfringolysin O relative to healthy red blood cells. Taken together, these studies indicate that the diversity of cell response to pneumolysin within a population of human red blood cells is influenced by the biophysical and biochemical status of the plasma membrane and the chemical and/or oxidative stress pre-history of the cell.
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Affiliation(s)
- Monika Bokori-Brown
- From the College of Life and Environmental Sciences, School of Biosciences, University of Exeter, Exeter EX4 4QD, United Kingdom,
| | - Peter G Petrov
- the College of Engineering, Mathematics and Physical Sciences, School of Physics, University of Exeter, Exeter EX4 4QL, United Kingdom
| | - Mawya A Khafaji
- the College of Engineering, Mathematics and Physical Sciences, School of Physics, University of Exeter, Exeter EX4 4QL, United Kingdom
| | - Muhammad K Mughal
- the Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Claire E Naylor
- the Department of Biological Sciences, Birkbeck College, Malet Street, London WC1E 7HX, United Kingdom
| | - Angela C Shore
- the Department of Diabetes and Vascular Medicine, University of Exeter Medical School, Barrack Road, Exeter EX2 5AX, United Kingdom, the National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter National Health Service Foundation Trust, Exeter EX2 5DW, United Kingdom, and
| | - Kim M Gooding
- the Department of Diabetes and Vascular Medicine, University of Exeter Medical School, Barrack Road, Exeter EX2 5AX, United Kingdom, the National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter National Health Service Foundation Trust, Exeter EX2 5DW, United Kingdom, and
| | - Francesco Casanova
- the Department of Diabetes and Vascular Medicine, University of Exeter Medical School, Barrack Road, Exeter EX2 5AX, United Kingdom, the National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter National Health Service Foundation Trust, Exeter EX2 5DW, United Kingdom, and
| | - Tim J Mitchell
- the Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Richard W Titball
- From the College of Life and Environmental Sciences, School of Biosciences, University of Exeter, Exeter EX4 4QD, United Kingdom
| | - C Peter Winlove
- the College of Engineering, Mathematics and Physical Sciences, School of Physics, University of Exeter, Exeter EX4 4QL, United Kingdom
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12
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Popkirov S, Schlegel U, Skodda S. Is postoperative encephalopathy with choreoathetosis an acquired form of neuroacanthocytosis? Med Hypotheses 2016; 89:21-3. [PMID: 26968902 DOI: 10.1016/j.mehy.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/01/2016] [Indexed: 12/01/2022]
Abstract
Postoperative encephalopathy with choreoathetosis ("postpump chorea") is a rare complication of open-heart surgery and, in particular, the employment of a cardiopulmonary bypass pump. It almost exclusively occurs in young children. While risk factors and the underlying histopathology have been identified, the pathogenesis of postpump chorea, crucially, remains largely unknown. Transient cerebral hypoperfusion associated with cardiopulmonary bypass is considered a likely candidate mechanism, but the evidence is insufficient and inconclusive. It is hypothesized in this article, that postpump chorea may be caused by mechanical trauma to red blood cells and resulting acanthocytosis. These dysfunctional erythrocytes could then lead to damage to the globus pallidus and disease development akin to that presumed in neuroacanthocytosis. In patients with neuroacanthocytosis an association between acanthocytosis and basal ganglia pathology has been suggested. To test the mechanism hypothesized here, the effects of cardiopulmonary bypass on erythrocyte morphology and function could be systematically tested in children undergoing cardiac surgery. Ideally, the extent of erythrocyte damage could be correlated with the risk of developing postpump chorea. Finally, if the proposed hypothesis is supported by empirical findings, efforts to reduce blood cell damage during extracorporeal circulation in children might prevent this devastating complication.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Germany.
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Germany
| | - Sabine Skodda
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Germany
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13
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Neurodegeneration in the elderly – When the blood type matters: An overview of the McLeod syndrome with focus on hematological features. Transfus Apher Sci 2015; 52:277-84. [DOI: 10.1016/j.transci.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Abnormal red cell structure and function in neuroacanthocytosis. PLoS One 2015; 10:e0125580. [PMID: 25933379 PMCID: PMC4416783 DOI: 10.1371/journal.pone.0125580] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/24/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Panthothenate kinase-associated neurodegeneration (PKAN) belongs to a group of hereditary neurodegenerative disorders known as neuroacanthocytosis (NA). This genetically heterogeneous group of diseases is characterized by degeneration of neurons in the basal ganglia and by the presence of deformed red blood cells with thorny protrusions, acanthocytes, in the circulation. OBJECTIVE The goal of our study is to elucidate the molecular mechanisms underlying this aberrant red cell morphology and the corresponding functional consequences. This could shed light on the etiology of the neurodegeneration. METHODS We performed a qualitative and semi-quantitative morphological, immunofluorescent, biochemical and functional analysis of the red cells of several patients with PKAN and, for the first time, of the red cells of their family members. RESULTS We show that the blood of patients with PKAN contains not only variable numbers of acanthocytes, but also a wide range of other misshapen red cells. Immunofluorescent and immunoblot analyses suggest an altered membrane organization, rather than quantitative changes in protein expression. Strikingly, these changes are not limited to the red blood cells of PKAN patients, but are also present in the red cells of heterozygous carriers without neurological problems. Furthermore, changes are not only present in acanthocytes, but also in other red cells, including discocytes. The patients' cells, however, are more fragile, as observed in a spleen-mimicking device. CONCLUSION These morphological, molecular and functional characteristics of red cells in patients with PKAN and their family members offer new tools for diagnosis and present a window into the pathophysiology of neuroacanthocytosis.
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Walker RH. Untangling the Thorns: Advances in the Neuroacanthocytosis Syndromes. J Mov Disord 2015; 8:41-54. [PMID: 26090076 PMCID: PMC4460540 DOI: 10.14802/jmd.15009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/25/2022] Open
Abstract
There have been significant advances in neuroacanthocytosis (NA) syndromes in the past 20 years, however, confusion still exists regarding the precise nature of these disorders and the correct nomenclature. This article seeks to clarify these issues and to summarise the recent literature in the field. The four key NA syndromes are described here-chorea-acanthocytosis, McLeod syndrome, Huntington's disease-like 2, and pantothenate kinase- associated neurodegeneration. In the first two, acanthocytosis is a frequent, although not invariable, finding; in the second two, it occurs in approximately 10% of patients. Degeneration affecting the basal ganglia is the key neuropathologic finding, thus the clinical presentations can be remarkably similar. The characteristic phenotype comprises a variety of movement disorders, including chorea, dystonia, and parkinsonism, and also psychiatric and cognitive symptoms attributable to basal ganglia dysfunction. The age of onset, inheritance patterns, and ethnic background differ in each condition, providing diagnostic clues. Other investigations, including routine blood testing and neuroimaging can be informative. Genetic diagnosis, if available, provides a definitive diagnosis, and is important for genetic counseling, and hopefully molecular therapies in the future. In this article I provide a historical perspective on each NA syndrome. The first 3 disorders, chorea-acanthocytosis, McLeod syndrome, Huntington's disease-like 2, are discussed in detail, with a comprehensive review of the literature to date for each, while pantothenate kinase-associated neurodegeneration is presented in summary, as this disorder has recently been reviewed in this journal. Therapy for all of these diseases is, at present, purely symptomatic.
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Affiliation(s)
- Ruth H. Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
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Schiessl-Weyer J, Roa P, Laccone F, Kluge B, Tichy A, De Almeida Ribeiro E, Prohaska R, Stoeter P, Siegl C, Salzer U. Acanthocytosis and the c.680 A>G Mutation in the PANK2 Gene: A Study Enrolling a Cohort of PKAN Patients from the Dominican Republic. PLoS One 2015; 10:e0125861. [PMID: 25915509 PMCID: PMC4411072 DOI: 10.1371/journal.pone.0125861] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Abstract
Pantothenate Kinase-Associated Neurodegeneration (PKAN) is a form of Neurodegeneration with Brain Iron Accumulation (NBIA) associated with mutations in the pantothenate kinase 2 gene (PANK2). Pantothenate kinases catalyze the rate-limiting step of coenzyme A synthesis and Pank2 is the only pantothenate kinase isoform in humans that is localized to mitochondria. Acanthocytosis, the occurrence of spiculated erythrocytes, is observed in about 10% of the PKAN patients. Therefore PKAN is also classified together with other rare neurodegenerative diseases like Chorea Acanthocytosis (ChAc) and McLeod syndrome (MLS) into the Neuroacanthocytosis (NA) syndromes. It has not been investigated yet whether acanthocytosis in PKAN is associated with a specific subset of Pank2 mutations. In this study, we analyzed acanthocytosis of a cohort of 25 PKAN patients from the Dominican Republic that are homozygous for the c.680 A>G mutation in the PANK2 gene as compared to control donors that are heterozygous or wild-type with respect to this mutation. 3D modeling of this mutation indicated that the replacement of a tyrosine by a cysteine at position 227 in Pank2 disrupts a polar interaction within the A domain of the enzyme. Mean acanthocyte count was elevated in the cohort of patients, however, acanthocytosis varied among the patients with nearly half of them showing high (>20%) or elevated acanthocytosis and the rest showing mild (6-10%) or no (<6%) acanthocytosis. Heterozygous control donors revealed a tendency to mild acanthocytosis. Based on the insight that Pank2 is a normal constituent of red blood cells and de novo biosynthesis of coenzyme A is likely to take place in the erythrocyte cytosol we propose a hypothetical model that accounts for the variability in the occurrence of acanthocytic cells in PKAN.
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Affiliation(s)
- Jasmin Schiessl-Weyer
- Department of Medical Biochemistry, Max F. Perutz Laboratories, Medical University of Vienna, Vienna, Austria
| | - Pedro Roa
- Centro de Diagnostico Medicina Avanzada, Laboratorio y Telemedicina, Santo Domingo, República Dominicana
| | - Franco Laccone
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Britta Kluge
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Alexander Tichy
- Platform Bioinformatics and Biostatistics, University of Veterinary Medicine, Vienna, Austria
| | - Euripedes De Almeida Ribeiro
- Department of Structural and Computational Biology, Max F. Perutz Laboratories, University of Vienna, Vienna, Austria
| | - Rainer Prohaska
- Department of Medical Biochemistry, Max F. Perutz Laboratories, Medical University of Vienna, Vienna, Austria
| | - Peter Stoeter
- Centro de Diagnostico Medicina Avanzada, Laboratorio y Telemedicina, Santo Domingo, República Dominicana
| | - Claudia Siegl
- Department of Medical Biochemistry, Max F. Perutz Laboratories, Medical University of Vienna, Vienna, Austria
| | - Ulrich Salzer
- Department of Medical Biochemistry, Max F. Perutz Laboratories, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Abnormal red cell features associated with hereditary neurodegenerative disorders: the neuroacanthocytosis syndromes. Curr Opin Hematol 2015; 21:201-9. [PMID: 24626044 DOI: 10.1097/moh.0000000000000035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This review discusses the mechanisms involved in the generation of thorny red blood cells (RBCs), known as acanthocytes, in patients with neuroacanthocytosis, a heterogenous group of neurodegenerative hereditary disorders that include chorea-acanthocytosis (ChAc) and McLeod syndrome (MLS). RECENT FINDINGS Although molecular defects associated with neuroacanthocytosis have been identified recently, their pathophysiology and the related RBC abnormalities are largely unknown. Studies in ChAc RBCs have shown an altered association between the cytoskeleton and the integral membrane protein compartment in the absence of major changes in RBC membrane composition. In ChAc RBCs, abnormal Lyn kinase activation in a Syk-independent fashion has been reported recently, resulting in increased band 3 tyrosine phosphorylation and perturbation of the stability of the multiprotein band 3-based complexes bridging the membrane to the spectrin-based membrane skeleton. Similarly, in MLS, the absence of XK-protein, which is associated with the spectrin-actin-4.1 junctional complex, is associated with an abnormal membrane protein phosphorylation state, with destabilization of the membrane skeletal network resulting in generation of acanthocytes. SUMMARY A novel mechanism in generation of acanthocytes involving abnormal Lyn activation, identified in ChAc, expands the acanthocytosis phenomenon toward protein-protein interactions, controlled by phosphorylation-related abnormal signaling.
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