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Sahoo P, Kollmeier JM, Wenkel N, Badura S, Gärtner J, Frahm J, Dreha-Kulaczewski S. CSF and venous blood flow from childhood to adulthood studied by real-time phase-contrast MRI. Childs Nerv Syst 2024; 40:1377-1388. [PMID: 38206441 PMCID: PMC11026278 DOI: 10.1007/s00381-024-06275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
PURPOSE In vivo measurements of CSF and venous flow using real-time phase-contrast (RT-PC) MRI facilitate new insights into the dynamics and physiology of both fluid systems. In clinical practice, however, use of RT-PC MRI is still limited. Because many forms of hydrocephalus manifest in infancy and childhood, it is a prerequisite to investigate normal flow parameters during this period to assess pathologies of CSF circulation. This study aims to establish reference values of CSF and venous flow in healthy subjects using RT-PC MRI and to determine their age dependency. METHODS RT-PC MRI was performed in 44 healthy volunteers (20 females, age 5-40 years). CSF flow was quantified at the aqueduct (Aqd), cervical (C3) and lumbar (L3) spinal levels. Venous flow measurements comprised epidural veins, internal jugular veins and inferior vena cava. Parameters analyzed were peak velocity, net flow, pulsatility, and area of region of interest (ROI). STATISTICAL TESTS linear regression, student's t-test and analysis of variance (ANOVA). RESULTS In adults volunteers, no significant changes in flow parameters were observed. In contrast, pediatric subjects exhibited a significant age-dependent decrease of CSF net flow and pulsatility in Aqd, C3 and L3. Several venous flow parameters decreased significantly over age at C3 and changed more variably at L3. CONCLUSION Flow parameters varies depending on anatomical location and age. We established changes of brain and spinal fluid dynamics over an age range from 5-40 years. The application of RT-PC MRI in clinical care may improve our understanding of CSF flow pathology in individual patients.
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Affiliation(s)
- Prativa Sahoo
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert Koch Street 40, 37075, Göttingen, Germany.
| | - Jost M Kollmeier
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Nora Wenkel
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert Koch Street 40, 37075, Göttingen, Germany
| | - Simon Badura
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert Koch Street 40, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert Koch Street 40, 37075, Göttingen, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert Koch Street 40, 37075, Göttingen, Germany.
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Dreha-Kulaczewski S, Sahoo P, Preusse M, Gkalimani I, Dechent P, Helms G, Hofer S, Steinfeld R, Gärtner J. Folate receptor α deficiency - Myelin-sensitive MRI as a reliable biomarker to monitor the efficacy and long-term outcome of a new therapeutic approach. J Inherit Metab Dis 2024; 47:387-403. [PMID: 38200656 DOI: 10.1002/jimd.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
Cerebral folate transport deficiency, caused by a genetic defect in folate receptor α, is a devastating neurometabolic disorder that, if untreated, leads to epileptic encephalopathy, psychomotor decline and hypomyelination. Currently, there are limited data on effective dosage and duration of treatment, though early diagnosis and therapy with folinic acid appears critical. The aim of this long-term study was to identify new therapeutic approaches and novel biomarkers for assessing efficacy, focusing on myelin-sensitive MRI. Clinical, biochemical, structural and quantitative MRI parameters of seven patients with genetically confirmed folate receptor α deficiency were acquired over 13 years. Multimodal MRI approaches comprised MR-spectroscopy (MRS), magnetization transfer (MTI) and diffusion tensor imaging (DTI) sequences. Patients started oral treatment immediately following diagnosis or in an interval of up to 2.5 years. Escalation to intravenous and intrathecal administration was performed in the absence of effects. Five patients improved, one with a presymptomatic start of therapy remained symptom-free, and one with inconsistent treatment deteriorated. While CSF 5-methyltetrahydrofolate and MRS parameters normalized immediately after therapy initiation, myelin-sensitive MTI and DTI measures correlated with gradual clinical improvement and ongoing myelination under therapy. Early initiation of treatment at sufficient doses, considering early intrathecal applications, is critical for favorable outcome. The majority of patients showed clinical improvements that correlated best with MTI parameters, allowing individualized monitoring of myelination recovery. Presymptomatic therapy seems to ensure normal development and warrants newborn screening. Furthermore, the quantitative parameters of myelin-sensitive MRI for therapy assessments can now be used for hypomyelination disorders in general.
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Affiliation(s)
- Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Prativa Sahoo
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Preusse
- Kinderkrankenhaus Amsterdamer Strasse, Klinik für Kinder- und Jugendmedizin, Köln, Germany
| | - Irini Gkalimani
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Dechent
- MR-Research in Neuroscience, Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Gunther Helms
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Sabine Hofer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Robert Steinfeld
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
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Marten LM, Krätzner R, Salomons GS, Fernandez Ojeda M, Dechent P, Gärtner J, Huppke P, Dreha-Kulaczewski S. Long term follow-up in GAMT deficiency - Correlation of therapy regimen, biochemical and in vivo brain proton MR spectroscopy data. Mol Genet Metab Rep 2024; 38:101053. [PMID: 38469086 PMCID: PMC10926185 DOI: 10.1016/j.ymgmr.2024.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 03/13/2024] Open
Abstract
GAMT deficiency is a rare autosomal recessive disease within the group of cerebral creatine deficiency syndromes. Cerebral creatine depletion and accumulation of guanidinoacetate (GAA) lead to clinical presentation with intellectual disability, seizures, speech disturbances and movement disorders. Treatment consists of daily creatine supplementation to increase cerebral creatine, reduction of arginine intake and supplementation of ornithine for reduction of toxic GAA levels. This study represents the first long-term follow-up over a period of 14 years, with detailed clinical data, biochemical and multimodal neuroimaging findings. Developmental milestones, brain MRI, quantitative single voxel 1H magnetic resonance spectroscopy (MRS) and biochemical analyses were assessed. The results reveal insights into the dose dependent effects of creatine/ornithine supplementation and expand the phenotypic spectrum of GAMT deficiency. Of note, the creatine concentrations, which were regularly monitored over a long follow-up period, increased significantly over time, but did not reach age matched control ranges. Our patient is the second reported to show normal neurocognitive outcome after an initial delay, stressing the importance of early diagnosis and treatment initiation.
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Affiliation(s)
- Lara M. Marten
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Germany
| | - Ralph Krätzner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Germany
| | - Gajja S. Salomons
- Amsterdam UMC location University of Amsterdam, Dept of Laboratory Medicine, Laboratory Genetic Metabolic Diseases and Dept of Pediatrics Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Matilde Fernandez Ojeda
- Amsterdam UMC location University of Amsterdam, Dept of Laboratory Medicine, Laboratory Genetic Metabolic Diseases and Dept of Pediatrics Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Peter Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, University Medical Center Goettingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Germany
| | - Peter Huppke
- Department of Neuropediatrics, Jena University Hospital, Germany
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Huppke B, Reinert MC, Hummel-Abmeier H, Stark W, Gärtner J, Huppke P. Pretreatment Neurofilament Light Chain Serum Levels, Early Disease Severity, and Treatment Response in Pediatric Multiple Sclerosis. Neurology 2023; 101:e1873-e1883. [PMID: 37748882 PMCID: PMC10663003 DOI: 10.1212/wnl.0000000000207791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High disease activity and frequent therapy failure in pediatric multiple sclerosis (MS) make prognostic biomarkers urgently needed. We investigated whether serum neurofilament light chain (sNfL) levels in treatment-naive pediatric patients with MS are associated with early disease severity and indicate treatment outcomes. METHODS A retrospective cohort study of patients seen in the Göttingen Center for MS in Childhood and Adolescence, Germany. Inclusion criteria were MS diagnosis according to the McDonald criteria, MS onset <18 years, and available pretreatment serum sample. sNfL levels were analyzed using a single-molecule array assay. Associations with clinical and MRI evidence of disease severity at sampling were evaluated using the Spearman correlations and nonparametric tests for group comparisons. Correlations between pretreatment sNfL and annualized relapse and new T2 lesion rate on first-line therapy, and odd ratios for switch to high-efficacy therapy were assessed. RESULTS A total of 178 patients (116 women [65%]) with a mean sampling age of 14.3 years were included in the study. Pretreatment sNfL levels were above the ≥90th percentile reported for healthy controls in 80% of patients (median 21.1 pg/mL) and correlated negatively with age, but no correlation was seen with sex, oligoclonal band status, or body mass index. High pretreatment sNfL levels correlated significantly with a high number of preceding relapses, a shorter first interattack interval, a high T2 lesion count, and recent gadolinium-enhancing lesions. Of interest, sNfL levels reflected more strongly MRI activity rather than clinical activity. Pretreatment sNfL levels also correlated significantly with the relapse rate and occurrence of new/enlarging T2 lesions while on first-line injectable therapy. Odds of future therapy escalation increased from 0.14 for sNfL below 7.5 pg/mL to 6.38 for sNfL above 15 pg/mL. In patients with a recent relapse, higher sNfL levels were associated with poorer recovery 3 months after attack. DISCUSSION The results of this study have 3 important implications: First, pretreatment sNfL levels are a valuable biomarker for underlying disease activity in pediatric patients with MS. Second, pretreatment sNfL levels in pediatric patients with MS have a predictive value for the response to first-line therapy and the necessity of future therapy escalation. Third, high sNfL levels during a relapse are associated with poor recovery in this age group.
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Affiliation(s)
- Brenda Huppke
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany.
| | - Marie-Christine Reinert
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Hannah Hummel-Abmeier
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Wiebke Stark
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Jutta Gärtner
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Peter Huppke
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany.
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5
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Wong KM, Wegener E, Baradaran-Heravi A, Huppke B, Gärtner J, Huppke P. Evaluation of Novel Enhancer Compounds in Gentamicin-Mediated Readthrough of Nonsense Mutations in Rett Syndrome. Int J Mol Sci 2023; 24:11665. [PMID: 37511424 PMCID: PMC10380790 DOI: 10.3390/ijms241411665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Rett syndrome (RTT), a severe X-linked neurodevelopmental disorder, is primarily caused by mutations in the methyl CpG binding protein 2 gene (MECP2). Over 35% RTT patients carry nonsense mutation in MECP2, making it a suitable candidate disease for nonsense suppression therapy. In our previous study, gentamicin was found to induce readthrough of MECP2 nonsense mutations with modest efficiency. Given the recent discovery of readthrough enhancers, CDX compounds, we herein evaluated the potentiation effect of CDX5-1, CDX5-288, and CDX6-180 on gentamicin-mediated readthrough efficiency in transfected HeLa cell lines bearing the four most common MECP2 nonsense mutations. We showed that all three CDX compounds potentiated gentamicin-mediated readthrough and increased full-length MeCP2 protein levels in cells expressing the R168X, R255X, R270X, and R294X nonsense mutations. Among all three CDX compounds, CDX5-288 was the most potent enhancer and enabled the use of reduced doses of gentamicin, thus mitigating the toxicity. Furthermore, we successfully demonstrated the upregulation of full-length Mecp2 protein expression in fibroblasts derived from Mecp2R255X/Y mice through combinatorial treatment. Taken together, findings demonstrate the feasibility of this combinatorial approach to nonsense suppression therapy for a subset of RTT patients.
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Affiliation(s)
- Keit Men Wong
- Department of Neuropediatrics, Jena University Hospital, 07747 Jena, Germany
- Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany
| | - Eike Wegener
- Department of Pediatrics and Adolescent Medicine, Division of Neuropediatrics, Pediatric Neurology University Medical Center Göttingen, Georg August University Göttingen, 37075 Göttingen, Germany
| | - Alireza Baradaran-Heravi
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver BC V6T 1Z3, Canada
| | - Brenda Huppke
- Department of Neuropediatrics, Jena University Hospital, 07747 Jena, Germany
- Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Neuropediatrics, Pediatric Neurology University Medical Center Göttingen, Georg August University Göttingen, 37075 Göttingen, Germany
| | - Peter Huppke
- Department of Neuropediatrics, Jena University Hospital, 07747 Jena, Germany
- Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany
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Gärtner J, Schröder S. Next-generation sequencing and its clinical application in leukoencephalopathies and other pediatric neurological disorders. Eur J Paediatr Neurol 2023; 45:A2-A3. [PMID: 37414653 DOI: 10.1016/j.ejpn.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Jutta Gärtner
- Dept. Pediatrics and Adolescent Medicine, Div. Pediatric Neurology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany.
| | - Simone Schröder
- Dept. Pediatrics and Adolescent Medicine, Div. Pediatric Neurology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
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Schittkowski MP, Naxer S, Elabbasy M, Herholz L, Breitling V, Finglas A, Gärtner J, Schlotawa L. Multiple Sulfatase Deficiency from an Ophthalmologist's Perspective-Case Report and Literature Review. Children (Basel) 2023; 10:children10030595. [PMID: 36980153 PMCID: PMC10047279 DOI: 10.3390/children10030595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Multiple sulfatase deficiency (MSD) is an extremely rare autosomal recessively inherited disease with a prevalence of 1:500.000 caused by mutations on the sulfatase-modifying-Factor 1 gene (SUMF1). MSD is most specifically characterised by a combination of developmentally retarded psychomotoric functions, neurodegeneration that entails the loss of many already acquired abilities, and by ichthyosis. Other symptoms include those associated with mucopolysaccharidosis, i.e., facial dysmorphy, dwarfism, and hepatosplenomegaly. In 50-75% of all MSD-affected patients, functional or structural ocular damage is likely. MSD seldom affects the anterior segment of the eye. The main pathology these patients present is a highly conspicuous tapetoretinal degeneration, similar to severe Retinitis pigmentosa, that leads to blindness at an early age. An initially five-year-old boy with MSD, genetically verified at his first examination in our opthalmology department (SUMF1 mutations c.776A>T, p.Asn259Ile; c.797A>T, p.Pro266Leu; c.836A>T, p.Ala279Val), and a 4, 5 year regular follow-up are described. The patient had some visual potential ("tunnel view"), which deteriorated dramatically after his fifth birthday. We observed no evidence of worsening retinal involvement in this patient in spite of his progressively worsening clinical symptoms, extending to total blindness/no light perception. OCT revealed that the outer retinal layers containing photoreceptors were diseased; the ellipsoid zone was only partially discernible and the outer nuclear layer appeared to be thinned out. The inner nuclear layer, ganglion cell layer, and retinal nerve fibre layer were indistinguishable. These anomalies are indicative of a severe pathology within the retina's inner layers. Characteristic anomalies in the fundus should stimulate clinicians to suspect a case of MSD in their differential diagnosis, and thus to order thorough genetic and paediatric diagnostics.
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Affiliation(s)
- Michael P Schittkowski
- Section for Strabismus and Neuroophthalmology, Department of Ophthalmology, University Medical Centre Goettingen; Robert-Koch-Str. 40, 37085 Goettingen, Germany
| | - Sabine Naxer
- Section for Strabismus and Neuroophthalmology, Department of Ophthalmology, University Medical Centre Goettingen; Robert-Koch-Str. 40, 37085 Goettingen, Germany
| | - Mohamed Elabbasy
- Section for Strabismus and Neuroophthalmology, Department of Ophthalmology, University Medical Centre Goettingen; Robert-Koch-Str. 40, 37085 Goettingen, Germany
| | - Leonie Herholz
- Division for Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, University Medical Centre Goettingen, 37075 Goettingen, Germany
| | - Vivian Breitling
- Division for Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, University Medical Centre Goettingen, 37075 Goettingen, Germany
| | | | - Jutta Gärtner
- Division for Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, University Medical Centre Goettingen, 37075 Goettingen, Germany
| | - Lars Schlotawa
- Division for Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, University Medical Centre Goettingen, 37075 Goettingen, Germany
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Schlotawa L, Tyka K, Kettwig M, Ahrens‐Nicklas RC, Baud M, Berulava T, Brunetti‐Pierri N, Gagne A, Herbst ZM, Maguire JA, Monfregola J, Pena T, Radhakrishnan K, Schröder S, Waxman EA, Ballabio A, Dierks T, Fischer A, French DL, Gelb MH, Gärtner J. Drug screening identifies tazarotene and bexarotene as therapeutic agents in multiple sulfatase deficiency. EMBO Mol Med 2023; 15:e14837. [PMID: 36789546 PMCID: PMC9994482 DOI: 10.15252/emmm.202114837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023] Open
Abstract
Multiple sulfatase deficiency (MSD, MIM #272200) results from pathogenic variants in the SUMF1 gene that impair proper function of the formylglycine-generating enzyme (FGE). FGE is essential for the posttranslational activation of cellular sulfatases. MSD patients display reduced or absent sulfatase activities and, as a result, clinical signs of single sulfatase disorders in a unique combination. Up to date therapeutic options for MSD are limited and mostly palliative. We performed a screen of FDA-approved drugs using immortalized MSD patient fibroblasts. Recovery of arylsulfatase A activity served as the primary readout. Subsequent analysis confirmed that treatment of primary MSD fibroblasts with tazarotene and bexarotene, two retinoids, led to a correction of MSD pathophysiology. Upon treatment, sulfatase activities increased in a dose- and time-dependent manner, reduced glycosaminoglycan content decreased and lysosomal position and size normalized. Treatment of MSD patient derived induced pluripotent stem cells (iPSC) differentiated into neuronal progenitor cells (NPC) resulted in a positive treatment response. Tazarotene and bexarotene act to ultimately increase the stability of FGE variants. The results lay the basis for future research on the development of a first therapeutic option for MSD patients.
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Affiliation(s)
- Lars Schlotawa
- Department of Paediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Karolina Tyka
- Department of Paediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Matthias Kettwig
- Department of Paediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Rebecca C Ahrens‐Nicklas
- Division of Human Genetics and MetabolismThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Matthias Baud
- School of Chemistry and Institute for Life SciencesUniversity of SouthamptonSouthamptonUK
| | - Tea Berulava
- Department for Epigenetics and Systems Medicine in Neurodegenerative DiseasesGerman Centre for Neurodegenerative DiseasesGöttingenGermany
| | - Nicola Brunetti‐Pierri
- Telethon Institute of Genetics and MedicinePozzuoliItaly
- Department of Translational MedicineUniversity of Naples Federico IINaplesItaly
| | - Alyssa Gagne
- Center for Cellular and Molecular TherapeuticsThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pathology and Laboratory MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | | | - Jean A Maguire
- Center for Cellular and Molecular TherapeuticsThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pathology and Laboratory MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Jlenia Monfregola
- Telethon Institute of Genetics and MedicinePozzuoliItaly
- Department of Translational MedicineUniversity of Naples Federico IINaplesItaly
| | - Tonatiuh Pena
- Department for Epigenetics and Systems Medicine in Neurodegenerative DiseasesGerman Centre for Neurodegenerative DiseasesGöttingenGermany
- Bioinformatics UnitGerman Centre for Neurodegenerative DiseasesGöttingenGermany
| | | | - Sophie Schröder
- Department for Epigenetics and Systems Medicine in Neurodegenerative DiseasesGerman Centre for Neurodegenerative DiseasesGöttingenGermany
| | - Elisa A Waxman
- Center for Cellular and Molecular TherapeuticsThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pathology and Laboratory MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Andrea Ballabio
- Telethon Institute of Genetics and MedicinePozzuoliItaly
- Department of Translational MedicineUniversity of Naples Federico IINaplesItaly
- Department of Molecular and Human Genetics and Neurological Research InstituteBaylor College of MedicineHoustonTXUSA
| | - Thomas Dierks
- Faculty of Chemistry, Biochemistry IBielefeld UniversityBielefeldGermany
| | - André Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative DiseasesGerman Centre for Neurodegenerative DiseasesGöttingenGermany
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
- Multiscale Bioimaging Cluster of Excellence, University Medical Center GöttingenUniversity of GöttingenGöttingenGermany
| | - Deborah L French
- Center for Cellular and Molecular TherapeuticsThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pathology and Laboratory MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Michael H Gelb
- Department of ChemistryUniversity of WashingtonSeattleWAUSA
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
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9
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Musante L, Faletra F, Meier K, Tomoum H, Najarzadeh Torbati P, Blair E, North S, Gärtner J, Diegmann S, Beiraghi Toosi M, Ashrafzadeh F, Ghayoor Karimiani E, Murphy D, Murru FM, Zanus C, Magnolato A, La Bianca M, Feresin A, Girotto G, Gasparini P, Costa P, Carrozzi M. TTC5 syndrome: Clinical and molecular spectrum of a severe and recognizable condition. Am J Med Genet A 2022; 188:2652-2665. [PMID: 35670379 PMCID: PMC9541101 DOI: 10.1002/ajmg.a.62852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 01/24/2023]
Abstract
Biallelic mutations in the TTC5 gene have been associated with autosomal recessive intellectual disability (ARID) and subsequently with an ID syndrome including severe speech impairment, cerebral atrophy, and hypotonia as clinical cornerstones. A TTC5 role in IDs has been proposed based on the physical interaction of TTC5 with p300, and possibly reducing p300 co-activator complex activity, similarly to what was observed in Menke-Hennekam 1 and 2 patients (MKHK1 and 2) carrying, respectively, mutations in exon 30 and 31 of CREBBP and EP300, which code for the TTC5-binding region. Recently, TTC5-related brain malformation has been linked to tubulinopathies due to the function of TTC5 in tubulins' dynamics. We reported seven new patients with novel or recurrent TTC5 variants. The deep characterization of the molecular and phenotypic spectrum confirmed TTC5-related disorder as a recognizable, very severe neurodevelopmental syndrome. In addition, other relevant clinical aspects, including a severe pre- and postnatal growth retardation, cryptorchidism, and epilepsy, have emerged from the reversal phenotype approach and the review of already published TTC5 cases. Microcephaly and facial dysmorphism resulted in being less variable than that documented before. The TTC5 clinical features have been compared with MKHK1 published cases in the hypothesis that clinical overlap in some characteristics of the two conditions was related to the common p300 molecular pathway.
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Affiliation(s)
- Luciana Musante
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Flavio Faletra
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Kolja Meier
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Hoda Tomoum
- Department of PediatricsAin Shams UniversityCairoEgypt
| | | | - Edward Blair
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Sally North
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Susann Diegmann
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Mehran Beiraghi Toosi
- Pediatric Neurology Department, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Farah Ashrafzadeh
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ehsan Ghayoor Karimiani
- Department of Molecular GeneticsNext Generation Genetic PolyclinicMashhadIran
- Molecular and Clinical Sciences InstituteSt. George's, University of LondonLondonUK
- Innovative Medical Research Center, Mashhad BranchIslamic Azad UniversityMashhadIran
| | - David Murphy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Flora Maria Murru
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Caterina Zanus
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Andrea Magnolato
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Martina La Bianca
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Agnese Feresin
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Giorgia Girotto
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Paolo Gasparini
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Paola Costa
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Marco Carrozzi
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
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10
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Gärtner J, Hauser S, Bar-Or A, Montalban X, Cohen J, Cross A, Deiva K, Häring D, Su W. 113 Benefit-risk of ofatumumab in treatment-naïve early relapsing multiple sclerosis patients. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveTo evaluate the benefit-risk profile of ofatumumab treatment in patients with early relapsing multiple sclerosis (RMS) subgroup in Phase 3 ASCLEPIOS I/II trials.MethodsKey efficacy and safety outcomes were assessed in the newly diagnosed, treatment-naïve subgroup who received ofatumumab or teriflunomide as first-line therapy in the trials (n=615, 32.7% of total patients).ResultsCompared to patients on teriflunomide, ofatumumab reduced ARR by 50.3% (0.09 vs 0.18; p<0.001), 3mCDW risk by 38% (10.1% vs 12.8%; p=0.065), 6mCDW risk by 46% (5.9% vs 10.4%; p=0.044), gadolinium- enhancing T1 lesions/scan by 95.4% (0.02 vs 0.39: p<0.001), and new/enlarging T2 lesions/year by 82.0% (0.86 vs 4.78, p<0.001). Treatment-emergent adverse events (AEs) occurred in 84.7% ofatumumab vs 86.0% teriflunomide-treated patients; serious AEs were reported in 7.0% and 5.3%, respectively. Infection rates were comparable between ofatumumab (56.1%) and teriflunomide (56.5%); serious infection rates were 1.9% and 0.7%, respectively. 99.8% of injection reactions were mild-to-moderate; after the 4th injection, >70% RMS patients self-injected at home.ConclusionOfatumumab is the first anti-CD20 DMT that can be self-administered at home, as demonstrated in ASCLEPIOS. Here, ofatumumab showed superior efficacy vs teriflunomide with low absolute relapse rates, very low MRI lesion activity and prolonged time to disability worsening. Funding statement: This study was funded by Novartis Pharma AG, Basel, Switzerland.teresa.sawtell@novartis.com
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11
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Graves JS, Thomas M, Li J, Shah AR, Goodyear A, Lange MR, Schmidli H, Häring DA, Friede T, Gärtner J. Improving pediatric multiple sclerosis interventional phase III study design: a meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864211070449. [PMID: 35514529 PMCID: PMC9066624 DOI: 10.1177/17562864211070449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To support innovative trial designs in a regulatory setting for pediatric-onset multiple sclerosis (MS), the study aimed to perform a systematic literature review and meta-analysis of relapse rates with interferon β (IFN β), fingolimod, and natalizumab and thereby demonstrate potential benefits of Bayesian and non-inferiority designs in this population. Methods: We conducted a literature search in MEDLINE and EMBASE from inception until 17 June 2020 of all studies reporting annualized relapse rates (ARR) in IFN β-, fingolimod-, or natalizumab-treated patients with pediatric-onset relapsing–remitting MS. These interventions were chosen because the literature was mainly available for these treatments, and they are currently used for the treatment of pediatric MS. Two researchers independently extracted data and assessed study quality using the Cochrane Effective Practice and Organization of Care – Quality Assessment Tool. The meta-analysis estimates were obtained by Bayesian random effects model. Data were summarized as ARR point estimates and 95% credible intervals. Results: We found 19 articles, including 2 randomized controlled trials. The baseline ARR reported was between 1.4 and 3.7. The meta-analysis-based ARR was significantly higher in IFN β-treated patients (0.69, 95% credible interval: 0.51–0.91) versus fingolimod (0.11, 0.04–0.27) and natalizumab (0.17, 0.09–0.31). Based on the meta-analysis results, an appropriate non-inferiority margin versus fingolimod could be in the range of 2.29–2.67 and for natalizumab 1.72–2.29 on the ARR ratio scale. A Bayesian design, which uses historical information for a fingolimod or natalizumab control arm, could reduce the sample size of a new trial by 18 or 14 patients, respectively. Conclusion: This meta-analysis provides evidence that relapse rates are considerably higher with IFNs versus fingolimod or natalizumab. The results support the use of innovative Bayesian or non-inferiority designs to avoid exposing patients to less effective comparators in trials and bringing new medications to patients more efficiently.
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Affiliation(s)
- Jennifer S. Graves
- Department of Neurosciences, University of California, San Diego, Box 0662 ACTRI, 9452 Medical Center Drive, Suite 4W-222, San Diego, CA 92037, USA
| | | | - Jun Li
- Novartis Pharma AG, Basel, Switzerland
| | | | - Alexandra Goodyear
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA at the time of article development
| | | | | | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence, University Medical Center Göttingen, Göttingen, Germany
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12
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Luebben AV, Bender D, Becker S, Crowther LM, Erven I, Hofmann K, Söding J, Klemp H, Bellotti C, Stäuble A, Qiu T, Kathayat RS, Dickinson BC, Gärtner J, Sheldrick GM, Krätzner R, Steinfeld R. Cln5 represents a new type of cysteine-based S-depalmitoylase linked to neurodegeneration. Sci Adv 2022; 8:eabj8633. [PMID: 35427157 PMCID: PMC9012467 DOI: 10.1126/sciadv.abj8633] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/01/2022] [Indexed: 05/26/2023]
Abstract
Genetic CLN5 variants are associated with childhood neurodegeneration and Alzheimer's disease; however, the molecular function of ceroid lipofuscinosis neuronal protein 5 (Cln5) is unknown. We solved the Cln5 crystal structure and identified a region homologous to the catalytic domain of members of the N1pC/P60 superfamily of papain-like enzymes. However, we observed no protease activity for Cln5; and instead, we discovered that Cln5 and structurally related PPPDE1 and PPPDE2 have efficient cysteine palmitoyl thioesterase (S-depalmitoylation) activity using fluorescent substrates. Mutational analysis revealed that the predicted catalytic residues histidine-166 and cysteine-280 are critical for Cln5 thioesterase activity, uncovering a new cysteine-based catalytic mechanism for S-depalmitoylation enzymes. Last, we found that Cln5-deficient neuronal progenitor cells showed reduced thioesterase activity, confirming live cell function of Cln5 in setting S-depalmitoylation levels. Our results provide new insight into the function of Cln5, emphasize the importance of S-depalmitoylation in neuronal homeostasis, and disclose a new, unexpected enzymatic function for the N1pC/P60 superfamily of proteins.
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Affiliation(s)
- Anna V. Luebben
- Institute of Inorganic Chemistry, University of
Göttingen, Tammannstrasse 4, 37077 Göttingen, Germany
| | - Daniel Bender
- Department of Pediatric Neurology, University
Children’s Hospital Zürich, University of Zurich,
Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Stefan Becker
- Department of NMR-based Structural Biology, Max
Planck Institute for Biophysical Chemistry, Fassberg 11, 37077
Göttingen, Germany
| | - Lisa M. Crowther
- Department of Pediatric Neurology, University
Children’s Hospital Zürich, University of Zurich,
Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Ilka Erven
- Institute for Genetics, University of Cologne,
Zülpicher Str.47a, 50674 Cologne, Germany
| | - Kay Hofmann
- Institute for Genetics, University of Cologne,
Zülpicher Str.47a, 50674 Cologne, Germany
| | - Johannes Söding
- Quantitative Biology and Bioinformatics and
Department of Molecular Biology, Max-Planck Institute for Biophysical Chemistry,
Am Fassberg 11, 37077 Göttingen, Germany
| | - Henry Klemp
- Department of Pediatrics and Adolescent Medicine,
Division of Pediatric Neurology, University of Göttingen,
Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Cristina Bellotti
- Department of Pediatric Neurology, University
Children’s Hospital Zürich, University of Zurich,
Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Andreas Stäuble
- Department of Pediatric Neurology, University
Children’s Hospital Zürich, University of Zurich,
Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Tian Qiu
- Department of Chemistry, University of Chicago,
Chicago, IL, USA
| | | | | | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine,
Division of Pediatric Neurology, University of Göttingen,
Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - George M. Sheldrick
- Institute of Inorganic Chemistry, University of
Göttingen, Tammannstrasse 4, 37077 Göttingen, Germany
| | - Ralph Krätzner
- Department of Pediatrics and Adolescent Medicine,
Division of Pediatric Neurology, University of Göttingen,
Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Robert Steinfeld
- Department of Pediatric Neurology, University
Children’s Hospital Zürich, University of Zurich,
Steinwiesstrasse 75, 8032 Zürich, Switzerland
- Department of Pediatrics and Adolescent Medicine,
Division of Pediatric Neurology, University of Göttingen,
Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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13
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Gärtner J, Hauser SL, Bar-Or A, Montalban X, Cohen JA, Cross AH, Deiva K, Ganjgahi H, Häring DA, Li B, Pingili R, Ramanathan K, Su W, Willi R, Kieseier B, Kappos L. Efficacy and safety of ofatumumab in recently diagnosed, treatment-naive patients with multiple sclerosis: Results from ASCLEPIOS I and II. Mult Scler 2022; 28:1562-1575. [PMID: 35266417 PMCID: PMC9315184 DOI: 10.1177/13524585221078825] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: In the phase III ASCLEPIOS I and II trials, participants with relapsing
multiple sclerosis receiving ofatumumab had significantly better clinical
and magnetic resonance imaging (MRI) outcomes than those receiving
teriflunomide. Objectives: To assess the efficacy and safety of ofatumumab versus teriflunomide in
recently diagnosed, treatment-naive (RDTN) participants from ASCLEPIOS. Methods: Participants were randomized to receive ofatumumab (20 mg subcutaneously
every 4 weeks) or teriflunomide (14 mg orally once daily) for up to
30 months. Endpoints analysed post hoc in the protocol-defined RDTN
population included annualized relapse rate (ARR), confirmed disability
worsening (CDW), progression independent of relapse activity (PIRA) and
adverse events. Results: Data were analysed from 615 RDTN participants (ofatumumab:
n = 314; teriflunomide: n = 301). Compared
with teriflunomide, ofatumumab reduced ARR by 50% (rate ratio (95%
confidence interval (CI)): 0.50 (0.33, 0.74);
p < 0.001), and delayed 6-month CDW by 46% (hazard ratio
(HR; 95% CI): 0.54 (0.30, 0.98); p = 0.044) and 6-month
PIRA by 56% (HR: 0.44 (0.20, 1.00); p = 0.049). Safety
findings were manageable and consistent with those of the overall ASCLEPIOS
population. Conclusion: The favourable benefit–risk profile of ofatumumab versus teriflunomide
supports its consideration as a first-line therapy in RDTN patients. ASCLEPIOS I and II are registered at ClinicalTrials.gov (NCT02792218 and
NCT02792231).
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Affiliation(s)
- Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jeffrey A Cohen
- Department of Neurology, Mellen MS Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anne H Cross
- Department of Neurology, Section of Neuroimmunology, Washington University School of Medicine, St Louis, MO, USA
| | - Kumaran Deiva
- Department of Pediatric Neurology, University Hospitals Paris Saclay, Hôpital Bicêtre, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre, France
| | - Habib Ganjgahi
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK/Statistics Department, University of Oxford, Oxford, UK
| | | | - Bingbing Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, and Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital of Basel, University of Basel, Basel, Switzerland
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14
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Kollmeier JM, Gürbüz-Reiss L, Sahoo P, Badura S, Ellebracht B, Keck M, Gärtner J, Ludwig HC, Frahm J, Dreha-Kulaczewski S. Deep breathing couples CSF and venous flow dynamics. Sci Rep 2022; 12:2568. [PMID: 35173200 PMCID: PMC8850447 DOI: 10.1038/s41598-022-06361-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Venous system pathologies have increasingly been linked to clinically relevant disorders of CSF circulation whereas the exact coupling mechanisms still remain unknown. In this work, flow dynamics of both systems were studied using real-time phase-contrast flow MRI in 16 healthy subjects during normal and forced breathing. Flow evaluations in the aqueduct, at cervical level C3 and lumbar level L3 for both the CSF and venous fluid systems reveal temporal modulations by forced respiration. During normal breathing cardiac-related flow modulations prevailed, while forced breathing shifted the dominant frequency of both CSF and venous flow spectra towards the respiratory component and prompted a correlation between CSF and venous flow in the large vessels. The average of flow magnitude of CSF was increased during forced breathing at all spinal and intracranial positions. Venous flow in the large vessels of the upper body decreased and in the lower body increased during forced breathing. Deep respiration couples interdependent venous and brain fluid flow—most likely mediated by intrathoracic and intraabdominal pressure changes. Further insights into the driving forces of CSF and venous circulation and their correlation will facilitate our understanding how the venous system links to intracranial pressure regulation and of related forms of hydrocephalus.
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Affiliation(s)
- Jost M Kollmeier
- Biomedizinische NMR, Max-Planck-Institut für multidisziplinäre Naturwissenschaften, 37077, Göttingen, Germany
| | - Lukas Gürbüz-Reiss
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Prativa Sahoo
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Simon Badura
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Ben Ellebracht
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Mathilda Keck
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Hans-Christoph Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für multidisziplinäre Naturwissenschaften, 37077, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany.
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15
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Kettwig M, Ternka K, Wendland K, Krüger DM, Zampar S, Schob C, Franz J, Aich A, Winkler A, Sakib MS, Kaurani L, Epple R, Werner HB, Hakroush S, Kitz J, Prinz M, Bartok E, Hartmann G, Schröder S, Rehling P, Henneke M, Boretius S, Alia A, Wirths O, Fischer A, Stadelmann C, Nessler S, Gärtner J. Interferon-driven brain phenotype in a mouse model of RNaseT2 deficient leukoencephalopathy. Nat Commun 2021; 12:6530. [PMID: 34764281 PMCID: PMC8586222 DOI: 10.1038/s41467-021-26880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
Infantile-onset RNaseT2 deficient leukoencephalopathy is characterised by cystic brain lesions, multifocal white matter alterations, cerebral atrophy, and severe psychomotor impairment. The phenotype is similar to congenital cytomegalovirus brain infection and overlaps with type I interferonopathies, suggesting a role for innate immunity in its pathophysiology. To date, pathophysiological studies have been hindered by the lack of mouse models recapitulating the neuroinflammatory encephalopathy found in patients. In this study, we generated Rnaset2-/- mice using CRISPR/Cas9-mediated genome editing. Rnaset2-/- mice demonstrate upregulation of interferon-stimulated genes and concurrent IFNAR1-dependent neuroinflammation, with infiltration of CD8+ effector memory T cells and inflammatory monocytes into the grey and white matter. Single nuclei RNA sequencing reveals homeostatic dysfunctions in glial cells and neurons and provide important insights into the mechanisms of hippocampal-accentuated brain atrophy and cognitive impairment. The Rnaset2-/- mice may allow the study of CNS damage associated with RNaseT2 deficiency and may be used for the investigation of potential therapies.
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Affiliation(s)
- Matthias Kettwig
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - Katharina Ternka
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Kristin Wendland
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Dennis Manfred Krüger
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Silvia Zampar
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Charlotte Schob
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
- Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Max Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Abhishek Aich
- Department of Cellular Biochemistry, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Anne Winkler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Sadman Sakib
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Lalit Kaurani
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Robert Epple
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Hauke B Werner
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Bartok
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
- Unit of Experimental Immunology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - Simone Schröder
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Peter Rehling
- Department of Cellular Biochemistry, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Marco Henneke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Susann Boretius
- Functional Imaging Laboratory, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - A Alia
- Institute for Medical Physics and Biophysics, University of Leipzig, Leipzig, Germany
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Oliver Wirths
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Andre Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Stefan Nessler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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16
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Kettwig M, Klemp H, Nessler S, Streit F, Krätzner R, Rosewich H, Gärtner J. Targeted metabolomics revealed changes in phospholipids during the development of neuroinflammation in Abcd1 tm1Kds mice and X-linked adrenoleukodystrophy patients. J Inherit Metab Dis 2021; 44:1174-1185. [PMID: 33855724 DOI: 10.1002/jimd.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/06/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is the most common leukodystrophy. Despite intensive research in recent years, it remains unclear, what drives the different clinical disease courses. Due to this missing pathophysiological link, therapy for the childhood cerebral disease course of X-ALD (CCALD) remains symptomatic; the allogenic hematopoietic stem cell transplantation or hematopoietic stem-cell gene therapy is an option for early disease stages. The inclusion of dried blood spot (DBS) C26:0-lysophosphatidylcholine to newborn screening in an increasing number of countries is leading to an increasing number of X-ALD patients diagnosed at risk for CCALD. Current follow-up in asymptomatic boys with X-ALD requires repetitive cerebral MRIs under sedation. A reliable and easily accessible biomarker that predicts CCALD would therefore be of great value. Here we report the application of targeted metabolomics by AbsoluteIDQ p180-Kit from Biocrates to search for suitable biomarkers in X-ALD. LysoPC a C20:3 and lysoPC a C20:4 were identified as metabolites that indicate neuroinflammation after induction of experimental autoimmune encephalitis in the serum of Abcd1tm1Kds mice. Analysis of serum from X-ALD patients also revealed different concentrations of these lipids at different disease stages. Further studies in a larger cohort of X-ALD patient sera are needed to prove the diagnostic value of these lipids for use as early biomarkers for neuroinflammation in CCALD patients.
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Affiliation(s)
- Matthias Kettwig
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Henry Klemp
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Stefan Nessler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Frank Streit
- Institute for Clinical Chemistry, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Ralph Krätzner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Hendrik Rosewich
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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17
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Ludwig HC, Bock HC, Gärtner J, Schiller S, Frahm J, Dreha-Kulaczewski S. Hydrocephalus Revisited: New Insights into Dynamics of Neurofluids on Macro- and Microscales. Neuropediatrics 2021; 52:233-241. [PMID: 34192788 DOI: 10.1055/s-0041-1731981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
New experimental and clinical findings question the historic view of hydrocephalus and its 100-year-old classification. In particular, real-time magnetic resonance imaging (MRI) evaluation of cerebrospinal fluid (CSF) flow and detailed insights into brain water regulation on the molecular scale indicate the existence of at least three main mechanisms that determine the dynamics of neurofluids: (1) inspiration is a major driving force; (2) adequate filling of brain ventricles by balanced CSF upsurge is sensed by cilia; and (3) the perivascular glial network connects the ependymal surface to the pericapillary Virchow-Robin spaces. Hitherto, these aspects have not been considered a common physiologic framework, improving knowledge and therapy for severe disorders of normal-pressure and posthemorrhagic hydrocephalus, spontaneous intracranial hypotension, and spaceflight disease.
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Affiliation(s)
- Hans C Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Hans C Bock
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Stina Schiller
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
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18
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Bergner CG, Genc N, Hametner S, Franz J, van der Meer F, Mitkovski M, Weber MS, Stoltenburg-Didinger G, Kühl JS, Köhler W, Brück W, Gärtner J, Stadelmann C. Concurrent axon and myelin destruction differentiates X-linked adrenoleukodystrophy from multiple sclerosis. Glia 2021; 69:2362-2377. [PMID: 34137074 DOI: 10.1002/glia.24042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
Cerebral disease manifestation occurs in about two thirds of males with X-linked adrenoleukodystrophy (CALD) and is fatally progressive if left untreated. Early histopathologic studies categorized CALD as an inflammatory demyelinating disease, which led to repeated comparisons to multiple sclerosis (MS). The aim of this study was to revisit the relationship between axonal damage and myelin loss in CALD. We applied novel immunohistochemical tools to investigate axonal damage, myelin loss and myelin repair in autopsy brain tissue of eight CALD and 25 MS patients. We found extensive and severe acute axonal damage in CALD already in prelesional areas defined by microglia loss and relative myelin preservation. In contrast to MS, we did not observe selective phagocytosis of myelin, but a concomitant decay of the entire axon-myelin unit in all CALD lesion stages. Using a novel marker protein for actively remyelinating oligodendrocytes, breast carcinoma-amplified sequence (BCAS) 1, we show that repair pathways are activated in oligodendrocytes in CALD. Regenerating cells, however, were affected by the ongoing disease process. We provide evidence that-in contrast to MS-selective myelin phagocytosis is not characteristic of CALD. On the contrary, our data indicate that acute axonal injury and permanent axonal loss are thus far underestimated features of the disease that must come into focus in our search for biomarkers and novel therapeutic approaches.
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Affiliation(s)
- Caroline G Bergner
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Nafiye Genc
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Max Planck Institute for Experimental Medicine, Göttingen, Germany.,Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
| | | | - Miso Mitkovski
- Light Microscopy Facility, Max-Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Martin S Weber
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Hematology, and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Wolfgang Köhler
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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19
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Klemp HG, Kettwig M, Streit F, Gärtner J, Rosewich H, Krätzner R. LC-MS Based Platform Simplifies Access to Metabolomics for Peroxisomal Disorders. Metabolites 2021; 11:metabo11060347. [PMID: 34072483 PMCID: PMC8226985 DOI: 10.3390/metabo11060347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023] Open
Abstract
Peroxisomes are central hubs for cell metabolism and their dysfunction is linked to devastating human disorders, such as peroxisomal biogenesis disorders and single peroxisomal enzyme/protein deficiencies. For decades, biochemical diagnostics have been carried out using classical markers such as very long-chain fatty acids (VLCFA), which can be inconspicuous in milder and atypical cases. Holistic metabolomics studies revealed several potentially new biomarkers for peroxisomal disorders for advanced laboratory diagnostics including atypical cases. However, establishing these new markers is a major challenge in routine diagnostic laboratories. We therefore investigated whether the commercially available AbsoluteIDQ p180 kit (Biocrates Lifesciences), which utilizes flow injection and liquid chromatography mass spectrometry, may be used to reproduce some key results from previous global metabolomics studies. We applied it to serum samples from patients with mutations in peroxisomal target genes PEX1, ABCD1, and the HSD17B4 gene. Here we found various changes in sphingomyelins and lysophosphatidylcholines. In conclusion, this kit can be used to carry out extended diagnostics for peroxisomal disorders in routine laboratories, even without access to a metabolomics unit.
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Affiliation(s)
- Henry Gerd Klemp
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (H.G.K.); (M.K.); (J.G.)
| | - Matthias Kettwig
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (H.G.K.); (M.K.); (J.G.)
| | - Frank Streit
- Department of Clinical Chemistry, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany;
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (H.G.K.); (M.K.); (J.G.)
| | - Hendrik Rosewich
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (H.G.K.); (M.K.); (J.G.)
- Correspondence: (H.R.); (R.K.); Tel.: +49-551-39-67019 (H.R.); +49-551-39-66236 (R.K.)
| | - Ralph Krätzner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (H.G.K.); (M.K.); (J.G.)
- Correspondence: (H.R.); (R.K.); Tel.: +49-551-39-67019 (H.R.); +49-551-39-66236 (R.K.)
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20
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Sofou K, Meier K, Sanderson LE, Kaminski D, Montoliu‐Gaya L, Samuelsson E, Blomqvist M, Agholme L, Gärtner J, Mühlhausen C, Darin N, Barakat TS, Schlotawa L, van Ham T, Asin Cayuela J, Sterky FH. Bi-allelic VPS16 variants limit HOPS/CORVET levels and cause a mucopolysaccharidosis-like disease. EMBO Mol Med 2021; 13:e13376. [PMID: 33938619 PMCID: PMC8103096 DOI: 10.15252/emmm.202013376] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Lysosomal storage diseases, including mucopolysaccharidoses, result from genetic defects that impair lysosomal catabolism. Here, we describe two patients from two independent families presenting with progressive psychomotor regression, delayed myelination, brain atrophy, neutropenia, skeletal abnormalities, and mucopolysaccharidosis-like dysmorphic features. Both patients were homozygous for the same intronic variant in VPS16, a gene encoding a subunit of the HOPS and CORVET complexes. The variant impaired normal mRNA splicing and led to an ~85% reduction in VPS16 protein levels in patient-derived fibroblasts. Levels of other HOPS/CORVET subunits, including VPS33A, were similarly reduced, but restored upon re-expression of VPS16. Patient-derived fibroblasts showed defects in the uptake and endosomal trafficking of transferrin as well as accumulation of autophagosomes and lysosomal compartments. Re-expression of VPS16 rescued the cellular phenotypes. Zebrafish with disrupted vps16 expression showed impaired development, reduced myelination, and a similar accumulation of lysosomes and autophagosomes in the brain, particularly in glia cells. This disorder resembles previously reported patients with mutations in VPS33A, thus expanding the family of mucopolysaccharidosis-like diseases that result from mutations in HOPS/CORVET subunits.
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Affiliation(s)
- Kalliopi Sofou
- Department of PaediatricsInstitute of Clinical SciencesUniversity of GothenburgGothenburgSweden
| | - Kolja Meier
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GoettingenGoettingenGermany
| | - Leslie E Sanderson
- Department of Clinical GeneticsErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Debora Kaminski
- Department of Laboratory MedicineInstitute of BiomedicineUniversity of GothenburgGothenburgSweden
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
| | - Laia Montoliu‐Gaya
- Department of Laboratory MedicineInstitute of BiomedicineUniversity of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
| | - Emma Samuelsson
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
| | - Maria Blomqvist
- Department of Laboratory MedicineInstitute of BiomedicineUniversity of GothenburgGothenburgSweden
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
| | - Lotta Agholme
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GoettingenGoettingenGermany
| | - Chris Mühlhausen
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GoettingenGoettingenGermany
| | - Niklas Darin
- Department of PaediatricsInstitute of Clinical SciencesUniversity of GothenburgGothenburgSweden
| | - Tahsin Stefan Barakat
- Department of Clinical GeneticsErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Lars Schlotawa
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GoettingenGoettingenGermany
| | - Tjakko van Ham
- Department of Clinical GeneticsErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Jorge Asin Cayuela
- Department of Laboratory MedicineInstitute of BiomedicineUniversity of GothenburgGothenburgSweden
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
| | - Fredrik H Sterky
- Department of Laboratory MedicineInstitute of BiomedicineUniversity of GothenburgGothenburgSweden
- Department of Clinical ChemistrySahlgrenska University HospitalGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
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21
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Gizak A, Diegmann S, Dreha-Kulaczewski S, Wiśniewski J, Duda P, Ohlenbusch A, Huppke B, Henneke M, Höhne W, Altmüller J, Thiele H, Nürnberg P, Rakus D, Gärtner J, Huppke P. A novel remitting leukodystrophy associated with a variant in FBP2. Brain Commun 2021; 3:fcab036. [PMID: 33977262 PMCID: PMC8097510 DOI: 10.1093/braincomms/fcab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
Leukodystrophies are genetic disorders of cerebral white matter that almost exclusively have a progressive disease course. We became aware of three members of a family with a disorder characterized by a sudden loss of all previously acquired abilities around 1 year of age followed by almost complete recovery within 2 years. Cerebral MRI and myelin sensitive imaging showed a pronounced demyelination that progressed for several months despite signs of clinical improvement and was followed by remyelination. Exome sequencing did not-identify any mutations in known leukodystrophy genes but revealed a heterozygous variant in the FBP2 gene, c.343G>A, p. Val115Met, shared by the affected family members. Cerebral MRI of other family members demonstrated similar white matter abnormalities in all carriers of the variant in FBP2. The FBP2 gene codes for muscle fructose 1,6-bisphosphatase, an enzyme involved in gluconeogenesis that is highly expressed in brain tissue. Biochemical analysis showed that the variant has a dominant negative effect on enzymatic activity, substrate affinity, cooperativity and thermal stability. Moreover, it also affects the non-canonical functions of muscle fructose 1,6-bisphosphatase involved in mitochondrial protection and regulation of several nuclear processes. In patients’ fibroblasts, muscle fructose 1,6-bisphosphatase shows no colocalization with mitochondria and nuclei leading to increased reactive oxygen species production and a disturbed mitochondrial network. In conclusion, the results of this study indicate that the variant in FBP2 disturbs cerebral energy metabolism and is associated with a novel remitting leukodystrophy.
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Affiliation(s)
- Agnieszka Gizak
- Department of Molecular Physiology and Neurobiology, University of Wrocław, 50-335 Wrocław, Poland
| | - Susann Diegmann
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany
| | - Janusz Wiśniewski
- Department of Molecular Physiology and Neurobiology, University of Wrocław, 50-335 Wrocław, Poland
| | - Przemysław Duda
- Department of Molecular Physiology and Neurobiology, University of Wrocław, 50-335 Wrocław, Poland
| | - Andreas Ohlenbusch
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany
| | - Brenda Huppke
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany.,Department of Neuropediatrics, Jena University Hospital, 07747 Jena, Germany
| | - Marco Henneke
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany
| | - Wolfgang Höhne
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Holger Thiele
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG) and Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Dariusz Rakus
- Department of Molecular Physiology and Neurobiology, University of Wrocław, 50-335 Wrocław, Poland
| | - Jutta Gärtner
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany
| | - Peter Huppke
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University, 37075 Göttingen, Germany.,Department of Neuropediatrics, Jena University Hospital, 07747 Jena, Germany
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22
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Rascher W, Klingebiel T, Herting E, Hoffmann GF, Berner R, Krägeloh-Mann I, Gärtner J, Zepp F, Schara U. Erratum zu: Arzneimittel für neuartige Therapien – Perspektiven, Chancen, Herausforderungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Rascher W, Klingebiel T, Herting E, Hoffmann GF, Berner R, Krägeloh-Mann I, Gärtner J, Zepp F, Schara U. Arzneimittel für neuartige Therapien. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Meier K, Gärtner J, Huppke P. Tumefactive inflammatory lesions in juvenile metachromatic leukodystrophy. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e922. [PMID: 33229454 PMCID: PMC7713719 DOI: 10.1212/nxi.0000000000000922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kolja Meier
- From the Department of Pediatrics and Adolescent Medicine, Pediatric Neurology, University Medical Center Göttingen, Georg August University, Germany
| | - Jutta Gärtner
- From the Department of Pediatrics and Adolescent Medicine, Pediatric Neurology, University Medical Center Göttingen, Georg August University, Germany
| | - Peter Huppke
- From the Department of Pediatrics and Adolescent Medicine, Pediatric Neurology, University Medical Center Göttingen, Georg August University, Germany.
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25
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Rascher W, Klingebiel T, Herting E, Hoffmann GF, Berner R, Krägeloh-Mann I, Gärtner J, Zepp F, Schara U. Arzneimittel für neuartige Therapien – Perspektiven, Chancen, Herausforderungen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01056-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
ZusammenfassungArzneimittel für neuartige Therapien (ATMP) wie somatische Gentherapie und Zelltherapie besitzen ein hohes therapeutisches Potenzial für Krankheiten, die sehr früh im Leben beginnen, und die bisher nicht behandelbar waren. Sie werden oft in einem sehr frühen Entwicklungsstadium zugelassen, wenn an wenigen Betroffenen die Wirksamkeit gezeigt wurde und sich ein bisher nie dagewesener Therapieerfolg auftut, vor allem, wenn die Therapie vor Eintritt von Organschäden greift. Dadurch ergeben sich für Pädiater neue arzneimittelrechtliche und ethische Fragen.Um die neuen Behandlungsmöglichkeiten adäquat einzusetzen, muss die Diagnose früher als bisher gestellt werden, oder neue Screeningmethoden müssen zur Verfügung stehen. Denkbar ist, dass das Neugeborenenscreening in zeitkritische Krankheiten in den ersten 72 h nach Geburt und ein genetisches Screening (z. B. in der 4. bis 5. Lebenswoche) aufgeteilt wird.ATMP sind bei ihrer Zulassung noch nicht in ausreichender Anzahl angewendet worden, sodass die notwendigen Erkenntnisse für Wirksamkeit und Sicherheit noch nicht vorliegen (Nutzen-Risiko-Verhältnis). Deswegen werden sie unter strengen Auflagen in spezialisierten Behandlungszentren nach Qualitätskriterien eingesetzt, die der Gemeinsame Bundesausschuss (G-BA) nach Beratung mit den Fachgesellschaften festlegt. Der Aufwand der Therapie und der Dokumentation des Verlaufes in Registern ist erheblich und muss entsprechend vergütet werden.Der Wert eines ATMP wird erst mit seiner breiteren Anwendung nach der Zulassung klar, ähnlich wie die Sicherheit eines Arzneimittels nicht mit der Zulassung vollumfänglich bekannt ist. Für die Pädiatrie ergeben sich neue Herausforderungen und Chancen.
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26
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Dibaj P, Brockmann K, Gärtner J. Dopamine-Mediated Yawning-Fatigue Syndrome With Specific Recurrent Initiation and Responsiveness to Opioids. JAMA Neurol 2020; 77:254. [PMID: 31790550 DOI: 10.1001/jamaneurol.2019.3937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Payam Dibaj
- Center for Rare Diseases Göttingen, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany.,Max-Planck-Institute for Experimental Medicine, Göttingen, Germany.,Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Knut Brockmann
- Center for Rare Diseases Göttingen, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany.,Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Center for Rare Diseases Göttingen, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany.,Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
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27
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Pennisi A, Rötig A, Roux CJ, Lévy R, Henneke M, Gärtner J, Teke Kisa P, Sarioglu FC, Yiş U, Konczal LL, Burkardt DD, Wu S, Gaignard P, Besmond C, Hubert L, Rio M, Barcia G, Munnich A, Boddaert N, Schiff M. Heterogeneity of PNPT1 neuroimaging: mitochondriopathy, interferonopathy or both? J Med Genet 2020; 59:204-208. [PMID: 33199448 DOI: 10.1136/jmedgenet-2020-107367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biallelic variants in PNPT1 cause a mitochondrial disease of variable severity. PNPT1 (polynucleotide phosphorylase) is a mitochondrial protein involved in RNA processing where it has a dual role in the import of small RNAs into mitochondria and in preventing the formation and release of mitochondrial double-stranded RNA into the cytoplasm. This, in turn, prevents the activation of type I interferon response. Detailed neuroimaging findings in PNPT1-related disease are lacking with only a few patients reported with basal ganglia lesions (Leigh syndrome) or non-specific signs. OBJECTIVE AND METHODS To document neuroimaging data in six patients with PNPT1 highlighting novel findings. RESULTS Two patients exhibited striatal lesions compatible with Leigh syndrome; one patient exhibited leukoencephalopathy and one patient had a normal brain MRI. Interestingly, two unrelated patients exhibited cystic leukoencephalopathy resembling RNASET2-deficient patients, patients with Aicardi-Goutières syndrome (AGS) or congenital CMV infection. CONCLUSION We suggest that similar to RNASET2, PNPT1 be searched for in the setting of cystic leukoencephalopathy. These findings are in line with activation of type I interferon response observed in AGS, PNPT1 and RNASET2 deficiencies, suggesting a common pathophysiological pathway and linking mitochondrial diseases, interferonopathies and immune dysregulations.
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Affiliation(s)
- Alessandra Pennisi
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
- Inserm UMR_S1163, Institut Imagine, Paris, France
| | - Agnès Rötig
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
- Inserm UMR_S1163, Institut Imagine, Paris, France
| | - Charles-Joris Roux
- Necker Hospital, APHP, Pediatric Radiology Department, University of Paris, Paris, France
| | - Raphaël Lévy
- Necker Hospital, APHP, Pediatric Radiology Department, University of Paris, Paris, France
| | - Marco Henneke
- Department of Paediatrics and Adolescent Medicine, Germany, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, Germany, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Pelin Teke Kisa
- Pediatric Metabolism and Nutrition, Dokuz Eylül University, Izmir, Turkey
| | | | - Uluç Yiş
- Pediatric Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Laura L Konczal
- Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Genetics, Case Western Reserve University, Cleveland, OH, USA
| | - Deepika D Burkardt
- Center for Human Genetics, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Genetics, Case Western Reserve University, Cleveland, OH, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sulin Wu
- Department of Genetics, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Pauline Gaignard
- Bicêtre Hospital, APHP, Department of Biochemistry, Bicêtre, France
| | | | | | - Marlène Rio
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
| | - Giulia Barcia
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
| | - Arnold Munnich
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
- Inserm UMR_S1163, Institut Imagine, Paris, France
| | - Nathalie Boddaert
- Inserm UMR_S1163, Institut Imagine, Paris, France
- Necker Hospital, APHP, Pediatric Radiology Department, University of Paris, Paris, France
| | - Manuel Schiff
- Necker Hospital, APHP, Reference Center for Mitochondrial Diseases, Genetics Department, Institut Imagine, University of Paris, Paris, France
- Inserm UMR_S1163, Institut Imagine, Paris, France
- Necker Hospital, APHP, Reference Center for Inborn Errors of Metabolism, Institut Imagine, University of Paris, Paris, France
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28
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Ostendorf T, Zillinger T, Andryka K, Schlee-Guimaraes TM, Schmitz S, Marx S, Bayrak K, Linke R, Salgert S, Wegner J, Grasser T, Bauersachs S, Soltesz L, Hübner MP, Nastaly M, Coch C, Kettwig M, Roehl I, Henneke M, Hoerauf A, Barchet W, Gärtner J, Schlee M, Hartmann G, Bartok E. Immune Sensing of Synthetic, Bacterial, and Protozoan RNA by Toll-like Receptor 8 Requires Coordinated Processing by RNase T2 and RNase 2. Immunity 2020; 52:591-605.e6. [PMID: 32294405 DOI: 10.1016/j.immuni.2020.03.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/24/2020] [Accepted: 03/18/2020] [Indexed: 01/13/2023]
Abstract
Human toll-like receptor 8 (TLR8) activation induces a potent T helper-1 (Th1) cell response critical for defense against intracellular pathogens, including protozoa. The receptor harbors two distinct binding sites, uridine and di- and/or trinucleotides, but the RNases upstream of TLR8 remain poorly characterized. We identified two endolysosomal endoribonucleases, RNase T2 and RNase 2, that act synergistically to release uridine from oligoribonucleotides. RNase T2 cleaves preferentially before, and RNase 2 after, uridines. Live bacteria, P. falciparum-infected red blood cells, purified pathogen RNA, and synthetic oligoribonucleotides all required RNase 2 and T2 processing to activate TLR8. Uridine supplementation restored RNA recognition in RNASE2-/- or RNASET2-/- but not RNASE2-/-RNASET2-/- cells. Primary immune cells from RNase T2-hypomorphic patients lacked a response to bacterial RNA but responded robustly to small-molecule TLR8 ligands. Our data identify an essential function of RNase T2 and RNase 2 upstream of TLR8 and provide insight into TLR8 activation.
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Affiliation(s)
- Thomas Ostendorf
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Thomas Zillinger
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Katarzyna Andryka
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | | | - Saskia Schmitz
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Samira Marx
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Kübra Bayrak
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Rebecca Linke
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Sarah Salgert
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Julia Wegner
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Tatjana Grasser
- Axolabs GmbH, Fritz-Hornschuch-Strasse 9, 95326 Kulmbach, Germany
| | - Sonja Bauersachs
- Axolabs GmbH, Fritz-Hornschuch-Strasse 9, 95326 Kulmbach, Germany
| | - Leon Soltesz
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Marc P Hübner
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Maximilian Nastaly
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany; Miltenyi Biotech, Biomedicine Division, Bergisch Gladbach, Germany
| | - Matthias Kettwig
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Ingo Roehl
- Axolabs GmbH, Fritz-Hornschuch-Strasse 9, 95326 Kulmbach, Germany
| | - Marco Henneke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Winfried Barchet
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Martin Schlee
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Gunther Hartmann
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Eva Bartok
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
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Schlotawa L, Preiskorn J, Ahrens-Nicklas R, Schiller S, Adang LA, Gärtner J, Friede T. A systematic review and meta-analysis of published cases reveals the natural disease history in multiple sulfatase deficiency. J Inherit Metab Dis 2020; 43:1288-1297. [PMID: 32621519 DOI: 10.1002/jimd.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 12/29/2022]
Abstract
Multiple Sulfatase Deficiency (MSD, MIM#272200) is an ultra-rare lysosomal storage disorder arising from mutations in the SUMF1 gene, which encodes the formylglycine-generating enzyme (FGE). FGE is necessary for the activation of sulfatases, a family of enzymes that are involved in the degradation of sulfated substrates such as glycosaminoglycans and sulfolipids. SUMF1 mutations lead to functionally impaired FGE and individuals with MSD demonstrate clinical signs of single sulfatase deficiencies, including metachromatic leukodystrophy (MLD) and several mucopolysaccharidosis (MPS) subtypes. Comprehensive information related to the natural history of MSD is missing. We completed a systematic literature review and a meta-analysis on data from published cases reporting on MSD. As available from these reports, we extracted clinical, genetic, biochemical, and brain imaging information. We identified 75 publications with data on 143 MSD patients with a total of 53 unique SUMF1 mutations. The mean survival was 13 years (95% CI 9.8-16.2 years). Seventy-five clinical signs and 11 key clusters of signs were identified. The most frequently affected organs systems were the nervous, skeletal, and integumentary systems. The most frequent MRI features were abnormal myelination and cerebral atrophy. Individuals with later onset MSD signs and survived longer than those with signs at birth. Less severe mutations, low disease burden and achievement of independent walking positively correlated with longer survival. Despite the limitations of our approach, we were able to define clinical characteristics and disease outcomes in MSD. This work will provide the foundation of natural disease history data needed for future clinical trial design.
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Affiliation(s)
- Lars Schlotawa
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Joana Preiskorn
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Rebecca Ahrens-Nicklas
- Division of Clinical Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stina Schiller
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Laura A Adang
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
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30
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Adang LA, Schlotawa L, Groeschel S, Kehrer C, Harzer K, Staretz‐Chacham O, Silva TO, Schwartz IVD, Gärtner J, De Castro M, Costin C, Montgomery EF, Dierks T, Radhakrishnan K, Ahrens‐Nicklas RC. Natural history of multiple sulfatase deficiency: Retrospective phenotyping and functional variant analysis to characterize an ultra-rare disease. J Inherit Metab Dis 2020; 43:1298-1309. [PMID: 32749716 PMCID: PMC7693296 DOI: 10.1002/jimd.12298] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 12/20/2022]
Abstract
Multiple sulfatase deficiency (MSD) is an ultra-rare neurodegenerative disorder caused by pathogenic variants in SUMF1. This gene encodes formylglycine-generating enzyme (FGE), a protein required for sulfatase activation. The clinical course of MSD results from additive effect of each sulfatase deficiency, including metachromatic leukodystrophy (MLD), several mucopolysaccharidoses (MPS II, IIIA, IIID, IIIE, IVA, VI), chondrodysplasia punctata, and X-linked ichthyosis. While it is known that affected individuals demonstrate a complex and severe phenotype, the genotype-phenotype relationship and detailed clinical course is unknown. We report on 35 cases enrolled in our retrospective natural history study, n = 32 with detailed histories. Neurologic function was longitudinally assessed with retrospective scales. Biochemical and computational modeling of novel SUMF1 variants was performed. Genotypes were classified based on predicted functional change, and each individual was assigned a genotype severity score. The median age at symptom onset was 0.25 years; median age at diagnosis was 2.7 years; and median age at death was 13 years. All individuals demonstrated developmental delay, and only a subset of individuals attained ambulation and verbal communication. All subjects experienced an accumulating systemic symptom burden. Earlier age at symptom onset and severe variant pathogenicity correlated with poor neurologic outcomes. Using retrospective deep phenotyping and detailed variant analysis, we defined the natural history of MSD. We found that attenuated cases can be distinguished from severe cases by age of onset, attainment of ambulation, and genotype. Results from this study can help inform prognosis and facilitate future study design.
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Affiliation(s)
- Laura A. Adang
- Division of NeurologyThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Lars Schlotawa
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGermany
| | | | | | | | | | - Thiago Oliveira Silva
- Nuclimed‐Clinical Research Center, Hospital de Clinicas de Porto Alegre‐RSPorto AlegreBrazil
| | - Ida Vanessa D. Schwartz
- Nuclimed‐Clinical Research Center, Hospital de Clinicas de Porto Alegre‐RSPorto AlegreBrazil
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGermany
| | | | | | | | - Thomas Dierks
- Department of Chemistry, Biochemistry IBielefeld UniversityBielefeldGermany
| | | | - Rebecca C. Ahrens‐Nicklas
- Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia, Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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31
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Mühlhausen C, Henneke L, Schlotawa L, Behme D, Grüneberg M, Gärtner J, Marquardt T. Mannose phosphate isomerase deficiency-congenital disorder of glycosylation (MPI-CDG) with cerebral venous sinus thrombosis as first and only presenting symptom: A rare but treatable cause of thrombophilia. JIMD Rep 2020; 55:38-43. [PMID: 32905087 PMCID: PMC7463055 DOI: 10.1002/jmd2.12149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 01/26/2023] Open
Abstract
Mannose phosphate isomerase deficiency-congenital disorder of glycosylation (MPI-CDG; formerly named CDG type 1b) is characterized by the clinical triad of hepatopathy, protein-losing enteropathy, and hyperinsulinemic hypoglycemia in combination with coagulation disorder (thrombophilia, depletion of antithrombin, proteins C and S, factor XI). In the majority of patients, MPI-CDG manifests during early infancy or childhood. Here, we present a 15-year-old female patient with unremarkable medical history suffering from acute cerebral venous sinus thrombosis necessitating interventional thrombectomy and neurosurgical decompression. Diagnostic work-up of thrombophilia revealed deficiency of antithrombin (AT), proteins C and S, and factor XI. Detailed evaluation identified MPI-CDG as the underlying cause of disease. After initiation of mannose therapy, coagulation parameters normalized. The girl fully recovered without any neurologic sequelae, and remains free of further thrombotic events or any other clinical and laboratory abnormalities on follow-up 1 year after start of mannose treatment. In conclusion, we here present the significant case of MPI-CDG with a severe cerebral venous sinus thrombosis as the first and only symptom of the disease. In light of the high frequency of AT deficiency on one hand, and the excellent treatability of MPI-CDG on the other hand, CDG screening should be included as a routine analysis in all patients presenting with unexplained coagulation disorder, especially when comprising AT deficiency.
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Affiliation(s)
- Chris Mühlhausen
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Lisa Henneke
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Lars Schlotawa
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
| | - Daniel Behme
- Department of NeuroradiologyUniversity Medical Centre GöttingenGöttingenGermany
| | | | - Jutta Gärtner
- Department of Pediatrics and Adolescent MedicineUniversity Medical Centre GöttingenGöttingenGermany
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32
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Lazarov E, Hillebrand M, Schröder S, Ternka K, Hofhuis J, Ohlenbusch A, Barrantes-Freer A, Pardo LA, Fruergaard MU, Nissen P, Brockmann K, Gärtner J, Rosewich H. Comparative analysis of alternating hemiplegia of childhood and rapid-onset dystonia-parkinsonism ATP1A3 mutations reveals functional deficits, which do not correlate with disease severity. Neurobiol Dis 2020; 143:105012. [PMID: 32653672 DOI: 10.1016/j.nbd.2020.105012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Heterozygous mutations in the ATP1A3 gene, coding for an alpha subunit isoform (α3) of Na+/K+-ATPase, are the primary genetic cause for rapid-onset dystonia-parkinsonism (RDP) and alternating hemiplegia of childhood (AHC). Recently, cerebellar ataxia, areflexia, pes cavus, optic atrophy and sensorineural hearing loss (CAPOS), early infantile epileptic encephalopathy (EIEE), childhood rapid onset ataxia (CROA) and relapsing encephalopathy with rapid onset ataxia (RECA) extend the clinical spectrum of ATP1A3 related disorders. AHC and RDP demonstrate distinct clinical features, with AHC symptoms being generally more severe compared to RDP. Currently, it is largely unknown what determines the disease severity, and whether severity is linked to the degree of functional impairment of the α3 subunit. Here we compared the effect of twelve different RDP and AHC specific mutations on the expression and function of the α3 Na+/K+-ATPase in transfected HEK cells and oocytes. All studied mutations led to functional impairment of the pump, as reflected by lower survival rate and reduced pump current. No difference in the extent of impairment, nor in the expression level, was found between the two phenotypes, suggesting that these measures of pump dysfunction do not exclusively determine the disease severity.
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Affiliation(s)
- Elinor Lazarov
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Merle Hillebrand
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Simone Schröder
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Katharina Ternka
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Julia Hofhuis
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Andreas Ohlenbusch
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | | | - Luis A Pardo
- Department of Molecular Biology of Neuronal Signals, Max Planck Institute of Experimental Medicine, Göttingen, Germany.
| | - Marlene U Fruergaard
- DANDRITE - Nordic EMBL Partnership for Molecular Medicine, Dept. Molecular Biology and Genetics, Aarhus University, Gustav Wieds Vej 10C, DK-8000 Aarhus C, Denmark.
| | - Poul Nissen
- DANDRITE - Nordic EMBL Partnership for Molecular Medicine, Dept. Molecular Biology and Genetics, Aarhus University, Gustav Wieds Vej 10C, DK-8000 Aarhus C, Denmark.
| | - Knut Brockmann
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Jutta Gärtner
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
| | - Hendrik Rosewich
- University Medical Center Göttingen, Georg August University, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Germany.
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Chitnis T, Banwell B, Krupp L, Arnold DL, Bar-Or A, Brück W, Giovannoni G, Greenberg B, Ghezzi A, Waubant E, Rostasy K, Deiva K, Huppke P, Wolinsky JS, Zhang Y, Azmon A, K-Laflamme A, Karan R, Gärtner J. Temporal profile of lymphocyte counts and relationship with infections with fingolimod therapy in paediatric patients with multiple sclerosis: Results from the PARADIG MS study. Mult Scler 2020; 27:922-932. [PMID: 32633694 DOI: 10.1177/1352458520936934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reduction in absolute lymphocyte count (ALC) is expected with fingolimod treatment. OBJECTIVE To evaluate the effect of fingolimod 0.5 mg versus intramuscular interferon β-1a (30 μg) on ALC and its relationship with infections in paediatric-onset multiple sclerosis (POMS) up to 4 years. METHODS We assessed ALC at baseline, monthly till 3 months, and every 3 months (core phase) and with variable periodicity (extension phase) of Phase 3 PARADIGMS study (N = 215). Incidence rates (IRs) of infection-related adverse events (infAEs)/100 patient-years were analysed by on-study nadir ALC. RESULTS With fingolimod, ALC rapidly reduced to 29.9%-34.4% of baseline values within 2 weeks and remained stable thereafter; no relevant changes observed with interferon. IRs of infAEs were 67.6 with fingolimod and 61.8 with interferon; IR ratios with respect to interferon, overall: 1.09, by nadir ALC 0.2-0.4 × 109/L: 1.13 and >0.4 × 109/L: 0.91. Three patients had a single episode of ALC <0.2 × 109/L (core phase). No opportunistic infections were observed and infection risk did not increase during the extension phase. CONCLUSION In paediatric patients, the overall incidence of infections was comparable between fingolimod and interferon. No association was observed between nadir ALC and infections in POMS, although sample size may have been too small to rule an association.
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Affiliation(s)
- Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Brenda Banwell
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Krupp
- Pediatric MS Center, NYU Langone, New York, NY, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada/ NeuroRx Research, Montreal, QC, Canada
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Centre, Göttingen, Germany
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Benjamin Greenberg
- Departments of Neurology and Neurotherapeutics, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kevin Rostasy
- Division of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Kumaran Deiva
- Pediatric Neurology Department, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, site Bicêtre, Le Kremlin Bicêtre, France
| | - Peter Huppke
- Division of Paediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ying Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Jutta Gärtner
- Division of Paediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
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34
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Reinert MC, Benkert P, Wuerfel J, Michalak Z, Ruberte E, Barro C, Huppke P, Stark W, Kropshofer H, Tomic D, Leppert D, Kuhle J, Brück W, Gärtner J. Serum neurofilament light chain is a useful biomarker in pediatric multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/4/e749. [PMID: 32404429 PMCID: PMC7238898 DOI: 10.1212/nxi.0000000000000749] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Objective To investigate serum neurofilament light chain (sNfL) as a potential biomarker for disease activity and treatment response in pediatric patients with multiple sclerosis (MS). Methods In this retrospective cohort study, sNfL levels were measured in a pediatric MS cohort (n = 55, follow-up 12–105 months) and in a non-neurologic pediatric control cohort (n = 301) using a high-sensitivity single-molecule array assay. Association of sNfL levels and treatment and clinical and MRI parameters were calculated. Results Untreated patients had higher sNfL levels than controls (median 19.0 vs 4.6 pg/mL; CI [4.732, 6.911]), p < 0.001). sNfL levels were significantly associated with MRI activity (+9.1% per contrast-enhancing lesion, CI [1.045, 1.138], p < 0.001; +0.6% per T2-weighted lesion, CI [1.001, 1.010], p = 0.015). Higher values were associated with a relapse <90 days ago (+51.1%; CI [1.184, 1.929], p < 0.001) and a higher Expanded Disability Status Scale score (CI [1.001, 1.240], p = 0.048). In patients treated with interferon beta-1a/b (n = 27), sNfL levels declined from 14.7 to 7.9 pg/mL after 6 ± 2 months (CI [0.339, 0.603], p < 0.001). Patients with insufficient control of clinical or MRI disease activity under treatment with interferon beta-1a/b or glatiramer acetate who switched to fingolimod (n = 18) showed a reduction of sNfL levels from 16.5 to 10.0 pg/mL 6 ± 2 months after switch (CI [0.481, 0.701], p < 0.001). Conclusions sNfL is a useful biomarker for monitoring disease activity and treatment response in pediatric MS. It is most likely helpful to predict disease severity and to guide treatment decisions in patients with pediatric MS. This study provides Class III evidence that sNfL levels are associated with disease activity in pediatric MS.
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Affiliation(s)
- Marie-Christine Reinert
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany.
| | - Pascal Benkert
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Jens Wuerfel
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Zuzanna Michalak
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Esther Ruberte
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Christian Barro
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Peter Huppke
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Wiebke Stark
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Harald Kropshofer
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Davorka Tomic
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - David Leppert
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Jens Kuhle
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Wolfgang Brück
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Jutta Gärtner
- From the Department of Pediatrics and Adolescent Medicine (M.-C.R., P.H., W.S., J.G.), Division of Pediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Germany; Clinical Trial Unit (P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Medical Image Analysis Centre Basel (MIAC AG) (J.W., E.R.); Department of Biomedical Engineering (J.W.), University Basel; Neurologic Clinic and Policlinic (Z.M., C.B., D.L., J.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.T.), Basel, Switzerland; and Institute of Neuropathology (W.B.), University Medical Centre Göttingen, Georg August University Göttingen, Germany
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Weber T, Schlotawa L, Dosch R, Hamilton N, Kaiser J, Schiller S, Wenske B, Gärtner J, Henneke M. Zebrafish disease model of human RNASET2-deficient cystic leukoencephalopathy displays abnormalities in early microglia. Biol Open 2020; 9:bio049239. [PMID: 32295832 PMCID: PMC7225086 DOI: 10.1242/bio.049239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
Human infantile-onset RNASET2-deficient cystic leukoencephalopathy is a Mendelian mimic of in utero cytomegalovirus brain infection with prenatally developing inflammatory brain lesions. We used an RNASET2-deficient zebrafish model to elucidate the underlying disease mechanisms. Mutant and wild-type zebrafish larvae brain development between 2 and 5 days post fertilization (dpf) was examined by confocal live imaging in fluorescent reporter lines of the major types of brain cells. In contrast to wild-type brains, RNASET2-deficient larvae displayed increased numbers of microglia with altered morphology, often containing inclusions of neurons. Furthermore, lysosomes within distinct populations of the myeloid cell lineage including microglia showed increased lysosomal staining. Neurons and oligodendrocyte precursor cells remained unaffected. This study provides a first look into the prenatal onset pathomechanisms of human RNASET2-deficient leukoencephalopathy, linking this inborn lysosomal disease to the innate immune system and other immune-related childhood encephalopathies like Aicardi-Goutières syndrome (AGS).
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Affiliation(s)
- Thomas Weber
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Lars Schlotawa
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Roland Dosch
- Department of Human Genetics, University Medical Center Goettingen, Justus-von-Liebig-Weg 11, 37077 Goettingen, Germany
| | - Noémie Hamilton
- The Bateson Centre, University of Sheffield, Firth Court D31, Sheffield S10 2PT, United Kingdom
| | - Jens Kaiser
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Stina Schiller
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Britta Wenske
- Department of Haematology and Oncology, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
| | - Marco Henneke
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Robert- Koch- Str. 40, 37075 Goettingen, Germany
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36
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Arnold DL, Banwell B, Bar-Or A, Ghezzi A, Greenberg BM, Waubant E, Giovannoni G, Wolinsky JS, Gärtner J, Rostásy K, Krupp L, Tardieu M, Brück W, Stites TE, Pearce GL, Häring DA, Merschhemke M, Chitnis T. Effect of fingolimod on MRI outcomes in patients with paediatric-onset multiple sclerosis: results from the phase 3 PARADIG MS study. J Neurol Neurosurg Psychiatry 2020; 91:483-492. [PMID: 32132224 PMCID: PMC7231437 DOI: 10.1136/jnnp-2019-322138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE PARADIGMS demonstrated superior efficacy and comparable safety of fingolimod versus interferon β-1a (IFN β-1a) in paediatric-onset multiple sclerosis (PoMS). This study aimed to report all predefined MRI outcomes from this study. METHODS Patients with multiple sclerosis (MS) (aged 10-<18 years) were randomised to once-daily oral fingolimod (n=107) or once-weekly intramuscular IFN β-1a (n=108) in this flexible duration study. MRI was performed at baseline and every 6 months for up to 2 years or end of the study (EOS) in case of early treatment discontinuation/completion. Key MRI endpoints included the annualised rate of formation of new/newly enlarging T2 lesions, gadolinium-enhancing (Gd+) T1 lesions, new T1 hypointense lesions and combined unique active (CUA) lesions (6 months onward), changes in T2 and Gd+ T1 lesion volumes and annualised rate of brain atrophy (ARBA). RESULTS Of the randomised patients, 107 each were treated with fingolimod and IFN β-1a for up to 2 years. Fingolimod reduced the annualised rate of formation of new/newly enlarging T2 lesions (52.6%, p<0.001), number of Gd+ T1 lesions per scan (66.0%, p<0.001), annualised rate of new T1 hypointense lesions (62.8%, p<0.001) and CUA lesions per scan (60.7%, p<0.001) versus IFN β-1a at EOS. The percent increases from baseline in T2 (18.4% vs 32.4%, p<0.001) and Gd+ T1 (-72.3% vs 4.9%, p=0.001) lesion volumes and ARBA (-0.48% vs -0.80%, p=0.014) were lower with fingolimod versus IFN β-1a, the latter partially due to accelerated atrophy in the IFN β-1a group. CONCLUSION Fingolimod significantly reduced MRI activity and ARBA for up to 2 years versus IFN β-1a in PoMS.
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Affiliation(s)
- Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada .,NeuroRx Research, Montreal, Quebec, Canada
| | - Brenda Banwell
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadephia, Pennsylvania, USA, Montreal, Quebec, Canada.,Neuroimmunology Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada, Philadephia, Pennsylvania, USA
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy
| | - Benjamin M Greenberg
- Department of Neurology and Neurotherapeutics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, California, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Jerry S Wolinsky
- McGovern Medical School, Department of Neurology, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA, Houston, Texas, USA
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, German Centre for Multiple Sclerosis in Childhood and Adolescence, University Medical Centre, Göttingen, Germany
| | - Kevin Rostásy
- Division of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Lauren Krupp
- Department of Neurology; Pediatric MS Center, NYU Langone Health, New York, NY USA, USA, New York, USA
| | - Marc Tardieu
- Hôpitaux universitaires Paris Sud, Paediatric Neurology Department, Assistance Publique-Hôpitaux de Paris, Paris France, Paris, France
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Centre, Göttingen, Germany
| | - Tracy E Stites
- Neuroscience TA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Bartok ES, Ostendorf T, Zillinger T, Andryka K, Guimaraes TM, Schmitz S, Marx S, Bayrak K, Linke R, Salgert S, Grasser T, Baersachs S, Hübner M, Soltesz L, Kettwig M, Nastaly M, Roehl I, Henneke M, Barchet W, Gärtner J, Schlee M, Hartmann G. Immune sensing of synthetic, bacterial and protozoan RNA by TLR8 requires coordinated processing of RNA substrates by RNaseT2 and RNase2. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.226.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Human TLR8 is an essential sensor of bacterial RNA which induces proinflammatory and Th1 cytokines. Crystallography revealed that TLR8 binds both uridine and short single-stranded RNA, but the RNases that process the RNA are still unknown. Herein, we demonstrate that two endosomal endoribonucleases, RNaseT2 and RNase2, can process RNA for TLR8 recognition. In the endosome, RNase2 and -T2 act synergistically to release uridine from oligoribonucleotides, with RNaseT2 cleaving preferentially before and RNase2 after uridines. Live bacteria, P. falciparum-infected red blood cells, purified pathogen RNA, and synthetic ligands all required RNase processing for TLR8 activation, and uridine supplementation restored RNA recognition in RNASE2−/− or RNASET2−/− but not double knockout cells. Strikingly, peripheral blood mononuclear cells from RNaseT2 hypomorphic patients did not respond to bacterial RNA but did to small-molecule TLR8 agonists. Our data provide a novel insight into TLR8 activation and its differences between cell types and species.
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Affiliation(s)
- Eva Sarah Bartok
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Thomas Ostendorf
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Thomas Zillinger
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Katarzyna Andryka
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | | | - Saskia Schmitz
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Samira Marx
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Kübra Bayrak
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Rebecca Linke
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Sarah Salgert
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | | | | | - Marc Hübner
- 3Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Leon Soltesz
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Matthias Kettwig
- 4Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Maximilian Nastaly
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | | | - Marco Henneke
- 4Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Winfried Barchet
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Jutta Gärtner
- 4Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Martin Schlee
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
| | - Gunther Hartmann
- 1Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany
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Hamilton N, Rutherford HA, Petts JJ, Isles HM, Weber T, Henneke M, Gärtner J, Dunning MJ, Renshaw SA. The failure of microglia to digest developmental apoptotic cells contributes to the pathology of RNASET2-deficient leukoencephalopathy. Glia 2020; 68:1531-1545. [PMID: 32212285 PMCID: PMC8647916 DOI: 10.1002/glia.23829] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
The contribution of microglia in neurological disorders is emerging as a leading disease driver rather than a consequence of pathology. RNAseT2‐deficient leukoencephalopathy is a severe childhood white matter disorder affecting patients in their first year of life and mimicking a cytomegalovirus brain infection. The early onset and resemblance of the symptoms to a viral infection suggest an inflammatory and embryonic origin of the pathology. There are no treatments available for this disease as our understanding of the cellular drivers of the pathology are still unknown. In this study, using a zebrafish mutant for the orthologous rnaset2 gene, we have identified an inflammatory signature in early development and an antiviral immune response in mature adult brains. Using the optical transparency and the ex utero development of the zebrafish larvae we studied immune cell behavior during brain development and identified abnormal microglia as an early marker of pathology. Live imaging and electron microscopy identified that mutant microglia displayed an engorged morphology and were filled with undigested apoptotic cells and undigested substrate. Using microglia‐specific depletion and rescue experiments, we identified microglia as drivers of this embryonic phenotype and potential key cellular player in the pathology of RNAseT2‐deficient leukoencephalopathy. Our zebrafish model also presented with reduced survival and locomotor defects, therefore recapitulating many aspects of the human disease. Our study therefore placed our rnaset2 mutant at the forefront of leukodystrophy preclinical models and highlighted tissue‐specific approaches as future therapeutic avenues.
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Affiliation(s)
- Noémie Hamilton
- The Bateson Centre, Department of Infection, Immunity and Cadiovascular Disease, University of Sheffield, Sheffield, UK
| | - Holly A Rutherford
- The Bateson Centre, Department of Infection, Immunity and Cadiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jessica J Petts
- The Bateson Centre, Department of Infection, Immunity and Cadiovascular Disease, University of Sheffield, Sheffield, UK
| | - Hannah M Isles
- The Bateson Centre, Department of Infection, Immunity and Cadiovascular Disease, University of Sheffield, Sheffield, UK
| | - Thomas Weber
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Marco Henneke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Mark J Dunning
- The Bioinformatics Core, Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Stephen A Renshaw
- The Bateson Centre, Department of Infection, Immunity and Cadiovascular Disease, University of Sheffield, Sheffield, UK
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Deiva K, Huppke P, Banwell B, Chitnis T, Gärtner J, Krupp L, Waubant E, Stites T, Pearce GL, Merschhemke M. Consistent control of disease activity with fingolimod versus IFN β-1a in paediatric-onset multiple sclerosis: further insights from PARADIG MS. J Neurol Neurosurg Psychiatry 2020; 91:58-66. [PMID: 31467033 PMCID: PMC6952840 DOI: 10.1136/jnnp-2019-321124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND In PARADIGMS, a double-blind phase III trial in 215 paediatric patients with multiple sclerosis (MS) (10 to <18 years), fingolimod administered for up to 2 years significantly reduced the annualised relapse rate (ARR) and rate of new/newly enlarged T2 (n/neT2) lesions compared with interferon (IFN) β-1a. OBJECTIVES To investigate (1) differences between treatment groups across subpopulations (treatment-naïve, younger/prepubertal patients); (2) disability progression. METHODS ARRs at 10, 11 and 12 years were estimated based on predefined modelling extrapolations. Changes in Expanded Disability Status Scale (EDSS), and in 3 month (3M) and 6 month (6M) confirmed disability progression (CDP) were evaluated post hoc. RESULTS In the treatment-naïve subpopulation, fingolimod reduced ARR and n/neT2 lesions by 85.8% and 53.4%, respectively versus INF β-1a (both p<0.001), compared with 81.9% and 52.6% in the overall population. Model-based ARR reductions in younger patients (≤12 years) were 91.9%-94.6%. Twice as many IFN β-1a-treated than fingolimod-treated patients had worse EDSS scores at study end (20.6% vs 10.5%, p=0.043). Risk reductions in 3M-CDP and 6M-CDP were 77.2% (p=0.007) and 80.2% (p=0.040), respectively. CONCLUSIONS Fingolimod in paediatric MS was associated with consistent control of disease activity versus IFN β-1a (including treatment-naïve and younger patients) and resulted in less disability progression for up to 2 years. TRIAL REGISTRATION NUMBER NCT01892722.
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Affiliation(s)
- Kumaran Deiva
- Department of Pediatric Neurology, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France .,Immunology of Viral Infections and Autoimmune Diseases, Universite Paris 11 Faculte de Medecine, Le Kremlin-Bicetre, France
| | - Peter Huppke
- Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence, University Medical Center Göttingen, Gottingen, Germany
| | - Brenda Banwell
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence, University Medical Center Göttingen, Gottingen, Germany
| | - Lauren Krupp
- Pediatric MS Center, NYU Langone Health, New York City, New York, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Tracy Stites
- Neuroscience Department, Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
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Schiller S, Rosewich H, Grünewald S, Gärtner J. Inborn errors of metabolism leading to neuronal migration defects. J Inherit Metab Dis 2020; 43:145-155. [PMID: 31747049 DOI: 10.1002/jimd.12194] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
The development and organisation of the human brain start in the embryonic stage and is a highly complex orchestrated process. It depends on series of cellular mechanisms that are precisely regulated by multiple proteins, signalling pathways and non-protein-coding genes. A crucial process during cerebral cortex development is the migration of nascent neuronal cells to their appropriate positions and their associated differentiation into layer-specific neurons. Neuronal migration defects (NMD) comprise a heterogeneous group of neurodevelopmental disorders including monogenetic disorders and residual syndromes due to damaging factors during prenatal development like infections, maternal diabetes mellitus or phenylketonuria, trauma, and drug use. Multifactorial causes are also possible. Classification into lissencephaly, polymicrogyria, schizencephaly, and neuronal heterotopia is based on the visible morphologic cortex anomalies. Characteristic clinical features of NMDs are severe psychomotor developmental delay, severe intellectual disability, intractable epilepsy, and dysmorphisms. Neurometabolic disorders only form a small subgroup within the large group of NMDs. The prototypes are peroxisomal biogenesis disorders, peroxisomal ß-oxidation defects and congenital disorders of O-glycosylation. The rapid evolution of biotechnology has resulted in an ongoing identification of metabolic and non-metabolic disease genes for NMDs. Nevertheless, we are far away from understanding the specific role of cortical genes and metabolites on spatial and temporal regulation of human cortex development and associated malformations. This limited understanding of the pathogenesis hinders the attempt for therapeutic approaches. In this article, we provide an overview of the most important cortical malformations and potential underlying neurometabolic disorders.
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Affiliation(s)
- Stina Schiller
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Hendrik Rosewich
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Stephanie Grünewald
- Metabolic Unit, Great Ormond Street Hospital and Institute of Child Health, University College London, London, UK
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
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Huppke B, Ellenberger D, Hummel H, Stark W, Röbl M, Gärtner J, Huppke P. Association of Obesity With Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children. JAMA Neurol 2019; 76:1157-1165. [PMID: 31305922 PMCID: PMC6632118 DOI: 10.1001/jamaneurol.2019.1997] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
Importance Obesity reportedly increases the risk of pediatric multiple sclerosis (MS), but little is known about its association with disease course. Objective To investigate the association of obesity with pediatric MS risk and with first-line therapy response among children with MS. Design, Setting, and Participants This single-center retrospective study used the medical records and database at the Center for MS in Childhood and Adolescence, Göttingen, Germany. The study included 453 patients with relapsing-remitting pediatric MS and body mass index (BMI) measurement taken within 6 months of diagnosis. Onset of the disease occurred between April 28, 1990, and June 26, 2016, and the mean disease duration was 38.4 months. Data were collected from July 14, 2016, to December 18, 2017. Main Outcomes and Measures Data on BMIs were stratified by sex and age using German BMI references and compared with the BMI data of 14 747 controls from a nationwide child health survey for odds ratio (OR) estimates. Baseline magnetic resonance imaging findings, intervals between first and second MS attacks, annualized relapse rates before and during treatment with interferon beta-1a or -1b and glatiramer acetate, frequency of second-line treatment, and Expanded Disability Status Scale (EDSS) scores were compared between nonoverweight (BMI≤90th percentile), overweight (BMI>90th-97th percentile), and obese (BMI>97th percentile) patients. Results In total, 453 patients with pediatric MS were included, of whom 306 (67.5%) were female, and the mean (SD) age at diagnosis was 13.7 (2.7) years. At diagnosis, 126 patients (27.8%) were overweight or obese, with obesity associated with statistically significant twofold odds of MS in both sexes (girls OR, 2.19; 95% CI, 1.5-3.1; P < .001 vs boys OR, 2.14; 95% CI, 1.3-3.5; P = .003). Obese patients, compared with nonoverweight patients, had statistically significantly more relapses on first-line treatment with interferon beta and glatiramer acetate (ARR, 1.29 vs 0.72; P < .001) and a higher rate of second-line treatment (21 [56.8%] of 37 vs 48 [38.7%] of 124; P = .06). Baseline neuroimaging, interval between first and second MS attacks, pretreatment relapses, and EDSS progression scores were not correlated with BMI. Conclusions and Relevance In this study, increased pediatric MS risk appeared to be associated with obesity, and obese patients did not respond well to first-line medications; altered pharmacokinetics appeared to be most likely factors in treatment response, suggesting that achieving healthy weight or adjusting the dose according to BMI could improve therapy response.
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Affiliation(s)
- Brenda Huppke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - David Ellenberger
- Department of Medical Statistics, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Hannah Hummel
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Wiebke Stark
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Markus Röbl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Peter Huppke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
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Stumpf SK, Berghoff SA, Trevisiol A, Spieth L, Düking T, Schneider LV, Schlaphoff L, Dreha-Kulaczewski S, Bley A, Burfeind D, Kusch K, Mitkovski M, Ruhwedel T, Guder P, Röhse H, Denecke J, Gärtner J, Möbius W, Nave KA, Saher G. Correction to: Ketogenic diet ameliorates axonal defects and promotes myelination in Pelizaeus-Merzbacher disease. Acta Neuropathol 2019; 138:673-674. [PMID: 31482207 PMCID: PMC6778063 DOI: 10.1007/s00401-019-02064-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/24/2022]
Abstract
The original article was published.
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Affiliation(s)
- Sina K Stumpf
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Stefan A Berghoff
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Andrea Trevisiol
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lena Spieth
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Tim Düking
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lennart V Schneider
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lennart Schlaphoff
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center, 37075, Göttingen, Germany
| | - Annette Bley
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Dinah Burfeind
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Kathrin Kusch
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Miso Mitkovski
- Light Microscopy Facility, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Torben Ruhwedel
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Philipp Guder
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Heiko Röhse
- Light Microscopy Facility, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Jonas Denecke
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center, 37075, Göttingen, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
- Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), 37073, Göttingen, Germany
| | - Klaus-Armin Nave
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
- Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), 37073, Göttingen, Germany
| | - Gesine Saher
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany.
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Schlotawa L, Dierks T, Christoph S, Cloppenburg E, Ohlenbusch A, Korenke GC, Gärtner J. Severe neonatal multiple sulfatase deficiency presenting with hydrops fetalis in a preterm birth patient. JIMD Rep 2019; 49:48-52. [PMID: 31497481 PMCID: PMC6718111 DOI: 10.1002/jmd2.12074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 01/30/2023] Open
Abstract
Multiple sulfatase deficiency (MSD) is an ultra-rare lysosomal storage disorder (LSD). Mutations in the SUMF1 gene encoding the formylglycine generating enzyme (FGE) result in an unstable FGE protein with reduced enzymatic activity, thereby affecting the posttranslational activation of newly synthesized sulfatases. Complete absence of FGE function results in the most severe clinical form of MSD with neonatal onset and rapid deterioration. We report on a preterm infant presenting with hydrops fetalis, lung hypoplasia, and dysmorphism as major clinical signs. The patient died after 6 days from an intraventricular hemorrhage followed by multi-organ failure. MSD was caused by a homozygous SUMF1 stop mutation (c.191C>A, p.Ser64Ter). FGE protein and sulfatase activities were absent in patient fibroblasts. Hydrops fetalis is a rare symptom of LSDs and should be considered in the differential diagnosis in combination with dysmorphism. The diagnostic set up should include measurements of glycosaminoglycan excretion and lysosomal enzyme activities, among them at least two sulfatases, and molecular confirmation.
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Affiliation(s)
- Lars Schlotawa
- Department of Paediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Thomas Dierks
- Department of Chemistry, Biochemistry IBielefeld UniversityBielefeldGermany
| | - Sophie Christoph
- Department of Child Neurology and Metabolic Disorders, Medical Centre OldenburgUniversity Children's Hospital OldenburgOldenburgGermany
| | - Eva Cloppenburg
- Department of Neonatology, Intensive Care Medicine and Paediatric Cardiology, Medical Centre OldenburgUniversity Children's Hospital OldenburgOldenburgGermany
| | - Andreas Ohlenbusch
- Department of Paediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - G. Christoph Korenke
- Department of Child Neurology and Metabolic Disorders, Medical Centre OldenburgUniversity Children's Hospital OldenburgOldenburgGermany
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
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Rosewich H, Nessler S, Brück W, Gärtner J. B cell depletion can be effective in multiple sclerosis but failed in a patient with advanced childhood cerebral X-linked adrenoleukodystrophy. Ther Adv Neurol Disord 2019; 12:1756286419868133. [PMID: 31452685 PMCID: PMC6696829 DOI: 10.1177/1756286419868133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/04/2019] [Indexed: 12/20/2022] Open
Abstract
Rituximab exerts its clinical efficacy by its specific pattern of depletion of CD20+ B lymphocytes and it has been demonstrated that rituximab is an effective treatment for relapsing remitting multiple sclerosis. X-linked adrenoleukodystrophy (X-ALD), the most common monogenetic neuroinflammatory disorder, shares substantial overlap with multiple sclerosis in the neuropathological changes found in brain tissues in advanced stages of the disease. While there is no effective therapy for these patients, we hypothesized that rituximab might be effective in arresting the neuroinflammatory process. Our detailed clinical, imaging and immunological data revealed that rituximab is not effective in advanced stages of X-ALD and consequently should not be applied for compassionate use in these patients.
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Affiliation(s)
- Hendrik Rosewich
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Georg August University, Robert Koch Strasse 40, Göttingen, 37075, Germany
| | - Stefan Nessler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Georg August University, Germany
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Abstract
Leukodystrophies (LDs) predominantly affect the white matter of the central nervous system and its main component, the myelin. The majority of LDs manifests in infancy with progressive neurodegeneration. Main clinical signs are intellectual and motor function losses of already attained developmental skills. Classical LDs include lysosomal storage disorders like metachromatic leukodystrophy (MLD), peroxisomal disorders like X-linked adrenoleukodystrophy (X-ALD), disorders of mitochondrial dysfunction, and myelin protein defects like Pelizaeus-Merzbacher disease. So far, there are only single LD disorders with effective treatment options in an early stage of disease. The increasing number of patients diagnosed with LDs emphasizes the need for novel therapeutic options. Impressive advances in biotechnology have not only led to the continuous identification of new disease genes for so far unknown LDs but also led to new effective neuroprotective and disease-modifying therapeutic approaches. This review summarizes ongoing and novel innovative treatment options for LD patients and their challenges. It includes in vitro and in vivo approaches with focus on stem cell and gene therapies, intrathecal substrate or enzyme replacement, and genome editing.
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Affiliation(s)
- Stina Schiller
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Marco Henneke
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Germany
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Germany
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Hu H, Kahrizi K, Musante L, Fattahi Z, Herwig R, Hosseini M, Oppitz C, Abedini SS, Suckow V, Larti F, Beheshtian M, Lipkowitz B, Akhtarkhavari T, Mehvari S, Otto S, Mohseni M, Arzhangi S, Jamali P, Mojahedi F, Taghdiri M, Papari E, Soltani Banavandi MJ, Akbari S, Tonekaboni SH, Dehghani H, Ebrahimpour MR, Bader I, Davarnia B, Cohen M, Khodaei H, Albrecht B, Azimi S, Zirn B, Bastami M, Wieczorek D, Bahrami G, Keleman K, Vahid LN, Tzschach A, Gärtner J, Gillessen-Kaesbach G, Varaghchi JR, Timmermann B, Pourfatemi F, Jankhah A, Chen W, Nikuei P, Kalscheuer VM, Oladnabi M, Wienker TF, Ropers HH, Najmabadi H. Genetics of intellectual disability in consanguineous families. Mol Psychiatry 2019; 24:1027-1039. [PMID: 29302074 DOI: 10.1038/s41380-017-0012-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 01/17/2023]
Abstract
Autosomal recessive (AR) gene defects are the leading genetic cause of intellectual disability (ID) in countries with frequent parental consanguinity, which account for about 1/7th of the world population. Yet, compared to autosomal dominant de novo mutations, which are the predominant cause of ID in Western countries, the identification of AR-ID genes has lagged behind. Here, we report on whole exome and whole genome sequencing in 404 consanguineous predominantly Iranian families with two or more affected offspring. In 219 of these, we found likely causative variants, involving 77 known and 77 novel AR-ID (candidate) genes, 21 X-linked genes, as well as 9 genes previously implicated in diseases other than ID. This study, the largest of its kind published to date, illustrates that high-throughput DNA sequencing in consanguineous families is a superior strategy for elucidating the thousands of hitherto unknown gene defects underlying AR-ID, and it sheds light on their prevalence.
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Affiliation(s)
- Hao Hu
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany.,Guangzhou Women and Children's Medical Center, 510623, Guangzhou, China
| | - Kimia Kahrizi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Luciana Musante
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | - Zohreh Fattahi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Ralf Herwig
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | - Masoumeh Hosseini
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Cornelia Oppitz
- IMP-Research Institute of Molecular Pathology, 1030, Vienna, Austria
| | - Seyedeh Sedigheh Abedini
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Vanessa Suckow
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | - Farzaneh Larti
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Maryam Beheshtian
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | | | - Tara Akhtarkhavari
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Sepideh Mehvari
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Sabine Otto
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | - Marzieh Mohseni
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Sanaz Arzhangi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Payman Jamali
- Shahrood Genetic Counseling Center, Welfare Office, Semnan, 36156, Iran
| | - Faezeh Mojahedi
- Mashhad Medical Genetic Counseling Center, Mashhad, 91767, Iran
| | - Maryam Taghdiri
- Shiraz Genetic Counseling Center, Welfare Office, Shiraz, Iran
| | - Elaheh Papari
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | | | - Saeide Akbari
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Seyed Hassan Tonekaboni
- Pediatric Neurology Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15468, Iran
| | - Hossein Dehghani
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Mohammad Reza Ebrahimpour
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Ingrid Bader
- Kinderzentrum München, Technische Universität München, 81377, München, Germany
| | - Behzad Davarnia
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Monika Cohen
- Children's Center Munich, 81377, Munich, Germany
| | - Hossein Khodaei
- Meybod Genetics Research Center, Welfare Organization, Yazd, 89651, Iran
| | - Beate Albrecht
- Institute of Human Genetics, University Hospital Essen, 45122, Essen, Germany
| | - Sarah Azimi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Birgit Zirn
- Genetikum Counseling Center, 70173, Stuttgart, Germany
| | - Milad Bastami
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Dagmar Wieczorek
- Institute of Human Genetics and Anthropology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Gholamreza Bahrami
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Krystyna Keleman
- IMP-Research Institute of Molecular Pathology, 1030, Vienna, Austria.,Howard Hughes Medical Institute, Janelia Research Campus, Ashburn, VA, 20147, USA
| | - Leila Nouri Vahid
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Andreas Tzschach
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany.,Institute of Clinical Genetics, Technische Universität Dresden, Dresden, Germany
| | - Jutta Gärtner
- University Medical Center, Georg August University Göttingen, 37075, Göttingen, Germany
| | | | | | - Bernd Timmermann
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | | | - Aria Jankhah
- Shiraz Genetic Counseling Center, Shiraz, 71346, Iran
| | - Wei Chen
- Berlin Institute for Medical Systems Biology, Max Delbrueck Center for Molecular Medicine, 13125, Berlin, Germany
| | - Pooneh Nikuei
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Morteza Oladnabi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran
| | - Thomas F Wienker
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany
| | - Hans-Hilger Ropers
- Max-Planck-Institute for Molecular Genetics, 14195, Berlin, Germany. .,Institute of Human Genetics, University Medicine, Mainz, Germany.
| | - Hossein Najmabadi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, 19857, Iran. .,Kariminejad - Najmabadi Pathology & Genetics Centre, Tehran, 14667-13713, Iran.
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Stumpf SK, Berghoff SA, Trevisiol A, Spieth L, Düking T, Schneider LV, Schlaphoff L, Dreha-Kulaczewski S, Bley A, Burfeind D, Kusch K, Mitkovski M, Ruhwedel T, Guder P, Röhse H, Denecke J, Gärtner J, Möbius W, Nave KA, Saher G. Ketogenic diet ameliorates axonal defects and promotes myelination in Pelizaeus-Merzbacher disease. Acta Neuropathol 2019; 138:147-161. [PMID: 30919030 PMCID: PMC6570703 DOI: 10.1007/s00401-019-01985-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/24/2022]
Abstract
Pelizaeus-Merzbacher disease (PMD) is an untreatable and fatal leukodystrophy. In a model of PMD with perturbed blood-brain barrier integrity, cholesterol supplementation promotes myelin membrane growth. Here, we show that in contrast to the mouse model, dietary cholesterol in two PMD patients did not lead to a major advancement of hypomyelination, potentially because the intact blood-brain barrier precludes its entry into the CNS. We therefore turned to a PMD mouse model with preserved blood-brain barrier integrity and show that a high-fat/low-carbohydrate ketogenic diet restored oligodendrocyte integrity and increased CNS myelination. This dietary intervention also ameliorated axonal degeneration and normalized motor functions. Moreover, in a paradigm of adult remyelination, ketogenic diet facilitated repair and attenuated axon damage. We suggest that a therapy with lipids such as ketone bodies, that readily enter the brain, can circumvent the requirement of a disrupted blood-brain barrier in the treatment of myelin disease.
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Affiliation(s)
- Sina K Stumpf
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Stefan A Berghoff
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Andrea Trevisiol
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lena Spieth
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Tim Düking
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lennart V Schneider
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Lennart Schlaphoff
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center, 37075, Göttingen, Germany
| | - Annette Bley
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Dinah Burfeind
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Kathrin Kusch
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
| | - Miso Mitkovski
- Light Microscopy Facility, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Torben Ruhwedel
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Philipp Guder
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Heiko Röhse
- Light Microscopy Facility, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
| | - Jonas Denecke
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center, 37075, Göttingen, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
- Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), 37073, Göttingen, Germany
| | - Klaus-Armin Nave
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany
- Electron Microscopy Core Unit, Max-Planck-Institute of Experimental Medicine, 37075, Göttingen, Germany
- Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), 37073, Göttingen, Germany
| | - Gesine Saher
- Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075, Göttingen, Germany.
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48
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Huppke P, Wegener E, Gilley J, Angeletti C, Kurth I, Drenth JPH, Stadelmann C, Barrantes-Freer A, Brück W, Thiele H, Nürnberg P, Gärtner J, Orsomando G, Coleman MP. Homozygous NMNAT2 mutation in sisters with polyneuropathy and erythromelalgia. Exp Neurol 2019; 320:112958. [PMID: 31132363 DOI: 10.1016/j.expneurol.2019.112958] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
We identified a homozygous missense mutation in the gene encoding NAD synthesizing enzyme NMNAT2 in two siblings with childhood onset polyneuropathy with erythromelalgia. No additional homozygotes for this rare allele, which leads to amino acid substitution T94M, were present among the unaffected relatives tested or in the 60,000 exomes of the ExAC database. For axons to survive, axonal NMNAT2 activity has to be maintained above a threshold level but the T94M mutation confers a partial loss of function both in the ability of NMNAT2 to support axon survival and in its enzymatic properties. Electrophysiological tests and histological analysis of sural nerve biopsies in the patients were consistent with loss of distal sensory and motor axons. Thus, it is likely that NMNAT2 mutation causes this pain and axon loss phenotype making this the first disorder associated with mutation of a key regulator of Wallerian-like axon degeneration in humans. This supports indications from numerous animal studies that the Wallerian degeneration pathway is important in human disease and raises important questions about which other human phenotypes could be linked to this gene.
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Affiliation(s)
- Peter Huppke
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany.
| | - Eike Wegener
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany.
| | - Jonathan Gilley
- John van Geest Centre for Brain Repair, University of Cambridge, ED Adrian Building, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; Babraham Institute, Babraham Research Campus, Babraham, Cambridge CB22 3AT, UK.
| | - Carlo Angeletti
- Department of Clinical Sciences (DISCO), Section of Biochemistry, Polytechnic University of Marche, Via Ranieri 67, 60131 Ancona, Italy.
| | - Ingo Kurth
- Institute of Human Genetics, Medical Faculty, RWTH, 52074 Aachen, Germany.
| | - Joost P H Drenth
- Department of Gastroenterology & Hepatology, Radboud UMC, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center, Georg August University Göttingen, Germany.
| | - Alonso Barrantes-Freer
- Institute of Neuropathology, University Medical Center, Georg August University Göttingen, Germany; Department of Neuropathology, University Medical Center Leipzig, Leipzig, Germany.
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Georg August University Göttingen, Germany.
| | - Holger Thiele
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.
| | - Jutta Gärtner
- Department of Pediatrics and Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen, Germany.
| | - Giuseppe Orsomando
- Department of Clinical Sciences (DISCO), Section of Biochemistry, Polytechnic University of Marche, Via Ranieri 67, 60131 Ancona, Italy.
| | - Michael P Coleman
- John van Geest Centre for Brain Repair, University of Cambridge, ED Adrian Building, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; Babraham Institute, Babraham Research Campus, Babraham, Cambridge CB22 3AT, UK.
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49
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Bock HC, Dreha-Kulaczewski SF, Alaid A, Gärtner J, Ludwig HC. Upward movement of cerebrospinal fluid in obstructive hydrocephalus-revision of an old concept. Childs Nerv Syst 2019; 35:833-841. [PMID: 30919042 DOI: 10.1007/s00381-019-04119-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The specific pathophysiological processes in many forms of obstructive hydrocephalus (HC) are still unclear. Current concepts of cerebrospinal fluid (CSF) dynamics presume a constant downward flow from the lateral ventricles towards subarachnoid spaces, which are in contrast to neurosurgical observations and findings of MRI flow studies. The aim of our study was to analyze CSF movements in patients with obstructive HC by neuroendoscopic video recordings, X-ray studies, and MRI. METHODS One hundred seventeen pediatric patients with obstructive HC who underwent neuroendoscopy in our center were included. Video recordings were analyzed in 85 patients. Contrast-enhanced X-rays were conducted during surgery prior to intervention in 75 patients, and flow void signals on pre-operative MRI could be evaluated in 110 patients. RESULTS In 83.5% of the video recordings, CSF moved upwards synchronous to inspiration superimposed by cardiac pulsation. Application of contrast medium revealed a flow delay in 52% of the X-ray studies prior to neurosurgery, indicating hindered CSF circulation. The appearances and shapes of flow void signals in 88.2% of the pre-operative MRI studies suggested valve-like mechanisms and entrapment of CSF. CONCLUSIONS Neuroendoscopic observations in patients with obstructive HC revealed upward CSF movements and the corresponding MRI signs of trapped CSF in brain cavities. These observations are in contrast to the current pathophysiological concept of obstructive HC. However, recent real-time flow MRI studies demonstrated upward movement of CSF, hence support our clinical findings. The knowledge of cranial-directed CSF flow expands our understanding of pathophysiological mechanisms in HC and is the key to effective treatment.
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Affiliation(s)
- Hans C Bock
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Steffi F Dreha-Kulaczewski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Awad Alaid
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Hans C Ludwig
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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50
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Aktas G, Kollmeier JM, Joseph AA, Merboldt KD, Ludwig HC, Gärtner J, Frahm J, Dreha-Kulaczewski S. Spinal CSF flow in response to forced thoracic and abdominal respiration. Fluids Barriers CNS 2019; 16:10. [PMID: 30947716 PMCID: PMC6449937 DOI: 10.1186/s12987-019-0130-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/27/2019] [Indexed: 11/15/2022] Open
Abstract
Background Respiration-induced pressure changes represent a powerful driving force of CSF dynamics as previously demonstrated using flow-sensitive real-time magnetic resonance imaging (MRI). The purpose of the present study was to elucidate the sensitivity of CSF flow along the spinal canal to forced thoracic versus abdominal respiration. Methods Eighteen subjects without known illness were studied using real-time phase-contrast flow MRI at 3 T in the aqueduct and along the spinal canal at levels C3, Th1, Th8 and L3. Subjects performed a protocol of forced breathing comprising four cycles of 2.5 s inspiration and 2.5 s expiration. Results The quantitative results for spinal CSF flow rates and volumes confirm previous findings of an upward movement during forced inspiration and reversed downward flow during subsequent exhalation—for both breathing types. However, the effects were more pronounced for abdominal than for thoracic breathing, in particular at spinal levels Th8 and L3. In general, CSF net flow volumes were very similar for both breathing conditions pointing upwards in all locations. Conclusions Spinal CSF dynamics are sensitive to varying respiratory performances. The different CSF flow volumes in response to deep thoracic versus abdominal breathing reflect instantaneous adjustments of intrathoracic and intraabdominal pressure, respectively. Real-time MRI access to CSF flow in response to defined respiration patterns will be of clinical importance for patients with disturbed CSF circulation like hydrocephalus, pseudotumor cerebri and others. Electronic supplementary material The online version of this article (10.1186/s12987-019-0130-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gökmen Aktas
- School of Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jost M Kollmeier
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
| | - Arun A Joseph
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Klaus-Dietmar Merboldt
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
| | - Hans-Christoph Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany.
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