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Abstract
Krabbe disease (KD) (globoid cell leukodystrophy) is a degenerative, lysosomal storage disease, caused by a severe loss of galactocerebrosidase (GALC) enzymatic activity. The inheritance is autosomal recessive. KD affects the white matter of the central and peripheral nervous systems. We present a 3 year old boy in whom the disease had an 'infantile' or 'classic' presentation, with spasticity, irritability, and developmental delay. In addition the boy showed progressive severe motor and mental deterioration, difficulties in swallowing and decerebration. Molecular analysis revealed that the child is a compound heterozygote: p.Asp187Val (c.560A>T) and p.Ile250Thr (c.749T>C). The father was the carrier of p.Asp187Val (c.560A>T), while the mother was the carrier of the p.Ile250Thr (c.749T>C) in exon 6 of the GALC gene. The clinical course in this compound heterozygote is severe and the patient passed away at the age of 3 years. Genotype-phenotype relations are discussed in this Macedonian patient with KD.
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Smith BR, Santos MB, Marshall MS, Cantuti-Castelvetri L, Lopez-Rosas A, Li G, van Breemen R, Claycomb KI, Gallea JI, Celej SM, Crocker S, Givogri MI, Bongarzone ER. Neuronal inclusions of α-synuclein contribute to the pathogenesis of Krabbe disease. J Pathol 2014; 232:509-21. [PMID: 24415155 PMCID: PMC3977150 DOI: 10.1002/path.4328] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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: 07/26/2013] [Revised: 11/26/2013] [Accepted: 12/29/2013] [Indexed: 11/11/2022]
Abstract
Demyelination is a major contributor to the general decay of neural functions in children with Krabbe disease. However, recent reports have indicated a significant involvement of neurons and axons in the neuropathology of the disease. In this study, we have investigated the nature of cellular inclusions in the Krabbe brain. Brain samples from the twitcher mouse model for Krabbe disease and from patients affected with the infantile and late-onset forms of the disease were examined for the presence of neuronal inclusions. Our experiments demonstrated the presence of cytoplasmic aggregates of thioflavin-S-reactive material in both human and murine mutant brains. Most of these inclusions were associated with neurons. A few inclusions were detected to be associated with microglia and none were associated with astrocytes or oligodendrocytes. Thioflavin-S-reactive inclusions increased in abundance, paralleling the development of neurological symptoms, and distributed throughout the twitcher brain in areas of major involvement in cognition and motor functions. Electron microscopy confirmed the presence of aggregates of stereotypic β-sheet folded proteinaceous material. Immunochemical analyses identified the presence of aggregated forms of α-synuclein and ubiquitin, proteins involved in the formation of Lewy bodies in Parkinson's disease and other neurodegenerative conditions. In vitro assays demonstrated that psychosine, the neurotoxic sphingolipid accumulated in Krabbe disease, accelerated the fibrillization of α-synuclein. This study demonstrates the occurrence of neuronal deposits of fibrillized proteins including α-synuclein, identifying Krabbe disease as a new α-synucleinopathy.
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Affiliation(s)
- Benjamin R. Smith
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Marta B. Santos
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Michael S. Marshall
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Ludovico Cantuti-Castelvetri
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Aurora Lopez-Rosas
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Guanan Li
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Richard van Breemen
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Kumiko I. Claycomb
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT
| | - Jose I. Gallea
- Departamento de Quimica Biologica, CIQUIBIC, CONICET, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Soledad M. Celej
- Departamento de Quimica Biologica, CIQUIBIC, CONICET, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Stephen Crocker
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT
| | - Maria I. Givogri
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
| | - Ernesto R. Bongarzone
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois, University of Illinois Chicago, Chicago Il 60612
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Chabali R, Matre WM, Greene MK. Infant with irritability, feeding problems, and progressive developmental abnormalities presenting repeatedly to a pediatric emergency department. Pediatr Emerg Care 1997; 13:123-6. [PMID: 9127423 DOI: 10.1097/00006565-199704000-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Emergency physicians often deal with diagnostically elusive cases that may present repeatedly over the course of illness. The infant presented here had a chronic history, prompting multiple physician contacts for initially seemingly common problems. Assessing the patient's progression of symptoms over time and eliciting a brief developmental history in the emergency department (ED) helped guide decision-making toward admission and appropriate diagnostic workup.
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Affiliation(s)
- R Chabali
- Department of Pediatrics, Wright State University School of Medicine, Dayton, Ohio, USA
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Abstract
Neuropsychological assessment is essential in providing documentation of the untreated natural history of storage diseases associated with dementia and quantifying the effectiveness of treatment on central nervous system function. Baseline characterization and outcome of bone marrow transplantation (BMT) for three leukodystrophies and three mucopolysaccharidoses are presented. Results suggests that BMT for Hurler syndrome, adrenoleukodystrophy, and globoid cell leukodystrophy can be effective in preventing dementia if done early enough in the disease. Sanfilippo and Hunter syndromes do not benefit and BMT is not recommended. For metachromatic leukodystrophy, BMT is not recommended for symptomatic early-onset forms of the disease. Further longitudinal follow-up is needed to determine whether the benefits outweigh the risks of BMT for late-onset and preclinical metachromatic leukodystrophy.
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Affiliation(s)
- E G Shapiro
- Department of Neurology, University of Minnesota, Minneapolis 55455, USA
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Christomanou H, Jaffé S, Martinius J, Cáp C, Betke K. Biochemical, genetic, psychometric, and neuropsychological studies in heterozygotes of a family with globoid cell leucodystrophy (Krabbe's disease). Hum Genet 1981; 58:179-83. [PMID: 7287002 DOI: 10.1007/bf00278707] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Detection of a patient suffering from Krabbe's disease led to carrier screening in his family. Determination of galactosylceramide beta-galactosidase activity revealed the occurrence of two different alleles among the carriers of the same family. Heterozygotes and their noncarrier relatives were studied using psychometric and neuropsychological tests under blind conditions. It was found that compared to seven adult noncarrier relatives 19 adult carriers differ significantly in their general IQ and some subtests of the Wechsler Intelligence Scale for adults (WISA), including spatial cognition. Reaction times were significantly slower in the carriers with enzyme activity below 25% of the control values. Most of the carriers of this family have had myopia since early childhood.
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