Ryogen Sasaki

CHCHD2 mutations in autosomal dominant late-onset Parkinson's disease: a genome-wide linkage and sequencing study

BACKGROUND Identification of causative genes in mendelian forms of Parkinsons disease is valuable for understanding the cause of the disease. We did genetic studies in a Japanese family with autosomal dominant Parkinsons disease to identify novel causative genes. METHODS We did a genome-wide linkage analysis on eight affected and five unaffected individuals from a family with autosomal dominant Parkinsons disease (family A). Subsequently, we did exome sequencing on three patients and whole-genome sequencing on one patient in family A. Variants were validated by Sanger sequencing in samples from patients with autosomal dominant Parkinsons disease, patients with sporadic Parkinsons disease, and controls. Participants were identified from the DNA bank of the Comprehensive Genetic Study on Parkinsons Disease and Related Disorders (Juntendo University School of Medicine, Tokyo, Japan) and were classified according to clinical information obtained by neurologists. Splicing abnormalities of CHCHD2 mutants were analysed in SH-SY5Y cells. We used the Fishers exact test to calculate the significance of allele frequencies between patients with sporadic Parkinsons disease and unaffected controls, and we calculated odds ratios and 95% CIs of minor alleles. FINDINGS We identified a missense mutation (CHCHD2, 182C>T, Thr61Ile) in family A by next-generation sequencing. We obtained samples from a further 340 index patients with autosomal dominant Parkinsons disease, 517 patients with sporadic Parkinsons disease, and 559 controls. Three CHCHD2 mutations in four of 341 index cases from independent families with autosomal dominant Parkinsons disease were detected by CHCHD2 mutation screening: 182C>T (Thr61Ile), 434G>A (Arg145Gln), and 300+5G>A. Two single nucleotide variants (-9T>G and 5C>T) in CHCHD2 were confirmed to have different frequencies between sporadic Parkinsons disease and controls, with odds ratios of 2·51 (95% CI 1·48-4·24; p=0·0004) and 4·69 (1·59-13·83, p=0·0025), respectively. One single nucleotide polymorphism (rs816411) was found in CHCHD2 from a previously reported genome-wide association study; however, there was no significant difference in its frequency between patients with Parkinsons disease and controls in a previously reported genome-wide association study (odds ratio 1·17, 95% CI 0·96-1·19; p=0·22). In SH-SY5Y cells, the 300+5G>A mutation but not the other two mutations caused exon 2 skipping. INTERPRETATION CHCHD2 mutations are associated with, and might be a cause of, autosomal dominant Parkinsons disease. Further genetic studies in other populations are needed to confirm the pathogenicity of CHCHD2 mutations in autosomal dominant Parkinsons disease and susceptibility for sporadic Parkinsons disease, and further functional studies are needed to understand how mutant CHCHD2 might play a part in the pathophysiology of Parkinsons disease. FUNDING Japan Society for the Promotion of Science; Japanese Ministry of Education, Culture, Sports, Science and Technology; Japanese Ministry of Health, Labour and Welfare; Takeda Scientific Foundation; Cell Science Research Foundation; and Nakajima Foundation.

Familial amyotrophic lateral sclerosis and parkinsonism-dementia complex of the Kii peninsula of Japan: Clinical and neuropathological study and tau analysis

We report the first case of neuropathologically verified parkinsonism‐dementia complex of the Kii peninsula, together with the patients brother, who had amyotrophic lateral sclerosis. The propositus woman developed parkinsonism and dementia at 63 years of age and died at 70 without displaying clinical features of amyotrophic lateral sclerosis. The brain exhibited marked atrophy of the frontal and temporal lobes. Microscopically, there were many neurofibrillary tangles in the central nervous system, most markedly in the mesial temporal lobe and deep nuclei, as well as changes of amyotrophic lateral sclerosis but no senile plaques or Lewy bodies. Neurofibrillary tangles exhibited twisted tubule structures on electon microscopic examination, and an analysis of insoluble tau protein extracted from the fresh brain revealed a 60‐, 64‐, 68‐kD triplet. The tau gene exhibited no mutations. Her brother developed progressive bulbar palsy–type amyotrophic lateral sclerosis at 45 years of age and died at 49 without presenting with dementia or parkinsonism. Neuropathological examination revealed not only pathologic features of amyotrophic lateral sclerosis but also a moderate number of neurofibrillary tangles in the temporal cortex and deep nuclei. The siblings were neuropathologically similar despite their different clinical manifestations. These findings suggest that amyotrophic lateral sclerosis and parkinsonism‐dementia complex of this family may be phenotypic variants of a tauopathy caused by genetic abnormalities. Ann Neurol 2001;49:501–511

Widespread expression of α-synuclein and τ immunoreactivity in Hallervorden-Spatz syndrome with protracted clinical course

Hallervorden-Spatz syndrome (HSS) is a rare autosomal recessive disorder clinically characterized by extrapyramidal signs and progressive dementia. In a typical case, the clinical symptoms become apparent during late childhood, and usually the course is protracted over a decade or more. We recently had an opportunity to study the brains of two cases of HSS with a clinical course of over 30 years. Case 1 was a 44-year-old female and case 2 was a 37-year-old male. Grossly, the brains showed severe fronto-temporal lobar atrophy with abundant spheroids and mild iron deposits in the globus pallidus, associated with features of motor neuron disease. In addition, there was diffuse sponginess in the atrophic cortex as well as widespread Alzheimers neurofibrillary tangles (NFTs) and Lewy bodies (LBs) in the cortical and subcortical regions, including the spinal cord. Ultrastructurally, NFTs were composed of paired helical filaments, and LBs of central dense cores with radiating fibrils. Discrete immunostaining was demonstrated in NFTs and neuropil threads with various antibodies against phosphorylated tau, and in LBs with antibody against alpha-synuclein. In addition, diffuse, overlapping immunoreactivity of alpha-synuclein and phosphorylated tau was seen within the cytoplasm of many neurons. However, when LBs and NFTs coexisted within the same neurons, they were clearly segregated. The findings of our present cases as well as those reported in the literature may indicate that simultaneous and extensive occurrence of abnormal phosphorylation of tau and accumulation of alpha-synuclein may constitute cardinal pathological features of HSS with protracted clinical course.

Analyses of the MAPT, PGRN, and C9orf72 mutations in Japanese patients with FTLD, PSP, and CBS

BACKGROUND Mutations in the microtubule associated protein tau (MAPT) and progranulin (PGRN) have been identified in several neurodegenerative disorders, such as frontotemporal lobar degeneration (FTLD), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). Recently, C9orf72 repeat expansion was reported to cause FTLD and amyotrophic lateral sclerosis (ALS). To date, no comprehensive analyses of mutations in these three genes have been performed in Asian populations. The aim of this study was to investigate the genetic and clinical features of Japanese patients with MAPT, PGRN, or C9orf72 mutations. METHODS MAPT and PGRN were analyzed by direct sequencing and gene dosage assays, and C9orf72 repeat expansion was analyzed by repeat-primed PCR in 75 (48 familial, 27 sporadic) Japanese patients with FTLD, PSP, or CBS. RESULTS We found four MAPT mutations in six families, one novel PGRN deletion/insertion, and no repeat expansion in C9orf72. Intriguingly, we identified a de novo MAPT p.S285R mutation. All six patients with early-onset PSP and the abnormal eye movements that are not typical of sporadic PSP had MAPT mutations. The gene dosages of MAPT and PGRN were normal. DISCUSSION MAPT p.S285R is the first reported de novo mutation in a sporadic adult-onset patient. MAPT mutation analysis is recommended in both familial and sporadic patients, especially in early-onset PSP patients with these abnormal eye movements. Although PGRN and C9orf72 mutations were rare in this study, the PGRN mutation was found in this Asian FTLD. These genes should be studied further to improve the clinicogenetic diagnoses of FTLD, PSP, and CBS.

VPS35 mutation in Japanese patients with typical Parkinson's disease†‡§

Vacuolar protein sorting 35 (VPS35) was recently reported to be a pathogenic gene for late‐onset autosomal dominant Parkinsons disease (PD), using exome sequencing. To date, VPS35 mutations have been detected only in whites with PD. The aim of the present study was to determine the incidence and clinical features of Asian PD patients with VPS35 mutations. We screened 7 reported nonsynonymous missense variants of VPS35, including p.D620N, known as potentially disease‐associated variants of PD, in 300 Japanese index patients with autosomal dominant PD and 433 patients with sporadic PD (SPD) by direct sequencing or high‐resolution melting (HRM) analysis. In addition, we screened 579 controls for the p.D620N mutation by HRM analysis. The p.D620N mutation was detected in 3 patients with autosomal dominant PD (1.0%), in 1 patient with SPD (0.23%), and in no controls. None of the other reported variants of VPS35 were detected. Haplotype analysis suggested at least 3 independent founders for Japanese patients with p.D620N mutation. Patients with the VPS35 mutation showed typical tremor‐predominant PD. We report Asian PD patients with the VPS35 mutation. Although VPS35 mutations are uncommon in PD, the frequency of such mutation is relatively higher in Japanese than reported in other populations. In VPS35, p.D620N substitution may be a mutational hot spot across different ethnic populations. Based on the clinical features, VPS35 should be analyzed in patients with PD, especially autosomal dominant PD or tremor‐predominant PD.

TRPM7 is not associated with amyotrophic lateral sclerosis-parkinsonism dementia complex in the Kii peninsula of Japan.

Amyotrophic lateral sclerosis‐parkinsonism dementia complex (ALS/PDC) is a distinct neurodegenerative disorder characterized by ALS pathology with neurofibrillary tangles (NFTs) in the spinal cord and brain. Recent clinical studies have revealed a high incidence and a high familial occurrence of ALS/PDC in both Guam and the Kii peninsula of Japan, suggesting a strong genetic predisposition to this disorder. The T1482I variant (rs8042919) of TRPM7 gene which is suggested to play roles in regulating the cellular homeostasis of Ca2+, Mg2+, and trace metals, has recently been reported to be associated with Guamanian patients with ALS/PDC. To investigate whether TRPM7 is associated with Kii ALS/PDC, we conducted parametric linkage analyses of the TRPM7 locus in a large extended family with ALS/PDC. Linkage analysis did not reveal any evidence supporting the linkage to the TRPM7 locus. Resequencing of the entire coding region of TRPM7 did not reveal any pathogenic mutations in an affected individual in this family. The allele frequencies of the T1482I in affected individuals in this family or in those from other families are not significantly different from those in regional controls or those in HapMap‐JPT samples. These results indicate that TRPM7 is not associated with ALS/PDC in the Kii peninsula of Japan.

New mutation of the Na channel in the severe form of potassium-aggravated myotonia.

Myotonia manifests in several hereditary diseases, including hyperkalemic periodic paralysis (HyperPP), paramyotonia congenita (PMC), and potassium‐aggravated myotonia (PAM). These are allelic disorders originating from missense mutations in the gene that codes the skeletal muscle sodium channel, Nav1.4. Moreover, a severe form of PAM has been designated as myotonia permanens. A new mutation of Nav1.4, Q1633E, was identified in a Japanese family presenting with the PAM phenotype. The proband suffered from cyanotic attacks during infancy. The mutated amino acid residue is located on the EF‐hand calcium‐binding motif in the intracellular C‐terminus. A functional analysis of the mutant channel using the voltage‐clamp method revealed disruption of fast inactivation, a slower rate of current decay, and a depolarized shift in the voltage dependence of availability. This study has identified a new mutation of PAM with a severe phenotype and emphasizes the importance of the C‐terminus for fast inactivation of the sodium channel. Muscle Nerve 39: 666–673, 2009

PLA2G6 variant in Parkinson's disease

PLA2G6 was reported recently as the causative gene for PARK14-linked autosomal recessive early-onset dystonia-parkinsonism. In a recent study in Singapore, heterozygous PLA2G6 p.P806R (c.2417C>G) mutation in exon 17 was reported to be a possible Parkinsons disease (PD)-related mutation. To determine the significance of the PLA2G6 mutation, we conducted an association study by performing direct sequencing of PLA2G6 exon 17 in 379 Japanese sporadic PD patients and 310 controls in the Japanese general population. In this group, we found 12 patients (12/379=3.16%) and 10 controls (10/310=3.23%) with a heterozygous p.P806R mutation (P=0.96, χ2=0.0019). Therefore, our large case–controlled study suggests that PLA2G6 p.P806R is not a disease-associated polymorphism in PD. Moreover, we performed direct sequencing of all exons and exon-intron boundaries of PLA2G6 in 116 Japanese patients with sporadic PD. Two single heterozygous variants (p.R301C or p.D331N) were found (both frequencies: 1/379 patients vs 0/310 controls) and the roles of their variants were unclear. Finally, combined with the previous report, our findings emphasize that PLA2G6 mutations are unlikely to be the major causes or risk factors of PD at least in Asian populations. However, further large studies in various populations are needed because patients with PLA2G6 mutations can show heterogeneous clinical features.

Mutation analyses in amyotrophic lateral sclerosis/parkinsonism-dementia complex of the Kii peninsula, Japan.

To clarify the genetic background of amyotrophic lateral sclerosis (ALS)/parkinsonism–dementia complex (PDC) of the Kii peninsula, Japan (Kii ALS/PDC), we performed extended mutation analyses of three patients with pathologically diagnosed Kii ALS/PDC. Direct sequencing analyses were performed in 19 genes, including ALS/frontotemporal lobar degeneration (FTLD)‐related genes (SOD2, SOD3, ALS2/alsin, SMN1, PGRN, ANG, VEGF, VCP, VAPB, DCTN1, CHMP2B, and TARDBP or TDP‐43), tauopathy‐related gene (GSK3β), and parkinsonism‐related genes (alpha‐synuclein, LRRK2, parkin, DJ‐1, PINK1, and ATP13A2). Gene dosage analyses were conducted in screening of MAPT, alpha‐synuclein, TDP‐43 (or TARDBP), GSK3β, and parkin. We found no mutation in the 19 genes. We found a homozygous nonsynonymous SNP (ALS2/alsin V368M) shared by all the three patients. Gene dosage was normal in MAPT, alpha‐synuclein, TDP‐43, GSK3β, and parkin. The present findings, together with a previous negative study on MAPT and SOD1 mutation, further elucidated the lack of causative mutations in all exons, exon–intron boundaries, or some rearrangements of the reported major causative or susceptible genes related to ALS, FTLD, parkinsonism, synucleinopathy, TDP‐43 proteinopathy, and tauopathy. However, the familial aggregation and lack of any environment factors suggest that Kii ALS/PDC is caused by other yet unidentified genetic factors.

Hyperkalemic periodic paralysis and paramyotonia congenita – A novel sodium channel mutation –

Sirs: The group of hereditary sodium channel diseases, also termed sodium channelopathies, comprises hyperkalemic periodic paralysis (HyperPP), some forms of hypokalemic periodic paralysis, paramyotonia congenita (PC) and potassium aggravated myotonia [1, 4, 5, 7, 8]. They occur by autosomal dominant inheritance caused by point mutations in the gene encoding the α-subunit of the adult human skeletal muscle sodium channel (SCN4A) [1, 7, 8]. Here we report a case of HyperPP and PC with novel point mutation on the SCN4A gene. A 23-year-old man was admitted to our hospital for periodic muscle weakness in his lower extremities. One morning 7 years previously, he noticed muscle soreness and weakness in the lower extremities, which completely disappeared within one week. The same attack was repeated nearly every 6 months (especially the next morning after overeating). He also noticed muscle stiffness in his face and fingers during exercise in the cold. Serum creatine kinase (CK) on admission was 2264 IU/l (normal range:35–169) and potassium was 5.4 mEq/l (3.5–4.7), both levels soon normalized. Electromyography (EMG) showed myotonic discharges in all extremities (Fig. 1B upper). Immediately after a provocative test with potassium infusion had induced muscle weakness in the lower extremities, a biopsy from the gastocnemius muscle was performed that revealed mild variability in fiber size without vacuolar changes and an increase in the number of central nuclei. He did not have grip myotonia, but we discovered that myotonia of the face and fingers induced by cold water or inside a cold room (4 °C) could be increased with repeated contraction (paradoxical myotonia). Based on these findings, we diagnosed overlapping syndromes of HyperPP and PC (Table 1). The patient’s father had experienced periodic paralysis (PP) that gradually faded with age and still had muscle stiffness during exercise in the cold (Fig. 1A). His younger sister had muscle stiffness but not PP, and his younger brother had both. Their EMGs showed myotonic discharges (Fig. 1B middle and lower). A molecular analysis of the SCN4A gene revealed an A-to-G transition at nucleotide 4,108, causing the substitution of valine for methionine at codon 1370 (Fig. 1C). Up to date, approximately 20 point mutations have been detected in the SCN4A gene that can cause sodium channelopathy [1, 7]. As the present patient and symptomatic family members had the same point mutation in SCN4A and neither asymptomatic family members nor 30 healthy subjects had this point mutation, we concluded this mutation could be pathogenic. This is a novel sodium channel mutation at methionine 1370 of the SCN4A gene. This mutation, Met1370Val, produces clinical symptom of only PC in females (in LETTER TO THE EDITORS