In the last 7 years, changes in five genes SLC20A2, PDGFRB, PDGFB, XPR1, and MYORG have been implicated in the pathogenesis of primary familial brain calcification (PFBC), allowing for genetic ...delineation of this phenotypically complex neurodegenerative disorder. This review explores how the ensuing plethora of reported PFBC patients and their disease-causing variants improved our understanding of disease, pathogenesis, clinical manifestation, and penetrance.
In PFBC patients, pathogenic changes have been most frequently described in SLC20A2, accounting for approximately the same number of patients as the variants in the other four PFBC genes combined. There is no appreciable relationship between any combination of the following three variables: the type of disease-causing change, the pattern or extent of calcifications, and the presence or nature of clinical manifestation in PFBC patients. Nevertheless, elucidation of underlying genetic factors provided important recent insights into the pathogenic mechanisms of PFBC, which collectively point toward a compromised neurovascular unit.
The ongoing clinical and molecular research increases our understanding of PFBC facilitating diagnosis and identifying potential therapeutic targets for this multifaceted and likely underdiagnosed condition.
Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics ...once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.
In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients). In all patients, antibiotic treatment was administered intravenously for at least 10 days. If feasible, patients in the orally treated group were discharged to outpatient treatment. The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed.
After randomization, antibiotic treatment was completed after a median of 19 days (interquartile range, 14 to 25) in the intravenously treated group and 17 days (interquartile range, 14 to 25) in the orally treated group (P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in the intravenously treated group and in 18 (9.0%) in the orally treated group (between-group difference, 3.1 percentage points; 95% confidence interval, -3.4 to 9.6; P=0.40), which met noninferiority criteria.
In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment. (Funded by the Danish Heart Foundation and others; POET ClinicalTrials.gov number, NCT01375257 .).
Genetic Parkinson disease (PD) has been associated with mutations in PINK1, a gene encoding a mitochondrial kinase implicated in the regulation of mitochondrial degradation. While the studies so far ...examined PINK1 function in non-neuronal systems or through PINK1 knockdown approaches, there is an imperative to examine the role of endogenous PINK1 in appropriate human-derived and biologically relevant cell models. Here we report the generation of induced pluripotent stem (iPS) cells from skin fibroblasts taken from three PD patients with nonsense (c.1366C>T; p.Q456X) or missense (c.509T>G; p.V170G) mutations in the PINK1 gene. These cells were differentiated into dopaminergic neurons that upon mitochondrial depolarization showed impaired recruitment of lentivirally expressed Parkin to mitochondria, increased mitochondrial copy number, and upregulation of PGC-1α, an important regulator of mitochondrial biogenesis. Importantly, these alterations were corrected by lentiviral expression of wild-type PINK1 in mutant iPS cell-derived PINK1 neurons. In conclusion, our studies suggest that fibroblasts from genetic PD can be reprogrammed and differentiated into neurons. These neurons exhibit distinct phenotypes that should be amenable to further mechanistic studies in this relevant biological context.
•In addition to the cardinal signs, Parkin-PD patients most commonly suffer from dystonia and rarely from dementia.•The majority of juvenile and early-onset PD patients harbor biallelic Parkin ...mutations.•Two thirds of Parkin-PD patients carry at least one exon rearrangement.•By regulating the balance between mitochondrial biogenesis and mitophagy, loss of Parkin function contributes to neurodegeneration.•Mitochondrial damage may lead to neuroinflammation, thus strengthening the need for treatments targeting mitochondrial quality control.
With over 7 million patients worldwide, Parkinson’s disease (PD) is becoming more prevalent as life span and industrialization increase. While the majority of cases are sporadic and present in individuals over 65, inherited mutations in Parkin can manifest in individuals as young as teenagers. The involvement of Parkin in neurodegeneration has been widely investigated and its role in mitophagy is undeniable. In the recent years, however, additional functions of the protein are beginning to come to light, which in turn may influence the way patients harboring Parkin mutations are treated. In the present article, we discuss the clinical and genetic aspects of Parkin-linked PD. For this purpose, we consulted the MDSGene database, which comprises the literature of more than 1000 patients with Parkin mutations. In addition, we provide insight into Parkin’s multifaceted role in mitochondrial clearance and maintenance. Finally, we discuss treatment strategies such as brain stimulation, small molecule drugs and dopaminergic cell replacement that could be tailored to improve the clinical phenotypes in Parkin-linked PD.
Parkinson’s disease patients report disturbed sleep patterns long before motor dysfunction. Here, in parkin and pink1 models, we identify circadian rhythm and sleep pattern defects and map these to ...specific neuropeptidergic neurons in fly models and in hypothalamic neurons differentiated from patient induced pluripotent stem cells (iPSCs). Parkin and Pink1 control the clearance of mitochondria by protein ubiquitination. Although we do not observe major defects in mitochondria of mutant neuropeptidergic neurons, we do find an excess of endoplasmic reticulum-mitochondrial contacts. These excessive contact sites cause abnormal lipid trafficking that depletes phosphatidylserine from the endoplasmic reticulum (ER) and disrupts the production of neuropeptide-containing vesicles. Feeding mutant animals phosphatidylserine rescues neuropeptidergic vesicle production and acutely restores normal sleep patterns in mutant animals. Hence, sleep patterns and circadian disturbances in Parkinson’s disease models are explained by excessive ER-mitochondrial contacts, and blocking their formation or increasing phosphatidylserine levels rescues the defects in vivo.
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•Parkinson’s disease (PD) models (parkin/pink1 loss) have circadian and sleep defects•Increased ER-mitochondria contacts cause neuropeptide accumulation in ER in PD models•Depletion of phosphatidylserine from ER causes sleep pattern phenotypes in PD models•Phosphatidylserine supplementation rescues circadian and sleep defects of PD models
Valadas et al. show that ER lipid imbalance causes sleep pattern defects in Parkinson’s disease by preventing the formation of secretory vesicles required for the release of the neuropeptides. Restoring the ER lipid balance by supplementation with phosphatidylserine rescues the cellular and behavioral defects.
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