Genotype-phenotype correlation in French patients with myelin protein zero gene-related inherited neuropathy

Background and purpose Preparations for clinical trials of unfolded protein response (UPR) inhibitors (such as Sephin1) that target the upregulated UPR in patients with Charcot-Marie-Tooth disease (CMT) carrying MPZ mutations are currently underway. The inclusion criteria for these trials are still being formulated. Our objective was to characterize the relation between genotypes and phenotypes in patients with CMT caused by MPZ mutations, and to refine the inclusion criteria for future trials. Methods Clinical and neurophysiological data of CMT patients with MPZ mutations were retrospectively collected at 11 French reference centers. Results Forty-four mutations in MPZ were identified in 91 patients from 61 families. There was considerable heterogeneity. The same mutation was found to cause either axonal or demyelinating neuropathy. Three groups were identified according to the age at disease onset. CMT Examination Score (CMTES) tended to be higher in the early (<= 22 years) and adult (23-47 years) onset groups (mean CMTESv2 = 10.4 and 10.0, respectively) than in the late onset group (>47 years, mean CMTESv2 = 8.6, p = 0.47). There was a significant positive correlation between CMTESv2 and the age of patients in Groups I (p = 0.027) and II (p = 0.023), indicating that clinical severity progressed with age in these patients. Conclusions To optimize the selection of CMT patients carrying MPZ mutations for the upcoming trials, inclusion criteria should take into account the pathophysiology of the disease (upregulated UPR). Recruited patients should have a mild to moderate disease severity and a disease onset at between 18 and 50 years, as these patients exhibit significant disease progression over time.

Automated summary

This study retrospectively collected clinical and neurophysiological data of CMT patients with MPZ mutations in French reference centers. The results showed heterogeneous manifestations of MPZ mutations causing axonal or demyelinating neuropathy and different age groups. Patients with early and adult onset CMT had higher disease severity, which progressed with age. To optimize patient selection for upcoming trials, inclusion criteria should consider disease pathophysiology and select patients with mild to moderate severity and onset between 18 and 50 years.