4.4 Review

Genetics of amyotrophic lateral sclerosis: seeking therapeutic targets in the era of gene therapy

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Summary: Mendelian randomization studies on amyotrophic lateral sclerosis show a causal link between blood lipids and the disease risk, while factors like smoking and immune function require further investigation for confirmation. The use of high methodological standards and replication across different datasets are essential for reliable results in Mendelian randomization studies.
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Summary: This review outlines the advances in iPSC modeling and therapeutic development for major neurodegenerative diseases, including amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease.

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Antisense oligonucleotide silencing of FUS expression as a therapeutic approach in amyotrophic lateral sclerosis

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Summary: This study demonstrates that an antisense oligonucleotide can effectively lower the levels of FUS protein in mice and in a patient with FUS-dependent ALS. The research provides evidence that the insolubility of FUS and related RNA-binding proteins contribute to neurodegeneration in ALS-FTD. Silencing FUS using a non-allele-specific antisense oligonucleotide delays motor neuron degeneration in a disease-relevant mouse model and reduces the burden of FUS aggregates in ALS patients.

NATURE MEDICINE (2022)

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Suppression of mutant C9orf72 expression by a potent mixed backbone antisense oligonucleotide

Helene Tran et al.

Summary: The study successfully generated and optimized ASOs that blunt the G(4)C(2) repeat-containing transcripts in the C9ORF72 gene, demonstrating potential therapeutic efficacy for patients with ALS and FTD.

NATURE MEDICINE (2022)

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Answer ALS, a large-scale resource for sporadic and familial ALS combining clinical and multi-omics data from induced pluripotent cell lines

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NATURE NEUROSCIENCE (2022)

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Pathological phase transitions in ALS-FTD impair dynamic RNA-protein granules

Natalia B. Nedelsky et al.

Summary: Genetics of human disease plays a crucial role in understanding cellular processes and vulnerabilities associated with dysfunction. The genetics of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) have revealed the role of biomolecular condensation in organizing cellular contents and its link to neurodegeneration.
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SOD1 mutations associated with amyotrophic lateral sclerosis analysis of variant severity

Mariusz Berdynski et al.

Summary: The study investigated the relations between SOD1 mutations and clinical presentation in ALS patients, identifying significant correlations between SOD1 mutations and clinical phenotype as well as associations between different types of mutations and clinical outcomes.

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Structural variation analysis of 6,500 whole genome sequences in amyotrophic lateral sclerosis

Ahmad Al Khleifat et al.

Summary: There is a strong genetic contribution to the risk of Amyotrophic lateral sclerosis (ALS), with heritability estimates of up to 60%. Variants in ALS genes, including repeat expansion in C9orf72, inversion in VCP, and insertion in ERBB4, have been identified as associated with ALS risk and specific disease phenotypes.

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De novo mutations in SOD1 are a cause of ALS

Kathrin Muller et al.

Summary: De novo mutations in SOD1 have been identified as a cause of sporadic ALS, potentially impacting both isolated cases and smaller familial groups. While the exact origin of these mutations remains uncertain, the findings suggest the importance of genetic counseling and screening for all ALS patients to potentially benefit from personalized therapy.

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TDP-43 loss and ALS-risk SNPs drive mis-splicing and depletion of UNC13A

Anna-Leigh Brown et al.

Summary: Risk variants in the synaptic gene UNC13A are associated with increased risk of ALS and FTD. These variants lead to the inclusion of a cryptic exon in UNC13A when TDP-43 is depleted, resulting in the loss of UNC13A protein. Two common UNC13A polymorphisms strongly associated with ALS and FTD risk overlap with TDP-43 binding sites.

NATURE (2022)

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TDP-43 represses cryptic exon inclusion in the FTD-ALS gene UNC13A

X. Rosa Ma et al.

Summary: A hallmark feature of ALS and FTD is the depletion of RNA-binding protein TDP-43 from neurons, and a major function of TDP-43 is to repress cryptic exon inclusion. UNC13A gene polymorphisms are strongly associated with FTD and ALS, and this study shows that loss of TDP-43 leads to cryptic exon splicing in UNC13A. The top genetic risk factors for FTD and ALS (UNC13A genetic variants) are shown to be functionally linked to TDP-43 dysfunction.

NATURE (2022)

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Genetic and functional analysis of KIF5A variants in Japanese patients with sporadic amyotrophic lateral sclerosis

Ryoichi Nakamura et al.

Summary: Two recent genetic studies found that loss-of-function mutation of the C-terminal cargo-binding tail domain of the KIF5A gene cause amyotrophic lateral sclerosis (ALS). This study in Japanese patients with sporadic ALS identified a novel loss-of-function variant in KIF5A, highlighting its rare occurrence as a cause of ALS.

NEUROBIOLOGY OF AGING (2021)

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ALS-related FUS mutations alter axon growth in motoneurons and affect HuD/ELAVL4 and FMRP activity

Maria Giovanna Garone et al.

Summary: The study found that mutations in the FUS gene are associated with ALS, affecting the activity of two RBPs related to neuronal RNA metabolism. Mutant FUS increases HuD protein levels by competing with FMRP for HuD mRNA binding, leading to excessive stability of its target gene transcript levels. Mutant FUS motoneurons exhibit increased axon branching and growth, potentially representing early events in ALS pathogenesis.

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Mitochondrial bioenergetic deficits in C9orf72 amyotrophic lateral sclerosis motor neurons cause dysfunctional axonal homeostasis

Arpan R. Mehta et al.

Summary: The study found that axonal dysfunction in C9orf72-ALS patients is associated with shorter axons, impaired mitochondrial transport, and altered mitochondrial bioenergetics, indicating that mitochondrial dysfunction is a key factor in axonal dysfunction. Increasing mitochondrial biogenesis through genetic manipulation can correct the bioenergetic deficit and rescue axonal length and transport phenotypes.

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Current Clinical Applications of In Vivo Gene Therapy with AAVs

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Summary: Hereditary diseases are caused by gene mutations, affecting millions of Americans, and gene therapy using adeno-associated virus (AAV) has shown promise in treating these diseases. Five treatments have been approved for commercialization, with many more in clinical trials, showcasing the potential of gene therapy in treating a wide range of genetic disorders.

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The functional organization of axonal mRNA transport and translation

Irene Dalla Costa et al.

Summary: Recent publications have revealed new mechanisms for regulating axonal transport and localized translation of mRNA, converging on RNA regulons that drive various axonal functions. These different regulatory pathways act as organizing platforms to modulate the axon's proteome to meet its physiological needs.

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Mutational Analysis of Known ALS Genes in an Italian Population-Based Cohort

Maurizio Grassano et al.

Summary: Our study assessed the burden of rare genetic variants and estimated the contribution of known ALS genes in an Italian population-based cohort through whole genome sequencing. We identified potential disease-causing variants in 11.9% of ALS patients and confirmed the strong association of rare variants in SOD1 with the disease. We also found that the contribution of rare variants in other known ALS genes to disease risk in our cohort is limited.

NEUROLOGY (2021)

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The Role of Nucleocytoplasmic Transport Defects in Amyotrophic Lateral Sclerosis

Joni Vanneste et al.

Summary: There is evidence suggesting that nucleocytoplasmic-transport deficits may be important in the pathogenesis of ALS, but current data are limited in clarifying the exact causal and temporal role. Understanding this will be significant for therapeutically targeting nucleocytoplasmic transport and associated proteins.

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Effect of Ezogabine on Cortical and Spinal Motor Neuron Excitability in Amyotrophic Lateral Sclerosis A Randomized Clinical Trial

Brian J. Wainger et al.

Summary: This study found that ezogabine can decrease cortical and spinal motor neuron excitability in patients with ALS, indicating the potential use of neurophysiological metrics as pharmacodynamic biomarkers in multi-site clinical trials.

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Searching Far and Genome-Wide: The Relevance of Association Studies in Amyotrophic Lateral Sclerosis

Kelly A. Rich et al.

Summary: GWAS and RVAS are used to analyze genetic variation in complex diseases, identifying variants and biological pathways associated with disease status. However, the novel associations identified by these methods typically have lower effect sizes and have not yet led to new therapeutic interventions.

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Safety and efficacy of oral levosimendan in people with amyotrophic lateral sclerosis (the REFALS study) : a randomised, double-blind, placebo-controlled phase 3 trial

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Summary: The study found that levosimendan was not superior to placebo in maintaining respiratory function in a broad population with amyotrophic lateral sclerosis. While generally well tolerated, levosimendan had a higher frequency of adverse events such as increased heart rate and headache compared to placebo. Further evaluation is needed to determine if there is a clinically relevant subgroup that may respond to the drug.

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Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

Wouter van Rheenen et al.

Summary: A cross-ancestry genome-wide association meta-analysis of amyotrophic lateral sclerosis (ALS) identified 15 risk loci with distinct genetic architectures and neuron-specific biology. The study emphasized the urgent need for disease-modifying therapies for ALS. High cholesterol levels were suggested to have a causal role in the onset of ALS, among other environmental and lifestyle risk factors.

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Circulating miR-181 is a prognostic biomarker for amyotrophic lateral sclerosis

Iddo Magen et al.

Summary: The study identified miRNA-based biomarkers in the blood of ALS patients, with miR-181 levels alone or in combination with established protein biomarkers predicting disease severity and prognosis. This approach may enhance the power of clinical trials for ALS and improve patient stratification accuracy.

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Multi-omic analysis of selectively vulnerable motor neuron subtypes implicates altered lipid metabolism in ALS

Hojae Lee et al.

Summary: By comparing human induced pluripotent stem cell-derived spinal and ocular motor neurons, researchers identified low levels of a natural 5-lipoxygenase inhibitor in ALS spinal motor neurons and found that analogs of 5-lipoxygenase inhibitors can improve ALS phenotypes. Multi-omics analysis revealed shared metabolic perturbations in ALS spinal motor neurons, specifically dysregulation in lipid metabolism, which was confirmed through targeted metabolomics. These findings highlight a potential therapeutic target in lipid metabolism for ALS.

NATURE NEUROSCIENCE (2021)

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ALS antisense drug falters in phase III

Asher Mullard

Summary: The SOD1-antisense oligonucleotide tofersen, developed by Biogen and Ionis, failed a phase III trial, prompting concerns about the drug's future and the direction of ALS trials to come.

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Secreted Signaling Molecules at the Neuromuscular Junction in Physiology and Pathology

Bisei Ohkawara et al.

Summary: This review focuses on secreted signaling molecules that regulate the clustering of acetylcholine receptors (AChRs) at the neuromuscular junction (NMJ), including neural agrin, Lrp4, MuSK, Rspo2, Fgf18, and Ctgf. These molecules play crucial roles in ensuring efficient signal transduction at the NMJ.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

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Value of systematic genetic screening of patients with amyotrophic lateral sclerosis

Stephanie R. Shepheard et al.

Summary: Routine genetic sequencing in a cohort of 100 ALS patients revealed that 21% carried pathogenic or likely pathogenic mutations, with 93% lacking family history. An additional 21% had variants of uncertain significance in ALS-associated genes. The presence of multiple genetic variants in known ALS-linked genes may impact disease onset age.

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Comprehensive in silico analysis and molecular dynamics of the superoxide dismutase 1 (SOD1) variants related to amyotrophic lateral sclerosis

Gabriel Rodrigues Coutinho Pereira et al.

Summary: ALS is a common motor neuron disorder with no cure, and missense mutations in SOD1 can have harmful effects on protein structure and function, contributing to the development of the disease.

PLOS ONE (2021)

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Ribonuclease recruitment using a small molecule reduced c9ALS/FTD r(G4C2) repeat expansion in vitro and in vivo ALS models

Jessica A. Bush et al.

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Axonal TDP-43 condensates drive neuromuscular junction disruption through inhibition of local synthesis of nuclear encoded mitochondrial proteins

Topaz Altman et al.

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Marcial Camacho et al.

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Proteostatic imbalance and protein spreading in amyotrophic lateral sclerosis

Maria Elena Cicardi et al.

Summary: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder with complex pathological mechanisms involving the seeding and transmission of pathological proteins. Evidence suggests that the rapid propagation of these proteins along the neural axis contributes to the fast progression of ALS. This review highlights the behavior of ALS-associated proteins like SOD1, FUS, TDP-43, and C9orf72-linked dipeptide repeats in the disease, discussing their potential as biomarkers and implications for future research.

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Parkin beyond Parkinson's Disease-A Functional Meaning of Parkin Downregulation in TDP-43 Proteinopathies

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Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy in patients with two copies of SMN2 (STR1VE): an open-label, single-arm, multicentre, phase 3 trial

John W. Day et al.

Summary: The study evaluated the safety and efficacy of onasemnogene abeparvovec gene therapy in symptomatic patients with infantile-onset spinal muscular atrophy. Results showed that patients achieved independent sitting and survival rates without permanent ventilation at certain time points, with a favorable benefit-risk profile supporting the use of onasemnogene abeparvovec for treatment of this condition.

LANCET NEUROLOGY (2021)

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Gene therapy for ALS: A review

Defne A. Amado et al.

Summary: ALS has historically been challenging for gene therapy due to a lack of therapeutic targets and difficulty accessing the brain and spinal cord. Recent advances in disease mechanism understanding, ALS genetics, and CNS targeting, along with progress in gene delivery and editing techniques, have opened new therapeutic possibilities. Gene therapy clinical trials are underway for ALS patients with various genetic mutations, showing potential for disease-modifying treatment.

MOLECULAR THERAPY (2021)

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Altered perivascular fibroblast activity precedes ALS disease onset

Anna Manberg et al.

Summary: The study suggests that increased activity of perivascular fibroblast cells and vascular remodeling early in ALS pathogenesis can predict patient survival time. Elevated levels of SPP1 in plasma at disease diagnosis are a stronger predictor of shorter survival in ALS patients than established risk factors.

NATURE MEDICINE (2021)

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Unbiased Label-Free Quantitative Proteomics of Cells Expressing Amyotrophic Lateral Sclerosis (ALS) Mutations in CCNF Reveals Activation of the Apoptosis Pathway: A Workflow to Screen Pathogenic Gene Mutations

Flora Cheng et al.

Summary: In the past decade, there has been a rapid increase in the discovery of new genetic causes of ALS, with over 20 genes now implicated. These genes encode proteins with various molecular functions that contribute to the understanding of ALS pathogenesis. One challenge in ALS research is early determination of whether a new gene mutation is disease-specific and linked to neuronal cell death pathways.

FRONTIERS IN MOLECULAR NEUROSCIENCE (2021)

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Cholesterol-functionalized DNA/RNA heteroduplexes cross the blood-brain barrier and knock down genes in the rodent CNS

Tetsuya Nagata et al.

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NATURE BIOTECHNOLOGY (2021)

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Interactions between ALS-linked FUS and nucleoporins are associated with defects in the nucleocytoplasmic transport pathway

Yen-Chen Lin et al.

Summary: The study showed that ALS-linked mutations in FUS lead to reduced NCT and Nup density, causing cytoplasmic mislocalization in neurons, with aberrant interactions between FUS and nucleoporins. Drosophila experiments further supported these findings, highlighting the importance of proper nucleocytoplasmic transport for cell function.

NATURE NEUROSCIENCE (2021)

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Prediagnostic Neurofilament Light Chain Levels in Amyotrophic Lateral Sclerosis

Kjetil Bjornevik et al.

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NEUROLOGY (2021)

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Youngdae Gwon et al.

Summary: Stress granules are dynamic condensates composed of RNA and protein that disassemble in a context-dependent manner, with ubiquitination of G3BP1 being required for disassembly in the setting of heat shock.

SCIENCE (2021)

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Nuclear accumulation of CHMP7 initiates nuclear pore complex injury and subsequent TDP-43 dysfunction in sporadic and familial ALS

Alyssa N. Coyne et al.

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Hitoki Nanaura et al.

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NATURE COMMUNICATIONS (2021)

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Association of Variants in the SPTLC1 Gene With Juvenile Amyotrophic Lateral Sclerosis

Janel O. Johnson et al.

Summary: This study identified variants in the SPTLC1 gene associated with juvenile ALS, suggesting that screening for these variants may be important for patients presenting with juvenile ALS.

JAMA NEUROLOGY (2021)

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Shio Mitsuzawa et al.

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STEM CELL REPORTS (2021)

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Charis Wong et al.

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Hiroya Naruse et al.

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