期刊
BRAIN
卷 136, 期 -, 页码 1708-1717出版社
OXFORD UNIV PRESS
DOI: 10.1093/brain/awt095
关键词
iron; NBIA; autophagy; basal ganglia; Rett syndrome
资金
- NBIA Disorders Association
- Hoffnungsbaum e.V.
- Associazione Italiana Sindromi Neurodegenerative da Accumulo di Ferro
- Oregon Clinical and Translational Research Institute, a component of the NIH [UL1 RR024140 NCRR]
- NIH Roadmap for Medical Research
- TIRCON consortium (European Commission) [277984]
- American Academy of Neurology
- Dystonia Medical Research Foundation
- Child Neurology Foundation
- American Philosophical Society
- Great Ormond Street Children's Charities
- Action Medical Research
- Wellcome Trust
- German Federal Ministry of Education and Research (BMBF) [SysMBo 0315494A]
- German Network for Mitochondrial Disorders [mitoNET 01GM0867]
- European Commission 7th Framework Program [261123]
- Genetic European Variation in Disease Consortium
- German Ministry for Education and Research [01GR0804-4]
- MRC [G0802760, MR/J004758/1, G1001253, G108/638] Funding Source: UKRI
- Medical Research Council [G0802760, G108/638, MR/J004758/1, G1001253] Funding Source: researchfish
- Fondazione Telethon Funding Source: Custom
Neurodegenerative disorders with high iron in the basal ganglia encompass an expanding collection of single gene disorders collectively known as neurodegeneration with brain iron accumulation. These disorders can largely be distinguished from one another by their associated clinical and neuroimaging features. The aim of this study was to define the phenotype that is associated with mutations in WDR45, a new causative gene for neurodegeneration with brain iron accumulation located on the X chromosome. The study subjects consisted of WDR45 mutation-positive individuals identified after screening a large international cohort of patients with idiopathic neurodegeneration with brain iron accumulation. Their records were reviewed, including longitudinal clinical, laboratory and imaging data. Twenty-three mutation-positive subjects were identified (20 females). The natural history of their disease was remarkably uniform: global developmental delay in childhood and further regression in early adulthood with progressive dystonia, parkinsonism and dementia. Common early comorbidities included seizures, spasticity and disordered sleep. The symptoms of parkinsonism improved with l-DOPA; however, nearly all patients experienced early motor fluctuations that quickly progressed to disabling dyskinesias, warranting discontinuation of l-DOPA. Brain magnetic resonance imaging showed iron in the substantia nigra and globus pallidus, with a 'halo' of T-1 hyperintense signal in the substantia nigra. All patients harboured de novo mutations in WDR45, encoding a beta-propeller protein postulated to play a role in autophagy. Beta-propeller protein-associated neurodegeneration, the only X-linked disorder of neurodegeneration with brain iron accumulation, is associated with de novo mutations in WDR45 and is recognizable by a unique combination of clinical, natural history and neuroimaging features.
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