综述与专论: 胶质细胞病——伴皮层下囊肿的巨脑性脑白质病致病机制研究进展

伴皮层下囊肿的巨脑性脑白质病（MLC）是MLC1或GlialCAM突变导致的星形胶质细胞功能障碍的中枢神经系统髓鞘变性疾病,以星形胶质细胞肿胀与髓鞘囊泡形成为特征性病理改变。MLC/GlialCAM与ClC-2共定位于星形胶质细胞终足处,既往研究发现MLC1/GlialCAM突变后影响ClC-2通道的电容传导性,导致星形胶质细胞的水离子稳态失衡参与MLC的发病,但在GlialCAM纯合敲除的小鼠中,通过与选择性开放Clc-2通道的转基因小鼠杂交并不能纠正小鼠表型,提示有其他因素共同参与了MLC的发生发展。最近研究表明,突变后的MLC1通过促进Connexin43的内化,减少其在细胞膜处形成缝隙连接,影响细胞间通讯效率,从而导致水肿形成和髓鞘囊泡形成,进一步导致MLC的发生。这些研究提示,少突胶质细胞、星形胶质细胞及缝隙连接蛋白等构成的胶质细胞合胞体的功能异常是MLC致病机制的研究方向。     

综述与专论: 机械敏感性离子通道TMEM63A在髓鞘形成障碍相关疾病中的作用

跨膜蛋白63A（transmembrane protein 63,TMEM63A）是一种机械敏感性离子通道（mechanosensitive ion channel,MSC）,在髓鞘形成过程中发挥重要作用。TMEM63A于2019年与髓鞘形成低下性脑白质营养不良19型（hypomyelinating leukodystrophy 19,HLD19）相关联,确定为HLD19的致病基因。髓鞘是神经系统中由少突胶质细胞形成的兼具营养轴突和加速动作电位传导的结构,髓鞘形成障碍可表现为髓鞘形成低下、髓鞘囊性化和髓鞘变性。髓鞘中脂质含量丰富,不同脂质参与髓鞘形成、修复和胶质细胞与轴突识别等重要过程。TMEM63A变异导致的HLD19为髓鞘形成低下性疾病。TMEM63A变异可引起渗透压改变,细胞上TMEM63A跨膜蛋白受机械刺激产生电流,从而影响少突胶质细胞分化、成熟,导致髓鞘形成异常;同时,TMEM63A变异也可引起细胞膜脂质的分布异常,影响脂质正常功能,异常的脂质通过参与不同的髓鞘形成环节最终导致了髓鞘形成障碍。     

研究报告: TMEM163变异致髓鞘形成低下患者随访两例及iPSC构建

目的 探讨TMEM163变异导致髓鞘形成低下性脑白质营养不良（HLD）患者的临床特征及遗传学特点，归纳自然病程，以提高对该疾病认识，并构建患者来源诱导多能干细胞，为致病机制研究建立基础。方法 随访2009~2022年北京大学第一医院儿科就诊的2例TMEM163变异致病患儿，对临床表现、遗传学数据、蛋白质结构数据进行分析，总结临床遗传学特点，并采集患儿外周血构建诱导多能干细胞。结果 临床特点：2例患儿均具有早期运动语言发育迟缓、头颅磁共振成像显示脑白质髓鞘化不良，且症状随生长发育逐渐减轻的特点；均于婴儿期起病，以眼球震颤为首发症状，学龄期症状好转。遗传学特点：2例患儿均为TMEM163同一位点新发错义变异c.227T>G p.（L76R）、c.227T>C p.（L76P），均为国际上首例报道。病例2来源外周血单个核细胞成功重编程为诱导多能干细胞。结论 本研究为国际首次随访TMEM163变异致病髓鞘形成低下性脑白质营养不良患儿，完善了其自然病程，扩展了对髓鞘形成低下性脑白质营养不良临床表型认识，并首次构建了TMEM163 c.227T>C p.（L76P）变异患者来源诱导多能干细胞，为进一步致病机制研究打下基础。     

综述与专论: 白质消融性白质脑病研究进展

白质消融性白质脑病（leukoencephalopathy with vanishing white matter,VWM）是一种常染色体隐性遗传性脑白质病,其致病基因EIF2B 1~5分别编码真核细胞蛋白质翻译起始因子2B（eukaryotic initiation factor 2B,eIF2B）的5个亚基α~ε,其中任一编码基因突变均可引起发病。起病多见于婴幼儿及儿童期,临床表型差异大,典型表现为进行性运动功能退行,可伴共济失调和癫痫。应激（发热、外伤等）可导致发作性加重。影像学显示大脑白质进行性液化。尸解神经病理学特征主要表现为广泛性白质稀疏和囊性变性,无神经胶质细胞反应性增生,星形胶质细胞形态异常,过表达祖细胞标志物巢蛋白（Nestin）和胶质纤维酸性蛋白δ（GFAPδ）,少突前体细胞数量增加和成熟少突胶质细胞减少、泡沫化且凋亡增加。VWM致病基因EIF2B 1~5是管家基因,但多数患者通常仅脑白质受累。少数胎儿期及婴儿早期发病的患者可出现多系统受累,成年女性患者可有卵巢功能障碍。目前认为,星形胶质细胞在其致病机制中起着核心作用,病理性星形胶质细胞继发性引起少突胶质细胞成熟障碍和髓鞘形成异常,进而导致脑白质病变。其他疾病机制包括内质网应激后未折叠蛋白反应（UPR）过度激活、线粒体功能障碍、自噬抑制等,尚不完全明确。     

克罗米芬促进髓鞘发育并改善缺氧性运动功能障碍

目的 研究选择性雌激素受体调节剂克罗米芬在促进白质损伤模型动物大脑少突胶质前体细胞分化和髓鞘形成中的作用和对运动功能障碍的影响。方法 离体少突胶质前体细胞纯化培养;新生3 d小鼠连续缺氧(10%O₂)7 d,模拟新生儿脑白质损伤;采用免疫荧光染色、运动协调功能检测等方法,观察克罗米芬对大脑皮质和胼胝体区域少突胶质细胞和髓鞘发育与运动功能的影响。结果 克罗米芬可促进纯化培养的少突胶质前体细胞分化为成熟少突胶质细胞,显著增加脑白质损伤模型小鼠脑组织2种髓鞘标志物——髓鞘碱性蛋白和髓鞘蛋白脂蛋白的表达,也显著增加成熟少突胶质细胞标志物腺瘤性结肠息肉病蛋白的表达;平衡杆实验证明克罗米芬治疗能够改善低氧导致的小鼠远期运动协调功能障碍。结论 克罗米芬能有效促进慢性缺氧诱导的白质损伤模型小鼠髓鞘形成和改善神经功能异常,为治疗脑白质损伤提供可能的临床药物。     

PCDHα在髓鞘形成和少突胶质细胞发育中的作用

该文通过免疫组化及蛋白免疫印迹的方法分别对Pcdhα基因敲除和对照组小鼠的中枢神经系统内的髓鞘碱性蛋白表达以及少突胶质细胞的发育进行了测定。结果表明:1)Pcdhα基因缺失小鼠中枢神经系统中的髓鞘碱性蛋白较对照组小鼠明显减少;2)Pcdhα基因敲除可导致少突胶质细胞发育异常:在小脑中,处于成熟期的少突胶质细胞减少,而处于前体细胞阶段的少突胶质细胞增多。上述结果提示Pcdhα可以通过调控少突胶质细胞的成熟过程进而影响髓鞘的形成。     

肺囊康定产生菌Glarea lozoyensis线粒体基因组序列的再分析

[目的] Glarea lozoyensis是抗真菌药物卡泊芬净的产生菌,其突变菌株ATCC 74030的线粒体基因组已被报道。我们此前的研究发现诱变剂能引起该菌某些细胞核基因的突变,但诱变剂是否也能引起线粒体DNA序列的改变并不清楚。[方法] 组装野生型菌株ATCC 20868的线粒体基因组,并与发表的突变型菌株ATCC 74030的线粒体基因组进行比较。通过PCR验证野生和突变菌株线粒体基因组间表现差异之处,并利用正确的线粒体基因组序列进行新的分析。[结果] 我们成功组装出野生型菌株ATCC 20868的线粒体基因组,通过比较其与发表的ATCC 74030的线粒体基因组序列,发现存在6处单核苷酸变异位点和2处具有长度差异的区域。然而,随后的PCR验证和序列比较并没有发现2个菌株间存在这些差异。最初观察到的碱基差异是因为发表的ATCC 74030线粒体基因组存在序列错误。有趣的是,在Glarea lozoyensis的线粒体基因组中,我们发现存在3个具有内含子的tRNA基因和1个rnpB基因。同时,该菌线粒体基因组中存在多种重复序列,在其线粒体和细胞核基因组间也存在明显的DNA片段重复事件。[结论] 诱变剂没有引起G. lozoyensis线粒体DNA的任何改变;发表的ATCC 74030的线粒体基因组存在序列错误。我们报道G. lozoyensis正确的线粒体基因组序列,并且发现该菌线粒体和细胞核基因组间频繁的基因交流。     

拟态弧菌金属蛋白酶基因PrtV缺失株的构建及生物学特性分析

【背景】研究发现PrtV基因编码含多囊肾病(polycystic kidney disease)结构域的金属蛋白酶,其在多种细菌的致病过程中具有重要作用。拟态弧菌是一种感染多种水生动物的重要病原菌,PrtV基因在拟态弧菌致病中的作用尚不清楚。【目的】探究PrtV基因对拟态弧菌致病相关生物学特性的影响。【方法】采用自然转化的方法构建拟态弧菌PrtV基因缺失株(ΔPrtV),同时通过基因与质粒重组后电转化导入缺失株构建回补株(ΔPrtV/pPrtV),对突变株的生长特性、生化特征、生物被膜形成、自聚集能力、胞外产物卵磷脂酶和蛋白酶活性,以及致病性和细胞毒性等进行分析。【结果】与野生株相比,缺失株的生长特性、生物被膜形成、自聚集能力和卵磷脂酶活性无变化,但分解尿素、甘氨酸、香豆酸盐、鸟氨酸和赖氨酸的理化特性改变;胞外产物蛋白酶活性显著降低(P<0.05),细胞毒性显著下降(P<0.05),对杂交鲇的致病力下降10倍。【结论】PrtV基因与拟态弧菌的细胞毒性及致病性等多种生物学特性有关。该结果为进一步解析拟态弧菌PrtV基因功能及其致病机制提供了依据。     

mapZ基因缺失对变异链球菌生长分裂及氯己定作用下生物膜形成能力的影响

探究变异链球菌（Streptococcus mutans）分裂调控基因mapZ缺失对变异链球菌生长分裂、氯己定（Chlorhexidine, CHX）作用下生物膜形成能力的影响。针对前期课题组成功构建的变异链球菌的mapZ基因缺失突变株（ΔsmmapZ）,通过扫描电镜（SEM）观察细菌细胞生长形态及分裂隔膜的位置变化;通过实时定量PCR技术检测mapZ基因缺失对分裂基因ftsZ相对表达含量的影响;通过检测氯己定最小抑菌浓度（MIC）并在不同药物浓度下培养生物膜来探究mapZ基因缺失对变异链球菌生物膜形成能力的影响。结果表明：与野生株相比,ΔsmmapZ突变株形态发生改变（变为短圆球状）,分裂隔膜位置错乱;ΔsmmapZ突变株分裂基因ftsZ相对表达含量较UA159下降四分之一,具有统计学差异;ΔsmmapZ突变株MIC值为0.125 00 μg/mL,UA159野生株MIC值为0.250 00 μg/mL,且在药物浓度为0.125 00 μg/mL的氯已定作用下,野生株可以形成生物膜,而ΔsmmapZ则无生物膜形成。变异链球菌缺失mapZ基因影响细菌细胞的胞质分裂,降低分裂基因ftsZ的表达和氯己定下变异链球菌生物膜的形成能力。mapZ可作为潜在的抗菌药物研发靶点。     

毒力岛基因ibeT有助于大肠杆菌抵抗人脑微血管内皮细胞溶酶体的降解

大肠杆菌是导致新生儿细菌性脑膜炎最常见的革兰氏阴性致病菌．为探讨毒力岛基因ibeT在大肠杆菌K1株致病过程中的作用,构建了ibeT基因缺失的大肠杆菌K1株,细菌在细胞内存活试验结果显示,ibeT基因缺失抑制了大肠杆菌K1株在人脑微血管内皮细胞中的生长．利用激光共聚焦扫描显微镜观察到,在细菌侵袭进入人脑微血管内皮细胞后,与野生型相比,ibeT基因缺失突变株较多地滞留在溶酶体内;透射电镜结果进一步显示,ibeT基因缺失使大肠杆菌K1株逃逸ECV(含有大肠杆菌的囊泡)的能力发生了下降,继而使其在细胞浆内的复制减少．利用体外模拟的弱酸性环境,检测大肠杆菌菌体胞内的缓冲容量,发现ibeT基因缺失突变株菌体胞内的缓冲能力较野生型低．这些结果提示,在大肠杆菌K1株侵袭进入人脑微血管内皮细胞后,ibeT基因有利于大肠杆菌降解ECV膜,避免与溶酶体融合,进而促使大肠杆菌逃逸进入细胞浆并进行复制．     

A duplicated PLP gene causing Pelizaeus-Merzbacher disease detected by comparative multiplex PCR.

Pelizaeus-Merzbacher disease (PMD) is an X-linked dysmyelinating disorder caused by abnormalities in the proteolipid protein (PLP) gene, which is essential for oligodendrocyte differentiation and CNS myelin formation. Although linkage analysis has shown the homogeneity at the PLP locus in patients with PMD, exonic mutations in the PLP gene have been identified in only 10%-25% of all cases, which suggests the presence of other genetic aberrations, including gene duplication. In this study, we examined five families with PMD not carrying exonic mutations in PLP gene, using comparative multiplex PCR (CM-PCR) as a semiquantitative assay of gene dosage. PLP gene duplications were identified in four families by CM-PCR and confirmed in three families by densitometric RFLP analysis. Because a homologous myelin protein gene, PMP22, is duplicated in the majority of patients with Charcot-Marie-Tooth 1A, PLP gene overdosage may be a important genetic abnormality in PMD and affect myelin formation.     

Elevated CSF N-acetylaspartylglutamate suggests specific molecular diagnostic abnormalities in patients with white matter diseases

Background: In order to identify biomarkers useful for the diagnosis of genetic white matter disorders we compared the metabolic profile of patients with leukodystrophies with a hypomyelinating or a non-hypomyelinating MRI pattern. Methods: We used a non-a priori method of in vitro ¹H-NMR spectroscopy on CSF samples of 74 patients with leukodystrophies. Results: We found an elevation of CSF N-acetylaspartylglutamate (NAAG) in patients with Pelizaeus–Merzbacher disease (PMD)—PLP1 gene, Pelizaeus–Merzbacher-like disease—GJC2 gene and Canavan disease—ASPA gene. In the PMD group, NAAG was significantly elevated in the CSF of all patients with PLP1 duplication (19/19) but was strictly normal in 6 out of 7 patients with PLP1 point mutations. Additionally, we previously reported increased CSF NAAG in patients with SLC17A5 mutations. Conclusions: Elevated CSF NAAG is a biomarker that suggests specific molecular diagnostic abnormalities in patients with white matter diseases. Our findings also point to unique pathological functions of the overexpressed PLP in PMD patients with duplication of this gene.     

Increased Plp1 gene expression leads to massive microglial cell activation and inflammation throughout the brain

PMD (Pelizaeus–Merzbacher disease) is a rare neurodegenerative disorder that impairs motor and cognitive functions and is associated with a shortened lifespan. The cause of PMD is mutations of the PLP1 [proteolipid protein 1 gene (human)] gene. Transgenic mice with increased Plp1 [proteolipid protein 1 gene (non-human)] copy number model most aspects of PMD patients with duplications. Hypomyelination and demyelination are believed to cause the neurological abnormalities in mammals with PLP1 duplications. We show, for the first time, intense microglial reactivity throughout the grey and white matter of a transgenic mouse line with increased copy number of the native Plp1 gene. Activated microglia in the white and grey matter of transgenic mice are found as early as postnatal day 7, before myelin commences in normal cerebra. This finding indicates that degeneration of myelin does not cause the microglial response. Microglial numbers are doubled due to in situ proliferation. Compared with the jp (jimpy) mouse, which has much more oligodendrocyte death and hardly any myelin, microglia in the overexpressors show a more dramatic microglial reactivity than jp, especially in the grey matter. Predictably, many classical markers of an inflammatory response, including TNF-α (tumour necrosis factor-α) and IL-6, are significantly up-regulated manyfold. Because inflammation is believed to contribute to axonal degeneration in multiple sclerosis and other neurodegenerative diseases, inflammation in mammals with increased Plp1 gene dosage may also contribute to axonal degeneration described in patients and rodents with PLP1 increased gene dosage.     

A DNA replication mechanism for generating nonrecurrent rearrangements associated with genomic disorders

The prevailing mechanism for recurrent and some nonrecurrent rearrangements causing genomic disorders is nonallelic homologous recombination (NAHR) between region-specific low-copy repeats (LCRs). For other nonrecurrent rearrangements, nonhomologous end joining (NHEJ) is implicated. Pelizaeus-Merzbacher disease (PMD) is an X-linked dysmyelinating disorder caused most frequently (60%-70%) by nonrecurrent duplication of the dosage-sensitive proteolipid protein 1 (PLP1) gene but also by nonrecurrent deletion or point mutations. Many PLP1 duplication junctions are refractory to breakpoint sequence analysis, an observation inconsistent with a simple recombination mechanism. Our current analysis of junction sequences in PMD patients confirms the occurrence of simple tandem PLP1 duplications but also uncovers evidence for sequence complexity at some junctions. These data are consistent with a replication-based mechanism that we term FoSTeS, for replication Fork Stalling and Template Switching. We propose that complex duplication and deletion rearrangements associated with PMD, and potentially other nonrecurrent rearrangements, may be explained by this replication-based mechanism.     

Therapy of Pelizaeus-Merzbacher disease in mice by feeding a cholesterol-enriched diet

Duplication of PLP1 (proteolipid protein gene 1) and the subsequent overexpression of the myelin protein PLP (also known as DM20) in oligodendrocytes is the most frequent cause of Pelizaeus-Merzbacher disease (PMD), a fatal leukodystrophy without therapeutic options. PLP binds cholesterol and is contained within membrane lipid raft microdomains. Cholesterol availability is the rate-limiting factor of central nervous system myelin synthesis. Transgenic mice with extra copies of the Plp1 gene are accurate models of PMD. Dysmyelination followed by demyelination, secondary inflammation and axon damage contribute to the severe motor impairment in these mice. The finding that in Plp1-transgenic oligodendrocytes, PLP and cholesterol accumulate in late endosomes and lysosomes (endo/lysosomes), prompted us to further investigate the role of cholesterol in PMD. Here we show that cholesterol itself promotes normal PLP trafficking and that dietary cholesterol influences PMD pathology. In a preclinical trial, PMD mice were fed a cholesterol-enriched diet. This restored oligodendrocyte numbers and ameliorated intracellular PLP accumulation. Moreover, myelin content increased, inflammation and gliosis were reduced and motor defects improved. Even after onset of clinical symptoms, cholesterol treatment prevented disease progression. Dietary cholesterol did not reduce Plp1 overexpression but facilitated incorporation of PLP into myelin membranes. These findings may have implications for therapeutic interventions in patients with PMD.     

Complete deletion of the proteolipid protein gene (PLP) in a family with X-linked Pelizaeus-Merzbacher disease.

Pelizaeus-Merzbacher disease (PMD) is an X-linked neurologic disorder characterized by dysmyelination in the central nervous system. Proteolipid protein (PLP), a major structural protein of myelin, is coded on the X chromosome. It has been postulated that a defect in the PLP gene is responsible for PMD. Different single-nucleotide substitutions have been found in conserved regions of the PLP gene of four unrelated PMD patients. Novel Southern blot patterns suggested a complex rearrangement in a fifth family. Linkage to PLP has been shown in others. We evaluated the PLP locus in a four-generation family with two living males affected with X-linked PMD. Analysis of DNA from the affected males revealed complete absence of a band, with PLP probes encompassing the promoter region, the entire coding region, and the 3' untranslated region and spanning at least 29 kb of genomic DNA. DNA from unaffected relatives gave the expected band pattern. Two obligate and one probable carrier women were hemizygous for the PLP locus by dosage analysis. Although it is unlikely, the previously described point mutations in PLP could represent polymorphisms. The finding of complete deletion of the PLP gene in our family is a stronger argument that mutations in PLP are responsible for X-linked PMD.     

Genetic homogeneity of Pelizaeus-Merzbacher disease: tight linkage to the proteolipoprotein locus in 16 affected families. PMD Clinical Group.

Among the numerous leukodystrophies that have an early onset and no biochemical markers, Pelizaeus-Merzbacher disease (PMD) is one that can be identified using strict clinical criteria and demonstrating an abnormal formation of myelin that is restricted to the CNS in electrophysiological studies and brain magnetic resonance imaging (MRI). In PMD, 12 different base substitutions and one total deletion of the genomic region containing the PLP gene have been reported, but, despite extensive analysis, PLP exon mutations have been found in only 10%-25% of the families analyzed. To test the genetic homogeneity of this disease, we have carried out linkage analysis with polymorphic markers of the PLP genomic region in 16 families selected on strict diagnostic criteria of PMD. We observed a tight linkage of the PMD locus with markers of the PLP gene (cDNA PLP, exon IV polymorphism) and of the Xq22 region (DXS17, DXS94, and DXS287), whereas the markers located more proximally (DXYS1X and DXS3) or distally (DXS11) were not linked to the PMD locus. Multipoint analysis gave a maximal location score for the PMD locus (13.98) and the PLP gene (8.32) in the same interval between DXS94 and DXS287, suggesting that in all families PMD is linked to the PLP locus. Mutations of the extraexonic PLP gene sequences or of another unknown close gene could be involved in PMD. In an attempt to identify molecular defects of this genomic region that are responsible for PMD, these results meant that RFLP analysis could be used to improve genetic counseling for the numerous affected families in which a PLP exon mutation could not be demonstrated.     

Pelizaeus-Merzbacher disease: identification of Xq22 proteolipid-protein duplications and characterization of breakpoints by interphase FISH.

Pelizaeus-Merzbacher disease (PMD) is an X-linked, dysmyelinating disorder of the CNS. Duplications of the proteolipid protein (PLP) gene have been found in a proportion of patients, suggesting that, in addition to coding-region or splice-site mutations, overdosage of the gene can cause PMD. We show that the duplication can be detected by interphase FISH, using a PLP probe in five patients and their four asymptomatic carrier mothers. The extent of the duplication was analyzed in each family by interphase FISH, with probes from a 1. 7-Mb region surrounding the PLP gene between markers DXS83 and DXS94. A large duplication >=500 kb was detected, with breakpoints that differed, between families, at the proximal end. Distinct separation of the duplicated PLP signals could be seen only on metaphase chromosomes in one family, providing further evidence that different duplication events are involved. Quantitative fluorescent multiplex PCR was used to confirm the duplication in patients, by the detection of increased copy number of the PLP gene. Multiallelic markers from the duplicated region were analyzed, since the identification of two alleles in an affected boy would indicate a duplication. The majority of boys were homozygous for all four markers, compared with their mothers, who were heterozygous for one to three of the markers. These results suggest that intrachromosomal rearrangements may be a common mechanism by which duplications arise in PMD. One boy was heterozygous for the PLP marker, indicating a duplication and suggesting that interchromosomal rearrangements of maternal origin also can be involved. Since duplications are a major cause of PMD, we propose that interphase FISH is a reliable method for diagnosis and identification of female carriers.