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: 少突胶质细胞病——佩梅病的临床特点及致病机制

佩梅病（Pelizaeus-Merzbacher disease,PMD）是髓鞘形成低下性脑白质营养不良疾病中最常见的一种,其临床特点主要表现为发育落后尤其是大运动落后、眼震、肌张力低下等。其致病机制主要为脑白质髓鞘形成细胞-少突胶质细胞发生病理性改变从而导致髓鞘形成不良,相应理论基础包括以往研究中PLP1点突变通过影响PLP1/DM20寡聚体的形成,进而影响少突胶质细胞的存活,髓鞘分子结构的形成等;而PLP1重复突变则使少突胶质细胞及髓鞘脂的发育停止。近年来对细胞器互作网络（organelle interaction network,OIN）的研究进一步揭示了PLP1突变的致病机制：PLP1点突变通过影响PLP1蛋白上膜进而影响少突胶质细胞髓鞘化。PLP1重复突变则改变内质网线粒体间的连接,继而影响线粒体的形态功能等产生致病作用。目前已有相关研究表明,一些小分子化合物或药物例如胆固醇、吡拉西坦等以及基因疗法在动物体内对PMD临床症状有改善作用,其在PMD 患者体内的疗效有待进一步证实。     

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: 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。     

中枢神经系统轴突再生抑制蛋白

中枢神经系统 (CNS)轴突再生的主要障碍之一是存在抑制再生的蛋白 ,迄今 ,已在少突胶质细胞 /髓鞘中相继发现至少三个重要的轴突再生抑制蛋白 ,即髓鞘相关糖蛋白 (MAG)、Nogo A和少突胶质细胞 /髓鞘糖蛋白 (OMgp)。最近的研究又证实 ,这三个不同的抑制成分可能主要通过与一个共同的受体Nogo6 6受体 (NgR)结合而发挥作用。这些研究成果扩充了对CNS损伤后轴突再生障碍的理解 ,也为探讨CNS损伤的治疗新策略提供了新的思路。     

内毒素休克大鼠肝线粒体质子跨膜转运的改变

用稳态荧光探针标记技术动态观察内毒素休克大鼠肝亚线粒体质子跨膜转运的变化.发现,休克5 h ATP、NADH和琥珀酸钠所致的9-氨基-6-氯-2-甲氧基吖啶(ACMA）最大荧光淬灭值（ΔA_max）显著低于对照组(P＜0.05)、最大荧光淬灭时间（T_ΔAmax）、半数荧光淬灭时间（T_1/2ΔAmax）非常显著延长(P＜0.01),肝线粒体质子跨膜转运能力下降;膜脂分子烃链和膜脂深层次流动性下降;线粒体膜PLA₂活性增加;血浆脂质过氧化产物MDA和线粒体MDA含量均显著增加.可能膜脂质过氧化和磷脂酶A₂的水解是引起内毒素休克肝线粒体质子转运功能改变的重要因素.     

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。     

髓鞘脂质的代谢与功能研究进展

髓鞘是包绕神经轴突的高度特化的膜性结构,其主要功能是保护轴突、绝缘和维持神经冲动的跳跃式传导。髓鞘膜富含脂质,其脂质构成与其他生物膜明显不同。由于髓鞘的形成需要高水平的脂质合成,多种脂代谢紊乱性疾病均可导致髓鞘的完整性被破坏。针对各种脂质合成通路关键分子的转基因小鼠研究有利于我们清楚地认识髓鞘脂质的功能。此外,成髓鞘神经胶质细胞对外源性脂质的摄取也可在髓鞘形成中发挥作用。了解髓鞘脂质的代谢与功能,将有助于我们深入认识脂质在髓鞘损伤和疾病中的作用,并且为脱髓鞘疾病的治疗提供新的策略。本文就脂质在髓鞘形成和维持过程中的代谢和功能相关研究进展作一综述。     

大鼠脊髓胸段平面少突胶质细胞分布和形态学差异的研究

目的：观察大鼠脊髓胸段（T8-T10）平面中少突胶质细胞在白质和灰质中分布和形态学差异。方法：应用免疫荧光组织化学方法,利用少突胶质细胞特异性标志物一抗大鼠Nogo-A分子单克隆抗体,观察大鼠脊髓胸段平面白质和灰质中少突胶质细胞分布和形态学差异。结果：Nogo—A免疫阳性标记主要集中在少突胶质细胞的胞体、突起及其形成的髓鞘。在冠状切面中,白质中的少突胶质细胞广泛分布,而灰质中少突胶质细胞主要分布于神经元的周围;白质中少突胶质细胞胞体较灰质中少突胶质细胞的胞体大,且白质中少突胶质细胞突起及形成的髓鞘结构较灰质中明显。在矢状切面中,白质中少突胶质细胞多成”串珠状”排列,而灰质中少突胶质细胞则紧贴神经元。在脊髓近端背根结结构中,可以观察到少突胶质细胞形成的轴突呈”蜂窝状”结构。结论：应用抗大鼠Nogo—A分子单克隆抗体的免疫荧光组织化学染色方法能够较好展示少突胶质细胞分布特点和形态学差异,与少突胶质细胞类别（束内细胞,卫星细胞）和功能特点相适应,为进一步研究生理和病理条件下,少突胶质细胞的机能奠定基础。     

Transmembrane protein 106A is silenced by promoter region hypermethylation and suppresses gastric cancer growth by inducing apoptosis

Inactivation of tumour suppressor genes by promoter methylation plays an important role in the initiation and progression of gastric cancer (GC). Transmembrane 106A gene (TMEM106A) encodes a novel protein of previously unknown function. This study analysed the biological functions, epigenetic changes and the clinical significance of TMEM106A in GC. Data from experiments indicate that TMEM106A is a type II membrane protein, which is localized to mitochondria and the plasma membrane. TMEM106A was down‐regulated or silenced by promoter region hypermethylation in GC cell lines, but expressed in normal gastric tissues. Overexpression of TMEM106A suppressed cell growth and induced apoptosis in GC cell lines, and retarded the growth of xenografts in nude mice. These effects were associated with the activation of caspase‐2, caspase‐9, and caspase‐3, cleavage of BID and inactivation of poly (ADP‐ribose) polymerase (PARP). In primary GC samples, loss or reduction of TMEM106A expression was associated with promoter region hypermethylation. TMEM106A was methylated in 88.6% (93/105) of primary GC and 18.1% (2/11) in cancer adjacent normal tissue samples. Further analysis suggested that TMEM106A methylation in primary GCs was significantly correlated with smoking and tumour metastasis. In conclusion, TMEM106A is frequently methylated in human GC. The expression of TMEM106A is regulated by promoter hypermethylation. TMEM106A is a novel functional tumour suppressor in gastric carcinogenesis.     

Genetic Variants Affecting Phenoloxidase Activity in Drosophila melanogaster

In Drosophila melanogaster, two new variants affecting the activity of phenoloxidase were found in natural populations at Gomel in Belorussia and at Krasnodar in Russia. Prophenoloxidases, A ₁ and A ₃ , in these variants had the same mobilities on native electrophoresis as the wild type. However, enzymatic activities in their activated states were much lower than in the wild type, whereas the existence of prophenoloxidase proteins was demonstrated. Egg-to-adult and relative viabilities in the variants did not decrease at temperatures between 18 and 29°C. Genetic analyses indicated that the genes showing the phenotype of variants are new alleles of Mox and Dox-3 on the second chromosome.     

Ultrastructural changes of human sural nerves in the neuropathy induced by intrauterine methylmercury poisoning (so-called fetal Minamata disease).

Biopsy of the sural nerve was performed on three patients with severe Minamata disease of more than 10 years duration. There were so many unmyelinated and poorly myelinated nerve fibers that myelinated fibers scattered irregularly in small numbers or in groups of peculiar features in the intraneural bundle. Abnormaly thin or poorly formed myelin sheaths were noticed. Incomplete myelination and abnormal myelination varied in size and shape appeared as fetal anomaly. Regenerated axons extremely small in size remained singly or in groups following regenerative sprouting. Sometimes, extremely small axons with normal myelination were noticeable, while the axons were lost, leaving myelin sheaths. Axons occasionally contained increased neurofilaments. Schwann cells were not so increased as in adult Minamata disease. Degenerative changes of nerve fibers still proceeded, presumably because the patients lived in the mercury-contaminated district. Myelin degenerations and glycogen deposits in the axoplasm were identified.     

Astrocytes promote myelination in response to electrical impulses

Myelin, the insulating layers of membrane wrapped around axons by oligodendrocytes, is essential for normal impulse conduction. It forms during late stages of fetal development but continues into early adult life. Myelination correlates with cognitive development and can be regulated by impulse activity through unknown molecular mechanisms. Astrocytes do not form myelin, but these nonneuronal cells can promote myelination in ways that are not understood. Here, we identify a link between myelination, astrocytes, and electrical impulse activity in axons that is mediated by the cytokine leukemia inhibitory factor (LIF). These findings show that LIF is released by astrocytes in response to ATP liberated from axons firing action potentials, and LIF promotes myelination by mature oligodendrocytes. This activity-dependent mechanism promoting myelination could regulate myelination according to functional activity or environmental experience and may offer new approaches to treating demyelinating diseases.     

Oligodendrocyte–Neuron Interactions: Impact on Myelination and Brain Function

In the past, glial cells were considered to be ‘glue’ cells whose primary role was thought to be merely filling gaps in neural circuits. However, a growing number of reports have indicated the role of glial cells in higher brain function through their interaction with neurons. Myelin was originally thought to be just a sheath structure surrounding neuronal axons, but recently it has been shown that myelin exerts effects on the conduction velocity of neuronal axons even after myelin formation. Therefore, the investigation of glial cell properties and the neuron-glial interactions is important for understanding higher brain function. Moreover, since there are many neurological disorders caused by glial abnormalities, further understanding of glial cell-related diseases and the development of effective therapeutic strategies are warranted. In this review, we focused on oligodendrocyte-neuron interactions, with particular attention on (1) axonal signals underlying oligodendrocyte differentiation and myelination, (2) neuronal activity-dependent myelination and (3) the effects of myelination on higher brain function.

     

TMEM106B p.T185S regulates TMEM106B protein levels: implications for frontotemporal dementia

Frontotemporal lobar degeneration (FTLD) is the second leading cause of dementia in individuals under age 65. In many patients, the predominant pathology includes neuronal cytoplasmic or intranuclear inclusions of ubiquitinated TAR DNA binding protein 43 (FTLD‐TDP). Recently, a genome‐wide association study identified the first FTLD‐TDP genetic risk factor, in which variants in and around the TMEM106B gene (top SNP rs1990622) were significantly associated with FTLD‐TDP risk. Intriguingly, the most significant association was in FTLD‐TDP patients carrying progranulin (GRN) mutations. Here, we investigated to what extent the coding variant, rs3173615 (p.T185S) in linkage disequilibrium with rs1990622, affects progranulin protein (PGRN) biology and transmembrane protein 106 B (TMEM106B) regulation. First, we confirmed the association of TMEM106B variants with FTLD‐TDP in a new cohort of GRN mutation carriers. We next generated and characterized a TMEM106B‐specific antibody for investigation of this protein. Enzyme‐linked immunoassay analysis of progranulin protein levels showed similar effects upon T185 and S185 TMEM106B over‐expression. However, over‐expression of T185 consistently led to higher TMEM106B protein levels than S185. Cycloheximide treatment experiments revealed that S185 degrades faster than T185 TMEM106B, potentially due to differences in N‐glycosylation at residue N183. Together, our results provide a potential mechanism by which TMEM106B variants lead to differences in FTLD‐TDP risk.

     

TMEM43 mutations associated with arrhythmogenic right ventricular cardiomyopathy in non-Newfoundland populations

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a myocardial disease characterized by fibro-fatty replacement of right ventricular free wall myocardium and life-threatening ventricular arrhythmias. A missense mutation, c.1073C>T (p.S358L) in the transmembrane protein 43 (TMEM43) gene, has been genetically identified to cause ARVC type 5 in a founder population from Newfoundland. It is unclear whether this mutation occurs in other populations outside of this founder population or if other variants of TMEM43 are associated with ARVC disease. We sought to identify non-Newfoundland individuals with TMEM43 variants among patient samples sent for genetic assessment for possible ARVC. Of 195 unrelated individuals with suspected ARVC, mutation of desmosomal proteins was seen in 28 and the p.S358L TMEM43 mutation in six. We identified a de novo p.S358L mutation in a non-Newfoundland patient and five separate rare TMEM43 (four novel) sequence variants in non-Newfoundland patients, each occurring in an evolutionarily conserved amino acid. TMEM43 mutations occur outside of the founder population of the island of Newfoundland where it was originally described. TMEM43 sequencing should be incorporated into clinical genetic testing for ARVC patients.     

TMEM126A is a mitochondrial located mRNA (MLR) protein of the mitochondrial inner membrane

Background

Hereditary optic neuropathies (HONs) are a heterogeneous group of disorders that affect retinal ganglion cells (RGCs) and axons that form the optic nerve. Leber's Hereditary Optic Neuropathy and the autosomal dominant optic atrophy related to OPA1 mutations are the most common forms. Nonsyndromic autosomal recessive optic neuropathies are rare and their existence has been long debated. We recently identified the first gene responsible for these conditions, TMEM126A. This gene is highly expressed in retinal cellular compartments enriched in mitochondria and supposed to encode a mitochondrial transmembrane protein of unknown function.

Methods

A specific polyclonal antibody targeting the TMEM126A protein has been generated. Quantitative fluorescent in situ hybridization, cellular fractionation, mitochondrial membrane association study, mitochondrial sub compartmentalization analysis by both proteolysis assays and transmission electron microscopy, and expression analysis of truncated TMEM126A constructs by immunofluorescence confocal microscopy were carried out.

Results

TMEM126A mRNAs are strongly enriched in the vicinity of mitochondria and encode an inner mitochondrial membrane associated cristae protein. Moreover, the second transmembrane domain of TMEM126A is required for its mitochondrial localization.

Conclusions

TMEM126A is a mitochondrial located mRNA (MLR) that may be translated in the mitochondrial surface and the protein is subsequently imported to the inner membrane. These data constitute the first step toward a better understanding of the mechanism of action of TMEM126A in RGCs and support the importance of mitochondrial dysfunction in the pathogenesis of HON.

General significance

Local translation of nuclearly encoded mitochondrial mRNAs might be a mechanism for rapid onsite supply of mitochondrial membrane proteins.