SPG15 (disease)

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Spastic paraplegia 15 (SPG15) is a form of hereditary spastic paraplegia that commonly becomes apparent during childhood or adolescence (e.g. between ages 5 and 18 years). The disease is caused by mutations within the ZFYVE26 gene - also known as the SPG15 gene - and is passed down in an autosomal recessive manner. [1]

Contents

The disease is characterised by progressive spasticity that starts within the lower extremities and spreads to the upper body and limbs. This can be accompanied by other manifestations, such as developmental delay or learning disability, often preceding motor involvement amongst others.  There have also been "extremely rare" cases of onset in adulthood. [2]

Signs and symptoms

Hereditary spastic paraplegia (HSP) type 15 is characterised by slowly progressive muscle stiffness (spasticity) and paralysis (paraplegia) in the lower limbs, resulting in gait disturbances. Symptoms usually appear during childhood or early adulthood. The disease also affects the upper limbs, and includes additional symptoms, which makes this type of HSP a complicated type (see Hereditary spastic paraplegia for clarification of complicated and uncomplicated HSPs). The additional symptoms include mild intellectual disability, mild cerebellar ataxia, peripheral neuropathy (with distal upper limb amyotrophy) and retinal degeneration. [3] [4]

Symptoms noted in patients (some of them may present or progress at different times over the course of the disease):

Depending on the severity in patients, mutations in SPG15 can cause other neurological complications such as:

Genetics

SPG15 is passed down from both parents to their child in an autosomal recessive manner. This means that each parent carries a pathogenic variant in one copy of the ZFYVE26 gene. If both pathogenic variants, one from mum and one from dad, are present in the child then there will be disease onset (25% of cases). If only one variant from mum or dad is passed to the child then they will simply be a carrier (50% chance of cases). Finally, in the optimal situation, neither of the variants will be passed to the child (25% chance of cases). It is possible to conduct prenatal genetic testing in families where the parents have been identified as carriers. [5]

Pathophysiology

At the molecular level, SPG15 is caused by loss of function mutations in the ZFYVE26 gene, encoding the protein spastizin. This protein is involved in the regulation of endosome and autophagosome reformation. The exact mechanism of action of cellular locations of spastizin have not been totally elucidated yet, but it is generally accepted that it interacts with the protein spatacsin and a complex containing AP5Z1, that when mutated are responsible for other forms of HSP, SPG11 and SPG48. These proteins have been localised to late endosomes and lysosomes and their function is considered to be important in endosomes and lysosome homeostasis. [6] Mouse models with Zfyve26 mutations show abnormal accumulation of vesicle-like structures, which leads to degeneration of the nerves and the development of the typical signs of the disease. [7]

Diagnosis

Diagnosis is initially by difficulties in walking (specifically Spasticity) that are not explainable by other common causes. This is followed up by brain imaging (Magnetic resonance imaging), with a particular focus on the thickness of the corpus callosum. [8] Final confirmation is by genetic testing to establish whether there are causal variants in both copies of the ZFYVE26 gene.

Management

Current treatment options are focussed on the management of symptoms and need to be assessed for the individual patient [9]

Prognosis

Currently the number of patients diagnosed with SPG15 is very small and there has been insufficient long-term follow-up to give confident predictions of progression, impact and care needs.

Research directions

Research is focussed on the fundamental understanding of the SPG15 protein in maintaining normal cell function and how this related degeneration of nerve cells [10] [11]

Epidemiology

SPG15 is classified as a rare disease with a prevalence of around ~75 individuals worldwide ranging from Europe, North and South America, the Middle East, East Asia. As genetic testing becomes more readily available and affordable, more patients will be identified. [12]

Related Research Articles

Hereditary spastic paraplegia (HSP) is a group of inherited diseases whose main feature is a progressive gait disorder. The disease presents with progressive stiffness (spasticity) and contraction in the lower limbs. HSP is also known as hereditary spastic paraparesis, familial spastic paraplegia, French settlement disease, Strumpell disease, or Strumpell-Lorrain disease. The symptoms are a result of dysfunction of long axons in the spinal cord. The affected cells are the primary motor neurons; therefore, the disease is an upper motor neuron disease. HSP is not a form of cerebral palsy even though it physically may appear and behave much the same as spastic diplegia. The origin of HSP is different from cerebral palsy. Despite this, some of the same anti-spasticity medications used in spastic cerebral palsy are sometimes used to treat HSP symptoms.

Propionic acidemia, also known as propionic aciduria or propionyl-CoA carboxylase deficiency, is a rare autosomal recessive metabolic disorder, classified as a branched-chain organic acidemia.

<span class="mw-page-title-main">Spinocerebellar ataxia</span> Medical condition

Spinocerebellar ataxia (SCA) is a progressive, degenerative, genetic disease with multiple types, each of which could be considered a neurological condition in its own right. An estimated 150,000 people in the United States have a diagnosis of spinocerebellar ataxia at any given time. SCA is hereditary, progressive, degenerative, and often fatal. There is no known effective treatment or cure. SCA can affect anyone of any age. The disease is caused by either a recessive or dominant gene. In many cases people are not aware that they carry a relevant gene until they have children who begin to show signs of having the disorder.

<span class="mw-page-title-main">Salla disease</span> Medical condition

Salla disease (SD) is an autosomal recessive lysosomal storage disease characterized by early physical impairment and intellectual disability. It was first described in 1979, after Salla, a municipality in Finnish Lapland and is one of 40 Finnish heritage diseases.

<span class="mw-page-title-main">Congenital muscular dystrophy</span> Medical condition

Congenital muscular dystrophies are autosomal recessively-inherited muscle diseases. They are a group of heterogeneous disorders characterized by muscle weakness which is present at birth and the different changes on muscle biopsy that ranges from myopathic to overtly dystrophic due to the age at which the biopsy takes place.

<span class="mw-page-title-main">Spastin</span> Protein

The human gene SPAST codes for the microtubule-severing protein of the same name, commonly known as spastin.

Atlastin-1, is a protein that in humans is encoded by the ATL1 gene.

<span class="mw-page-title-main">Paraplegin</span> Protein-coding gene in the species Homo sapiens

Paraplegin is a protein that in humans is encoded by the SPG7 gene located on chromosome 16.

<span class="mw-page-title-main">SPG20</span> Protein-coding gene in the species Homo sapiens

Spartin is a protein that in humans is encoded by the SPG20 gene.

Warburg Micro syndrome (WARBM), also known as Spastic Paraplegia 69 (SPG69) or RAB18 Deficiency, is a rare autosomal recessive genetic disorder characterized by congenital cataract, hypotonia, spastic diplegia, intellectual or developmental disability, microcephaly, microcornea, optic atrophy, and hypogenitalism.

<span class="mw-page-title-main">X-linked spinal muscular atrophy type 2</span> Medical condition

X-linked spinal muscular atrophy type 2, also known as arthrogryposis multiplex congenita X-linked type 1 (AMCX1), is a rare neurological disorder involving death of motor neurons in the anterior horn of spinal cord resulting in generalised muscle wasting (atrophy). The disease is caused by a mutation in UBA1 gene and is passed in an X-linked recessive manner by carrier mothers to affected sons.

<span class="mw-page-title-main">ZFYVE26</span> Protein-coding gene in the species Homo sapiens

Zinc finger, FYVE domain containing 26 is a protein that in humans is encoded by the ZFYVE26 gene.

<span class="mw-page-title-main">Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy</span> Medical condition

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is disease of the arteries in the brain, which causes tissue loss in the subcortical region of the brain and the destruction of myelin in the CNS. CARASIL is characterized by symptoms such as gait disturbances, hair loss, low back pain, dementia, and stroke. CARASIL is a rare disease, having only been diagnosed in about 50 patients, of which ten have been genetically confirmed. Most cases have been reported in Japan, but Chinese and caucasian individuals have also been diagnosed with the disease. CARASIL is inherited in an autosomal recessive pattern. There is currently no cure for CARASIL. Other names for CARASIL include familial young-adult-onset arteriosclerotic leukoencephalopathy with alopecia and lumbago without arterial hypertension, Nemoto disease and Maeda syndrome.

PRICKLE1-related progressive myoclonus epilepsy with ataxia is a very rare genetic disorder which is characterized by myoclonic epilepsy and ataxia.

GRIN2B-related neurodevelopmental disorder is a rare neurodevelopmental disorder which is characterized by developmental delays and intellectual disabilities of variable degrees, muscle tone anomalies, feeding difficulties, and behavioral problems.

<span class="mw-page-title-main">AP5B1</span> Protein-coding gene in the species Homo sapiens

AP-5 complex subunit beta (AP5B1) is a protein that in humans is encoded by the AP5B1 gene.

<span class="mw-page-title-main">AP5S1</span> Protein-coding gene in the species Homo sapiens

AP-5 complex subunit sigma (AP5S1) is a protein that in humans is encoded by the AP5S1 gene.

<span class="mw-page-title-main">Hypomyelination-congenital cataract syndrome</span> Medical condition

Hypomyelination-congenital cataract syndrome is a rare autosomal recessive hereditary disorder that affects the brain's white matter and is characterized by congenital cataract, psychomotor development delays, and moderate intellectual disabilities. It is a type of leukoencephalopathy.

Spastic paraplegia 31 is a rare type of hereditary spastic paraplegia which is characterized by sensation anomalies of the lower extremities.

Progressive pseudorheumatoid disyplasia, also known as progressive pseudorheumatoid arthropathy of childhood (PPAD), is a disorder of bone and cartilage that affects many joints. The disorder leads to stiff joints, short stature and widening of the ends of the finger and toe bones as well as other tubular bones.

References

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  3. RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Autosomal recessive spastic paraplegia type 15". www.orpha.net. Retrieved 2022-06-22.{{cite web}}: CS1 maint: numeric names: authors list (link)
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  8. "Spastic paraplegia 15 - About the Disease - Genetic and Rare Diseases Information Center". rarediseases.info.nih.gov. Retrieved 2022-07-05.
  9. Ebrahimi-Fakhari, Darius; Alecu, Julian E.; Blackstone, Craig (1993), Adam, Margaret P.; Mirzaa, Ghayda M.; Pagon, Roberta A.; Wallace, Stephanie E. (eds.), "Spastic Paraplegia 15", GeneReviews®, Seattle (WA): University of Washington, Seattle, PMID   34057829 , retrieved 2022-06-22
  10. Renvoisé, Benoît; Chang, Jaerak; Singh, Rajat; Yonekawa, Sayuri; FitzGibbon, Edmond J.; Mankodi, Ami; Vanderver, Adeline; Schindler, Alice; Toro, Camilo; Gahl, William A.; Mahuran, Don J. (2014-06-01). "Lysosomal abnormalities in hereditary spastic paraplegia types SPG15 and SPG11". Annals of Clinical and Translational Neurology. 1 (6): 379–389. doi:10.1002/acn3.64. ISSN   2328-9503. PMC   4078876 . PMID   24999486.
  11. Hirst, Jennifer; Hesketh, Geoffrey G.; Gingras, Anne-Claude; Robinson, Margaret S. (2021-02-01). "Rag GTPases and phosphatidylinositol 3-phosphate mediate recruitment of the AP-5/SPG11/SPG15 complex". The Journal of Cell Biology. 220 (2): e202002075. doi:10.1083/jcb.202002075. ISSN   1540-8140. PMC   7814351 . PMID   33464297.
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