Genetic Clues to Rare Childhood Disorder
Research from the University of California, San Diego School of Medicine provides new clues for the compulsive behavior and cognitive defects associated with a rare childhood neurological disease called Lesch-Nyhan Disease (LND). Two pathways found to be defective in LND are known to be associated with other neurodegenerative disease, such as Alzheimer’s and Parknson’s diseases, suggesting common causes of cognitive and behavioral defects in these neurological disorders.
The research is published on-line today in the PloS ONE.
“This study is important because it opens completely new and unexpected areas of research into the genetic cause of compulsive and self-injurious behavior in Lesch-Nyhan disease,” said principal investigator Theodore Friedmann, MD, professor of pediatrics at UCSD’s Center for Neural Circuit and Behavior and Rady Children’s Hospital-San Diego, a research and teaching affiliate of the UCSD School of Medicine.
“We think that the findings also have implications for far more common diseases related to the central nervous system, such as Alzheimer’s and Parkinson’s diseases, since defects similar or related to those that we’ve found are also seen in other neurodegenerative diseases – suggesting common mechanisms for some of the cognitive, behavioral and neurological defects in all these disorders,” Friedmann added.
LND is an inherited disease caused by a deficiency of the HGPRT enzyme, produced by mutations in the HPRT gene located on the X chromosome, which causes a build-up of uric acid in all bodily fluids. The rare disorder, first identified by medical student Michael Lesch and his mentor, William L. Nyhan – currently a research professor of pediatrics at UC San Diego School of Medicine – is almost always seen in males. Complications usually appear in the first year of life, with neurological signs including poor muscle control and moderate cognitive deficiencies. A particularly disturbing aspect of the disease is uncontrollable and involuntary compulsive self-mutilating behaviors, characterized by lip and finger biting.
What is Lesch-Nyhan syndrome?
Lesch-Nyhan syndrome is a condition characterized by the overproduction and accumulation of uric acid, a waste product of normal chemical processes that is found in blood and urine. The overproduction of uric acid can cause gouty arthritis (arthritis caused by an accumulation of uric acid in the joints), kidney stones, and bladder stones. Problems with the nervous system and behavioral disturbances are also characteristic of this disorder. Abnormal involuntary muscle movements such as flexing, jerking, and flailing are often displayed by people affected with this disorder. People with Lesch-Nyhan syndrome usually cannot walk, require assistance sitting, and are generally wheelchair-bound. Self-injury, including biting and head banging, is the most common and distinctive behavioral problem in those with Lesch-Nyhan syndrome.
How common is Lesch-Nyhan syndrome?
The prevalence of Lesch-Nyhan syndrome is approximately 1 in 380,000 individuals. This condition occurs with a similar frequency in all populations.
What genes are related to Lesch-Nyhan syndrome?
Mutations in the HPRT1 gene cause Lesch-Nyhan syndrome.
Mutations in the HPRT1 gene cause a severe deficiency of the enzyme hypoxanthine phosphoribosyltransferase 1. This enzyme is responsible for recycling purines, a type of building block of DNA and its chemical cousin RNA. When this enzyme is lacking, the breakdown of purines results in abnormally high levels of uric acid in the body. It is unclear how a shortage of this enzyme causes the neurological and behavioral problems characteristic of Lesch-Nyhan syndrome.
The late J. Edwin Seegmiller, MD, a pioneer in the field of human genetics and founding faculty member of the UCSD School of Medicine, first found that the HGPRT enzyme was missing in children with Lesch Nyhan Disease. Friedmann – who had studied in the Seegmiller lab at the National Institutes of Health and later joined UCSD’s pediatric department – was the first to isolate and study the human HPRT gene.
Now Friedmann and his team have discovered a connection between defects in the HPRT gene and two well-known signaling pathways. These defects were known to be associated with other neurological diseases including Parkinson’s, Alzheimer’s and Huntington diseases, but they had not previously been connected to LND.
HPRT is one of what is known as “housekeeping genes” that are expressed in most cells and usually thought to have simple functions in regulating metabolism and not necessarily in regulating complex processes in embryonic and neurological development. However, in 2009, Friedman’s lab showed that HPRT plays an important role in affecting how transcription factor genes are expressed, and thus helps regulate important developmental pathways.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for developing Lesch-Nyhan syndrome include:
* Sex: male
* Having male family members on the mother’s side of the family with Lesch-Nyhan syndrome
In this study, the researchers identified a number of signaling pathways that are significantly altered in HPRT-deficient cells, including aberrations related to the Wnt and presenilin (PS)-1 pathways. Wnt signaling controls many aspects of vertebrate development and biological processes including stem cell self-renewal and differentiation and neural pathway development, among others. Defects in the PS-1 signaling pathway play a causal role in forms of familial Alzheimer’s disease, and also interact with Wnt.
Analyzing microarray-based gene expression data, the researchers found that the abnormal purine metabolism found in patients with LND causes defects in these two pathways. Interactions between the Wnt and PS-1 signaling pathways also suggest that they may cooperate in other neurodegenerative diseases.
“Such similarities in cell function are not likely to be coincidental,” said Friedmann. “Instead, they offer important clues to cognitive defects and open up new targets for therapies to treat these diseases.”
Symptoms
The first symptom of Lesch-Nyhan syndrome is orange-colored crystal-like deposits in the diaper. This may occur in children as young as three months. These deposits are caused by increased uric acid in the urine. Other symptoms include:
* Irritability
* Nervous system impairment:
o 4 to 6 months - lack of muscle tone and inability to lift the head
o 6 months - unusual arching of the back
o 9 months - inability to crawl or stand
o 12 months - inability to walk
o 12+ months - spasms of the limbs and facial muscles
* Kidney stones
* Blood in the urine
* Pain and swelling of joints
* Difficulty swallowing ( dysphagia )
* Impaired kidney function
* Self-injury
Additional contributors include first author Tae Hyuk Kang and Ghiabe-Henri Guibinga, both at UC San Diego and Rady Children’s Hospital-San Diego.
###
Source: University of California, San Diego Health Sciences