Nakagawa Masanori
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Rinsho Shinkeigaku. 2008 Nov;48(11):1019-22. doi: 10.5692/clinicalneurol.48.1019.
Hereditary neuropathies are classified into Charcot-Marie-Tooth disease (CMT), familial amyloid polyneuropathy (FAP), hereditary motor neuropathies (HMN) and hereditary sensory (and autonomic) neuropathies (HSAN). CMTs are furthermore classified into demyelinating neuropathies (CMT1), axonal neuropathies (CMT2) and intermediate form. Duplication of PMP22 (CMT1A) accounts for about 70% of CMT1 and MFN2 mutations account for 25% of CMT2. Genes involved in phosphoinositide regulation cause CMT4; MTMR2 mutation in CMT 4B1 and MTMR13/SBF2 mutation in CMT4B2. In addition to these genes, FIG4, which is a causative gene of pale tremor mouse, is newly identified as a gene for CMT4J. MFN2 and GDAP1 cause CMT2 or CMT4. These genes regulate mitochondrial fusion and fission. Altered axonal mitochondrial transport is suggested as the pathogenesis of the CMT. In animal model with pmp22 duplication, ascorbic acid seems to be effective to prevent disease progression. Nationwide trial of ascorbic acid therapy for CMT1A is now ongoing by the intractable neuropathy study group. Curcumin treatment educes apoptosis of cells that express PMP22 point mutation and partially mitigates the severe neuropathy phenotype of Trembler-J mouse model in a dose-dependent manner. Curcumin treatment may have a potential therapeutic role in CMT with PMP22 point mutation in humans. The high throughput system of diagnosis for CMT has been developed by employing a resequencing array system.
遗传性神经病分为夏科-马里-图斯病(CMT)、家族性淀粉样多神经病(FAP)、遗传性运动神经病(HMN)和遗传性感觉(及自主)神经病(HSAN)。CMT又进一步分为脱髓鞘性神经病(CMT1)、轴索性神经病(CMT2)和中间型。PMP22重复(CMT1A)约占CMT1的70%,MFN2突变占CMT2的25%。参与磷酸肌醇调节的基因导致CMT4;CMT 4B1中的MTMR2突变和CMT4B2中的MTMR13/SBF2突变。除了这些基因外,苍白震颤小鼠的致病基因FIG4最近被确定为CMT4J的基因。MFN2和GDAP1导致CMT2或CMT4。这些基因调节线粒体融合和裂变。轴突线粒体运输改变被认为是CMT的发病机制。在pmp22重复的动物模型中,维生素C似乎对预防疾病进展有效。难治性神经病研究组正在进行全国范围内的维生素C治疗CMT1A的试验。姜黄素治疗可诱导表达PMP22点突变的细胞凋亡,并以剂量依赖的方式部分减轻震颤-J小鼠模型的严重神经病表型。姜黄素治疗可能对人类PMP22点突变的CMT具有潜在的治疗作用。通过采用重测序阵列系统开发了CMT的高通量诊断系统。