Birouk N
Service de neurophysiologie clinique, Rabat institut, hôpital des spécialités, CHU Ibn Sina, université Mohamed V-Souissi, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.
Rev Neurol (Paris). 2014 Dec;170(12):846-9. doi: 10.1016/j.neurol.2014.10.001. Epub 2014 Nov 20.
The recent literature included interesting reports on the pathogenic mechanisms of hereditary neuropathies. The axonal traffic and its abnormalities in some forms of Charcot-Marie-Tooth (CMT) disease were particularly reviewed by Bucci et al. Many genes related to CMT disease code for proteins that are involved directly or not in intracellular traffic. KIF1B controls vesicle motility on microtubules. MTMR2, MTMR13 and FIG4 regulate the metabolism of phosphoinositide at the level of endosomes. The HSPs are involved in the proteasomal degradation. GDAP1 and MFN2 regulate the mitochondrial fission and fusion respectively and the mitochondial transport within the axon. Pareyson et al. reported a review on peripheral neuropathies in mitochondrial disorders. They used the term of "mitochondrial CMT" for the forms of CMT with abnormal mitochondrial dynamic or structure. Among the new entities, we can draw the attention to a proximal form of hereditary motor and sensory neuropathy with autosomal dominant inheritance, which is characterized by motor deficit with cramps and fasciculations predominating in proximal muscles. Distal sensory deficit can be present. The gene TFG on chromosome 3 has been recently identified to be responsible for this form. Another rare form of axonal autosomal recessive neuropathy due to HNT1 gene mutation is characterized by the presence of hands myotonia that appears later than neuropathy but constitute an interesting clinical hallmark to orientate the diagnosis of this form. In terms of differential diagnosis, CMT4J due to FIG4 mutation can present with a rapidly progressive and asymmetric weakness that resembles CIDP. Bouhy et al. made an interesting review on the therapeutic trials, animal models and the future therapeutic strategies to be developed in CMT disease.
近期文献中有关于遗传性神经病发病机制的有趣报道。Bucci等人特别综述了某些类型夏科-马里-图斯病(CMT)中的轴突运输及其异常情况。许多与CMT病相关的基因编码的蛋白质直接或间接参与细胞内运输。KIF1B控制微管上的囊泡运动。MTMR2、MTMR13和FIG4在内体水平调节磷酸肌醇的代谢。热休克蛋白参与蛋白酶体降解。GDAP1和MFN2分别调节线粒体的分裂和融合以及轴突内的线粒体运输。Pareyson等人发表了一篇关于线粒体疾病中周围神经病的综述。他们将具有异常线粒体动力学或结构的CMT类型称为“线粒体CMT”。在新发现的疾病类型中,我们可以关注一种常染色体显性遗传的遗传性运动和感觉神经病的近端型,其特征为运动功能障碍,伴有痉挛和肌束震颤,以近端肌肉为主。可能存在远端感觉功能障碍。最近已确定3号染色体上的TFG基因是导致这种类型疾病的原因。另一种罕见的由HNT1基因突变引起的轴突常染色体隐性神经病,其特征是手部出现肌强直,出现时间晚于神经病,但构成了有助于该类型疾病诊断的有趣临床特征。在鉴别诊断方面,由FIG4突变引起的CMT4J可表现为快速进展且不对称的肌无力,类似于慢性炎症性脱髓鞘性多发性神经病(CIDP)。Bouhy等人对CMT病的治疗试验、动物模型及未来有待开发的治疗策略进行了有趣的综述。