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早发性遗传性神经元病:非 5q 运动神经元病的最新研究进展。

Early onset hereditary neuronopathies: an update on non-5q motor neuron diseases.

机构信息

Neuromuscular Repair Unit, Institute of Experimental Neurology (InSpe), Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.

Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK.

出版信息

Brain. 2023 Mar 1;146(3):806-822. doi: 10.1093/brain/awac452.

Abstract

Hereditary motor neuropathies (HMN) were first defined as a group of neuromuscular disorders characterized by lower motor neuron dysfunction, slowly progressive length-dependent distal muscle weakness and atrophy, without sensory involvement. Their cumulative estimated prevalence is 2.14/100 000 and, to date, around 30 causative genes have been identified with autosomal dominant, recessive,and X-linked inheritance. Despite the advances of next generation sequencing, more than 60% of patients with HMN remain genetically uncharacterized. Of note, we are increasingly aware of the broad range of phenotypes caused by pathogenic variants in the same gene and of the considerable clinical and genetic overlap between HMN and other conditions, such as Charcot-Marie-Tooth type 2 (axonal), spinal muscular atrophy with lower extremities predominance, neurogenic arthrogryposis multiplex congenita and juvenile amyotrophic lateral sclerosis. Considering that most HMN present during childhood, in this review we primarily aim to summarize key clinical features of paediatric forms, including recent data on novel phenotypes, to help guide differential diagnosis and genetic testing. Second, we describe newly identified causative genes and molecular mechanisms, and discuss how the discovery of these is changing the paradigm through which we approach this group of conditions.

摘要

遗传性运动神经病(HMN)最初被定义为一组以运动神经元功能障碍为特征的神经肌肉疾病,表现为进行性、远端肌无力和萎缩,呈长度依赖性,无感觉受累。其累积估计患病率为 2.14/10 万,迄今为止,已发现约 30 个致病基因,呈常染色体显性、隐性和 X 连锁遗传。尽管下一代测序技术取得了进展,但仍有超过 60%的 HMN 患者未明确其遗传病因。值得注意的是,我们越来越意识到同一基因的致病性变异可导致广泛的表型,并且 HMN 与其他疾病(如 Charcot-Marie-Tooth 型 2(轴索型)、以下肢为主的脊髓性肌萎缩症、先天性多发关节挛缩和青少年肌萎缩性侧索硬化症)之间存在相当大的临床和遗传重叠。鉴于大多数 HMN 在儿童时期发病,因此我们主要旨在总结儿科形式的关键临床特征,包括最近关于新型表型的数据,以帮助指导鉴别诊断和基因检测。其次,我们描述了新发现的致病基因和分子机制,并讨论了这些发现如何通过改变我们对这一组疾病的治疗方法来改变这一模式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fff3/9976982/1a16e5ff7037/awac452f1.jpg

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