Ziółkowska Ewa A, Jablonka-Shariff Albina, Williams Letitia L, Jansen Matthew J, Wang Sophie H, Eultgen Elizabeth M, Wood Matthew D, Hunter Daniel A, Sharma Jaiprakash, Sardiello Marco, Reese Robyn, Pestronk Alan, Sands Mark S, Snyder-Warwick Alison K, Cooper Jonathan D
Department of Pediatrics, School of Medicine, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA.
Acta Neuropathol Commun. 2025 Jul 23;13(1):160. doi: 10.1186/s40478-025-02059-z.
CLN3 disease is a neuronopathic lysosomal storage disorder that severely impacts the central nervous system (CNS) while also inducing notable peripheral neuromuscular symptoms. Although considerable attention has been directed towards the neurodegenerative consequences within the CNS, the involvement of peripheral tissues, including skeletal muscles and their innervation, has been largely neglected. We hypothesized that, CLN3 deficiency could directly influence peripheral nerves and investigated the neuromuscular system in Cln3 mice. Our study found no overt loss of sciatic nerve axons or demyelination in 18-month-old Cln3 mice at disease endstage, but a marked reduction of terminal Schwann cells (tSCs) at lower limb neuromuscular junctions (NMJs), culminating in progressive denervation of these NMJs which appeared abnormal. This led us to investigate skeletal muscle where we found significant myofiber atrophy and decreased and misplaced myofibril nuclei. Similar myopathic alterations were present in a muscle biopsy from an 8-year-old human CLN3 patient shortly after diagnosis. To assess a potential therapeutic intervention, we administered intravenous gene therapy using AAV9.hCLN3 to neonatal Cln3 mice, which at disease endstage, entirely prevented tSC loss and NMJ abnormalities, while also averting skeletal muscle atrophy. These findings underscore the underappreciated, yet substantial effects of CLN3 disease beyond the CNS, highlighting peripheral neuromuscular pathologies as novel features of this disorder. Our findings also indicate that these manifestations could be amenable to treatment via gene therapy, opening new therapeutic strategies in the management of CLN3 disease.
CLN3病是一种神经元性溶酶体贮积症,严重影响中枢神经系统(CNS),同时还会引发明显的外周神经肌肉症状。尽管人们对CNS内的神经退行性后果给予了相当多的关注,但包括骨骼肌及其神经支配在内的外周组织的受累情况在很大程度上被忽视了。我们推测,CLN3缺乏可能直接影响外周神经,并对Cln3小鼠的神经肌肉系统进行了研究。我们的研究发现,在疾病终末期的18月龄Cln3小鼠中,坐骨神经轴突没有明显丧失或脱髓鞘现象,但下肢神经肌肉接头(NMJ)处的终末施万细胞(tSC)显著减少,最终导致这些NMJ逐渐失神经支配并出现异常。这促使我们对骨骼肌进行研究,结果发现存在明显的肌纤维萎缩以及肌原纤维细胞核数量减少和位置异常的情况。在一名8岁的CLN3病人类患者诊断后不久的肌肉活检中也发现了类似的肌病性改变。为了评估一种潜在的治疗干预措施,我们对新生Cln3小鼠进行了静脉注射使用AAV9.hCLN3的基因治疗。在疾病终末期,这种治疗完全预防了tSC的丧失和NMJ异常,同时还避免了骨骼肌萎缩。这些发现强调了CLN3病在CNS之外未被充分认识但却很显著的影响,突出了外周神经肌肉病变是该疾病的新特征。我们的研究结果还表明,这些表现可以通过基因治疗得到改善,为CLN3病的治疗开辟了新的治疗策略。
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