Disorders of Sphingolipid Synthesis, Sphingolipidoses, Niemann-Pick Disease Type C and Neuronal Ceroid Lipofuscinoses

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Disorders of Sphingolipid Synthesis, Sphingolipidoses, Niemann-Pick Disease Type C and Neuronal Ceroid Lipofuscinoses 551 38 Disorders of Sphingolipid Synthesis, Sphingolipidoses, Niemann-Pick Disease Type C and Neuronal Ceroid Lipofuscinoses Marie T. Vanier, Catherine Caillaud, Thierry Levade 38.1 Disorders of Sphingolipid Synthesis – 553 38.2 Sphingolipidoses – 556 38.3 Niemann-Pick Disease Type C – 566 38.4 Neuronal Ceroid Lipofuscinoses – 568 References – 571 J.-M. Saudubray et al. (Eds.), Inborn Metabolic Diseases, DOI 10.1007/978-3-662-49771-5_ 38 , © Springer-Verlag Berlin Heidelberg 2016 552 Chapter 38 · Disor ders of Sphingolipid Synthesis, Sphingolipidoses, Niemann-Pick Disease Type C and Neuronal Ceroid Lipofuscinoses O C 22:0 (Fatty acid) Ganglio- series a series b HN OH Sphingosine (Sphingoid base) OH βββ β βββ β Typical Ceramide (Cer) -Cer -Cer GD1a GT1b Glc ββββ βββ β Gal -Cer -Cer Globo-series GalNAc GM1a GD1b Neu5Ac βαββ -Cer Gb4 ββ β ββ β -Cer -Cer αβ β -Cer GM2 GD2 Sphingomyelin Pcholine-Cer Gb3 B4GALNT1 [SPG46] [SPG26] β β β ββ ββ CERS1-6 GBA2 -Cer -Cer ST3GAL5 -Cer -Cer So1P So Cer GM3 GD3 GlcCer - LacCer UDP-Glc UDP Gal CMP -Neu5Ac - UDP Gal PAPS Glycosphingolipids GalCer Sulfatide ββ Dihydro -Cer -Cer SO 4 Golgi Ceramide apparatus 2-OH- 2-OH-FA Acyl-CoA FA2H CERS1-6 [SPG35] CYP4F22 ω-OH- ω-OH- FA Acyl-CoA ULCFA ULCFA-CoA ULCFA GM1, GM2, GM3: monosialo- Sphinganine gangliosides Endoplasmic GD3, GD2, GD1a, GD1b: disialo-gangliosides reticulum KetoSphinganine GT1b: trisialoganglioside SPTLC1/2 [HSAN1] N-acetyl-neuraminic acid: sialic acid found in normal human cells Palmitoyl-CoA Deoxy-sphinganine + Serine +Ala or Gly Deoxymethylsphinganine 38 . Fig. 38.1 Schematic representation of the structure of the main sphingolipids , and their biosynthetic pathways. Red arrows denote the defective pathways that are discussed in this chapter. The names of genes that are mutated are indicated. Cer, ceramide ; FA, fatty acid; Gal, galactose; GalCer, galactosylceramide ; GalNAc, N-acetyl-galactosamine ; Gb3, globotriaosylceramide ; Gb4, globo- tetraosylceramide (globoside ); Glc, glucose; GlcCer, glucosylceramide ; LacCer, lactosylceramide ; Neu5Ac, N-acetyl-neuraminic acid ; 2-OH-FA, 2-hydroxy-fatty acid; ω-OH-ULCFA, ω-hydroxy ultra-long chain fatty acid ; PAPS, 3’-phosphoadenosine-5’-phosphosulfate ; Pcholine, phosphorylcholine ; So, sphingosine ; So1P, sphingosine-1-phosphate. Solid bars indicate metabolic blocks Sphingolipid Structure and Metabolism Sphingolipids are ubiquitous lipids found (sphingosine being the prototype) that can phosphingolipids contain phosphoryl- in all mammalian cell membranes and in be N-acylated by a variety of fatty acids, choline (sphingomyelin), phosphoryle- plasma lipoproteins. Many exhibit dual forming ceramides (Cer) (. Fig. 38.1). thanolamine, or a phosphate group. functions, as key structural elements, but Depending on the type of hydrophilic Glycosphingolipids contain one (glucose also as modulators of numerous biologi- head group linked to the 1-OH group of or galactose) or several sugar residues, cal/physiological functions. Their back- the sphingoid base, two main classes of and can be very complex. Sialic acid bone is a long chain sphingoid base sphingolipids are distinguished. Phos- (N-acetyl-neuraminic acid in humans) 553 38 38.1 · Disorders of Sphingolipid Synthesis containing glycosphingolipids are named by the condensation of serine and palmi- leads to the formation of more complex gangliosides . Depending on the precise toyl-CoA, a reaction catalyzed by serine neutral glycosphingolipids and ganglio- structure (sugar and linkage) of the oligo- palmitoyltransferase . The resulting ketos- sides. Sphingolipids are then transported saccharide moiety, several glycosphingo- phinganine is reduced to sphinganine pri- and inserted in various membranes. lipid lineages (ganglio-, globo- etc.) have or to N-acylation by ceramide synthases . been defined. ›Cerebroside‹ usually refers Distinct fatty acids, including 2-hydroxy- Degradation to the major myelin lipid galactosylcer- lated long chain fatty acids and ω-hydrox- . Fig. 38.2. amide; ›sulfatide‹ to its sulfated deriva- ylated ultra-long chain fatty acids, can be After transport by the endolysosomal tive. Lysosphingolipids (e.g. psychosine ) incorporated. Then, dihydroceramide is pathway to the lysosome, sphingolipid lack the fatty acid of ceramide. The main desaturated to produce ceramide. The degradation proceeds by stepwise hydrol- sphingolipids are depicted in . Fig. 38.1 sphingosine that is released by the action ysis by specific acid sphingohydrolases, and . Fig. 38.2. Sphingolipids are synthe- of ceramidases on the ceramide derived some of which may need co-factors called sised and degraded in different cellular from the degradation of complex sphin- sphingolipid activator proteins (also compartments. A further aspect of sphin- golipids can also be N-acylated by lysosomal) for their in vivo action. golipid homeostasis not discussed here is ceramide synthases. Subsequent steps of the recycling or salvage pathway. sphingolipid synthesis (except galactosyl- ceramide) occur in the Golgi apparatus, Biosynthesis where ceramide is processed to sphingo- . Fig. 38.1. myelin or to glucosylceramide ; stepwise The de novo synthesis of ceramide occurs addition of further monosaccharides, in the endoplasmic reticulum and starts catalysed by specific glycosyltransferases , Sphingolipidoses are a subgroup of lysosomal storage disorders cholesterol and sphingolipids. This chapter also describes in which sphingolipids accumulate in one or several organs as neuronal ceroid lipofuscinoses, now recognised as another the result of a primary deficiency in enzymes or activator pro- subgroup of lysosomal storage diseases. Additionally, inherited teins. Niemann-Pick type C disease is currently considered as a defects of sphingolipid biosynthesis are presented (7 Sphingo- lipid trafficking disorder, resulting in lysosomal accumulation of lipid Structure and Metabolism). 38.1 Disorders of Sphingolipid Synthesis although biochemical testing in plasma is possible for detec- tion of HSAN1. There is currently no effective specific therapy Most of the genes encoding the enzymes, transporters and for this type of IEMs. Most of these conditions remain activators operating in the sphingolipid synthesis pathway extremely rare. Their clinical spectrum is broadening with have been characterised, and an increasing number of mono- description of new cases and the field is likely to quickly evolve genic defects affecting some steps of the biosynthesis of sphin- in the near future. For these reasons, and since comprehensive golipids have been delineated in recent years (. Table 38.1). A reviews on the subject with exhaustive referencing have been majority of disorders were first described as a component of a published very recently [1][2], only a brief outline of each dis- genetically heterogeneous clinical syndrome -e.g., hereditary order will be given in this chapter. sensory and autonomic neuropathies (HSAN), autosomal re- cessive hereditary spastic paraplegias… – before the function of the protein encoded by the mutated gene was recognised. 38.1.1 Serine Palmitoyltransferase Mechanisms underlying the pathophysiology of most sphin- (Subunit 1 or 2) Deficiency and HSAN1 golipid synthesis disorders are still enigmatic. With the excep- tion of HSAN1, the reported mutations result in a loss of func- A defect in the very first step of sphingolipid biosynthesis is tion of the corresponding enzyme. Alterations in the sphingo- the major cause underlying the dominant hereditary sensory lipid profile of the diseased tissues have not been described in and autonomic neuropathy (HSAN1) . Other (unrelated) all conditions. In general, it is still unknown whether tissue genes that have been linked to HSAN1 are ATL1, RAB7A and dysfunction and symptoms are due to the lack (or insufficient DNMT1 [1]. This peripheral neuropathy is characterised by a production) of one or more sphingolipid species, and/or accu- late onset (between the 2nd and 4th decade), a slow disease mulation of a precursor molecule or a potentially toxic metab- progression, and primarily sensory deficits (loss of pain and olite. temperature sensation spreading from the distal limbs). Pain- Regarding genetic transmission, with the exception of less ulcerations in the lower limbs are quite frequent, as well as HSAN1 due to a defect in serine palmitoyltransferase 1 or 2, spontaneous lancinating pain attacks. Hypohidrosis is also and possibly the defect in ceramide synthase 2, enzymatic de- seen. Some patients exhibit a more severe phenotype, starting ficiencies of sphingolipid synthesis are inherited as autosomal in early childhood, with motor involvement, global hypotro- recessive traits. So far, their diagnosis relies on DNA analysis phy, and developmental retardation [1]. 554 Chapter 38 · Disor ders of Sphingolipid Synthesis, Sphingolipidoses, Niemann-Pick Disease Type C and Neuronal Ceroid Lipofuscinoses . Table 38.1 Sphingolipid biosynthesis disorders Enzyme Gene Metabolic disturbance Main clinical features Disorders with primarily nervous system involvement Serine palmitoyltrans- SPTLC1 or Accumulation of 1-deoxysphingolipids [HSAN1] - Peripheral sensory neuropathy, ferase, subunit 1 or 2 SPTLC2 (in plasma) distal sensory loss, ulcerative mutilations Ceramide synthase 1 CERS1 Possibly decreased C18-ceramide levels Progressive myoclonic epilepsy and (in cultured cells) cognitive decline Ceramide synthase 2 CERS2 Possibly decreased very-long chain Progressive myoclonic epilepsy ceramide levels (in cultured cells) Fatty
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