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Homozygous boricua TBCK mutation causes neurodegeneration and aberrant autophagy
Xilma R Ortiz-González1,2,3, Jesus A Tintos-Hernández1,3,4, Kierstin Keller3,4
1Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Objective:
Autosomal-recessive mutations in TBCK cause intellectual disability of variable severity. Although the physiological function of TBCK remains unclear, loss-of-function mutations are associated with inhibition of mechanistic target of rapamycin complex 1 (mTORC1) signaling. Given that mTORC1 signaling is known to regulate autophagy, we hypothesized that TBCK-encephalopathy patients with a neurodegenerative course have defects in autophagic-lysosomal dysfunction.
Methods:
Children (n = 8) of Puerto Rican (Boricua) descent affected with homozygous TBCK p.R126X mutations underwent extensive neurological phenotyping and neurophysiological studies. We quantified autophagosome content in TBCK-/- patient-derived fibroblasts by immunostaining and assayed autophagic markers by western assay. Free sialylated oligosaccharide profiles were assayed in patient's urine and fibroblasts.
Results:
The neurological phenotype of children with TBCK p.R126X mutations, which we call TBCK-encephaloneuronopathy (TBCKE), include congenital hypotonia, progressive motor neuronopathy, leukoencephalopathy, and epilepsy. Systemic features include coarse facies, dyslipidemia, and osteoporosis. TBCK-/- fibroblasts in vitro exhibit increased numbers of LC3+ autophagosomes and increased autophagic flux by immunoblots. Free oligosaccharide profiles in fibroblasts and urine of TBCKE patients differ from control fibroblasts and are ameliorated by treatment with the mTORC1 activator leucine.
Interpretation:
TBCKE is a clinically distinguishable syndrome with progressive central and peripheral nervous system dysfunction, consistently observed in patients with the p.R126X mutation. We provide evidence that inappropriate autophagy in the absence of cellular stressors may play a role in this disorder, and that mTORC1 activation may ameliorate the autophagic-lysosomal system dysfunction. Free oligosaccharide profiles could serve as a novel biomarker for this disorder as well as a tool to evaluate potential therapeutic interventions. Ann Neurol 2018;83:153-165.
Insights
Mutations in TBCK cause TBCK-encephaloneuronopathy (TBCKE), a neurodegenerative disorder. This study found that activating mTORC1 may improve autophagic-lysosomal dysfunction in TBCKE patients.
Area of Science:
- Genetics and Neurology
- Molecular Biology
- Metabolic Disorders
Background:
- Autosomal-recessive mutations in TBCK gene are linked to intellectual disability.
- Loss-of-function TBCK mutations are associated with reduced mechanistic target of rapamycin complex 1 (mTORC1) signaling.
- mTORC1 signaling regulates autophagy, suggesting a potential link to neurodegeneration in TBCK-associated disorders.
Purpose of the Study:
- To investigate autophagic-lysosomal dysfunction in TBCK-encephalopathy patients with a neurodegenerative course.
- To characterize the neurological and systemic phenotype of TBCK-encephaloneuronopathy (TBCKE).
- To explore the potential therapeutic effect of mTORC1 activation on autophagic dysfunction.
Main Methods:
- Neurological phenotyping and neurophysiological studies in 8 children with TBCK p.R126X mutations.
- Quantification of autophagosome content and autophagic markers in patient-derived fibroblasts.
- Assay of free sialylated oligosaccharide profiles in patient urine and fibroblasts.
Main Results:
- TBCK-encephaloneuronopathy (TBCKE) presents with congenital hypotonia, progressive motor neuronopathy, leukoencephalopathy, epilepsy, coarse facies, dyslipidemia, and osteoporosis.
- TBCK-deficient fibroblasts show increased autophagosomes and autophagic flux.
- Patients' urine and fibroblasts exhibit altered free oligosaccharide profiles, which are improved by leucine (mTORC1 activator).
Conclusions:
- TBCK-encephaloneuronopathy (TBCKE) is a distinct syndrome characterized by progressive neurological dysfunction.
- Inappropriate autophagy, independent of cellular stress, may contribute to TBCKE pathogenesis.
- mTORC1 activation shows potential in ameliorating autophagic-lysosomal dysfunction, and oligosaccharide profiles may serve as biomarkers.
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