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      Antisense oligonucleotide therapy for spinocerebellar ataxia type 2

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          Abstract

          Adult human neurodegenerative diseases have no disease-modifying treatments. We used spinocerebellar ataxia type 2 (SCA2), an autosomal dominant polyglutamine disease 1, as a model to test RNA-targeted therapies 2 in two SCA2 mouse models. Both models recreate progressive adult-onset dysfunction and degeneration of a neuronal network including decreased firing frequency of cerebellar Purkinje cells (PCs) and decline in motor function 3, 4 . We developed a potential therapy directed at the ATXN2 gene by screening 152 antisense oligonucleotides (ASOs). Here we show that the most promising lead, ASO7, downregulated ATXN2 mRNA and protein resulting in delayed onset of SCA2 phenotypes. After delivery by intracerebroventricular injection (ICV) to ATXN2-Q127 mice, ASO7 localized to PCs, reduced cerebellar ATXN2 expression below 75% for >10 weeks without microglial activation, and reduced cerebellar ataxin-2 protein. ASO7 treatment of symptomatic mice improved motor functioning compared to saline-treated mice. ASO7 had a similar effect in the BAC-Q72 SCA2 mouse model, and in both mouse models it normalized protein levels of several SCA2-related PC proteins including Rgs8, Pcp2, Pcp4, Homer3, Cep76, and Fam107b. Most surprisingly, firing frequency of PCs returned to normal even when treatment was initiated >12 weeks after motor phenotype onset in BAC-Q72 mice. These findings support ASOs as a promising approach for treating some human neurodegenerative diseases.

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          RNAi suppresses polyglutamine-induced neurodegeneration in a model of spinocerebellar ataxia.

          The dominant polyglutamine expansion diseases, which include spinocerebellar ataxia type 1 (SCA1) and Huntington disease, are progressive, untreatable, neurodegenerative disorders. In inducible mouse models of SCA1 and Huntington disease, repression of mutant allele expression improves disease phenotypes. Thus, therapies designed to inhibit expression of the mutant gene would be beneficial. Here we evaluate the ability of RNA interference (RNAi) to inhibit polyglutamine-induced neurodegeneration caused by mutant ataxin-1 in a mouse model of SCA1. Upon intracerebellar injection, recombinant adeno-associated virus (AAV) vectors expressing short hairpin RNAs profoundly improved motor coordination, restored cerebellar morphology and resolved characteristic ataxin-1 inclusions in Purkinje cells of SCA1 mice. Our data demonstrate in vivo the potential use of RNAi as therapy for dominant neurodegenerative disease.
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            The genetics and neuropathology of Parkinson's disease.

            There has been tremendous progress toward understanding the genetic basis of Parkinson's disease and related movement disorders. We summarize the genetic, clinical and pathological findings of autosomal dominant disease linked to mutations in SNCA, LRRK2, ATXN2, ATXN3, MAPT, GCH1, DCTN1 and VPS35. We then discuss the identification of mutations in PARK2, PARK7, PINK1, ATP13A2, FBXO7, PANK2 and PLA2G6 genes. In particular we discuss the clinical and pathological characterization of these forms of disease, where neuropathology has been important in the likely coalescence of pathways highly relevant to typical PD. In addition to the identification of the causes of monogenic forms of PD, significant progress has been made in defining genetic risk loci for PD; we discuss these here, including both risk variants at LRRK2 and GBA, in addition to discussing the results of recent genome-wide association studies and their implications for PD. Finally, we discuss the likely path of genetic discovery in PD over the coming period and the implications of these findings from a clinical and etiological perspective.
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              Deranged calcium signaling and neurodegeneration in spinocerebellar ataxia type 2.

              Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominantly inherited, neurodegenerative disease caused by an expansion of polyglutamine tracts in the cytosolic protein ataxin-2 (Atx2). Cerebellar Purkinje cells (PCs) are predominantly affected in SCA2. The cause of PC degeneration in SCA2 is unknown. Here we demonstrate that mutant Atx2-58Q, but not wild-type (WT) Atx2-22Q, specifically associates with the cytosolic C-terminal region of type 1 inositol 1,4,5-trisphosphate receptor (InsP(3)R1), an intracellular calcium (Ca(2+)) release channel. Association with Atx2-58Q increased the sensitivity of InsP(3)R1 to activation by InsP(3) in planar lipid bilayer reconstitution experiments. To validate physiological significance of these findings, we performed a series of experiments with an SCA2-58Q transgenic mouse model that expresses human full-length Atx2-58Q protein under the control of a PC-specific promoter. In Ca(2+) imaging experiments, we demonstrated that stimulation with 3,5-dihydroxyphenylglycine (DHPG) resulted in higher Ca(2+) responses in 58Q PC cultures than in WT PC cultures. DHPG-induced Ca(2+) responses in 58Q PC cultures were blocked by the addition of ryanodine, an inhibitor of the ryanodine receptor (RyanR). We further demonstrated that application of glutamate induced more pronounced cell death in 58Q PC cultures than in WT PC cultures. Glutamate-induced cell death of 58Q PC cultures was attenuated by dantrolene, a clinically relevant RyanR inhibitor and Ca(2+) stabilizer. In whole animal experiments, we demonstrated that long-term feeding of SCA1-58Q mice with dantrolene alleviated age-dependent motor deficits (quantified in beam-walk and rotarod assays) and reduced PC loss observed in untreated SCA2-58Q mice by 12 months of age (quantified by stereology). Results of our studies indicate that disturbed neuronal Ca(2+) signaling may play an important role in SCA2 pathology and also suggest that the RyanR constitutes a potential therapeutic target for treatment of SCA2 patients.
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                Author and article information

                Journal
                0410462
                6011
                Nature
                Nature
                Nature
                0028-0836
                1476-4687
                9 July 2019
                12 April 2017
                20 April 2017
                12 July 2019
                : 544
                : 7650
                : 362-366
                Affiliations
                [1 ]Department of Neurology, University of Utah, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
                [2 ]Department of Neurobiology, University of California Los Angeles, Los Angeles, CA 90095, USA.
                [3 ]Ionis Pharmaceuticals, 2855 Gazelle Court, Carlsbad, CA 92010, USA
                Author notes
                [†]

                Present address: Roche Pharma Research and Early Development, Neuroscience, Ophthalmology, & Rare Diseases, Roche Innovation Center Basel Grenzacherstrasse 124, CH-4070, Basel, Switzerland.

                Author Contributions

                D.R.S. conceived and designed the study, performed experiments, conducted all ICV injections, analyzed all data, and wrote the manuscript. M.S. performed all motor testing experiments and with D.R.S. contributed to blinding of all mouse trials including ASO treatments, motor testing and electrophysiological evaluations. M.S. also conducted all qPCR analyses of mouse tissues. P.M. designed and performed all electrophysiological experiments, analyzed and interpreted the resulting data, and prepared figures. S.P. prepared all Western blots. W.D. conducted the study of SCA2 patient fibroblasts. K.P.F. was in charge of mouse breeding. G.H. led the ASO in silico design, ASO in vitro screening, advised the in vivo screening approach, and provided ASO powders. F.R., and C.F.B. contributed to the in vivo screening approach and design of motor phenotype studies. T.S.O. designed and helped interpret the electrophysiological analyses. S.M.P. conceived and designed the study with D.R.S. and contributed SCA2 patient fibroblasts. All authors contributed to the writing of the manuscript.

                [* ]Correspondence and requests for materials should be addressed to D.R.S. ( Daniel.Scoles@ 123456hsc.utah.edu ) or S.M.P. ( Stefan.Pulst@ 123456hsc.utah.edu ).
                Article
                NIHMS857881
                10.1038/nature22044
                6625650
                28405024
                3704a5d7-e8bc-4380-ad7e-09e6e99fbfd3

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