Cluster of invasive Neisseria meningitidis infections on a cruise ship, Italy, October 2012.

We describe a cluster of four cases of invasive meningococcal disease that occurred on a cruise ship sailing along the Italian coast in October 2012. All four cases were hospitalised with severe illness and one of them died. This report illustrates the importance of rapid implementation of emergency control measures such as administration of prophylaxis to all crew members and passengers to prevent the spread of the disease in such a close environment

ACO2 mutations: A novel phenotype associating severe optic atrophy and spastic paraplegia

International audienc

Clinical impairment in premanifest and early Huntington's disease is associated with regionally specific atrophy.

TRACK-HD is a multicentre longitudinal observational study investigating the use of clinical assessments and 3-Tesla magnetic resonance imaging as potential biomarkers for future therapeutic trials in Huntington's disease (HD). The cross-sectional data from this large well-characterized dataset provide the opportunity to improve our knowledge of how the underlying neuropathology of HD may contribute to the clinical manifestations of the disease across the spectrum of premanifest (PreHD) and early HD. Two hundred and thirty nine gene-positive subjects (120 PreHD and 119 early HD) from the TRACK-HD study were included. Using voxel-based morphometry (VBM), grey and white matter volumes were correlated with performance in four domains: quantitative motor (tongue force, metronome tapping, and gait); oculomotor [anti-saccade error rate (ASE)]; cognition (negative emotion recognition, spot the change and the University of Pennsylvania smell identification test) and neuropsychiatric measures (apathy, affect and irritability). After adjusting for estimated disease severity, regionally specific associations between structural loss and task performance were found (familywise error corrected, P < 0.05); impairment in tongue force, metronome tapping and ASE were all associated with striatal loss. Additionally, tongue force deficits and ASE were associated with volume reduction in the occipital lobe. Impaired recognition of negative emotions was associated with volumetric reductions in the precuneus and cuneus. Our study reveals specific associations between atrophy and decline in a range of clinical modalities, demonstrating the utility of VBM correlation analysis for investigating these relationships in HD

AP4 deficiency: A novel form of neurodegeneration with brain iron accumulation?

OBJECTIVE: To describe the clinico-radiological phenotype of 3 patients harboring a homozygous novel AP4M1 pathogenic mutation. METHODS: The 3 patients from an inbred family who exhibited early-onset developmental delay, tetraparesis, juvenile motor function deterioration, and intellectual deficiency were investigated by magnetic brain imaging using T1-weighted, T2-weighted, T2*-weighted, fluid-attenuated inversion recovery, susceptibility weighted imaging (SWI) sequences. Whole-exome sequencing was performed on the 3 patients. RESULTS: In the 3 patients, brain imaging identified the same pattern of bilateral SWI hyposignal of the globus pallidus, concordant with iron accumulation. A novel homozygous nonsense mutation was identified in AP4M1, segregating with the disease and leading to truncation of half of the adap domain of the protein. CONCLUSIONS: Our results suggest that AP4M1 represents a new candidate gene that should be considered in the neurodegeneration with brain iron accumulation (NBIA) spectrum of disorders and highlight the intersections between hereditary spastic paraplegia and NBIA clinical presentations

Intellectual enrichment and genetic modifiers of cognition and brain volume in Huntington's disease

An important step towards the development of treatments for cognitive impairment in ageing and neurodegenerative diseases is to identify genetic and environmental modifiers of cognitive function and understand the mechanism by which they exert an effect. In Huntington’s disease, the most common autosomal dominant dementia, a small number of studies have identified intellectual enrichment, i.e. a cognitively stimulating lifestyle and genetic polymorphisms as potential modifiers of cognitive function. The aim of our study was to further investigate the relationship and interaction between genetic factors and intellectual enrichment on cognitive function and brain atrophy in Huntington’s disease. For this purpose, we analysed data from Track-HD, a multi-centre longitudinal study in Huntington’s disease gene carriers and focused on the role of intellectual enrichment (estimated at baseline) and the genes FAN1, MSH3, BDNF, COMT and MAPT in predicting cognitive decline and brain atrophy. We found that carrying the 3a allele in the MSH3 gene had a positive effect on global cognitive function and brain atrophy in multiple cortical regions, such that 3a allele carriers had a slower rate of cognitive decline and atrophy compared with non-carriers, in agreement with its role in somatic instability. No other genetic predictor had a significant effect on cognitive function and the effect of MSH3 was independent of intellectual enrichment. Intellectual enrichment also had a positive effect on cognitive function; participants with higher intellectual enrichment, i.e. those who were better educated, had higher verbal intelligence and performed an occupation that was intellectually engaging, had better cognitive function overall, in agreement with previous studies in Huntington’s disease and other dementias. We also found that intellectual enrichment interacted with the BDNF gene, such that the positive effect of intellectual enrichment was greater in Met66 allele carriers than non-carriers. A similar relationship was also identified for changes in whole brain and caudate volume; the positive effect of intellectual enrichment was greater for Met66 allele carriers, rather than for non-carriers. In summary, our study provides additional evidence for the beneficial role of intellectual enrichment and carrying the 3a allele in MSH3 in cognitive function in Huntington’s disease and their effect on brain structure

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Improvement of a compound active against Huntington’s disease

Le sujet de cette thèse est la poursuite de la caractérisation et du développement à fins thérapeutiques du peptide P42 dans la maladie d’Huntington (MH). Ce peptide a été précédemment identifié dans l’équipe dirigée par Florence Maschat et est capable de réduire la présence d’agrégats dans différents modèles cellulaires, mais aussi de Drosophile et murins de maladie d’Huntington. P42 est aussi capable de prévenir la dégénérescence neuronale et les altérations du transport axonal dans des tests effectués chez la drosophile (Arribat et al. 2013). Enfin les anomalies motrices, la perte de poids, et l’atrophie cérébrale sont restituées in vivo dans des souris R6/2 traitées par P42. Dans ce cas, P42 a été conjugué au peptide de transduction TAT, dérivé de VIH, et a été inséré dans des microémulsions, permettant des administrations répétées du peptide par voie intra-muqueuse, protégeant le peptide jusqu’à son arrivée au cerveau et facilitant sa diffusion au travers des membranes et la barrière hémato-encéphalique (Arribat et al., 2014). L’efficacité de ce peptide a ainsi été montrée après administration dans une phase pré-symptomatique ; toutefois, des résultats non publiés suggèrent également une efficacité partielle au niveau post-symptomatique. Ainsi ce peptide agirait à travers l’inhibition de l’agrégation en interagissant avec la protéine Htt dans sa partie N-terminale, et notamment au niveau de la partie N17. Des résultats préliminaires suggèrent également que, en tant que partie physiologiquement présente dans la protéine Htt, P42 pourrait avoir un rôle bénéfique et physiologique, notamment au niveau du transport axonal, sur le niveau d’expression du Brain nerve factor (BDNF) et sur l’activité neuronale. Mon travail de thèse se compose d’une part d’un travail de laboratoire, et d’autre part d’un travail de documentation. Le travail de laboratoire a été conduit sur le modèle Drosophile. Dans une première partie j’ai essayé de mieux caractériser l’efficacité de P42TAT par rapport à P42 dans l’inhibition des agrégats dans les glandes salivaires et dans la protection de la dégénérescence de l’œil. Notamment, j’ai testé l’efficacité de l’administration orale de P42TAT sur la réduction des agrégats dans les glandes salivaires. Dans une deuxième partie j’ai contribué à évaluer l’efficacité d’un fragment plus court de P42, P42B ; ce fragment de 14 aa initialement identifié par des études de dégradation de P42TAT dans des extraits de cerveau par la technique MALDI est retrouvé après 3 h et pourrait donc être une partie active, suffisante pour l’efficacité du peptide. Dans une troisième partie j’ai contribué à des études visant à étudier le rôle physiologique de P42 dans le transport axonal. Le travail de documentation a été finalisé par la soumission d’un dossier à l’agence européenne pour la médecine (EMEA), qui a permis d’obtenir la reconnaissance de P42 en tant que médicament orphelin pour la MH. Ce résultat est particulièrement important et pourrait être un premier pas vers le développement clinique de ce peptide. En effet aucun traitement curatif n’existe à ce jour pour la MH et la possibilité de réaliser des tests pré-symptomatiques permet de disposer d’une fenêtre unique pour une intervention thérapeutique précoce. De plus, au cours de ces dernières années, des études cliniques de suivi de sujets pré-symptomatiques et symptomatiques ont été menées, (études PREDICT-HD et TRACK-HD), qui ont conduit à l’identification de bio-marqueurs, notamment d’imagerie, capables de suivre l’évolution de la maladie, dès un stade pré-symptomatique, utilisables pour évaluer de façon objective l’efficacité d’un traitement, si disponible. Enfin, l’ensemble de ce travail m’a permis d’acquérir une expertise et de mener une réflexion au sein du laboratoire sur l’utilisation des peptides à des fins thérapeutiques dans la maladie d’Huntington, avec la production d’un papier de revue sur le sujet, soumis dans une revue internationale.The subject of this thesis is the further characterization and development in therapeutic purpose of P42 peptide in Huntington's disease. This peptide was previously identified in the team led by Florence Maschat and it showed be able to reduce the presence of aggregates in different cell models, but also Drosophila and murine (mouse R6 / 2) of Huntington's disease. P42 is also able to prevent neuronal degeneration and alteration of axonal transport in the tests performed in Drosophila (Arribat et al. 2013). Finally the motor abnormalities, weight loss and brain atrophy are ameliorated in vivo in R6 / 2 mice treated with P42. In the latter case, P42 was conjugated to TAT transducing peptide, derived from HIV, and was inserted into microemulsions, with the purpose of enabling repeated administrations of the peptide by intra-mucosal route, protect the peptide until his arrival to the brain and facilitate its diffusion through the membranes and the blood-brain barrier (Arribat et al. 2014). The efficacy of this peptide has been shown following administration in a pre-symptomatic stage; however, unpublished results also suggest a partial efficacy in post-symptomatic level. Thus this peptide would be through the inhibition of aggregation by interacting with Htt in its N-terminal part, and in particular at the N17 part. Preliminary results also suggest that, as part physiologically present in the Htt protein, P42 and could have a beneficial physiological role, particularly in terms of axonal transport, level of expression of Brain nerve factor (BDNF), and neuronal activity.My thesis consists of a hand on a laboratory work, and secondly on a work documentation. The laboratory work was conducted using the Drosophila model. In the first part I tried to better characterize the effectiveness of P42TAT and compare it to that of P42 in inhibiting aggregates in the salivary glands and in the protection of the degeneration of the eye. In particular, I tested the efficacy of oral administration of the peptide P42TAT on reducing aggregates in the salivary glands. In the second part I helped evaluate the effectiveness of a shorter fragment of P42, P42B; this peptide was first identified through studies on the degradation of P42TAT in extracts of brain by MALDI; this fragment of 14 aa was found after 3 h and therefore could be an active portion, sufficient for the effectiveness of the peptide. In the third part I contributed to studies to study the physiological role of P42 in axonal transport.The documentation work was finalized at the submission of a dossier to the European Agency for medicine (EMEA), in order to obtain for P42 the label of orphan drug for Huntington's disease. This result is particularly important and could be a first step in the clinical development of this peptide. Indeed no curative treatment exists to date for Huntington's disease and the ability to perform pre-symptomatic tests can provide a single window for early therapeutic intervention. Moreover, in recent years, clinical studies monitoring symptomatic and pre-symptomatic patients were conducted (PREDICT-HD studies and TRACK-HD), which led to the identification of biomarkers, in particular of imaging, able to follow the evolution of the disease, already at a pre-symptomatic stage, be used to objectively evaluate the effectiveness of treatment if available. Finally, all of this work has allowed me to gain expertise and to reflect on the use of peptides for therapeutic purposes in Huntington's disease, with the production of paper review on the subject submitted to an international journal

The P42 peptide and Peptide-based therapies for Huntington’s disease

International audienceHuntington’s disease (HD) is a progressive neurodegenerative hereditary disease clinically characterised by the presence of involuntary movements, behavioural problems and cognitive decline. The disease-onset is usually between 30 and 50 years of age. HD is a rare disorder affecting approximately 1.3 in 10,000 people in the European Union. It is caused by an expanded CAG repeat in the first exon of the Huntingtin (HTT) gene, leading to an abnormal form of the Huntingtin protein (Htt) (polyQHtt), containing N-terminus, enlarged polyglutamine strands of variable length that stick together to form aggregates and nuclear inclusions in the damaged brain cells. Treatments currently used for Huntington’s disease are symptomatic and aimed at temporally relieving the symptoms of the disease; although some promising therapies are on study, there is no drug capable of stopping disease progression either in the form of delaying onset or slowing disability progression. The utilization of peptides interacting with polyQ stretches or with Htt protein to prevent misfolding and aggregation of the expanded polyQ protein is a fascinating idea, because of low potential toxicity and ability to target very initial steps in the pathophysiological cascade of the disease, such as aggregation or cleavage process. Indeed, several therapeutic peptides have been developed and were found to significantly slow down the progression of symptoms in experimental models of Huntington’s disease. This review is essentially focusing on the latest development concerning peptide strategy. In particular, we focused on a 23aa peptide P42, which is a part of the Htt protein. It is expected to work principally by preventing the abnormal Htt protein from sticking together, thereby preventing pathological consequences of aggregation and improving the symptoms of the disease. In the meantime, as P42 is part of the Htt protein, some therapeutic properties might be linked to the physiological actions of the peptide itself, considered as a functional domain of the Htt protein

Spinal cord involvement in adult-onset metabolic and genetic diseases

In adulthood, spinal cord MRI abnormalities such as T2-weighted hyperintensities and atrophy are commonly associated with a large variety of causes (inflammation, infections, neoplasms, vascular and spondylotic diseases). Occasionally, they can be due to rare metabolic or genetic diseases, in which the spinal cord involvement can be a prominent or even predominant feature, or a secondary one. This review focuses on these rare diseases and associated spinal cord abnormalities, which can provide important but over-ridden clues for the diagnosis. The review was based on a PubMed search (search terms: \u27spinal cord\u27 AND \u27leukoencephalopathy\u27 OR \u27leukodystrophy\u27; \u27spinal cord\u27 AND \u27vitamin\u27), further integrated according to the authors\u27 personal experience and knowledge. The genetic and metabolic diseases of adulthood causing spinal cord signal alterations were identified and classified into four groups: (1) leukodystrophies; (2) deficiency-related metabolic diseases; (3) genetic and acquired toxic/metabolic causes; and (4) mitochondrial diseases. A number of genetic and metabolic diseases of adulthood causing spinal cord atrophy without signal alterations were also identified. Finally, a classification based on spinal MRI findings is presented, as well as indications about the diagnostic work-up and differential diagnosis. Some of these diseases are potentially treatable (especially if promptly recognised), while others are inherited as autosomal dominant trait. Therefore, a timely diagnosis is needed for a timely therapy and genetic counselling. In addition, spinal cord may be the main site of pathology in many of these diseases, suggesting a tempting role for spinal cord abnormalities as surrogate MRI biomarkers