An investigation into the molecular aetiology of Parkinson's disease in South African patients

Glanzmann, Brigitte (2013-03)

Thesis (MScMedSc)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Parkinson's disease (PD) is a severely debilitating neurodegenerative disorder that results in motor circuit dysregulation and ultimately, causes impairment of movement. This condition is due to the selective degradation of the dopaminergic neurons in the substantia nigra pars compacta in the midbrain, which subsequently results in the pathological symptoms namely bradykinesia, resting tremor, postural instability and rigidity. It was initially hypothesized that individuals who develop PD were exposed to an environmental trigger(s) that caused the onset of the disease, but more recently, a significant genetic component, coupled to environmental factors have been implicated in disease pathogenesis. Currently, there are eight genes (Parkin, PINK1, LRRK2, SNCA, DJ-1, ATP13A2, EIF4G1 and VPS35) that have been directly implicated in PD. Worldwide, the prevalence of neurodegenerative disorders is increasing as populations are living longer. In Europe, Canada and USA, it has been projected that the prevalence of PD may increase by a factor of two between 2010 and 2050; approximately a 92% increase. In Tanzania (the only study done in sub-Saharan Africa) an even larger increase of 184% between 2005 and 2025 is predicted, due to the fact that the speed of populations ageing in developing countries, will exceed that of developed countries. Research into the causes and risk factors underlying neurodegenerative disorders such as PD is therefore urgently needed for policy makers and governments in developing nations to take appropriate action to deal with this impending health care problem. The aim of the present study was to investigate the molecular aetiology of a group of South African PD patients. A total of 262 patients from various ethnic backgrounds were recruited for the study, and 35% had a positive family history of PD with the average age at onset (AAO) being 54.3 years of age (SD = 12.5 years). Mutation screening of the known PD genes (Parkin, PINK1, LRRK2, SNCA and DJ-1) was performed using high resolution melt and Sanger sequencing. Genotyping was done using fluorescently-labelled PCR primers followed by electrophoresis on an ABI 3130xl genetic analyser (for CTG repeats in JPH3) and with a KASP™ Genotyping Assay (for a 16bp indel in DJ-1). In order to identify a novel PD-causing gene, whole exome sequencing (WES) was conducted on three Afrikaner probands with an Illumina Genome Hiseq 2000TM and the sequences were aligned using the NCBI Human Reference Genome 37.2. The BORG (Bio-Ontological Relationship Graph) semantic database, which models the relationship of human and model organism genes to functions, pathways and phenotypes, was used to filter and prioritise genetic variants shared between the three PD exomes. It was determined that the known PD genes do not play a significant role in disease pathogenesis in the South African patients as only 15/262 (5.7%) of the patients harboured mutations: seven in Parkin, one in PINK1, six in LRRK2 and one in SNCA. Only one of the patients harboured a 16bp indel variant at the transcription start site of DJ-1. None of the Black PD patients had pathogenic repeat expansions in JPH3 thereby excluding Huntington disease-like 2 as a cause of the disease phenotype. Genealogical analysis revealed that six of the apparently unrelated Afrikaner PD probands were related to a founder couple that immigrated to South Africa in the 1600s which suggests that there is a possible founder effect for the disease. Bioinformatics analysis of WES data on three of the probands identified 21 variants in 12 genes that were present in all three PD exomes and fulfilled various criteria. Sanger sequencing was used for verification of five variants and of these, two (in CDC27 and NEDD4) were found to be artefacts. The remaining three (in HECDT1, TBCC and RNF40) were excluded based on the lack of cosegregation with disease and the high frequency of the allele in controls. Further work is necessary to verify the presence of the remaining sixteen variants and to characterise each of them for their possible pathogenicity. The discovery of novel PD-causing genes is important as this may shed light on the pathways or processes that are involved. A current hypothesis implicates the lysosome-dependent pathway as a unifying biochemical pathway that can account for the phenotypic spectrum within PD. Notably, although Mendelian forms are thought to account for only about 10- 15% of cases, the study of Mendelian inherited variants is likely to provide insight into the pathophysiology of the more common sporadic form of this condition. Dissecting the key molecular mechanisms underlying PD will provide critical information for improved treatment strategies and drug interventions that will ultimately prevent or halt neuronal cell loss in susceptible individuals.

AFRIKAANSE OPSOMMING: Parkinson se siekte (PS) is 'n erge neurodegeneratiewe bewegings-siekte, wat motorstroombaan disregulasie veroorsaak. Dit lei uiteindelik tot beperkte bewegings vermoëns. Hierdie toestand word veroorsaak weens die selektiewe agteruitgang van die dopaminergeniese neurone in die substantia nigra pars compacta in die midbrein, wat later lei tot die patologiese simptome naamlik: bradykinesia, rustende spiersametrekkings, posturale onstabiliteit en rigiditeit. Daar is aanvanklik vermoed dat individue wat PS ontwikkel, aan 'n omgewingsfaktor(e) blootgestel is wat die aanvang van die siekte veroorsaak het, terwyl meer onlangs is daar 'n aansienlike genetiese komponent tesame met omgewingsfaktore geïdentifiseer, wat betrokke is by die patogenese van die siekte. Tans is daar agt gene (Parkin, PINK1, LRRK2, SNCA, DJ-1, ATP13A2, EIF4G1 en VPS35) wat direk by PS geïmpliseer is. Wêreldwyd is daar ‗n toenemende voorkoms van neurodegeneratiewe siektes aangesien bevolkings langer leef. In Europa, Kanada en die VSA, is daar geprojekteer dat die voorkoms van PS tussen 2010 en 2050 met 'n faktor van twee verhoog kan word. Dit is ongeveer 'n 92%- verhoging. In Tanzanië (die enigste studie wat tot dusver in sub-Sahara Afrika gedoen is) word daar selfs ‗n groter toename, van 184% tussen 2005 en 2025 voorspel. Dit is te danke aan die feit dat die bevolkings- veroudering in ontwikkelende lande die van ontwikkelde lande sal oorskry. Ondersoeke na die oorsake en risiko-faktore onderliggend aan neurodegeneratiewe siektes, byvoorbeeld PS, word dus dringend benodig deur beleidmakers en regerings in ontwikkelende lande, sodat hulle die nodige stappe kan neem om hierdie dreigende gesondheidsorg-probleem op te los. Die doel van die huidige studie was om ondersoek in te stel na die molekulêre etiologie van 'n groep Suid-Afrikaanse PS pasiënte. 'n Totaal van 262 pasiënte van verskillende etniese agtergronde, is gewerf vir die studie. Hiervan het 35% 'n positiewe familiegeskiedenis van PS en die gemiddelde aanvangs ouderdom (AAO) was 54,3 jaar (SD = 12,5 jaar). Mutasie-analise van die bekende PS gene is uitgevoer met behulp van hoë resolusie smelt en Sanger volgordebepaling. Genotipering is gedoen met behulp van fluoresserend geëtiketteerde PKR inleiers met elektroforese, op 'n ABI 3130xl genetiese analiseerder (CTG herhalings in JPH3), en met 'n KASP ™ Genotipering toets (vir 'n 16bp indel in DJ-1). Ten einde, om 'n nuwe PSveroorsakende geen te identifiseer was heel eksoom volgordebepaling (WES) uitgevoer op drie Afrikaner PS positiewe pasiënte met 'n Illumina Genome Hiseq 2000™ en die volgorders is gerangskik met behulp van die NCBI Menslike Verwysings Genoom 37.2. Die BORG (Bio- Ontologiese Verhoudings Grafiek) semantiese databasis, wat gebaseer is op die verhouding van die mens en model organisme gene funksies, paaie en fenotipes, en is gebruik om genetiese variante, wat gedeel word tussen die drie PS exome te filtreer en te prioritiseer. Daar is vasgestel dat die bekende PS gene nie 'n belangrike rol in die patogenese van die siekte in die Suid-Afrikaanse pasiënte speel nie. Dit is aangesien slegs 15/262 (5.7%) van die pasiënte bekende mutasies dra: sewe in Parkin, een in PINK1, ses in LRRK2 en een in SNCA. Slegs een van die pasiënte het 'n 16bp delesie variant in die transkripsie promotor area van DJ-1 gedra. Geen van die Swart PS pasiënte het patogeniese herhalings in JPH3 vertoon nie. Gevolglik is Huntington siekte-agtige 2 uitgesluit as 'n oorsaak van die siekte fenotipe. Genealogiese analise het getoon dat ses van die skynbaar onverwante Afrikaner PS pasiënte verwant is aan 'n stigter paartjie wat in die 1600's na Suid-Afrika geïmigreer het, wat daarop dui dat daar 'n moontlike stigter effek vir die siekte is. Bioinformatiese analise van WES data vir drie van die pasiënte, het 21 variante in 12 gene geïdentifiseer, wat in al drie PS exome teenwoordig was en verskeie kriteria vervul het. Sanger volgordebepaling is gebruik vir die bevestiging van vyf variante en van hierdie, is twee (in CDC27 en NEDD4) bevind om artefakte te wees. Die oorblywende drie (in HECDT1, TBCC en RNF40) is uitgesluit gebaseer op die gebrek aan gesamentlike-segregasie met die siekte en die hoë frekwensie van die allele in die kontrole groep. Verdere werk is nodig om die teenwoordigheid van die oorblywende variante te verifieer en om elkeen van hulle te karakteriseer vir hulle moontlike patogenisiteit. Die ontdekking van die nuwe PS-veroorsakende gene is belangrik aangesien dit lig kan werp op die stelsels of prosesse wat betrokke is. 'n Huidige hipotese impliseer die lisosoom-afhanklike pad as 'n verenigende biochemiese padweg, wat verantwoordelik is vir die fenotipiese spektrum binne PS. Alhoewel Mendeliese vorms vermoedelik verantwoordelik is vir slegs omgeveer 10-15% van die gevalle, is die studie van Mendelse gene geneig om insig te verkry in die patofisiologie van die meer algemene sporadiese vorm van hierdie toestand. Ontleding van die kern molekulêre meganismes onderliggend aan PS sal kritiese inligting vir beter strategieë vir behandeling en geneesmiddel-intervensies voorsien, wat gevolglik neuronale sel verlies in vatbare individue sal voorkom of beëindig.

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