Spinal and Bulbar Muscular Atrophy – Genetic Causes, Clinical Presentation and Treatment Perspectives
DOI:
https://doi.org/10.12775/JEHS.2024.74.52566Keywords
Spinal and Bulbar Muscular Atrophy, SBMA, Kennedy's disease, CAG repeat, Androgen receptor geneAbstract
Introduction and Purpose:
Spinal bulbar muscular atrophy (SBMA), also known as Kennedy's disease, is a rare genetic disorder characterized by progressive muscle weakness and atrophy. The purpose of this review is to provide a comprehensive understanding of SBMA, including its pathophysiology, clinical presentation, diagnostic tools, and therapeutic approaches. By examining the latest research findings, we aim to highlight the challenges inherent in managing SBMA.
Material and method:
For this review, we performed searches across multiple databases, including PubMed, Elsevier, Medline, and Google Scholar.
Description of the State of Knowledge:
SBMA arises from mutations in the androgen receptor (AR) gene, leading to the accumulation of toxic proteins and subsequent neurodegeneration. Clinical manifestations primarily involve muscle weakness, tremors, and difficulties with speech and swallowing, with symptoms typically appearing in mid-life. While no treatment currently modifies disease progression, symptomatic management and supportive care play crucial roles in enhancing quality of life for affected individuals. Recent research has focused on understanding the underlying mechanisms of SBMA and developing targeted therapies to address them. However, challenges remain in translating these findings into effective treatments.
Conclusions:
SBMA represents a complex and challenging neurodegenerative disorder with significant implications for affected individuals and their families. While our understanding of SBMA has advanced in recent years, much remains to be elucidated regarding its pathophysiology and optimal management strategies. Continued research efforts are essential to develop novel therapeutic interventions that can effectively target the underlying mechanisms of SBMA and improve outcomes for patients.
References
Banno H., Katsuno M., Suzuki K., Tanaka F., Sobue G. Pathogenesis and Molecular Targeted Therapy of Spinal and Bulbar Muscular Atrophy (SBMA) Cell Tissue Res. 2012;349:313–320. doi: 10.1007/s00441-012-1377-9.
Lund A., Udd B., Juvonen V., Andersen P.M., Cederquist K., Davis M., et al. Multiple founder effects in spinal and bulbar muscular atrophy (SBMA, Kennedy disease) around the world. Eur. J. Hum. Genet. 2001 Jun;9(6):431–436. doi: 10.1038/sj.ejhg.5200656.
La Spada AR, Wilson EM, Lubahn DB, Harding AE, Fischbeck KH. Androgen receptor gene mutations in X-linked spinal and bulbar muscular atrophy. Nature. 1991;352:77–79. doi: 10.1038/352077a0.
Pradat PF, Bernard E, Corcia P, et al. The French national protocol for Kennedy's disease (SBMA): consensus diagnostic and management recommendations. Orphanet J Rare Dis. 2020;15(1):90. Published 2020 Apr 10. doi:10.1186/s13023-020-01366-z
Ni W, Chen S, Qiao K, Wang N, Wu ZY. Genotype-phenotype correlation in Chinese patients with spinal and bulbar muscular atrophy. PLoS One. 2015;10(3):e0122279. Published 2015 Mar 26. doi:10.1371/journal.pone.0122279
Fratta P, Nirmalananthan N, Masset L, et al. Correlation of clinical and molecular features in spinal bulbar muscular atrophy. Neurology. 2014;82(23):2077-2084. doi:10.1212/WNL.0000000000000507
Tanaka S, Banno H, Katsuno M, et al. Distinct acoustic features in spinal and bulbar muscular atrophy patients with laryngospasm. J Neurol Sci. 2014;337(1-2):193-200. doi:10.1016/j.jns.2013.12.010
Grunseich C, Rinaldi C, Fischbeck KH. Spinal and bulbar muscular atrophy: pathogenesis and clinical management. Oral Dis. 2014;20(1):6-9. doi:10.1111/odi.12121
Dejager S, Bry-Gauillard H, Bruckert E, et al. A comprehensive endocrine description of Kennedy's disease revealing androgen insensitivity linked to CAG repeat length. J Clin Endocrinol Metab. 2002;87(8):3893-3901. doi:10.1210/jcem.87.8.8780
Orr HT, Zoghbi HY. Trinucleotide repeat disorders. Annu Rev Neurosci. 2007;30:575-621. doi:10.1146/annurev.neuro.29.051605.113042
Kim H, Lim YM, Lee EJ, Oh YJ, Kim KK. Correlation between the CAG repeat size and electrophysiological findings in patients with spinal and bulbar muscular atrophy. Muscle Nerve. 2018;57(4):683-686. doi:10.1002/mus.25977
Fratta P, Nirmalananthan N, Masset L, et al. Correlation of clinical and molecular features in spinal bulbar muscular atrophy. Neurology. 2014;82(23):2077-2084. doi:10.1212/WNL.0000000000000507
Sorarù G, D'Ascenzo C, Polo A, et al. Spinal and bulbar muscular atrophy: skeletal muscle pathology in male patients and heterozygous females. J Neurol Sci. 2008;264(1-2):100-105. doi:10.1016/j.jns.2007.08.012
Yu Z, Dadgar N, Albertelli M, et al. Androgen-dependent pathology demonstrates myopathic contribution to the Kennedy disease phenotype in a mouse knock-in model. J Clin Invest. 2006;116(10):2663-2672. doi:10.1172/JCI28773
Doyu M, Sobue G, Mukai E, et al. Severity of X-linked recessive bulbospinal neuronopathy correlates with size of the tandem CAG repeat in androgen receptor gene. Ann Neurol. 1992;32(5):707-710. doi:10.1002/ana.410320517
Nedelsky NB, Pennuto M, Smith RB, et al. Native functions of the androgen receptor are essential to pathogenesis in a Drosophila model of spinobulbar muscular atrophy. Neuron. 2010;67(6):936-952. doi:10.1016/j.neuron.2010.08.034
Pennuto M, Rinaldi C. From gene to therapy in spinal and bulbar muscular atrophy: Are we there yet?. Mol Cell Endocrinol. 2018;465:113-121. doi:10.1016/j.mce.2017.07.005
Katsuno M, Adachi H, Kume A, et al. Testosterone reduction prevents phenotypic expression in a transgenic mouse model of spinal and bulbar muscular atrophy. Neuron. 2002;35(5):843-854. doi:10.1016/s0896-6273(02)00834-6
Li M, Miwa S, Kobayashi Y, et al. Nuclear inclusions of the androgen receptor protein in spinal and bulbar muscular atrophy. Ann Neurol. 1998;44(2):249-254. doi:10.1002/ana.410440216
Nath SR, Yu Z, Gipson TA, et al. Androgen receptor polyglutamine expansion drives age-dependent quality control defects and muscle dysfunction. J Clin Invest. 2018;128(8):3630-3641. doi:10.1172/JCI99042
Bott LC, Badders NM, Chen KL, et al. A small-molecule Nrf1 and Nrf2 activator mitigates polyglutamine toxicity in spinal and bulbar muscular atrophy. Hum Mol Genet. 2016;25(10):1979-1989. doi:10.1093/hmg/ddw073
Chen ST, Okada M, Nakato R, Izumi K, Bando M, Shirahige K. The Deubiquitinating Enzyme USP7 Regulates Androgen Receptor Activity by Modulating Its Binding to Chromatin. J Biol Chem. 2015;290(35):21713-21723. doi:10.1074/jbc.M114.628255
Burska UL, Harle VJ, Coffey K, et al. Deubiquitinating enzyme Usp12 is a novel co-activator of the androgen receptor. J Biol Chem. 2013;288(45):32641-32650. doi:10.1074/jbc.M113.485912
Dahlqvist JR, Oestergaard ST, Poulsen NS, Knak KL, Thomsen C, Vissing J. Muscle contractility in spinobulbar muscular atrophy. Sci Rep. 2019;9(1):4680. Published 2019 Mar 18. doi:10.1038/s41598-019-41240-y
Ranganathan S, Harmison GG, Meyertholen K, Pennuto M, Burnett BG, Fischbeck KH. Mitochondrial abnormalities in spinal and bulbar muscular atrophy. Hum Mol Genet. 2009;18(1):27-42. doi:10.1093/hmg/ddn310
Piccioni F, Pinton P, Simeoni S, et al. Androgen receptor with elongated polyglutamine tract forms aggregates that alter axonal trafficking and mitochondrial distribution in motor neuronal processes. FASEB J. 2002;16(11):1418-1420. doi:10.1096/fj.01-1035fje
Malik B, Nirmalananthan N, Bilsland LG, et al. Absence of disturbed axonal transport in spinal and bulbar muscular atrophy. Hum Mol Genet. 2011;20(9):1776-1786. doi:10.1093/hmg/ddr061
Kemp MQ, Poort JL, Baqri RM, et al. Impaired motoneuronal retrograde transport in two models of SBMA implicates two sites of androgen action. Hum Mol Genet. 2011;20(22):4475-4490. doi:10.1093/hmg/ddr380
] Rocchi C, Greco V, Urbani A, et al. Subclinical autonomic dysfunction in spinobulbar muscular atrophy (Kennedy disease). Muscle Nerve. 2011;44(5):737-740. doi:10.1002/mus.221]
Kennedy WR, Alter M, Sung JH. Progressive proximal spinal and bulbar muscular atrophy of late onset. A sex-linked recessive trait. Neurology. 1968;18(7):671-680. doi:10.1212/wnl.18.7.671
Mariotti C, Castellotti B, Pareyson D, et al. Phenotypic manifestations associated with CAG-repeat expansion in the androgen receptor gene in male patients and heterozygous females: a clinical and molecular study of 30 families. Neuromuscul Disord. 2000;10(6):391-397. doi:10.1016/s0960-8966(99)00132-7
Atsuta N, Watanabe H, Ito M, et al. Natural history of spinal and bulbar muscular atrophy (SBMA): a study of 223 Japanese patients. Brain. 2006;129(Pt 6):1446-1455. doi:10.1093/brain/awl096
Nishiyama A, Sugeno N, Tateyama M, Nishiyama S, Kato M, Aoki M. Postural leg tremor in X-linked spinal and bulbar muscular atrophy. J Clin Neurosci. 2014;21(5):799-802. doi:10.1016/j.jocn.2013.07.026
] Jokela ME, Udd B. Diagnostic Clinical, Electrodiagnostic and Muscle Pathology Features of Spinal and Bulbar Muscular Atrophy. J Mol Neurosci. 2016;58(3):330-334. doi:10.1007/s12031-015-0684]
Rocchi C, Greco V, Urbani A, et al. Subclinical autonomic dysfunction in spinobulbar muscular atrophy (Kennedy disease). Muscle Nerve. 2011;44(5):737-740. doi:10.1002/mus.22159
Hashizume A, Banno H, Katsuno M, et al. Quantitative Assessment of Swallowing Dysfunction in Patients with Spinal and Bulbar Muscular Atrophy. Intern Med. 2017;56(23):3159-3165. doi:10.2169/internalmedicine.8799-16
Warnecke T, Oelenberg S, Teismann I, et al. Dysphagia in X-linked bulbospinal muscular atrophy (Kennedy disease). Neuromuscul Disord. 2009;19(10):704-708. doi:10.1016/j.nmd.2009.06.371
Sperfeld AD, Hanemann CO, Ludolph AC, Kassubek J. Laryngospasm: an underdiagnosed symptom of X-linked spinobulbar muscular atrophy. Neurology. 2005;64(4):753-754. doi:10.1212/01.WNL.0000151978.74467.E7
Finsterer J. Perspectives of Kennedy's disease. J Neurol Sci. 2010;298(1-2):1-10. doi:10.1016/j.jns.2010.08.025
Pedroso JL, Vale TC, Barsottini OG, Oliveira ASB, Espay AJ. Perioral and tongue fasciculations in Kennedy's disease. Neurol Sci. 2018;39(4):777-779. doi:10.1007/s10072-017-3170-8
Hashizume A, Katsuno M, Suzuki K, et al. Long-term treatment with leuprorelin for spinal and bulbar muscular atrophy: natural history-controlled study. J Neurol Neurosurg Psychiatry. 2017;88(12):1026-1032. doi:10.1136/jnnp-2017-316015
Atsuta N, Watanabe H, Ito M, et al. Natural history of spinal and bulbar muscular atrophy (SBMA): a study of 223 Japanese patients. Brain. 2006;129(Pt 6):1446-1455. doi:10.1093/brain/awl096
Breza M, Koutsis G. Kennedy's disease (spinal and bulbar muscular atrophy): a clinically oriented review of a rare disease. J Neurol. 2019;266(3):565-573. doi:10.1007/s00415-018-8968-7
Finsterer J. Bulbar and spinal muscular atrophy (Kennedy's disease): a review. Eur J Neurol. 2009;16(5):556-561. doi:10.1111/j.1468-1331.2009.02591.x
Fischbeck KH. Spinal and Bulbar Muscular Atrophy Overview. J Mol Neurosci. 2016;58(3):317-320. doi:10.1007/s12031-015-0674-7
Araki A, Katsuno M, Suzuki K, et al. Brugada syndrome in spinal and bulbar muscular atrophy. Neurology. 2014;82(20):1813-1821. doi:10.1212/WNL.0000000000000434
Steinmetz K, Rudic B, Borggrefe M, et al. J wave syndromes in patients with spinal and bulbar muscular atrophy. J Neurol. 2022;269(7):3690-3699. doi:10.1007/s00415-022-10992-5
Rhodes LE, Freeman BK, Auh S, et al. Clinical features of spinal and bulbar muscular atrophy. Brain. 2009;132(Pt 12):3242-3251. doi:10.1093/brain/awp258
Guber RD, Takyar V, Kokkinis A, et al. Nonalcoholic fatty liver disease in spinal and bulbar muscular atrophy. Neurology. 2017;89(24):2481-2490. doi:10.1212/WNL.0000000000004748
Francini-Pesenti F, Querin G, Martini C, Mareso S, Sacerdoti D. Prevalence of metabolic syndrome and non-alcoholic fatty liver disease in a cohort of italian patients with spinal-bulbar muscular atrophy. Acta Myol. 2018;37(3):204-209. Published 2018 Sep 1.
Querin G, Bertolin C, Da Re E, et al. Non-neural phenotype of spinal and bulbar muscular atrophy: results from a large cohort of Italian patients. J Neurol Neurosurg Psychiatry. 2016;87(8):810-816. doi:10.1136/jnnp-2015-311305
Pennuto M, Greensmith L, Pradat PF, Sorarù G; European SBMA Consortium. 210th ENMC International Workshop: Research and clinical management of patients with spinal and bulbar muscular atrophy, 27-29 March, 2015, Naarden, The Netherlands. Neuromuscul Disord. 2015;25(10):802-812. doi:10.1016/j.nmd.2015.06.462
Dahlqvist JR, Vissing J. Exercise Therapy in Spinobulbar Muscular Atrophy and Other Neuromuscular Disorders. J Mol Neurosci. 2016;58(3):388-393. doi:10.1007/s12031-015-0686-3
Fernández-Rhodes LE, Kokkinis AD, White MJ, et al. Efficacy and safety of dutasteride in patients with spinal and bulbar muscular atrophy: a randomised placebo-controlled trial. Lancet Neurol. 2011;10(2):140-147. doi:10.1016/S1474-4422(10)70321-5
] Katsuno M, Adachi H, Doyu M, et al. Leuprorelin rescues polyglutamine-dependent phenotypes in a transgenic mouse model of spinal and bulbar muscular atrophy. Nat Med. 2003;9(6):768-773. doi:10.1038/nm8
Banno H, Adachi H, Katsuno M, et al. Mutant androgen receptor accumulation in spinal and bulbar muscular atrophy scrotal skin: a pathogenic marker. Ann Neurol. 2006;59(3):520-526. doi:10.1002/ana.20735
Banno H, Katsuno M, Suzuki K, et al. Phase 2 trial of leuprorelin in patients with spinal and bulbar muscular atrophy. Ann Neurol. 2009;65(2):140-150. doi:10.1002/ana.21540
Fernández-Rhodes LE, Kokkinis AD, White MJ, et al. Efficacy and safety of dutasteride in patients with spinal and bulbar muscular atrophy: a randomised placebo-controlled trial. Lancet Neurol. 2011;10(2):140-147. doi:10.1016/S1474-4422(10)70321-5
Querin G, D'Ascenzo C, Peterle E, et al. Pilot trial of clenbuterol in spinal and bulbar muscular atrophy. Neurology. 2013;80(23):2095-2098. doi:10.1212/WNL.0b013e318295d766
Martínez-Rojas VA, Arosio D, Pennuto M, Musio C. Clenbuterol-sensitive delayed outward potassium currents in a cell model of spinal and bulbar muscular atrophy. Pflugers Arch. 2021;473(8):1213-1227. doi:10.1007/s00424-021-02559-6
Grunseich C, Miller R, Swan T, et al. Safety, tolerability, and preliminary efficacy of an IGF-1 mimetic in patients with spinal and bulbar muscular atrophy: a randomised, placebo-controlled trial. Lancet Neurol. 2018;17(12):1043-1052. doi:10.1016/S1474-4422(18)30320-X
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Sara Emerla, Natalia Małek, Konrad Karłowicz, Aleksandra Brożyna, Anita Kwiatkowska, Arkadiusz Bydliński, Maria Hermanowska, Julia Lubomirska, Patrycja Figurowska, Łukasz Ciulkiewicz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 462
Number of citations: 0