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Variability in SOD1-associated amyotrophic lateral sclerosis: geographic patterns, clinical heterogeneity, molecular alterations, and therapeutic implications

Huang, Miaodan, Liu, Yong U., Yao, Xiaoli, Qin, Dajiang, Su, Huanxing·2024·Translational Neurodegeneration

Abstract

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive loss of motor neurons, resulting in global health burden and limited post-diagnosis life expectancy. Although primarily sporadic, familial ALS (fALS) cases suggest a genetic basis. This review focuses on SOD1, the first gene found to be associated with fALS, which has been more recently confirmed by genome sequencing. While informative, databases such as ALSoD and STRENGTH exhibit regional biases. Through a systematic global examination of SOD1 mutations from 1993 to 2023, we found different geographic distributions and clinical presentations. Even though different SOD1 variants are expressed at different protein levels and have different half-lives and dismutase activities, these alterations lead to loss of function that is not consistently correlated with disease severity. Gain of function of toxic aggregates of SOD1 resulting from mutated SOD1 has emerged as one of the key contributors to ALS. Therapeutic interventions specifically targeting toxic gain of function of mutant SOD1, including RNA interference and antibodies, show promise, but a cure remains elusive. This review provides a comprehensive perspective on SOD1-associated ALS and describes molecular features and the complex genetic landscape of SOD1, highlighting its importance in determining diverse clinical manifestations observed in ALS patients and emphasizing the need for personalized therapeutic strategies.

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Figures

Fig. 1 Geographic distribution of ALS patients with different SOD1 variants. a Distribution of reported patients with SOD1 variants (count > 10) across countries (1993 to 2023). PubMed was searched on June 18, 2023, with keywords such as SOD1, ALS, patient, variant, mutation, and humans, resulting in 901 publications. A total of 251 publications containing valid patient information were selected for data extraction. b Distribution of reported patients with different SOD1 variants (count > 10) across continents. c Distribution of reported patients with different SOD1 variants (count > 5) across countries. There were 8 cases of patients reported as SOD1 V149G carriers in Australia of Oceania which was not ploted in this panel. Variants in non-coding regions were expressed by denoting the nucleic acid site of variants with the symbol 'c.', according to the SOD1 gene sequence from the NCBI database (Accession Number: NC_000021)
Fig. 1 Geographic distribution of ALS patients with different SOD1 variants. a Distribution of reported patients with SOD1 variants (count > 10) across countries (1993 to 2023). PubMed was searched on June 18, 2023, with keywords such as SOD1, ALS, patient, variant, mutation, and humans, resulting in 901 publications. A total of 251 publications containing valid patient information were selected for data extraction. b Distribution of reported patients with different SOD1 variants (count > 10) across continents. c Distribution of reported patients with different SOD1 variants (count > 5) across countries. There were 8 cases of patients reported as SOD1 V149G carriers in Australia of Oceania which was not ploted in this panel. Variants in non-coding regions were expressed by denoting the nucleic acid site of variants with the symbol 'c.', according to the SOD1 gene sequence from the NCBI database (Accession Number: NC_000021)CC BY · PubMed Central
Fig. 2 Clinical phenotypic heterogeneity. a Clinical phenotype distribution and reported patient counts by variants. b Distribution of age of onset in reported patients. c Distribution of disease duration in reported patients. Patients who were alive at the time of data collection in the original paper were excluded. d Age of onset in different continents. e Disease duration in different continents. f Age of onset distribution by clinical phenotype. g Disease duration by clinical phenotype. Swarmplots and boxplots (d-g) were generated using Matplotlib (version 3.5.2) and Seaborn (version 0.12.2). The Kruskal–Wallis test was used for overall statistical significance analysis across multiple groups and the Mann–Whitney test used for comparisons between two groups. Subsequently, P-values were adjusted with the Bonferroni correction to account for multiple comparisons. *P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001, ****P ≤ 0.0001
Fig. 2 Clinical phenotypic heterogeneity. a Clinical phenotype distribution and reported patient counts by variants. b Distribution of age of onset in reported patients. c Distribution of disease duration in reported patients. Patients who were alive at the time of data collection in the original paper were excluded. d Age of onset in different continents. e Disease duration in different continents. f Age of onset distribution by clinical phenotype. g Disease duration by clinical phenotype. Swarmplots and boxplots (d-g) were generated using Matplotlib (version 3.5.2) and Seaborn (version 0.12.2). The Kruskal–Wallis test was used for overall statistical significance analysis across multiple groups and the Mann–Whitney test used for comparisons between two groups. Subsequently, P-values were adjusted with the Bonferroni correction to account for multiple comparisons. *P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001, ****P ≤ 0.0001CC BY · PubMed Central
Fig. 3 Molecular alterations of SOD1 variants. a Location of SOD1 gene (Accession No: NC_000021). b Age of onset distribution among patients with different genetic locations of SOD1 variants. c Disease durations of patients with different genetic location of SOD1 variants. d Secondary structure of SOD1 protein. The secondary structural elements, including alpha-helices and beta-strands, were identified using the PyMOL software (version 2.5.0) based on the 3D crystal structure of the human SOD1 protein (PDB id: 2V0A). e The 3D crystal structure of the human SOD1 protein from the Protein Data Bank (PDB id: 2V0A). Codon colors represent the associations of the variants with the mean disease duration and the mean age of onset. Green represents disease duration longer than 56.17 months (the mean disease duration of the total SOD1-related ALS patients) and the age of onset older than 48.51 years (the mean age of onset of the total SOD1-related ALS patients), blue indicates longer duration and younger age, yellow signifies shorter duration and older age, and red indicates shorter duration and younger age. (f) Age of onset and disease duration of patients with different amino acid sites of variant. Significance was analyzed using Kruskal–Wallis test and P-values were adjusted to account for multiple comparisons using Bonferroni correction. *P ≤ 0.05, ** P ≤ 0.01, *** P ≤ 0.001, ****P ≤ 0.0001
Fig. 3 Molecular alterations of SOD1 variants. a Location of SOD1 gene (Accession No: NC_000021). b Age of onset distribution among patients with different genetic locations of SOD1 variants. c Disease durations of patients with different genetic location of SOD1 variants. d Secondary structure of SOD1 protein. The secondary structural elements, including alpha-helices and beta-strands, were identified using the PyMOL software (version 2.5.0) based on the 3D crystal structure of the human SOD1 protein (PDB id: 2V0A). e The 3D crystal structure of the human SOD1 protein from the Protein Data Bank (PDB id: 2V0A). Codon colors represent the associations of the variants with the mean disease duration and the mean age of onset. Green represents disease duration longer than 56.17 months (the mean disease duration of the total SOD1-related ALS patients) and the age of onset older than 48.51 years (the mean age of onset of the total SOD1-related ALS patients), blue indicates longer duration and younger age, yellow signifies shorter duration and older age, and red indicates shorter duration and younger age. (f) Age of onset and disease duration of patients with different amino acid sites of variant. Significance was analyzed using Kruskal–Wallis test and P-values were adjusted to account for multiple comparisons using Bonferroni correction. *P ≤ 0.05, ** P ≤ 0.01, *** P ≤ 0.001, ****P ≤ 0.0001CC BY · PubMed Central

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Authors
Huang, M., Liu, Y. U., Yao, X., Qin, D., & Su, H.
Venue
Translational Neurodegeneration
Published
2024-05-29
Volume
13
Issue
1
ISSN
2047-9158
Cited by
64
References
12
Language
en

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