Megalencephalic Leukoencephalopathy: Insights Into Pathophysiology and Perspectives for Therapy.

Assumpció Bosch,Raúl Estévez

doi:10.3389/fncel.2020.627887

Abstract

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare genetic disorder belonging to the group of vacuolating leukodystrophies. It is characterized by megalencephaly, loss of motor functions, epilepsy, and mild mental decline. In brain biopsies of MLC patients, vacuoles were observed in myelin and in astrocytes surrounding blood vessels. It is mainly caused by recessive mutations in MLC1 and HEPACAM (also called GLIALCAM) genes. These disease variants are called MLC1 and MLC2A with both types of patients sharing the same clinical phenotype. Besides, dominant mutations in HEPACAM were also identified in a subtype of MLC patients (MLC2B) with a remitting phenotype. MLC1 and GlialCAM proteins form a complex mainly expressed in brain astrocytes at the gliovascular interface and in Bergmann glia at the cerebellum. Both proteins regulate several ion channels and transporters involved in the control of ion and water fluxes in glial cells, either directly influencing their location and function, or indirectly regulating associated signal transduction pathways. However, the MLC1/GLIALCAM complex function and the related pathological mechanisms leading to MLC are still unknown. It has been hypothesized that, in MLC, the role of glial cells in brain ion homeostasis is altered in both physiological and inflammatory conditions. There is no therapy for MLC patients, only supportive treatment. As MLC2B patients show an MLC reversible phenotype, we speculated that the phenotype of MLC1 and MLC2A patients could also be mitigated by the re-introduction of the correct gene even at later stages. To prove this hypothesis, we injected in the cerebellar subarachnoid space of Mlc1 knockout mice an adeno-associated virus (AAV) coding for human MLC1 under the control of the glial-fibrillary acidic protein promoter. MLC1 expression in the cerebellum extremely reduced myelin vacuolation at all ages in a dose-dependent manner. This study could be considered as the first preclinical approach for MLC. We also suggest other potential therapeutic strategies in this review.

Highlights

Leukodystrophies are human diseases affecting the central nervous system (CNS) myelin
Magnetic resonance imaging (MRI) is crucial to diagnose the disease in childhood, showing diffuse signal abnormality, swelling of the cerebral white matter, and the presence of subcortical cysts, which are mostly present in the anterior temporal areas and often in the frontoparietal region
As the interaction with ClC-2 was dependent on extracellular potassium, we proposed that GlialCAM/MLC1 might regulate brain homeostasis by influencing the activity and the interaction with different transporters/ion channels that could be involved in controlling brain potassium levels (Estévez et al, 2018)

Summary

INTRODUCTION

Leukodystrophies are human diseases affecting the central nervous system (CNS) myelin. Biochemical studies suggest that dominant MLC2B mutations affect the trafficking of the wild-type protein, possibly by interfering with the formation of GlialCAM complexes in the same cell (cis-interactions) or between different cells (trans-interactions; Elorza-Vidal et al, 2020). These in vitro studies were validated in vivo with the generation of a Glialcam knockin (KI) mouse containing a dominant mutation, which showed that GlialCAM protein displays a trafficking defect in heterozygous mice (Hoegg-Beiler et al, 2014). ClC-2 localization change by GlialCAM (Jeworutzki et al., 2012)

KO of Mlc1 and Glialcam change The association between

Findings

CONCLUSIONS AND PERSPECTIVES