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June 2022; 8 (3) ReviewOpen Access

Expanding Clinical Spectrum of C9ORF72-Related Disorders and Promising Therapeutic Strategies

A Review

Sarah Breevoort, Summer Gibson, Karla Figueroa, Mark Bromberg, Stefan Pulst
First published April 29, 2022, DOI: https://doi.org/10.1212/NXG.0000000000000670
Sarah Breevoort
From the Department of Neurology, University of Utah, Salt Lake City.
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  • For correspondence: sarah.breevoort@hsc.utah.edu
Summer Gibson
From the Department of Neurology, University of Utah, Salt Lake City.
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  • For correspondence: summer.gibson@hsc.utah.edu
Karla Figueroa
From the Department of Neurology, University of Utah, Salt Lake City.
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  • For correspondence: karlaf@genetics.utah.edu
Mark Bromberg
From the Department of Neurology, University of Utah, Salt Lake City.
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  • For correspondence: mbromberg@hsc.utah.edu
Stefan Pulst
From the Department of Neurology, University of Utah, Salt Lake City.
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Expanding Clinical Spectrum of C9ORF72-Related Disorders and Promising Therapeutic Strategies
A Review
Sarah Breevoort, Summer Gibson, Karla Figueroa, Mark Bromberg, Stefan Pulst
Neurol Genet Jun 2022, 8 (3) e670; DOI: 10.1212/NXG.0000000000000670

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    Figure 1 Proposed Mechanisms of C9ORF72 Expansion

    (A) The C9ORF72 gene contains a polymorphic hexanucleotide (GGGGCC) repeat in a noncoding region. (B) RNA transcripts with the C9ORF72 repeat expansions are produced by both sense and antisense transcription, resulting in the accumulation of nuclear and cytoplasmic aggregation of both sense and antisense repeat-containing RNA. Repeat-containing RNA can cause sequestration of essential RNA-binding proteins leading to defects in pre-mRNA splicing. (C) Expansion repeat is a substrate for non–ATG-dependent translation event that generates dipeptide repeat proteins that cause toxicity through aggregation and altering multiple essential cellular functions. (D) Repeat expansion can interfere with transcription and cause downregulation of C9ORF72 gene expression and loss of C9ORF72 protein function. Adapted from Gitler et al. There has been an awakening: Emerging mechanisms C9orf72 mutations in FTD/ALS. Brain Res. 2016;1647.

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    Figure 2 Variable

    (A) RP-PCR/CE representative profile for a heterozygote normal range repeats denoted by the arrows indicate repeat with corresponding size below (2 and 10). (B) RP-PCR/CE fragment representative of a normal expanded repeats of (2 and 27), note the diminishing signal peak as the repeat becomes larger. (C) RP-PCR/CE representative of an expanded repeat greater than 30.

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    Figure 3 Variable Interpretations of the C9orf72 Hexanucleotide Repeat Number Among Commercial Laboratories

    Jennifer Roggenbuck. Neurol Genet. 2021;7:e542.

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    Figure 4 Synergistic Effect of C9ORF72 Gain of Toxicity and Loss of Function

    Loss of C9orf72 function exacerbates the accumulation of poly-dipeptide repeat proteins and leads to cellular toxicity. Zhu Q, et al. Reduced C9ORF72 function exacerbates gain of toxicity from ALS/FTD-causing repeat expansion in C9orf72. Nat Neurosci. 2020;23(5):615–624.

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  • Article
    • Abstract
    • Glossary
    • Pathogenesis of C9ORF72 Expansion
    • C9ORF72 Testing Methods
    • C9ORF72 ALS
    • C9ORF72 Expansions in Patients With ALS and FTD/FTSD and Families
    • Movement Disorders
    • C9ORF72 Mouse Models
    • Clinical Trials
    • Highlights
    • Study Funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures

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