表现为帕金森综合征的SCA3/MJD一家系临床及基因突变研究

近年来遗传因素在帕金森病发病机制的作用越来越受到关注。其中a-突触核蛋白（a-Synuclein）基因，泛素羟基末端水解酶L1（UCH-L1）基因，LRRK2基因同常染色体显性遗传帕金森病有关。遗传性脊髓小脑型共济失调（SCA）是一组包括多种亚型在内的神经系统退行性疾病。临床表现除了共济失调外可伴有帕金森综合征。近来有报道SCA患者可以表现为帕金森综合征而无明显的共济失调，我们对5个临床诊断为常染色体显性遗传的帕金森病家系进行SCA突变检测。     

家族性常染色体隐性遗传早发性帕金森综合征ATP13A2基因突变研究

目的 探讨常染色体隐性遗传早发性帕金森综合征(autosomal recessive early-onset parkinsonism,AREP)家系患者中ATP13A2基因的突变特点.方法 应用聚合酶链反应结合DNA直接序列分析方法对25个已排除Parkin,DJ-1和PINK1基因纯合突变及复合杂合突变的AREP家系共46例患者进行ATP13A2基因突变分析.结果 AREP患者中未发现ATP13A2基因的致病突变,发现了6个已知多态,为IVS6+70A>G、IVS12+66A>G、m1849C>T、IVS20-56 G>A、m2671C>T和m2824G>A.结论 家族性AREP患者中ATP13A2基因的突变可能罕见.     

应用SYBR GreenⅠ实时荧光定量聚合酶链反应检测常染色体隐性遗传早发性帕金森综合征的parkin基因外显子重排突变

目的 建立应用SYBR GreenⅠ实时荧光定量聚合酶链反应(Real-time PCR,RT-PCR)检测parkin基因外显子重排突变的技术平台,应用该技术对常染色体隐性遗传早发型帕金森综合征(autosomal recessive early-onset parkinsonism,AREP) 家系进行parkin基因外显子重排突变分析.方法 应用SYBR GreenⅠRT-PCR技术对32个中国AREP家系进行parkin基因外显子重排突变分析.结果 14个家系先证者存在parkin基因外显子重排突变,其中3个为纯合缺失突变、3个为复杂杂合缺失突变和8个杂合缺失突变,未发现外显子重复突变,突变主要累及第2～4号外显子.结论 建立了应用SYBR GreenⅠRT-PCR技术检测parkin基因外显子重排突变的基因检测平台;中国AREP 家系的parkin基因外显子重排突变频率为43.8%,与国外报道相似.     

RNA干扰技术阻断α-synuclein过表达诱导的细胞凋亡

BACKGROUND： Overexpression of α-synuclein can induce cell apoptosis. RNA interference （RNAi） may block specific gene function and cause gene silencing. OBJECTIVE： To construct a specific and effective RNAi plasmid for the α-synuclein gene and investigate if RNAi can block apoptosis in HEK293 cells, induced by overexpression of wild-type α-synuclein.
DESIGN, TIME AND SETTING： A contrast experiment based on genetically engineered cytobiology was performed at the State Key Lab of Medical Genetics of China, Xiangya Medical College of Central South University, between October 2004 and October 2008.
MATERIALS： HEK293 cells and pBSHH1 plasmid were provided by the State Key Lab of Medical Genetics of China; OligDNA sequence by Sagon Bioengineering Company, Shanghai; Lipofectamine 2000 by Invitrogen, USA; α-synuclein monoclonal antibody, Hoechst 33258, and MTT by Sigma, USA; Horseradish peroxidase-coupled goat anti-rat IgG by KPL, USA; FACSan flow cytometry by BD, USA.
METHODS： Four target sites were used to construct hairpin RNA pBSHH1 vectors - pSYNi-1, pSYNi-2, pSYNi-3 and pSYNi-4 - which were cloned in the pBSHH1 plasmid. HEK293 cells were transfected using Lipofectamine 2000. In addition, a non-transfect group and a negative plasmid transfect group were established. The cultured HEK293 cells were processed as follows： transfection of blank plasmid （blank control group）, transfection of α-synuclein-pEGFP and RNAi negative vector （negative control group）, and transfection of α-synuclein-pEGFP and pSYNi-1 （transfection group）. Cells in all groups were transfected with Lipofectamine 2000 for 48 hours.
MAIN OUTCOME MEASURES： Expression of α-synuclein mRNA and protein were detected by RT-PCR and Western blot. Cell morphology was observed under an inverted fluorescence microscope; cell viability was measured using MTT method; and cell apoptosis was determined with Annexin V-PE flow cytometry.
RESULTS： α-synuclein mRNA and protein expressions were significantly decreased in the pSYNi-1 group when compared with the non-transfect and negative plasmid transfect groups （P 〈 0.05）. The expressions were partially decreased in the pSYNi-2 group, but there was no significant difference in the pSYNi-3 and pSYNi-4 groups. Hoechst staining indicated that cell nuclei were enlarged in the negative control group, coloring was not uniform, and chromatin was accumulated and appeared spot-like. The nucleus coloring was uniform in the transfection group compared to negative control group. Cell viability in the negative control group was significantly lower than blank control group with cell apoptosis being significantly increased （P 〈 0.05）. In comparison with negative control group, cell viability was significantly increased in the transfection group and cell apoptosis was significantly decreased （P 〈 0.05）.
CONCLUSION： pSYNi-1 can inhibit α-synuclein gene expression and block apoptosis of HEK293 cells induced by overexpression of wild-type α-synuclein.     

脑内铁沉积神经变性病临床特点及PLA2G6基因突变研究

目的探讨中国脑内铁沉积神经变性病(neurodegeneration with brain iron accumulation,NBIA)患者的临床特点及PLA2G6基因的突变特点。方法对3个NBIA家系、6个散发性NBIA患者的临床特点进行回顾性分析,应用聚合酶链反应(PCR)结合DNA直接序列分析方法,对NBIA患者进行PLA2G6基因突变研究。结果所有患者主要表现为锥体外系症状;头部MRI T2加权像表现双侧苍白球、黑质等部位对称性低信号,其中1家系在苍白球低信号区的前内侧出现高信号,即"虎眼征";本组NBIA患者未发现PLA2G6基因的致病突变,共发现7个多态,分别为c.C511T、c.G87A、IVS2+16C→T、IVS4+71A→G、IVS5+43C→T、IVS6+19G→A、和IVS15+55G→A,其中2个(c.C511T、IVS6+19G→A)为新发现的多态。结论根据临床和头部MRI特征可临床诊断NBIA,中国人NBIA患者PLA2G6基因突变可能罕见。     

应用培高利特单药治疗早期帕金森病:随机、双盲、对照实验

目的:观察应用培高利特单药治疗早期帕金森病的疗效,为合理应用多巴胺受体激动剂干预帕金森病提供依据。方法:60例首次接受治疗的早期帕金森病患者为2002-10/2004-10湘雅医院收治,将患者随机分为两组:培高利特组、多巴丝肼组,分别于治疗前、治疗1,3及6个月后进行帕金森病评定量表评分、改良Hoehn-Yahr分级评分及临床疗效观察。结果:治疗3个月后,培高利特组改良Hoehn-Yahr分级评分与多巴丝肼组相比无统计学意义(P>0.05);治疗6个月后,培高利特组帕金森病评定量表评分与多巴丝肼组相比差异无显著性意义(P>0.05)。治疗6个月后,培高利特组的临床疗效与多巴丝肼组相比差异无显著性意义(P>0.05)。副反应观察发现,培高利特组患者副反应的发生率低于多巴丝肼组(30%比50%,P<0.01),其中培高利特组患者出现幻觉的比例稍高于多巴丝肼组,恶心、失眠、便秘、直立性低血压等副反应的发生率均低于多巴丝肼组(P<0.01)。结论:应用培高利特单药治疗早期帕金森病6个月后疗效与多巴丝肼相似,且副反应少。     

帕金森病基因治疗新进展

帕金森病是一种常见的神经系统退行性疾病。近年来基因治疗帕金森病显示了良好的潜力和发展前途。基因治疗主要通过三条途径:一是转染多种多巴胺合成途径中相关基因;二是转染能合成神经营养因子的基因;三是转染基因表达的调节基因,以避免因转基因产物过量合成而可能导致的副作用。多基因的联合转染可提高疗效。小干扰RNA也逐渐应用于帕金森病的研究。     

常染色体隐性遗传早发性帕金森病1个家系临床特征及parkin基因突变分析

目的探讨1个常染色体隐性遗传早发性帕金森病（autosomal recessive early-onset parkinson-ism，AREP）家系的临床特征及parkin基因突变情况。方法对1个AREP家系2例患者的临床资料进行回顾性分析，同时应用DNA直接测序、限制性内切酶酶切、荧光半定量PCR等技术方法进行parkin基因的突变分析。结果该家系共2例患者，发病年龄轻，分别为22岁和23岁；病情进展相对缓慢，症状有波动，呈晨轻暮重，腱反射活跃；对小剂量多巴制剂反应良好。基因突变发现该家系存在parkin基因的复合杂合突变（第7号外显子杂合的G859T和第4外显子杂合缺失突变），其中G859T为新报道的点突变。结论我国的AREP家系有帕金森病的一般临床表现，又有其独特的临床特征，存在parkin基因的突变。     

帕金森病痴呆

帕金森病（parkinson disease，PD）是一种常见的神经退行性疾病，主要临床特征有震颤、肌强直、运动减少以及姿势异常等运动障碍，很多患者还常伴有认知功能损害，严重影响其社会功能和生活质量，相当一部分患者在病程中逐渐进展成痴呆，临床上称之为帕金森病痴呆（parkinson disease dementia，PDD）。由于PDD与路易体痴呆（dementia with lewy bodies，DLB）在临床表现和发病机制以及病理等方面存在着交叉和重叠，使得有关PDD的研究更加复杂化。本文就PDD发生率、病理生化改变、诊断与鉴别诊断及治疗等方面的研究进展进行综述。     

三个常染色体隐性遗传性青少年型帕金森综合征家系的基因型与表型分析

目的探讨常染色体隐性遗传性青少年型帕金森综合征(autosomal recessive juvenile parkinson-ism,AR-JP)parkin基因的突变及临床特征。方法应用聚合酶链反应、DNA测序和限制性核酸内切酶酶切等技术对15个AR-JP家系先证者的parkin基因进行突变研究。结果发现3个家系有parkin基因的突变,其中2个家系含parkin基因的杂合缺失突变,分别为第2外显子的202-203delAG及第9外显子的1069-1074delGTGTCC;另一家系发现一个杂合点突变,为第12外显子的1422(T→C)。其中1069-1074delGTGTCC和1422(T→C)为新的突变。3个家系共6名患者,发病年龄18~31岁,平均25.2±5.7岁;病情进展慢,腱反射活跃或亢进、症状波动常见;对小剂量多巴制剂反应良好。结论我国的AR-JP家系存在parkin基因的突变;含parkin基因突变的AR-JP患者有帕金森病的一般临床表现,又有其独特的临床特征。