Measuring neurodegeneration in spinocerebellar ataxias

Written by Dr Hannah K Shorrock Edited by Dr. Maria do Carmo Costa

Neurofilament light chain predicts cerebellar atrophy across multiple types of spinocerebellar ataxia

A team led by Alexandra Durr at the Paris Brain Institute identified that the levels of neurofilament light chain (NfL) protein are higher in SCA1, 2, 3, and 7 patients than in the general population. The researchers also discovered that the level of NfL can predict the clinical progression of ataxia and changes in cerebellar volume. Because of this, identifying patients’ NfL levels may help to provide clearer information on disease progression in an individualized manner. This in turn means that NfL levels may be useful in refining inclusion criteria for clinical trials.

The group enrolled a total of 62 SCA patients with 17 SCA1 patients, 13 SCA2 patients, 19 SCA3 patients, and 13 SCA7 patients alongside 19 age-matched healthy individuals (“controls”) as part of the BIOSCA study. Using an ultrasensitive single-molecule array, the group measured NfL levels from blood plasma that was collected after the participants fasted.

The researchers found that NfL levels were significantly higher in SCA expansion carriers than in control participants at the start of the study (baseline). In control individuals, the group identified a correlation between age and NfL level that was not present among SCA patients. This indicates that disease stage rather than age plays a larger role in NfL levels in SCAs.

Looking at each disease individually, the group was able to generate an optimal disease cut-off score to differentiate between control and SCA patients. By comparing the different SCAs, the research group found that SCA3 had the highest NfL levels among the SCAs studied. As such, SCA3 had the most accurate disease cut-off level with 100% sensitivity and 95% specificity of defining SCA3 patients based on NfL levels.

Artist's drawing of a group of Laboratory Scientist sturying a larger-than life human brain
A team from the Paris Brain Institute identify that SCA1, 2, 3, and 7 patients have higher levels of NfL protein than the general population. Photo used under license by ivector/Shutterstock.com.
Continue reading “Measuring neurodegeneration in spinocerebellar ataxias”

Snapshot: What is Riluzole?

Riluzole, often sold under the trade name Rilutek, is a medication used for the treatment of amyotrophic lateral sclerosis (ALS). ALS is a fatal neurodegenerative disease that mainly affects neurons controlling muscle movements. The drug was approved by the FDA (1995), Health Canada (1997), and the European Commission (1996). It helps slow down disease progression and may extend patient survival. The medication is available in tablet and liquid form, generally well-tolerated. There are sometimes mild side effects, which may include loss of appetite, nausea, and abdominal pain.

Close up of a woman taking a pill with water
Riluzole has been used to treat ALS, and research has suggested it may also help with forms of ataxia. It is currently being tested in clinical trials. Photo used under license by fizkes/Shutterstock.com.

How does it work?

Exactly how Riluzole slows disease progression remains unknown. However, it is thought that its neuroprotective effects likely stem from reducing a phenomenon known as excitotoxicity.

Neurons communicate with each other through chemical messengers called neurotransmitters. The signalling of these messengers needs to be tightly controlled. Too little or too much signaling will disrupt normal functions of the brain and cause damage to cells. Excitotoxicity is the result of excessive signaling by glutamate, one of the most abundant neurotransmitters in the brain. Glutamate is also associated with many neurodegenerative diseases.

Riluzole prevents this excessive signaling through several mechanisms. It is hypothesized that the effectiveness of riluzole in ALS treatment is the result of this neuroprotective property.

Riluzole for Ataxia

The neuroprotective function of riluzole has been a point of interest for the treatment of other neurodegenerative diseases since its approval. Multiple clinical trials have been conducted for patients with neurodegenerative diseases including Parkinson’s disease, Huntington’s disease, multiple system atrophy, and ataxia.

In 2010, a pilot trial was conducted with 40 patients with cerebellar ataxia who showed a lower level of motor impairment, measured by the International Cooperative Ataxia Rating Scale. A follow-up trial was then performed in 2015 for 55 patients with spinocerebellar ataxia (SCA) or Friedreich’s ataxia. Similarly, patient impairment had improved by an alternative measurement using the Scale for the Assessment and Rating of Ataxia. These findings indicate the possibility of riluzole being an effective treatment for cerebellar ataxia. However, more long-term studies and ones that are specific to different types of SCA need to be conducted to confirm the results.

Riluzole in Development

Even though riluzole was discovered more than 25 years ago, variations of the drug are still under development. As ALS often affects a patient’s ability to swallow, a new formulation of riluzole that is absorbed by placing it under your tongue is being developed under the name Nurtec.

Another prodrug version of riluzole, named Troriluzole (BHV-4157), may be better absorbed by the body with fewer side effects. Troriluzole is currently in phase three clinical trial for patients with different types of SCA. The trial is expected to be complete by November 30, 2021, and will hopefully provide more insight into the effectiveness of Troriluzole in SCA patients.

If you would like to learn more about Riluzole, take a look at these resources by the ClinicalTrials.gov and the Mayo Clinic.

Snapshot written by Christina (Yi) Peng and edited by Terry Suk.

Spotlight: The Truant Lab

Truant lab logo of a brain. "Bright minds fixing sick brains"

Principal Investigator: Dr. Ray Truant

Location: McMaster University, Hamilton, Ontario, Canada

Year Founded: 1999

What disease areas do you research?

  • SCA1
  • SCA7
  • Huntington’s Disease
  • Parkinson’s Disease

What models and techniques do you use?

  • Human cell biology
  • High content screening
  • Biophotonics
  • Microscopy

Research Focus

What is your research about?

We are looking into the role of oxidative DNA damage as a trigger to diseases like ataxia and neurodegeneration. We examine the roles of the disease proteins (ataxin-1, ataxin-7, etc,) and genes which modify or change disease that are involved with DNA damage repair.

Why do you do this research?

We are looking at what triggers the very first steps of disease. If we can understand this, we can design a treatment to stop it from happening in the first place.

Research team of 10 holding a sign which reads "We are Ataxia Aware"
Group picture of the Truant Laboratory celebrating International Ataxia Awareness Day 2019.

Fun Lab Fact

All our fridges in the laboratory are named after Game of Thrones characters! (We have several proud nerds in the lab)

For More Information, check out the Truant Lab Website!

We have an open lab notebook blog where our post-doctoral fellow Dr. Tam Maiuri post updates on her experiments in real-time! We plan to launch an ataxia open notebook in Winter 2021.


Written by Ray Truant, Edited by Celeste Suart

Finding New Off-Balance Protein Networks in SCA7

Written by Frida Niss Edited by Dr. Siddharth Nath

Can neurodegeneration in SCA7 in part be due to faulty calcium homeostasis in the cerebellum?

Polyglutamine diseases are caused by an increase in the length of CAG repeats within a specific gene. The mutation for spinocerebellar ataxia type 7 (SCA7) was discovered more than two decades ago, but many of the details surrounding how the mutation actually causes disease remain fuzzy. We know that the increased repeat length in the gene makes it difficult for the resulting protein to arrange or fold itself properly. We also know that the mutated protein binds to itself and to other proteins in an unusual way. It building up large deposits of seemingly useless debris in the cell, called ‘aggregates’. However, the exact pathways this leads to cell death, and subsequently neurodegeneration, is not completely clear.

There is currently research underway to directly target and inhibit the repeat proteins themselves. However, finding other pathways in the cell that are easier to target with medication is also a priority. In this research, Stoyas and her colleagues wanted to find out more about which cellular pathways are disturbed in the polyglutamine disease SCA7.

A pair of hands in plastics gloves writes down scientific findings on a chart. Beside the hands are racks of tubes with lables of different samples and dates collected.
A laboratory scientist documents research findings. Image courtesy of the National Institutes of Health on Flickr.
SCA7 mice have disordered productions of proteins that help balance ions concentrations

In SCA7, the protein that carries the mutation is Ataxin-7. Ataxin-7 participates in transcription through complexes of proteins that together can change some signalling particles on the DNA. Depending on what signalling particles are attached to a certain gene, the gene is either transcribed and made into a protein, or “silenced” and skipped over. In the case of Ataxin-7 and its complex, they work together to cause transcription of genes. One of the main theories of how a polyglutamine mutation can be toxic in Ataxin-7 is that the mutation disturbs Ataxin-7’s normal function within this transcription activating complex. Instead of being regular and orderly, ataxin-7 starts acting unpredictably. Some things that should be transcribed are not, some that shouldn’t be transcribed are.

Continue reading “Finding New Off-Balance Protein Networks in SCA7”

Snapshot: What does dominant ataxia mean?

Ataxias can occur due to a multitude of reasons. One way a patient might acquire ataxia is from an accident or an injury – not as a result of genetics. On the other hand, a patient could also inherit a specific mutation (a genetic defect, in other words) from one or both of their parents. In this case, the ataxia is called “hereditary.” Hereditary ataxias can be further classified as either “dominant” or “recessive.”

What is a dominantly-inherited disorder?

Most genes in our body have two copies: one that we inherit from our mother, and one that we inherit from our father. Dominantly-inherited disorders are diseases in which a mutation in just one copy of a gene is enough to cause disease. When both copies of a gene need to be mutated to cause symptoms, the disorder is known as “recessive” (learn more in the Snapshot on recessive ataxias). For a patient with a dominantly-inherited ataxia, this means that there is a 1-in-2 chance that their children will inherit the disease-causing mutation (assuming that their spouse is unaffected). If both spouses are affected by the same dominantly-inherited disease, this chance increases to 3-in-4. In cases where the child inherits both mutant copies of the gene, the symptoms are often more severe than when a single copy is inherited.

Visual depiction of paragraph above
How dominant disorders are inherited. Illustration by Larissa Nitschke, created with BioRender.

Which ataxias are dominantly-inherited?

The most well-known ataxias with dominant inheritance patterns are the Spinocerebellar Ataxias (SCAs), such as SCA1, SCA2, SCA3, SCA6, and SCA7. Each disease is caused by defects in a different gene. Due to the high similarity in symptoms among all ataxias, genetic testing is often required to determine the exact gene mutation and type of ataxia a patient has.

How can a patient prevent passing on a dominantly-inherited disorder to their children?

There are multiple options to prevent passing on the disease to your child if you are affected by a hereditary ataxia. One potential option is to perform in vitro fertilization (IVF), a technology that is used the conceive embryos outside the human body. The embryos can be screened for genetic mutations, allowing only the healthy embryos to be implanted into the uterus.

If you are affected by a hereditary ataxia and want to prevent having a child with ataxia, it is recommended to talk to your physician and genetic counselor regarding reproductive options.

If you would like to learn more about in vitro fertilization and embryo screening, please take a look at these resources by the University of Pennsylvania. If you want to learn more about dominant ataxia, take a look at these resources by the National Organization for Rare Disorders and Ataxia Canada.

Snapshot written by Larissa Nitschke and edited by Dr. Marija Cvetanovic.