Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing degeneration of upper and lower motor neurons. Most ALS cases are sporadic; only 6% are associated with mutations in Cu, Zn superoxide dismutase (SOD1). It is believed, however, that sporadic and familiar forms of ALS share a common mechanism, where SOD1 plays an important role: SOD1 knockout mice do not develop ALS, whereas the overexpression of human SOD1 in mice produces ALS-like symptoms. Increasing evidence suggest that the SOD1 structure gains cytotoxic properties, but detailed description of the toxic species is missing. This thesis work is focused on understanding how structural and dynamic properties of SOD1 change along its folding free-energy landscape and indicates the structural hot-spots from where the cytotoxic species may originate. Thus, binding of the zinc controls folding, stability and turnover of SOD1: (i) miscoordination of Zn2+ by the Cu-ligands speeds up folding of the SOD1 core structure, however, it stabilizes SOD1 in a state where both active-site loops IV and VII are unfolded, (ii) coordination of Zn2+ in the Zn-site, induces the folding of loop VII and stabilizes the native and  functional fold of both active-site loops and (iii) the tremendous stability gain due to Zn-site metallation corresponds to a folded state’s lifetime of  &gt; 100 years, thus the cellular lifetime of SOD1 is likely controlled by Zn2+ release, which again is coupled to opening of active-site loops. Hence the active-site loops IV and VII stand out as critical and floppy parts of the SOD1 structure. Moreover, a number of ALS-associated mutations, benign to apo-SOD1 stability, are shown here to affect integrity of active-site loops in holo-SOD1, which, in turn, increases population of SOD1 species with these loops disorganized. Finally, the close relation between SOD1 and Zn2+ can also act in the reverse direction: a perturbed folding free-energy landscape of SOD1 can disturb Zn2+ homeostasis. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.</p>

Bakgrund: Amyotrofisk lateralskleros är en neurologisk sjukdom som i Sverige drabbar cirka 200 personer varje år. Sjukdomen är progressiv och gör att den drabbade personen förlorar kroppsliga funktioner och avlider oftast inom fem år. Att arbeta med personer som har en dödlig sjukdom kräver inte bara kunskap om sjukdomen utan också om hur personer upplever att leva med sjukdomen. Syfte: Syftet var att beskriva personers upplevelser av att leva med Amyotrofisk lateralskleros. Metod: En allmän litteraturstudie baserad på nio vetenskapliga artiklar genomfördes. Analysen gjordes genom en manifest innehållsanalys. Resultat: Fem kategorier presenterar upplevelserna av att leva med ALS. Dessa benämns En kropp i förändring, Relationer till andra påverkas, Hopp &amp; hopplöshet, Kontroll &amp; kontrollförlust samt Existensen utmanas. Slutsats: Personer som lever med ALS upplever ofta negativa känslor vilket påverkade deras livskvalitet i negativ riktning. Det uppmärksammades i mindre utsträckning även positiva känslor i samband med sjukdomen. För att kunna tillgodose en tillfredställande vård med grund i de individuella upplevelserna finns det behov av mer forskning inom ämnet. Genom mer kunskap om hur sjukdomen upplevs ökar förutsättningarna för personal att möta dem i deras individuella behov och därmed kan individens välbefinnande under sjukdomsförloppet öka. / Background: Amyotrophic lateral sclerosis is a neurological disorder and in Sweden it affects about 200 people each year. The disease is progressive and makes the affected person lose bodily functions and usually dies within five years. Working with people who have a terminal illness requires not only knowledge of the disease, but also about how people experience living with the disease. Objective: The objective was to describe people's experiences of living with Amyotrophic lateral sclerosis. Method: A general literature review based on nine scientific articles was conducted. The analysis was done by a manifest content analysis. Results: Five categories presents the experiences of living with ALS. These are called A body in change, Relationships with others are affected, Hope &amp; hopelessness, Control &amp; loss of control and The existence challenged. Conclusion: People living with ALS often experience negative emotions which affected their quality of lifein a negative direction. Positive emotions associated with the disease was noticed in a lesser extent. To be able to reach a satisfactory care with basis in the individual experiences, there is a need for more research on the subject. More knowledge about how the disease is experienced increase the chances for the staff to meet them in their individual needsand therefore, the individual's well-being during the disease progression increase.

Amyotrophic lateral sclerosis (ALS) is a devastating and progressive disease that results in selective death of motor neurons in the cortex, brain stem and spinal cord. ALS is the most common adult onset motor neuron disease resulting in paralysis and death, commonly within 2 – 5 years of symptom onset, yet there remains no effective treatment for the disease. The majority of ALS cases show no hereditary link (referred to as sporadic ALS or sALS); however, ~10% of cases show a dominant pattern of inheritance (referred to as familial ALS or fALS). Over 170 different mutations in human Cu, Zn superoxide dismutase (SOD1) have been identified to account for ~20% of fALS. SOD1 is a ubiquitously expressed homodimeric antioxidant enzyme. It is widely accepted that mutations in SOD1 result in a gain of toxic function, rather than a loss of native function. A prominent hypothesis for the gain of function is the formation of protein aggregates, which have been shown to be toxic to motor neurons. Protein aggregation is observed in a number of neurodegenerative disorders, including Alzheimer’s, Huntington’s and Parkinson’s disease. Each β-rich monomer of SOD1 binds one catalytic Cu ion and one structural Zn ion. The metallation state of SOD1 significantly influences the structure, dynamics, activity, stability, and aggregation propensity. A similar trend has been observed in a number of metalloenzymes and as such a method to rapidly and accurately quantitate metal ions in proteins is of great importance. Here a review of previous methods using the chromogenic chelator PAR to quantitate metal ions in proteins is presented. Three methods are assessed for their accuracy, precision and ease of use. The methods vary in accuracy, which is highest only under the specific conditions it was designed for. A robust new method is presented here that uses spectral decomposition software to accurately resolve the absorption bands of Cu and Zn with high precision. This method may be successful as a more general method for metal analysis of proteins allowing for the quantitation of additional metal combinations (e.g. Zn/Co, Ni/Cu, Ni/Co). Thermodynamic stability has widely been implicated as playing a major role in the aggregation of globular proteins. Metal loss significantly decreases the global stability of SOD1 and as such metal-depleted (apo) forms of SOD1 have largely been the focus of SOD1 investigations. Recent studies, however, suggest that complete global unfolding is not required for protein aggregation. Local unfolding has been investigated and proposed to be sufficient to induce irreversible protein aggregation in the absence of global destabilization. Enhanced local unfolding has been observed in a number of disease-related proteins. Since SOD1 aggregation may occur from partially unfolded forms, NMR temperature dependence studies have been carried out on the most abundant form of SOD1 in vivo, the fully metallated (holo) dimer, to provide a residue specific picture of subglobal structural changes in SOD1 upon heating. Amide proton (N1H) temperature coefficients report on the hydrogen bonding status of a protein. A curved N1H temperature dependence indicates that the proton populates an alternative conformation generally within 5 kcal/mol of the ground state. NMR temperature dependence studies of pseudoWT indicate that the thermal unfolding process of holo pWT begins with “fraying” of the structure at its periphery. In particular, increased disorder is observed in edge strands β5 and β6, as well as surrounding the zinc binding site. The local stability and conformational heterogeneity of ALS-associated mutants G93A, E100G and V148I was also assessed. All mutants display similar local unfolding patterns to pseudoWT, but also show distinct differences in the hydrogen bonding network surrounding the mutation site. Interestingly, each mutation regardless of its structural context results in altered dynamics at the β-barrel plug, a key stabilizing element in SOD1. A significant proportion of residues (~30%) access alternative states in both pseudoWT and mutants, however, overall mutants appear to be able to access higher free energy alternative states compared to pseudoWT. The implications of these results for the mechanism of protein aggregation and disease are discussed.

Bakgrund: Amyotrofisk lateralskleros är en neurologisk sjukdom som drabbar kroppens motoriska nervceller och leder till en försvagning av kroppens muskler. I Sverige drabbas årligen ca 200 personer av ALS. Sjukdomen är obotlig och den drabbade avlider oftast inom tre år efter sjukdomens debut. Syfte: Syftet var att beskriva personers upplevelser av att leva med ALS. Metod: En allmän litteraturstudie baserad på 12 vetenskapliga artiklar. Resultat: Två huvudkategorier bildades; oro och ångest över att leva med en obotlig sjukdom; att finna mening i livet trots sjukdomen. Slutsats: Personer med sjukdomen ALS upplever i större utsträckning känslor av sorg, oro och skuld, vilket mer eller mindre påverkar deras livskvalitet på ett negativt sätt. Sjuksköterskans uppgift är att vara öppensinnad, observant och lyhörd i mötet med personer som är i behov av fysisk såväl som psykisk omvårdnad varpå behovet av kunskap inom ämnet ökar i samband med personernas individuella behov. Mer ämnesrelaterad forskning, exempelvis i form av intervjuer med åldersgrupperade patienter, hade bidragit till djupare kunskaper om personernas egna upplevelser kring sjukdomen. Resultatet av vidare forskning kommer att bidra till bättre förutsättningar för sjuksköterskan att vårda denna patientgrupp, och kan således bidra till att personer med ALS får ett bättre liv. / Background: Amyotrophic lateral sclerosis is a neurological disorder that affects the body’s motor nerve cells and leads to a progressive weakening of the muscles. In Sweden, about 200 people are diagnosed with ALS annually. Patients usually die of this incurable disease within three years of onset. Purpose: The aim was to describe people’s experiences of living with ALS. Method: A literature review based on 12 scientific articles. Results: Two main categories were identified; worry and anxiety over living with an incurable disease; finding meaning in life despite the disease. Conclusion: People with ALS experience sadness, anxiety and guilt; this frequently has a negative impact upon the patient’s quality of life. The nurse’s role is to be open-minded, observant and responsive in meeting people who are in need of physical and mental nursing whereupon the need for knowledge of the subject increases with the individual’s needs. Further research, perhaps by interviewing ALS patients related to age, will lead to a deeper knowledge of the individual’s personal experiences surrounding the disease. The result of such further research will contribute better conditions for the nurse to care for this patient group, which may help people with ALS to a better life.

Amyotrophic lateral sclerosis (ALS) is a devastating motor neuron disease which results from the degeneration of upper and lower motor neurons in the brainstem, spinal cord and motor cortex. Tragically there is no treatment to prevent ALS. The drug Riluzole acts to delay progression, but only by a month or so in this disease that has a survival length of three to five years. The identification of genes that are mutated in patients with ALS would help devise novel therapeutic strategies as much remains to be discovered about the genetics of ALS. Familial forms of the disease account for only 5-10% of patients. Among these familial cases, about 15-20% are caused by mutations in the zinc/copper superoxide dismutase gene, but the genetic basis of the remaining familial cases and the many sporadic cases continues to be largely unknown. / Altogether, the results presented in this thesis came from the use of several strategies to establish the genetic cause of ALS and the related motor neuron disorders like hereditary spastic paraplegia (HSP) and primary lateral sclerosis (PLS). A concerted and collaborative effort was put forth to identify the gene causative for ALS3 on chromosome 18. In addition, a recently reported locus has been confirmed on chromosome 9p for patients that present both ALS and frontotemporal dementia. The major finding involves the discovery of eight mutations in the TARDBP gene in nine patients with sporadic and familial ALS. Furthermore, a large association study evaluated the role of common polymorphisms in the paraoxonase gene cluster in susceptibility to the development of ALS. In the analysis of upper motor neuron diseases, mutations in a novel gene, KIAA0196, were identified for the HSP locus SPG8 on chromosome 8. Finally, the first locus for PLS was discovered on the p-arm of chromosome 4 following genome scan analysis of a large Quebec family with PLS. / These genetic discoveries all contributed novel advances to the field of motor neuron disorders. As more is elucidated regarding the biochemical function of these the proteins encoded by these genes, a more comprehensive picture of ALS and other motor neuron disorders will hopefully emerge.

Doctor of Philosophy / Abstract Neurodegenerative disorders are a diverse group of disorders that affect specific subsets of neurons. Motor neuron diseases, neurodegenerative disorders of motor neurons, are seen commonly as sporadic cases and less frequently as familial disease forms. The familial forms show genetic and phenotypic heterogeneity. Clinically motor neuron diseases may be seen as rapidly progressive disorders like amyotrophic lateral sclerosis, ALS or slowly progressive disorders like hereditary motor neuropathies, HMN. The only proven causes for motor neuron diseases are gene mutations that lead to motor neuron degeneration in familial disease forms. Only some of these genes have been identified and have contributed greatly to our understanding of the neurobiology of familial and sporadic disease forms. Identification of additional disease causing genes would help enhance our knowledge of the pathophysiological mechanisms underlying all forms of motor neuron disorders, which would lead to early diagnoses, effective prophylaxis and efficient therapies for these disorders. This study aimed to find gene mutations that cause rapid and slowly progressive familial motor neuron disorders in Australian families and to determine their relevance to sporadic forms of motor neuron disease. The familial forms of ALS show reduced disease penetrance, that is, not all gene mutation carriers manifest the disease. This study examines ALS penetrance in a group of Australian families. The most frequently observed mutations in ALS families are cytosolic superoxide dismutase/SOD1 gene mutations. In a collection of ALS families in our centre, families without the common SOD1 gene mutations were genotyped for other ALS genes and loci and studied using genetic linkage and haplotype analyses. Studies in a large Australian ALS family further confirmed genetic heterogeneity in non-SOD familial ALS, all known autosomal dominant ALS genes and chromosomal loci were excluded as cause of disease in this family. Such families can be studied further to identify additional disease genes and loci mapped in other ALS families. These families represent powerful resources for identification of additional ALS genes. Identifying the pathogenic genes in families with reduced disease penetrance may be more relevant to sporadic forms of disease. dHMN is a chronic neurodegenerative disorder predominantly affecting motor neurons. In a large Australian dHMN family, all the known dHMN genes and chromosomal loci were excluded as cause of disease. A genome wide microsatellite screen was performed in this family and genetic linkage was established to a novel 12.98 Mb locus on chromosome 7q34.2-q36. Candidate genes in this large interval will be screened based on their function and expression profile. Identification of a new dHMN locus provides the basis for future identification of a novel gene involved in motor neuron degeneration. Genes in dHMN have been shown to be pathogenic in ALS and Charcot Marie Tooth syndromes. The new locus for dHMN mapped in this project would lead to identification of a novel dHMN gene, which may elucidate the pathogenesis underlying a wide range of neurodegenerative disorders.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 171-189).

Thesis (Ph. D.)--University of Sydney, 2007. / Title from title screen (viewed Apr. 12, 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Medicine. Includes bibliography. Also issued in print.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb 19, 2009). Includes bibliographical references (p. 114-124).