The Drosophila mutant fumble has a defect in mitochondrially targeted pantothenate kinase (PANK) and exhibits a movement disorder in the females. The human disease pantothenate kinase associated neurodegeneration (PKAN) has the same genetic defect and a neurodegenerative phenotype as well as iron accumulation in the brain. We have found that fumble females accumulate almost 2 fold more iron in the heads than wildtype. Dietary iron supplementation increases the iron accumulation in the heads further. The small isoform of malvolio (MVL), a homologue of mammalian NRAMP iron transporters, is expressed in the heads of flies. Its expression is upregulated in the fumble females, as well as in dietary iron supplemented wildtype flies. Unlike in the wildtype, dietary iron supplementation leads to a downregulation of MVL in the fumble flies. Although iron levels were elevated in fumble, ferritin expression was relatively unchanged and remained unchanged in the heads of fumble and wildtype with dietary iron supplementation. <p>The Drosophila mutant malvolio was used to determine how iron metabolism is affected when the MVL gene is defective. Iron levels were unchanged in malvolio relative to its parental strain (w1118) with or without dietary iron supplementation. Despite similar iron levels, a small decrease in ferritin expression was found in malvolio relative to w1118, and dietary iron increased ferritin expression in malvolio. However ferritin expression decreased in the parental strain of malvolio after iron supplementation. <p>Most of the iron in the Drosophila heads was in the form of goethite and ferrihydrite. The presence of iron oxides implies that this iron is in a mineralized storage form, likely ferritin. Dietary iron supplementation induced the appearance of ferric phosphates in fumble, malvolio, and wildtype. The subcellular location of this iron is unknown. It may be non-transferrin bound iron in the hemolymph, or a cytosolic intermediate in the labile iron pool. Also of note was the presence of transferrin-bound iron in wildtype heads on normal diet that was not seen after iron supplementation or in the heads of the fumble mutant. The presence in fumble of the kind of ferrihydrite characteristic of the mitochondrial protein frataxin may indicate that iron is accumulating in mitochondria.<p>The upregulation of MVL in the fumble mutant is of significant interest because it is the first protein involved in iron metabolism found to be altered with mitochondrial PANK deficiency. A disruption in MVL could be relevant to the brain iron accumulation in fumble and could be a treatment target for human PKAN.

The Drosophila mutant fumble has a defect in mitochondrially targeted pantothenate kinase (PANK) and exhibits a movement disorder in the females. The human disease pantothenate kinase associated neurodegeneration (PKAN) has the same genetic defect and a neurodegenerative phenotype as well as iron accumulation in the brain. We have found that fumble females accumulate almost 2 fold more iron in the heads than wildtype. Dietary iron supplementation increases the iron accumulation in the heads further. The small isoform of malvolio (MVL), a homologue of mammalian NRAMP iron transporters, is expressed in the heads of flies. Its expression is upregulated in the fumble females, as well as in dietary iron supplemented wildtype flies. Unlike in the wildtype, dietary iron supplementation leads to a downregulation of MVL in the fumble flies. Although iron levels were elevated in fumble, ferritin expression was relatively unchanged and remained unchanged in the heads of fumble and wildtype with dietary iron supplementation. <p>The Drosophila mutant malvolio was used to determine how iron metabolism is affected when the MVL gene is defective. Iron levels were unchanged in malvolio relative to its parental strain (w1118) with or without dietary iron supplementation. Despite similar iron levels, a small decrease in ferritin expression was found in malvolio relative to w1118, and dietary iron increased ferritin expression in malvolio. However ferritin expression decreased in the parental strain of malvolio after iron supplementation. <p>Most of the iron in the Drosophila heads was in the form of goethite and ferrihydrite. The presence of iron oxides implies that this iron is in a mineralized storage form, likely ferritin. Dietary iron supplementation induced the appearance of ferric phosphates in fumble, malvolio, and wildtype. The subcellular location of this iron is unknown. It may be non-transferrin bound iron in the hemolymph, or a cytosolic intermediate in the labile iron pool. Also of note was the presence of transferrin-bound iron in wildtype heads on normal diet that was not seen after iron supplementation or in the heads of the fumble mutant. The presence in fumble of the kind of ferrihydrite characteristic of the mitochondrial protein frataxin may indicate that iron is accumulating in mitochondria.<p>The upregulation of MVL in the fumble mutant is of significant interest because it is the first protein involved in iron metabolism found to be altered with mitochondrial PANK deficiency. A disruption in MVL could be relevant to the brain iron accumulation in fumble and could be a treatment target for human PKAN.

Neurodegeneration with Brain Iron Accumulation (NBIA) disorders, such as Phospholipase A2G6-Associated Neurodegeneration (PLAN) and Pantothenate Kinase-Associated Neurodegeneration (PKAN), are a group of rare early-onset, genetic disorders characterized by neurodegeneration and iron accumulation inside of the basal ganglia (BG), which is accompanied by progressive motor symptoms. In order to address the limitations in available models of NBIA, a B6.C3-Pla2g6m1J/CxRwb mouse model of PLAN was characterized. This model demonstrated key hallmarks of the disease presentation in NBIA, including a severe and early-onset motor deficit, neurodegeneration inside of the substantia nigra (SN) including a loss of dopaminergic function and the formation of abnormal spheroid inclusions as well as iron accumulation. The capture of these hallmarks of NBIA makes this an ideal animal research model for NBIA. Additionally, exploration of candidate systemic biomarkers of NBIA was performed in a case study of a patient with PLAN and in a cohort of 30 patients with PKAN. These investigations demonstrated reductions in transfer and slight, but not significant elevations in soluble transferrin receptor. No significant difference was seen in serum iron parameters. A systemic disease burden including chronic oxidative stress; elevated malondialdehyde, and inflammation; elevated C-reactive protein (CRP), IL-6 and TNFα was noted in both investigations. A number of candidate protein biomarkers including: fibrinogen, transthyretin, zinc alpha-2 glycoprotein and retinol binding protein were also identified. These markers correlated with measures of the severity of iron loading in the globus pallidus (GP); based on R2* magnetic resonance imaging (MRI) and the severity of motor symptoms (Barry-Albright Dystonia Rating Scale) making them potential candidates markers of dysfunction in NBIA. In the patient with PLAN, 37 weeks of therapy with the iron chelator deferiprone (DFP) as well as 20 months of therapy with the antioxidants alpha lipoic acid (ALA) and n-acetylcysteine (NAC) were efficacious in reducing the systemic oxidative and inflammatory disease burden, but it did not significantly alter the progression of the disease. In the antioxidant therapy, this efficacy was primarily due to ALA. When the cohort of patients with PKAN were treated with DFP for 18 months it was highly efficacious in lowering brain iron accumulation in the GP. No significant reduction in the speed of disease progression was seen in DFP treated patients compared to placebo based on initial analysis. Similar to the PLAN patient, DFP also mitigated the systemic disease burden in PKAN patients. In both cases DFP was well tolerated and had minimal impact on serum iron levels, TIBC and transferrin saturation. Collectively these investigations provide valuable insights into disease progression in NBIA. They also provide tools to aid further investigations in NBIA. These are provided in the form of a well-characterized B6.C3-Pla2g6m1J/CxRwb model of PLAN, which robustly captures the disease presentation seen in patients, as well as a panel of systemic blood-based markers of disease burden in NBIA and candidate markers of dysfunction in NBIA. These markers were used to assess two novel therapies in NBIA chelation with DFP and antioxidant therapy with ALA and NAC. / Graduate / 2019-04-19