Abstract
Duplication of the gene encoding the peripheral myelin protein of 22 kDa (PMP22) underlies the most common inherited neuropathy, Charcot-Marie-Tooth 1A (CMT1A)1,2,3, a disease without a known cure4,5,6. Although demyelination represents a characteristic feature, the clinical phenotype of CMT1A is determined by the degree of axonal loss, and patients suffer from progressive muscle weakness and impaired sensation4,7. CMT1A disease manifests within the first two decades of life8,9, and walking disabilities, foot deformities and electrophysiological abnormalities are already present in childhood7,8,9,10,11. Here, we show in Pmp22-transgenic rodent models of CMT1A that Schwann cells acquire a persistent differentiation defect during early postnatal development, caused by imbalanced activity of the PI3K-Akt and the Mek-Erk signaling pathways. We demonstrate that enhanced PI3K-Akt signaling by axonally overexpressed neuregulin-1 (NRG1) type I drives diseased Schwann cells toward differentiation and preserves peripheral nerve axons. Notably, in a preclinical experimental therapy using a CMT1A rat model, when treatment is restricted to early postnatal development, soluble NRG1 effectively overcomes impaired peripheral nerve development and restores axon survival into adulthood. Our findings suggest a model in which Schwann cell differentiation within a limited time window is crucial for the long-term maintenance of axonal support.
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Acknowledgements
We thank U. Suter (Eidgenössische Technische Hochschule Zurich) for providing Pmp22-deficient mice and C. Huxley (Imperial College School of Medicine, London) for providing Pmp22-transgenic mice. We are grateful to T. Durkaya, C. Maack, A. Fahrenholz, T. Freerck, M. Wehe and A. Wohltmann for technical support. We thank W. Möbius and T. Ruhwedel for help with electron microscopy. This work was supported by grants of the German Research Foundation (DFG) Research Center Molecular Physiology of the Brain, European Commission FP7-201535 (Neuron-Glia Interactions in Nerve Development and Disease) to K.-A.N. M.W.S. and R.F. were supported by the German Ministry of Education and Research (BMBF, FKZ 01ES0812 to M.W.S.). M.W.S. was also supported by the Association Francaise contre les Myopathies (NR 15037) and holds a Heisenberg Professorship granted by the DFG (GZ: SE 1944/1-1). K.-A.N. holds a European Research Council Advanced Investigator Grant.
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R.F. and R.M.S. designed the study, performed experiments and wrote the manuscript. A.K., T.P., L.M.R., T.K., T.A.M.A. and N.K. contributed to experiments. L.H. and D.C. performed threshold electrotonus measurements. C.S. and W.B. contributed to immunohistochemistry and discussions. M.W.S. and K.-A.N. contributed to the manuscript and supervised the project.
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Fledrich, R., Stassart, R., Klink, A. et al. Soluble neuregulin-1 modulates disease pathogenesis in rodent models of Charcot-Marie-Tooth disease 1A. Nat Med 20, 1055–1061 (2014). https://doi.org/10.1038/nm.3664
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DOI: https://doi.org/10.1038/nm.3664
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