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Chronic cyclodextrin treatment of murine Niemann-Pick C disease ameliorates neuronal cholesterol and glycosphingolipid storage and disease progression.
[gm1 gangliosidosis]
Niemann-
Pick
type
C
(
NPC
)
disease
is
a
fatal
neurodegenerative
disorder
caused
most
commonly
by
a
defect
in
the
NPC
1
protein
and
characterized
by
widespread
intracellular
accumulation
of
unesterified
cholesterol
and
glycosphingolipids
(
GSLs
)
.
While
current
treatment
therapies
are
limited
,
a
few
drugs
tested
in
Npc
1
(
-
/
-
)
mice
have
shown
partial
benefit
.
During
a
combination
treatment
trial
using
two
such
compounds
,
N-
butyldeoxynojirimycin
(
NB-DNJ
)
and
allopregnanolone
,
we
noted
increased
lifespan
for
Npc
1
(
-
/
-
)
mice
receiving
only
2
-
hydroxypropyl-
beta
-cyclodextrin
(
CD
)
,
the
vehicle
for
allopregnanolone
.
This
finding
suggested
that
administration
of
CD
alone
,
but
with
greater
frequency
,
might
provide
additional
benefit
.
Administration
of
CD
to
Npc
1
(
-
/
-
)
mice
beginning
at
either
P
7
or
P
21
and
continuing
every
other
day
delayed
clinical
onset
,
reduced
intraneuronal
cholesterol
and
GSL
storage
as
well
as
free
sphingosine
accumulation
,
reduced
markers
of
neurodegeneration
,
and
led
to
longer
survival
than
any
previous
treatment
regime
.
We
reasoned
that
other
lysosomal
diseases
characterized
by
cholesterol
and
GSL
accumulation
,
including
NPC
disease
due
to
NPC
2
deficiency
,
GM
1
gangliosidosis
and
mucopolysaccharidosis
(
MPS
)
type
IIIA
,
might
likewise
benefit
from
CD
treatment
.
Treated
Npc
2
(
-
/
-
)
mice
showed
benefits
similar
to
NPC
1
disease
,
however
,
mice
with
GM
1
gangliosidosis
or
MPS
IIIA
failed
to
show
reduction
in
storage
.
Treatment
with
CD
delayed
clinical
disease
onset
,
reduced
intraneuronal
storage
and
secondary
markers
of
neurodegeneration
,
and
significantly
increased
lifespan
of
both
Npc
1
(
-
/
-
)
and
Npc
2
(
-
/
-
)
mice
.
In
contrast
,
CD
failed
to
ameliorate
cholesterol
or
glycosphingolipid
storage
in
GM
1
gangliosidosis
and
MPS
IIIA
disease
.
Understanding
the
mechanism
(
s
)
by
which
CD
leads
to
reduced
neuronal
storage
may
provide
important
new
opportunities
for
treatment
of
NPC
and
related
neurodegenerative
diseases
characterized
by
cholesterol
dyshomeostasis
.
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Diseases presenting
"npc2 deficiency"
symptom
gm1 gangliosidosis
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