G.M.z.H. and T.P. contributed equally to this article.
Antiprogesterone therapy uncouples axonal loss from demyelination in a transgenic rat model of CMT1A neuropathy
Article first published online: 29 JAN 2007
Copyright © 2007 American Neurological Association
Annals of Neurology
Volume 61, Issue 1, pages 61–72, January 2007
How to Cite
Meyer zu Horste, G., Prukop, T., Liebetanz, D., Mobius, W., Nave, K.-A. and Sereda, M. W. (2007), Antiprogesterone therapy uncouples axonal loss from demyelination in a transgenic rat model of CMT1A neuropathy. Ann Neurol., 61: 61–72. doi: 10.1002/ana.21026
- Issue published online: 29 JAN 2007
- Article first published online: 29 JAN 2007
- Manuscript Accepted: 19 SEP 2006
- Manuscript Revised: 28 JUL 2006
- Manuscript Received: 9 JUN 2006
- European Union. Grant Number: LSHM-C72004-502987
- Myelin Project by the European Leukodystrophy Association
- German Research Foundation. Grant Number: DFG, OGM0643
- Fonds Anne Catherine del Marmol
Charcot–Marie–Tooth disease (CMT) is the most common inherited neuropathy, and a duplication of the Pmp22 gene causes the most frequent subform CMT1A. Using a transgenic rat model of CMT1A, we tested the hypothesis that long-term treatment with anti-progesterone (Onapristone) reduces Pmp22 overexpression and improves CMT disease phenotype of older animals, thereby extending a previous proof-of-concept observation in a more clinically relevant setting.
We applied placebo-controlled progesterone-antagonist therapy to CMT rats for 5 months and performed grip-strength analysis to assess the motor phenotype. Quantitative Pmp22 RT-PCR and complete histological analysis of peripheral nerves and skin biopsies were performed.
Anti-progesterone therapy significantly increased muscle strength and muscle mass of CMT rats and reduced the performance difference to wildtype rats by about 50%. Physical improvements can be explained by the prevention of axon loss. Surprisingly, the effects of anti-progesterone were not reflected by improved myelin sheath thickness. Electrophysiology confirmed unaltered NCV, but less reduced CMAP recordings in the treatment group. Moreover, the reduction of Pmp22 mRNA, as quantified in cutaneous nerves, correlated with the clinical phenotype at later stages.
Progesterone-antagonist treatment. Pmp22 overexpression to a degree at which the axonal support function of Schwann cells is better maintained than myelination. This suggests that axonal loss in CMT1A is not caused by demyelination, but rather by a Schwann cell defect that has been partially uncoupled by anti-progesterone treatment. Pmp22 expression analysis in skin may provide a prognostic marker for disease severity and for monitoring future clinical trials. Ann Neurol 2007;61:61–72