Montserrat Ruiz, Gholamreza Shariati, Cristina Pujades, Eric W. Klee, Odile Boespflug-Tanguy, Joseph G. Gleeson, Reza Maroofian, Filippo Vairo, Nathalie Launay, Stéphane Fourcade, Javier Joya, Lauren Brady, Mark A. Tarnopolsky, Nara Sobreira, Marc C. Patterson, Agatha Schlüter, Julie S. Cohen, Laurence Colleaux, Elizabeth Wohler, Carles Cornet, Jingmin Wang, Margit Burmeister, Neda Mazaheri, Isabelle Desguerre, Kiely N. James, Diana Rodriguez, Maria Eugenia Yoldi, Imen Dorboz, Huifang Yan, Dorothée Ville, Hamid Galehdari, Damir Musaev, Mary J H Willis, Ali Fatemi, Gaetan Lesca, Davide Rubbini, Maha S. Zaki, Aurora Pujol, Brendan C. Lanpher, Devesh C. Pant, Karine Siquier-Pernet, Javier Terriente, Carlos Casasnovas, Sergio Aguilera-Albesa, Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, Reproduction et Développement - Clermont Auvergne (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Institut de Chimie de la Matière Condensée de Bordeaux (ICMCB), Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB), Service de Génétique [HCL Groupement Hospitalier Est], Groupement hospitalier Lyon-Est, Department of Human Genetics, Department of Psychiatry, University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System-Molecular and Behavioral Neuroscience Institute, McMaster University [Hamilton, Ontario], Medical Research Council, Molecular and Clinical Sciences Institute - St George’s [London, UK] (Genetics Research Centre), University of London [London], Physiopathologie, conséquences fonctionnelles et neuroprotection des atteintes du cerveau en développement, Université Paris Diderot - Paris 7 (UPD7)-IFR2-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Neurogenetics, Howard Hughes Medical Institute, Department of Neurosciences, University of California [San Diego] (UC San Diego), University of California-University of California, Developmental Biology Group, Departament de Ciencies Experimentals i de la Salut, Universitat Pompeu Fabra [Barcelona], Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neurometabolic Diseases Laboratory [Barcelona, Spain], Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Groupement Hospitalier Lyon-Est (GHE), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of California (UC)-University of California (UC), Universitat Pompeu Fabra [Barcelona] (UPF), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM)
Sphingolipid imbalance is the culprit in a variety of neurological diseases, some affecting the myelin sheath. We have used whole-exome sequencing in patients with undetermined leukoencephalopathies to uncover the endoplasmic reticulum lipid desaturase DEGS1 as the causative gene in 19 patients from 13 unrelated families. Shared features among the cases include severe motor arrest, early nystagmus, dystonia, spasticity, and profound failure to thrive. MRI showed hypomyelination, thinning of the corpus callosum, and progressive thalamic and cerebellar atrophy, suggesting a critical role of DEGS1 in myelin development and maintenance. This enzyme converts dihydroceramide (DhCer) into ceramide (Cer) in the final step of the de novo biosynthesis pathway. We detected a marked increase of the substrate DhCer and DhCer/Cer ratios in patients' fibroblasts and muscle. Further, we used a knockdown approach for disease modeling in Danio rerio, followed by a preclinical test with the first-line treatment for multiple sclerosis, fingolimod (FTY720, Gilenya). The enzymatic inhibition of Cer synthase by fingolimod, 1 step prior to DEGS1 in the pathway, reduced the critical DhCer/Cer imbalance and the severe locomotor disability, increasing the number of myelinating oligodendrocytes in a zebrafish model. These proof-of-concept results pave the way to clinical translation. This study was supported by the ISCIII (FIS PI14/00581) (cofunded by the European Regional Development Fund); ‘La Marató de TV3’ Foundation 345/C/2014 (to AP, C. Casasnovas, and CP); the Hesperia Foundation and CIBER on Rare Diseases (CIBERER) (ACCI14-759) and the Secretariat for Universities and Research of the Ministry of Business and Knowledge of the Government of Catalonia (2017SGR1206) to AP; the Spanish Ministry of Economy and Competitiveness (MINECO-FEDER) (BFU2015-67400-P) to CP; the Spanish Institute for Health Carlos III (Miguel Servet program CPII16/00016) to SF; CIBERER to NL and MR; and a predoctoral fellowship awarded to DP from the Government of Catalonia through L′Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR; FI-DGR 2014). XJ acknowledges a Sara Borrell postdoctoral fellowship from Instituto de Salud Carlos III.