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Objective: X‐linked adrenoleukodystrophy is caused by mutations in the peroxisomal half‐transporter ABCD1. The most common manifestation is adrenomyeloneuropathy, a hereditary spastic paraplegia of adulthood. The present study set out to understand the role of neuronal ABCD1 in mice and humans with adrenomyeloneuropathy. Methods: Neuronal expression of ABCD1 during development was assessed in mice and humans. ABCD1‐deficient mice and human brain tissues were examined for corresponding pathology. Next, we silenced ABCD1 in cholinergic Sh‐sy5y neurons to investigate its impact on neuronal function. Finally, we tested adeno‐associated virus vector‐mediated ABCD1 delivery to the brain in mice with adrenomyeloneuropathy. Results: ABCD1 is highly expressed in neurons located in the periaqueductal gray matter, basal forebrain and hypothalamus. In ABCD1‐deficient mice (Abcd1−/y), these structures showed mild accumulations of α‐synuclein. Similarly, healthy human controls had high expression of ABCD1 in deep gray nuclei, whereas X‐ALD patients showed increased levels of phosphorylated tau, gliosis, and complement activation in those same regions, albeit not to the degree seen in neurodegenerative tauopathies. Silencing ABCD1 in Sh‐sy5y neurons impaired expression of functional proteins and decreased acetylcholine levels, similar to observations in plasma of Abcd1−/y mice. Notably, hind limb clasping in Abcd1−/y mice was corrected through transduction of ABCD1 in basal forebrain neurons following intracerebroventricular gene delivery. Interpretation: Our study suggests that the basal forebrain–cortical cholinergic pathway may contribute to dysfunction in adrenomyeloneuropathy. Rescuing peroxisomal transport activity in basal forebrain neurons and supporting glial cells might represent a viable therapeutic strategy. ANN NEUROL 2024;95:442–458 [ABSTRACT FROM AUTHOR]

Charcot-Marie-Tooth disease (CMT) due to GJB1 variants (CMTX1) is the second most common form of CMT. It is an X-linked disorder characterized by progressive sensory and motor neuropathy with males affected more severely than females. Many reported GJB1 variants remain classified as variants of uncertain significance (VUS). In this large, international, multicentre study we prospectively collected demographic, clinical and genetic data on patients with CMT associated with GJB1 variants. Pathogenicity for each variant was defined using adapted American College of Medical Genetics criteria. Baseline and longitudinal analyses were conducted to study genotype-phenotype correlations, to calculate longitudinal change using the CMT Examination Score (CMTES), to compare males versus females, and pathogenic/likely pathogenic (P/LP) variants versus VUS. We present 387 patients from 295 families harbouring 154 variants in GJB1. Of these, 319 patients (82.4%) were deemed to have P/LP variants, 65 had VUS (16.8%) and three benign variants (0.8%; excluded from analysis); an increased proportion of patients with P/LP variants compared with using ClinVar's classification (74.6%). Male patients (166/319, 52.0%, P/LP only) were more severely affected at baseline. Baseline measures in patients with P/LP variants and VUS showed no significant differences, and regression analysis suggested the disease groups were near identical at baseline. Genotype-phenotype analysis suggested c.-17G>A produces the most severe phenotype of the five most common variants, and missense variants in the intracellular domain are less severe than other domains. Progression of disease was seen with increasing CMTES over time up to 8 years follow-up. Standard response mean (SRM), a measure of outcome responsiveness, peaked at 3 years with moderate responsiveness [change in CMTES (ΔCMTES) = 1.3 ± 2.6, P = 0.00016, SRM = 0.50]. Males and females progressed similarly up to 8 years, but baseline regression analysis suggested that over a longer period, females progress more slowly. Progression was most pronounced for mild phenotypes (CMTES = 0–7; 3-year ΔCMTES = 2.3 ± 2.5, P = 0.001, SRM = 0.90). Enhanced variant interpretation has yielded an increased proportion of GJB1 variants classified as P/LP and will aid future variant interpretation in this gene. Baseline and longitudinal analysis of this large cohort of CMTX1 patients describes the natural history of the disease including the rate of progression; CMTES showed moderate responsiveness for the whole group at 3 years and higher responsiveness for the mild group at 3, 4 and 5 years. These results have implications for patient selection for upcoming clinical trials. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate effects of medetomidine on left ventricular outflow tract (LVOT) velocity in domestic short-haired cats. Eighteen healthy adult male domestic short-haired cats were used for this study. All animals were clientowned. Echocardiography machine with 7.50 MHz transducer was used. Specific veterinary two-dimensional and pulse-waved echocardiogram images in apical five chamber right parasternal view were obtained and blood velocity in LVOT was calculated. After baseline echocardiographic recordings, 0.04 mg kg-1 of medetomidine was intramuscularly administered to each animal and LVOT velocity was calculated after 15 (T15), 50 (T30) and 80 (T80) min following drug administration. The LVOT velocity values (mean ï,± SEM) of cats in baseline were 1.06 ± 0.04 m sec-1. There were significant differences between baseline and T15 and T30 regarding mean LVOT values. Age and weight had no significant effect on LVOT velocity values. The LVOT velocity values of T15, T50 and T80 were 0.77 ± 0.04, 0.80 ± 0.02 and 0.96±0.03 m sec-1, respectively. Our findings revealed significant decrease in mean LVOT velocity up to 50 min following medetomidine administration. The present study determined normal LVOT velocity range for a small population of cats before and after intra-muscular medetomidine administration. [ABSTRACT FROM AUTHOR]