GM2 Gangliosidoses: Clinical Features, Pathophysiological Aspects, and Current Therapies

• Published in: International journal of molecular sciences 2020-08, Vol.21 (17), p.6213
• Main Authors: Leal, Andrés Felipe, Benincore-Flórez, Eliana, Solano-Galarza, Daniela, Garzón Jaramillo, Rafael Guillermo, Echeverri-Peña, Olga Yaneth, Suarez, Diego A, Alméciga-Díaz, Carlos Javier, Espejo-Mojica, Angela Johana
• Format: Article
• Language: English
• Subjects: 1-Deoxynojirimycin - analogs & derivatives; 1-Deoxynojirimycin - therapeutic use; Apoptosis; beta-N-Acetylhexosaminidases - genetics; Blood-Brain Barrier; Capillaries; Cell adhesion & migration; Central nervous system; Chaperones; Chemical bonds; Chemical compounds; Clinical Trials as Topic; CRISPR; Diet, Ketogenic; Enzymes; G(M2) Activator Protein - genetics; G(M2) Ganglioside - metabolism; Ganglioside GM2; Gangliosidoses, GM2 - genetics; Gangliosidoses, GM2 - metabolism; Gangliosidoses, GM2 - pathology; Gangliosidoses, GM2 - therapy; Gene therapy; Genes; Genetic Therapy; Genome editing; Genomes; Hematopoietic stem cells; Humans; Inflammation; Mutation; Neurodevelopment; Peptides; Pharmacology; Physiology; Protein transport; Proteins; Pyrimethamine - therapeutic use; Review; Signal transduction; Stem Cell Transplantation; Stem cells; Tay-Sachs disease; Transplantation
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms21176213

GM2 gangliosidoses are a group of pathologies characterized by GM2 ganglioside accumulation into the lysosome due to mutations on the genes encoding for the β-hexosaminidases subunits or the GM2 activator protein. Three GM2 gangliosidoses have been described: Tay-Sachs disease, Sandhoff disease, and the AB variant. Central nervous system dysfunction is the main characteristic of GM2 gangliosidoses patients that include neurodevelopment alterations, neuroinflammation, and neuronal apoptosis. Currently, there is not approved therapy for GM2 gangliosidoses, but different therapeutic strategies have been studied including hematopoietic stem cell transplantation, enzyme replacement therapy, substrate reduction therapy, pharmacological chaperones, and gene therapy. The blood-brain barrier represents a challenge for the development of therapeutic agents for these disorders. In this sense, alternative routes of administration (e.g., intrathecal or intracerebroventricular) have been evaluated, as well as the design of fusion peptides that allow the protein transport from the brain capillaries to the central nervous system. In this review, we outline the current knowledge about clinical and physiopathological findings of GM2 gangliosidoses, as well as the ongoing proposals to overcome some limitations of the traditional alternatives by using novel strategies such as molecular Trojan horses or advanced tools of genome editing.