1
Mappings
0
Definitions
1
Inheritance
3
Pathophysiology
0
Histopathology
5
Phenotypes
3
Pathograph
1
Genes
2
Treatments
0
Subtypes
2
Differentials
0
Datasets
0
Trials
0
Models
1
Literature
🔗

Mappings

MONDO
MONDO:0011706 Kufor-Rakeb syndrome
skos:exactMatch MONDO
👪

Inheritance

1
Autosomal recessive inheritance HP:0000007
Kufor-Rakeb syndrome is inherited in an autosomal recessive pattern and is caused by biallelic inactivating ATP13A2 variants.
Autosomal recessive inheritance
Show evidence (1 reference)
PMID:29966207 SUPPORT Human Clinical
"Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia."
This directly establishes autosomal recessive inheritance for Kufor-Rakeb syndrome.

Pathophysiology

3
ATP13A2 loss impairs lysosomal polyamine transport
ATP13A2 is a lysosomal P5B-ATPase that transports polyamines. In Kufor-Rakeb syndrome, loss-of-function ATP13A2 variants impair endolysosomal polyamine transport, producing lysosomal dysfunction and creating a mechanistic basis for neurodegeneration.
neuron link
lysosomal transport link
Show evidence (2 references)
PMID:34715013 SUPPORT In Vitro
"Recent studies have suggested that ATP13A2 and its close homologs, collectively known as P5B-ATPases, are polyamine transporters at endo-/lysosomes."
This mechanistic study identifies ATP13A2 as an endolysosomal polyamine transporter, defining the core molecular function lost in disease.
PMID:40848257 SUPPORT In Vitro
"Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons."
This directly shows that ATP13A2 loss causes lysosomal polyamine storage in relevant cell models.
Lysosomal hydrolase dysfunction
ATP13A2 deficiency causes lysosomal polyamine accumulation that disrupts lysosomal pH and impairs β-glucocerebrosidase-mediated substrate hydrolysis.
dopaminergic neuron link
lysosome link
Show evidence (1 reference)
PMID:40848257 SUPPORT In Vitro
"Therefore, excess polyamine compromises lysosomes by disrupting pH and electrostatic interactions between GCase and BMP that enable efficient substrate hydrolysis, potentially clarifying pathogenic mechanisms and suggesting convergence on PD-relevant pathways."
This supports a downstream lysosomal hydrolase defect caused by ATP13A2 loss and links Kufor-Rakeb syndrome to broader Parkinson-relevant lysosomal biology.
Mitochondrial quality-control failure
ATP13A2 deficiency impairs maintenance of a healthy mitochondrial pool and likely compromises mitochondrial clearance, contributing to progressive neuronal dysfunction.
fibroblast link dopaminergic neuron link
mitophagy link ⚠ ABNORMAL autophagy link ⚠ ABNORMAL
Show evidence (2 references)
PMID:22296644 SUPPORT In Vitro
"These findings collectively suggest that ATP13A2 contributes to the maintenance of a healthy mitochondrial pool, supporting the hypothesis that impaired mitochondrial clearance represents an important pathogenic mechanism underlying KRS."
Patient-derived fibroblasts directly support mitochondrial quality-control failure as a pathogenic mechanism in Kufor-Rakeb syndrome.
PMID:41306646 PARTIAL Human Clinical
"This P5B-ATPase dysfunction impairs lysosomal processing, leading to the accumulation of α-synuclein."
The case report summarizes the accepted disease model linking ATP13A2 dysfunction to impaired lysosomal processing and alpha-synuclein buildup.

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Kufor-Rakeb syndrome Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.

Phenotypes

5
Eye 1
Vertical supranuclear gaze palsy Vertical supranuclear gaze palsy (HP:0000511)
Show evidence (1 reference)
PMID:29966207 PARTIAL Human Clinical
"Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia."
The abstract supports abnormal supranuclear ocular motility generally but does not specify the vertical subtype, so support is partial.
Musculoskeletal 1
Spastic paraparesis Spastic paraparesis (HP:0002313)
Show evidence (1 reference)
PMID:29966207 SUPPORT Human Clinical
"Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia."
This directly lists spastic paraparesis as part of the syndrome phenotype.
Nervous System 3
Parkinsonism Parkinsonism (HP:0001300)
Show evidence (1 reference)
PMID:29966207 SUPPORT Human Clinical
"Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia."
This directly identifies young-onset parkinsonism as the core motor phenotype of Kufor-Rakeb syndrome.
Cognitive impairment Cognitive impairment (HP:0100543)
Show evidence (1 reference)
PMID:41306646 SUPPORT Human Clinical
"Here, we present the first documented Guatemalan case of KRS, a young woman with progressive motor and cognitive decline."
This directly supports progressive cognitive impairment as part of the clinical phenotype.
Psychosis Psychosis (HP:0000709)
Show evidence (1 reference)
PMID:31232173 SUPPORT Human Clinical
"We present a case of a 32-year-old male with Kufor-Rakeb syndrome (KRS), a form of juvenile parkinsonism due to mutations of the ATP13A2 gene at PARK9 locus. The patient was seen for daily behavioral outbursts and psychotic symptoms."
This directly documents psychosis as a neuropsychiatric complication in a patient with Kufor-Rakeb syndrome.
🧬

Genetic Associations

1
ATP13A2 (Loss-of-function)
Show evidence (1 reference)
PMID:29966207 SUPPORT Human Clinical
"KRS is caused by homozygous/compound heterozygous inactivating mutations in ATP13A2."
This directly states the causal genetic mechanism for Kufor-Rakeb syndrome.
💊

Treatments

2
Pharmacotherapy for psychosis
Action: pharmacotherapy MAXO:0000058
Agent: aripiprazole
Low-dose aripiprazole can be used to control psychotic symptoms in Kufor-Rakeb syndrome without major motor worsening in at least isolated reported cases.
Show evidence (1 reference)
PMID:31232173 SUPPORT Human Clinical
"This significant improvement without drug-induced motor side effects suggests that aripiprazole at low doses (2-5 mg) is effective and tolerated in patients with KRS."
This directly supports low-dose aripiprazole as a symptomatic treatment option for psychosis in Kufor-Rakeb syndrome.
Multidisciplinary supportive care
Action: supportive care MAXO:0000950
Management relies on genetic diagnosis, counseling, and multidisciplinary supportive care for progressive motor and cognitive disability.
Show evidence (1 reference)
PMID:41306646 SUPPORT Human Clinical
"This report underscores the importance of recognizing KRS in diverse populations and of using gene-based testing to guide diagnosis, counseling, and multidisciplinary supportive care."
The case report explicitly frames multidisciplinary supportive care as part of current management.
🔀

Differential Diagnoses

2

Conditions with similar clinical presentations that must be differentiated from Kufor-Rakeb syndrome:

Overlapping Features Wilson disease can mimic juvenile parkinsonism with cognitive or psychiatric features but is distinguished by copper metabolism abnormalities and hepatic involvement.
Distinguishing Features
  • Abnormal copper studies, Kayser-Fleischer rings, and hepatic disease favor Wilson disease.
  • Biallelic ATP13A2 variants with spastic paraparesis and supranuclear gaze abnormalities favor Kufor-Rakeb syndrome.
Hereditary spastic paraplegia Not Yet Curated MONDO:0019064
Overlapping Features Hereditary spastic paraplegia may resemble Kufor-Rakeb syndrome when lower limb spasticity predominates, but typically lacks the characteristic juvenile parkinsonism syndrome.
Distinguishing Features
  • Predominant progressive lower-extremity spasticity without parkinsonism favors hereditary spastic paraplegia.
  • Early parkinsonism, supranuclear gaze palsy, and ATP13A2-associated lysosomal dysfunction favor Kufor-Rakeb syndrome.
📚

Literature Summaries

1
Asta
Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Kufor-Rakeb syndrome. Core disease mechanisms, molecular and cellular path...
Asta Scientific Corpus Retrieval 20 citations 2026-04-11T12:41:30.422649

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Kufor-Rakeb syndrome. Core disease mechanisms, molecular and cellular path...

This report is retrieval-only and is generated directly from Asta results.

  • Papers retrieved: 20
  • Snippets retrieved: 20

Relevant Papers

[1] Therapies for Mitochondrial Disease: Past, Present, and Future

  • Authors: Megan Ball, Nicole J. Van Bergen, A. Compton, David R Thorburn, S. Rahman et al.
  • Year: 2025
  • Venue: Journal of Inherited Metabolic Disease
  • URL: https://www.semanticscholar.org/paper/196ee50a950f29bc4134cfb8fe6bdfa9a3a1468b
  • DOI: 10.1002/jimd.70065
  • PMID: 40714961
  • PMCID: 12301291
  • Citations: 2
  • Summary: The latest developments in the pursuit to identify effective treatments for mitochondrial disease are examined and the barriers impeding their success in translation to clinical practice are discussed.
  • Evidence snippets:
  • Snippet 1 (score: 0.408) > Mitochondrial disease is a diverse group of clinically and genetically complex disorders caused by pathogenic variants in nuclear or mitochondrial DNA‐encoded genes that disrupt mitochondrial energy production or other important mitochondrial pathways. Mitochondrial disease can present with a wide spectrum of clinical features and can often be difficult to recognize. These conditions can be devastating; however, for the majority, there is no targeted treatment. In the last 60 years, mitochondrial medicine has experienced significant evolution, moving from the pre‐molecular era to the Age of Genomics in which considerable gene discovery and advancement in our understanding of the pathophysiology of mitochondrial disease have been made. In the last decade, in response to the urgent need for effective treatments, a wide range of emerging therapies have been developed, driven by innovative approaches addressing both the genetic and cellular mechanisms underpinning the diseases. Emerging therapies include dietary intervention, small molecule therapies aimed to restore mitochondrial function, stem cell or liver transplantation, and gene or RNA‐based therapies. However, despite these advances, translation to clinical practice is complicated by the sheer genetic and clinical complexity of mitochondrial disease, difficulty in efficient and precise delivery of therapies to affected tissues, rarity of individual genetic conditions, lack of reliable biomarkers and clinically relevant outcome measures, and the dearth of natural history data. This review examines the latest developments in the pursuit to identify effective treatments for mitochondrial disease and discusses the barriers impeding their success in translation to clinical practice. While treatment for mitochondrial disease may be on the horizon, many challenges must be addressed before it can become a reality.

[2] Changes in Serum Proteomic Profiles at Different Stages of Pregnancy Toxemia in Goats

  • Authors: M. Uzti̇mür, C. N. Ünal, Gurler Akpinar
  • Year: 2025
  • Venue: Journal of Veterinary Internal Medicine
  • URL: https://www.semanticscholar.org/paper/4b9c488b5dbd65d7b26fd2ad9aed70e8c4b59942
  • DOI: 10.1111/jvim.70139
  • PMID: 40492724
  • PMCID: 12150350
  • Summary: Understanding the serum proteome profiles of goats with pregnancy toxemia might help identify the proteomes and pathways responsible for the development of this disease and improve diagnosis and treatment.
  • Evidence snippets:
  • Snippet 1 (score: 0.394) > The pathophysiology and progression of this disease are not fully understood. > Traditional biomedical research has focused on the analysis of single genes, proteins, metabolites, or metabolic pathways in diseases. This molecular reductionist approach is based on the assumption that identifying genetic variations and molecular components will lead to new treatments for diseases [13][14][15][16]. However, many diseases are complex and multifactorial, and in order to determine the phenotype of such diseases, it is necessary to understand the changes that occur in more than one gene, pathway, protein, or metabolite at the cellular, tissue, and organismal levels [17][18][19]. Therefore, in recent years, proteomics, as one field of multi-omics technologies, has helped in evaluating the complex pathogenetic mechanisms of different diseases from a broad perspective and has made substantial contributions [20,21]. In veterinary medicine, proteomic analysis of metabolic diseases such as ketosis [16], hypocalcemia [22], and fatty liver [23] in dairy cows has contributed valuable insights for the definition of new pathophysiological pathways and new diagnosis and treatment protocols for these diseases. The proteomic approach can contribute importantly to a broad and detailed understanding of the changes that occur at the organismal level associated with the increase in BHBA concentration in goats with pregnancy toxemia. Our aim was to evaluate the serum protein profiles of goats with SPT or CPT using proteomic techniques to determine the proteomic profiles of these animals and to identify the relevant pathophysiological mechanisms.

[3] Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases

  • Authors: K. Lourida, G. Louridas
  • Year: 2022
  • Venue: Cardiogenetics
  • URL: https://www.semanticscholar.org/paper/3960806730c4c1115f527e22d6d0a76536570ec5
  • DOI: 10.3390/cardiogenetics12020015
  • Citations: 4
  • Influential citations: 1
  • Summary: Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.
  • Evidence snippets:
  • Snippet 1 (score: 0.385) > Treatment with ACEIs, ARBs, and β-blockers impedes deterioration of myocardial function as well as clinical deterioration caused by the deleterious impact of the compensatory systems [58,59]. Therefore, the therapy with ACEIs, ARBs, and β-blockers is the appropriate therapy to block LV remodeling and HF progression and reduce symptoms and/or mortality [55]. > In general, the HF syndrome demonstrates a modular construction with predictable behavior of functional clinical phenotypes having a strong impact on biological networks from epigenetic, cellular to regulatory systems [18]. The importance of individual genes for the pathogenesis and clinical progression of the HF syndrome is restricted to the hypertrophic and dilated cardiomyopathies. It seems that some HF patients have a complex multigenic inheritance, but the importance of individual genes is limited. In contrast, the significant role of epigenetics, proteomics, and metabolomics is increased; but, the complete genetic network system and the interactions between multiomics systems are still uncertain [60]. Multimodal systems that include genetic networks, multiomics, metabolic pathways, environmental factors, and sophisticated disease-related clinical networks are required to be integrated and provide a new holistic and realistic picture. > Significant breakthroughs have been made to understand many of the pathophysiological mechanisms of HFrEF but the natural pathophysiological history and clinical progression of HFpEF still remains inadequately defined [39]. The subclinical progression of pre-clinical diastolic dysfunction (PDD) of LV "to clinical phenotype of HFpEF and the further clinical progression to some more complex clinical models with multi-organ involvement . . . continue to be poorly understood" [40]. Prospective studies are expected to clarify the natural history and clinical progression of HFpEF and define the LV remodeling mechanisms involved. The pathophysiology of LV systolic dysfunction is different to the diastolic dysfunction, as systolic dysfunction is considered a disease of calcium handling and diastolic dysfunction is regarded as a disease of increased myofilament sensitivity to calcium [61][62][63].

[4] 18O-assisted dynamic metabolomics for individualized diagnostics and treatment of human diseases

  • Authors: E. Nemutlu, Song Zhang, N. Juranic, A. Terzic, S. Macura et al.
  • Year: 2012
  • Venue: Croatian Medical Journal
  • URL: https://www.semanticscholar.org/paper/880f053c7f060db4b990e447d0a22c4b69372ddb
  • DOI: 10.3325/cmj.2012.53.529
  • PMID: 23275318
  • PMCID: 3541579
  • Citations: 28
  • Summary: The potential use of dynamic phosphometabolomic platform for disease diagnostics currently under development at Mayo Clinic is described and discussed briefly.
  • Evidence snippets:
  • Snippet 1 (score: 0.384) > Living cells represent an integrated and interacting network of genes, transcripts, proteins, small signaling molecules, and metabolites that define cellular phenotype and function. Traditionally the focus of biomedical research was on individual genes, single protein targets, single metabolites, and metabolic or signaling pathways. This "molecular reductionist" paradigm was based on the assumption that identifying genetic variations and molecular components would lead to discovery of cures for human diseases. However, most of diseases are complex and multi-factorial and the disease phenotype is determined by the alterations of multiple genes, pathways, proteins and metabolites (at cellular, tissue, and organismal levels). Therefore, an integrated "omics" approach is more viable direction for uncovering alterations in metabolic networks, disease mechanisms, and mechanisms of drug effects. > Recent advent of large-scale metabolomics and fluxomic (metabolite dynamics and metabolic flux analysis) completed the "omics revolution" (Figure 1), where genomics, transcriptomics, proteomics, metabolomics, and fluxomics all together complement phenotype determination of living organism. Such integrated "omics" cascades provide a framework for advances in system and network biology, integrative physiology, and system medicine as well as system pharmacology and regenerative medicine. Noteworthy is the "reverse omic" approach or "metabolomicsinformed pharmacogenomics, " where discovery of specific metabolite changes have led to discovery of genetic alterations (2). Therefore, bringing new "omics" technologies to clinical practice will improve disease diagnostics and treatment by targeting drugs and procedures for each unique transcriptomic and metabolomic profiles.

[5] Effects of Noonan Syndrome-Germline Mutations on Mitochondria and Energy Metabolism

  • Authors: Donald Bajia, Emanuela Bottani, K. Derwich
  • Year: 2022
  • Venue: Cells
  • URL: https://www.semanticscholar.org/paper/e6a65a7366a07b67d4c715ae6f8aee9dc567e9c3
  • DOI: 10.3390/cells11193099
  • PMID: 36231062
  • PMCID: 9563972
  • Citations: 11
  • Summary: This manuscript comprehensively reviews the most frequently mutated genes responsible for NS and NSML, covering their role in the current knowledge of cellular signalling pathways, and focuses on the pathophysiological outcomes on mitochondria and energy metabolism.
  • Evidence snippets:
  • Snippet 1 (score: 0.377) > RASopathies are one of the most prominent groups of developmental disorders in humans with mutations in genes encoding proteins involved in the RAS/MAPK cascade. Over 20 genes have been associated with RASopathies so far [1]. Since the RAS pathway regulates cell cycle, cell growth, proliferation, differentiation, and metabolism, and it plays a crucial role in developing and maintaining homeostasis in different tissues, it is not surprising that its genetic dysregulations lead to severe clinical complications. The RASopathies include Noonan Syndrome [NS; Mendelian Inheritance in Men (MIM) #163950] and Noonan Syndrome with Multiple Lentigines [NSML, also termed LEOP-ARD syndrome; MIM #151100], and other related syndromes, which share overlapping clinical phenotypes spanning from developmental delay and reduced cognitive skills to heart defects and early-onset cancer [2]. Pre-diagnosis is based on recognising clinical phenotypes and is confirmed through molecular genetic testing. An accurate diagnosis improves the management of patients' symptoms and aids in designing clinical trials to develop potential treatments for the disease [3]. Mitochondria are the major source of adenosine triphosphate (ATP), synthesized by the mitochondrial respiratory chain through the process of oxidative phosphorylation (OXPHOS). ATP is the primary energy substrate required for all active processes within the cells, and ATP deficiency leads to cellular dysfunction and, ultimately, cell death. Though not all encoded proteins of NS/NSML genes have been reported directly localized to the mitochondria, research efforts suggest they might still play a role in mitochondrial function since they are important regulators of RAS

[6] Cardiac Phenotype and Gene Mutations in RASopathies

  • Authors: M. Faienza, G. Meliota, D. Mentino, R. Ficarella, Mattia Gentile et al.
  • Year: 2024
  • Venue: Genes
  • URL: https://www.semanticscholar.org/paper/a4087d3b73d20a6e2f46b7fb87eed4017ec9a9be
  • DOI: 10.3390/genes15081015
  • PMID: 39202376
  • PMCID: 11353738
  • Citations: 9
  • Influential citations: 1
  • Summary: The molecular mechanisms underlying the development of cardiac diseases associated particularly with NS are clarified, and the main morphological and clinical characteristics of the two most frequent cardiac disorders, namely pulmonary valve stenosis (PVS) and HCM are discussed.
  • Evidence snippets:
  • Snippet 1 (score: 0.373) > Cardiac involvement is a major feature of RASopathies, a group of phenotypically overlapping syndromes caused by germline mutations in genes encoding components of the RAS/MAPK (mitogen-activated protein kinase) signaling pathway. In particular, Noonan syndrome (NS) is associated with a wide spectrum of cardiac pathologies ranging from congenital heart disease (CHD), present in approximately 80% of patients, to hypertrophic cardiomyopathy (HCM), observed in approximately 20% of patients. Genotype–cardiac phenotype correlations are frequently described, and they are useful indicators in predicting the prognosis concerning cardiac disease over the lifetime. The aim of this review is to clarify the molecular mechanisms underlying the development of cardiac diseases associated particularly with NS, and to discuss the main morphological and clinical characteristics of the two most frequent cardiac disorders, namely pulmonary valve stenosis (PVS) and HCM. We will also report the genotype–phenotype correlation and its implications for prognosis and treatment. Knowing the molecular mechanisms responsible for the genotype–phenotype correlation is key to developing possible targeted therapies. We will briefly address the first experiences of targeted HCM treatment using RAS/MAPK pathway inhibitors.

[7] Nasopharyngeal Carcinoma Signaling Pathway: An Update on Molecular Biomarkers

  • Authors: W. Tulalamba, T. Janvilisri
  • Year: 2012
  • Venue: International Journal of Cell Biology
  • URL: https://www.semanticscholar.org/paper/307cb9186444d9dad6e2e3b53763be0de76de186
  • DOI: 10.1155/2012/594681
  • PMID: 22500174
  • PMCID: 3303613
  • Citations: 93
  • Influential citations: 5
  • Summary: The molecular signaling pathways in the NPC are discussed for the holistic view of NPC development and progression and the important insights toward NPC pathogenesis may offer strategies for identification of novel biomarkers for diagnosis and prognosis.
  • Evidence snippets:
  • Snippet 1 (score: 0.372) > In the pregenomic eras, highly integrated and complex circuitry of molecular signaling in NPC pathogenesis was only partially understood. Over the past decade, the knowledge of the molecular mechanisms in NPC carcinogenesis has been rapidly accumulated. Dysregulation and abnormal protein expression of molecules in certain signaling pathways involved in cellular functions including proliferation, adhesion, survival, and apoptosis has been demonstrated in the NPC cells. Detailed information on the complex network in signaling pathway leading to a coordinated pattern of gene expression and regulation in NPC will undoubtedly provide important clues to develop novel prognostic and therapeutic strategies for this cancer. Refining molecular markers into clinically relevant assays may assist in the detection of NPC in asymptomatic patients, as well as stage classification and monitoring disease progression and treatments. Furthermore, selective regulation of particular proteins targeting cancer cell proliferation, invasion, and apoptosis is a hopeful prospect for future anticancer therapy that slow disease progression and improve survival.

[8] Transcriptional profiling of Hutchinson-Gilford progeria patients identifies primary target pathways of progerin

  • Authors: Sandra Vidak, Sohyoung Kim, Tom Misteli
  • Year: 2026
  • Venue: Nucleus
  • URL: https://www.semanticscholar.org/paper/4bd99b0875508364d8672b6da5a50d024d485a53
  • DOI: 10.1080/19491034.2025.2611484
  • PMID: 41489464
  • PMCID: 12773485
  • Summary: To probe the clinical relevance of previously implicated cellular pathways and to address the extent of gene expression heterogeneity between patients, transcriptomic analysis of a comprehensive set of HGPS patients finds misexpression of several cellular pathways, including multiple signaling pathways, the UPR and mesodermal cell fate specification.
  • Evidence snippets:
  • Snippet 1 (score: 0.372) > Oxidative stress represents another key pathogenic mechanism in HGPS, as impaired NRF2 activity or increased reactive oxygen species (ROS) levels are sufficient to recapitulate HGPSassociated phenotypes [17,32,60]. Collectively, these findings underscore the multifactorial nature of HGPS pathogenesis, implicating interconnected signaling cascades involved in inflammation, oxidative stress, proteostasis, and vascular remodeling. Reassuringly, our findings indicate that many of the major pathways that have been described to contribute to HGPS phenotypes in mouse and cellular disease models are also misregulated in progeria patients, and targeting these pathways may provide therapeutic avenues to mitigate disease severity and improve outcomes in HGPS. > Although individuals with HGPS typically exhibit a characteristic set of clinical features, such as craniofacial abnormalities, growth retardation, and cardiovascular complications, there is notable variability in the age of onset, severity, and progression of symptoms between patients [7,9]. At the cellular level, HGPS is associated with several hallmark abnormalities, including nuclear envelope defects, decreased expression of several nuclear proteins and epigenetic marks, mitochondrial dysfunction, and increased cellular senescence [1,11,30,31,61]. These cellular phenotypes also exhibit considerable variation between patients, possibly contributing to differences in clinical outcomes. Our results indicate that even though some degree of transcriptional heterogeneity between the individual patients exists, the majority of patients exhibit misregulation of a set of shared pathways, suggesting that these pathways are universal driver mechanisms in HGPS. Further work is needed to understand the molecular and genetic factors that underlie inter-individual variability in disease expression and progression. > A limitation of pathway analysis of HGPS patient samples is to distinguish the pathways which are directly targeted by the disease-causing progerin protein and the emergence of adaptive secondary response pathways during progression of the disease in patients during their lifetime. The same caveat applies to the use of cell-based models used in the study of HGPS disease mechanisms.

[9] Systems pharmacology-based integration of human and mouse data for drug repurposing to treat thoracic aneurysms.

  • Authors: J. Hansen, J. Galatioto, Cristina I. Caescu, P. Arnaud, R. C. Calizo et al.
  • Year: 2019
  • Venue: JCI insight
  • URL: https://www.semanticscholar.org/paper/261628418de4c8b21daeb694301dc1b8759b622d
  • DOI: 10.1172/jci.insight.127652
  • PMID: 31167969
  • Citations: 20
  • Summary: System pharmacology approaches that compare patient- and mouse-derived transcriptomic data for subcellular pathway-based drug repurposing represent an effective strategy to identify potential new treatments of human diseases.
  • Evidence snippets:
  • Snippet 1 (score: 0.372) > TAA with ensuing dissection and rupture of the vessel wall is the clinical hallmark of Marfan syndrome (MFS), a relatively common connective tissue disease associated with mutations in the gene that codes for the multifunctional ECM glycoprotein fibrillin-1 (4,5). Fibrillin-1 assemblies (microfibrils and elastic fibers) impart specific physical properties to tissues, distribute mechanical forces within and across them, communicate to multiple types of vessel wall cells through integrin receptors, and modulate local bioavailability of ECM-bound latent TGF-β complexes (5). In spite of significant research effort, the molecular pathogenesis of arterial disease in MFS remains unresolved, therefore hindering advances in drug therapy. Earlier studies of MFS mice with nondissecting TAA (Fbn1 C1039G/+ mice) have correlated aneurysm onset and progression with increased TGF-β signaling in the media stimulated by improper angiotensin II (AngII) type I receptor (AT1r) activity (6,7). More recent findings indicate a more complex disease mechanism involving the gradual stratification of stress-stimulated interactions among different cell types and multiple regulatory pathways, of which the AT1r and TGF-β signaling pathways are a critical subset (8)(9)(10)(11)(12)(13)(14). > An overview of regulatory pathways and networks associated with a given pathology can often be obtained by examining changes in gene expression during disease progression. Systems pharmacology approaches that consider drug targets as nodes within cellular regulatory networks can use differentially expressed genes (DEGs) to predict dysregulated SCPs that underlie cell-level mechanisms (1,3). Further, computational analyses of the pharmacologically induced perturbations of gene expression listed in the Connectivity Map (CMap) database can predict drugs to be repurposed to normalize dysregulated SCPs (15).

[10] The hyperornithinemia–hyperammonemia-homocitrullinuria syndrome

  • Authors: D. Martinelli, D. Diodato, Emanuela Ponzi, M. Monné, S. Boenzi et al.
  • Year: 2015
  • Venue: Orphanet Journal of Rare Diseases
  • URL: https://www.semanticscholar.org/paper/ed033868ee677da141e5c926bc7c93cac242ea06
  • DOI: 10.1186/s13023-015-0242-9
  • PMID: 25874378
  • PMCID: 4358699
  • Citations: 92
  • Influential citations: 5
  • Summary: The clinical phenotype of HHH syndrome is extremely variable and its severity does not correlate with the genotype or with recorded ammonium/ornithine plasma levels, suggesting the need for a better understanding of the still unsolved pathophysiology of the disease.
  • Evidence snippets:
  • Snippet 1 (score: 0.366) > Although the disease responds well to treatment with low risk of relapse of hyperammonemia [38], slowly progressive pyramidal signs characterize the chronic course, as also seen in argininemia [89]. However, the mechanism(s) of pyramidal dysfunction in HHH syndrome still remains to be elucidated. Creatine deficiency may contribute to the pathogenetic mechanism of the syndrome, as creatine is relevant for mitochondrial energy metabolism, regulation of glycolysis, proteins synthesis, membrane stabilization and neuromodulation [77,78,85]. This could be in line with the finding of abnormally shaped mitochondria at electron microscopy studies in skin fibroblasts, hepatocytes and muscle biopsy from HHH syndrome patients [11,23,82]. Furthermore, a mitochondrial dysfunction has been recently related to the effects of ornithine and homocitrulline in causing oxidative stress and disturbed mitochondrial homeostasis [79,80]. > A further mechanism that can be involved in the pathophysiology of HHH syndrome is related to polyamines metabolism. Shimizu and colleagues reported increased total and fractional (putrescine, cadaverine, spermine, spermidine) polyamines in one HHH syndrome patient [30]. Indeed, the clinical similarities between HHH syndrome and argininemia, which has been associated to an abnormal polyamine metabolism [91,92], may suggest a common pathogenetic mechanism causing pyramidal dysfunction. > Overall, the pathogenesis of HHH syndrome is complex and not completely understood. It is likely that different mechanisms, including the impact of low mitochondrial ornithine on UC flux, the presence of hyperammonemic crises and the disturbance of other pathways in major organs play a role in determining the heterogeneous clinical presentation of ORC1 deficiency. > In addition, as molecular studies failed to disclose a correlation between type of mutations or ornithine transport capacity and disease severity, an effect of genetic modifiers, such as ORC genes redundancy, seems to be likely, but further studies are certainly needed to clarify this point.

[11] New therapeutic targets in rare genetic skeletal diseases

  • Authors: M. Briggs, Peter A. Bell, M. Wright, K. A. Pirog
  • Year: 2015
  • Venue: Expert Opinion on Orphan Drugs
  • URL: https://www.semanticscholar.org/paper/1363107f71ae6d2d60abca471cddf3da5d13644b
  • DOI: 10.1517/21678707.2015.1083853
  • PMID: 26635999
  • PMCID: 4643203
  • Citations: 37
  • Influential citations: 1
  • Summary: An overview of disease mechanisms that are shared amongst groups of different GSDs and potential therapeutic approaches that are under investigation are described to generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > proteins of the cartilage ECM such as type II collagen [50]. However, emerging knowledge suggests that the primary genetic defect may be less important than the cells' response to the expression of the mutant gene product [107]. Moreover, the largely overlooked response of a cell (i.e. chondrocyte) to the abnormal extracellular environment is also important for disease progression as illustrated by several GSDs discussed in this review. > It is important that 'omics'-based approaches and technologies are systematically applied to the study of rare GSDs so that definitive reference profiles and disease signatures are generated for each phenotype. These can then be used in a Systems Biology approach to identify both common and dissimilar pathological signatures and disease mechanisms. This approach is entirely dependent upon relevant in vitro and in vivo models (and also novel 'disease-mechanism phenocopies' [107]) for testing new diagnostic and prognostic tools and for determining the molecular mechanisms that underpin the pathophysiology so that effective therapeutic treatments can be developed and validated. This approach will eventually lead to personalized treatments and care strategies centred on shared disease mechanisms with the use of relevant biomarkers to monitor the efficacy of treatment and disease progression. > It is vital that all relevant stakeholders are involved from the outset in defining the appropriate outcomes of any potential therapeutic regime. The perceptions of a successful therapy can differ widely between the clinical academic community and the relevant patient-support groups and it is vital that there is engagement on all these issues. > In summary, the identification of causative genes and mutations for GSDs over the last 20 years, coupled with the generation and in-depth analysis of a plethora of relevant cell and mouse models, has derived new knowledge on disease mechanisms and suggested potential therapeutic targets. The fast-evolving hypothesis that clinically disparate diseases can share common disease mechanisms is a powerful concept that will generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.

[12] Role of Transcriptomics in Precision Oncology

  • Authors: Ruby Srivastava
  • Year: 2024
  • Venue: Reports of Radiotherapy and Oncology
  • URL: https://www.semanticscholar.org/paper/0bd862558bbb7286336111d9dfd232b5f905d3d9
  • DOI: 10.5812/rro-142195
  • Citations: 4
  • Summary: : Transcriptome profiling is one of the most widely used approaches in the field of multiomics research. It plays a crucial role in the prognostic, diagnostic, and predictive treatment of cancer patients. Novel next-generation sequencing (NGS) technologies permit the identification of cancer biomarkers, gene signatures, and their abnormal expression, affecting oncogenic and molecular targets and novel biomarkers for cancer therapies. Multiomics studies have changed the overall understanding o...
  • Evidence snippets:
  • Snippet 1 (score: 0.364) > : Transcriptome profiling is one of the most widely used approaches in the field of multiomics research. It plays a crucial role in the prognostic, diagnostic, and predictive treatment of cancer patients. Novel next-generation sequencing (NGS) technologies permit the identification of cancer biomarkers, gene signatures, and their abnormal expression, affecting oncogenic and molecular targets and novel biomarkers for cancer therapies. Multiomics studies have changed the overall understanding of cancer and opened a precise perspective for tumor diagnostics and therapy. The use of these approaches has strengthened our understanding of disease pathophysiology and classifications at the molecular level, including specific interference with drug mechanisms of action. Still, it has limited added value in the clinical setting. The omics data on precision medicine include the application of data from genes, transcripts, and proteins for diagnosis, monitoring of diseases, risk factor determination, counseling, and development of novel therapeutics. Bioinformatics applications have expanded statistics-based analysis toward deriving molecular pathways and process models for characterizing phenotypes and drug action mechanisms. In this review, we will discuss transcriptomics and interference analysis that allows the identification of predictive biomarkers at the molecular level to test drug response and analyze the molecular process interface of disease progression-relevant pathophysiology and mechanism of action to propose predictive biomarkers.

[13] Novel Approaches to Studying SLC13A5 Disease

  • Authors: Adriana S. Beltran
  • Year: 2024
  • Venue: Metabolites
  • URL: https://www.semanticscholar.org/paper/8469c534cd81d96f84b61e2d963dead12088feb7
  • DOI: 10.3390/metabo14020084
  • PMID: 38392976
  • PMCID: 10890222
  • Citations: 2
  • Summary: Current technologies for generating patient-specific induced pluripotent stem cells (iPSCs) and their inherent advantages and limitations are discussed, followed by a summary of the methods for differentiating iPSCs into neurons, hepatocytes, and organoids.
  • Evidence snippets:
  • Snippet 1 (score: 0.362) > The precise pathophysiology underlying how SLC13A5 loss-of-function results in epilepsy refractory to treatment is a subject of open and ongoing research. Several hypotheses suggest SLC13A5 alters metabolic pathways, leading to neuronal dysfunction. Conversely, therapeutic inhibition of NaCT in the liver is a target to improve metabolic diseases, including non-alcoholic fatty liver disease, obesity, and insulin resistance. Thus, functionally accurate modeling and characterization of the mechanisms involved in citrate transport disruption are critical for understanding its role in human disease. > IPSC-derived cellular systems are a powerful tool for modeling rare human genetic diseases, such as SLC13A5 (Figure 5). IPSCs derived from patients containing the genetic information of the disease can overcome the limitations of animal models, providing access to relevant human cell types that recapitulate the disease phenotype. For instance, patient-derived iPSCs differentiated into neurons or hepatocytes can be used to investigate molecular and cellular mechanisms, including citrate transport and accumulation, energy metabolism, oxidative stress, and other cellular processes. They can also be used to define the spectrum of the disease and how different mutations might lead to various disease severities, screen for potential therapeutic compounds that can restore the transporter function or ameliorate the symptoms, and enable personalized medicine approaches that can tailor treatments to individual patients based on their genetic background and disease severity. > transport disruption are critical for understanding its role in human disease. > IPSC-derived cellular systems are a powerful tool for modeling rare human genetic diseases, such as SLC13A5 (Figure 5). IPSCs derived from patients containing the genetic information of the disease can overcome the limitations of animal models, providing access to relevant human cell types that recapitulate the disease phenotype. For instance, patient-derived iPSCs differentiated into neurons or hepatocytes can be used to investigate molecular and cellular mechanisms, including citrate transport and accumulation, energy metabolism, oxidative stress, and other cellular processes.

[14] Pharmacogenomic characterization of gemcitabine response – a framework for data integration to enable personalized medicine

  • Authors: Michael Harris, K. Bhuvaneshwar, Thanemozhi Natarajan, L. Sheahan, Difei Wang et al.
  • Year: 2013
  • Venue: Pharmacogenetics and Genomics
  • URL: https://www.semanticscholar.org/paper/1382ddf84b87736a73c2f2f81164ca876c29f4c4
  • DOI: 10.1097/FPC.0000000000000015
  • PMID: 24401833
  • PMCID: 3888473
  • Citations: 16
  • Summary: This in-silico study identified gene variants significantly associated with gemcitabine response that may help to personalize treatment in the clinic and gain insights into drug response mechanisms and to facilitate clinical trial design and regulatory reviews.
  • Evidence snippets:
  • Snippet 1 (score: 0.362) > Understanding the genetic and molecular mechanisms underlying complex diseases such as cancer is extremely challenging. Genome-wide association studies (GWAS) have been extensively used in the past decade to discover important genetic variants. However, the identified SNPs explain only a small proportion of the phenotypic variation, and the predictive power of these SNPs remains low for many complex diseases [10]. To fully elucidate genetic underpinnings of disease a systems biology approach is necessary to characterize variants, mRNA, copy number, proteins, and metabolites, as well as their cellular interactions [11]. Gene set and pathway association analyses are playing an increasingly important role in explaining disease mechanisms through the identification of functional genetic interactions [12]. Many gene-disease association analyses are based on SNP genotype profiling or gene expression studies. However, SNPs can influence many downstream processes including the expression levels of multiple genes and/or protein levels, and variations in expression levels can directly or indirectly impact disease progression and even drug response [13]. An integrative approach combining multiple data types can more accurately capture pathway associations [12] for discovery of clinically actionable variants. > Statistical approaches commonly used to associate variants with disease and/or drug response Fisher's exact test (FET) is commonly used in the association of germline polymorphisms with drug response [14]. The use of probabilistic networks in conjunction with traditional statistical models for mining relationships and associations from genotype-phenotype data is well established [15]. Probabilistic network methods for pharmacogenomics and newer methods such as the Markov Blanket concept may be helpful to better analyze these complex genotype-phenotype associations [16]. Considering the complexity of both cancer prognosis and individual drug response to chemotherapeutics, application of these association methods in conjunction with novel informatics and data integration approaches is necessary to identify clinically relevant variants for validation studies and ultimately testing in the clinic for pharmacogenomics applications.

[15] Precision Therapeutics in Lennox–Gastaut Syndrome: Targeting Molecular Pathophysiology in a Developmental and Epileptic Encephalopathy

  • Authors: Debopam Samanta
  • Year: 2025
  • Venue: Children
  • URL: https://www.semanticscholar.org/paper/455479c1bfbea7b90b73c109228f67c813d13888
  • DOI: 10.3390/children12040481
  • PMID: 40310132
  • PMCID: 12025602
  • Citations: 19
  • Influential citations: 1
  • Summary: A narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies, receptor and ligand dysfunction, receptor and ligand dysfunction, cell signaling abnormalities, cell signaling abnormalities, synaptopathies, and the repurposing of existing medications with mechanism-specific effects.
  • Evidence snippets:
  • Snippet 1 (score: 0.361) > Lennox–Gastaut syndrome (LGS) is a severe childhood-onset developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Current treatments primarily focus on symptom management through antiseizure medications (ASMs), dietary therapy, epilepsy surgery, and neuromodulation, but often fail to address the underlying pathophysiology or improve cognitive outcomes. As genetic causes are identified in 30–40% of LGS cases, precision therapeutics targeting specific molecular mechanisms are emerging as promising disease-modifying approaches. This narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies (SCN2A, SCN8A, KCNQ2, KCNA2, KCNT1, CACNA1A), receptor and ligand dysfunction (GABA/glutamate systems), cell signaling abnormalities (mTOR pathway), synaptopathies (STXBP1, IQSEC2, DNM1), epigenetic dysregulation (CHD2), and CDKL5 deficiency disorder. Treatment modalities discussed include traditional ASMs, dietary therapy, targeted pharmacotherapy, antisense oligonucleotides, gene therapy, and the repurposing of existing medications with mechanism-specific effects. Early intervention with precision therapeutics may not only improve seizure control but could also potentially prevent progression to LGS in susceptible populations. Future directions include developing computable phenotypes for accurate diagnosis, refining molecular subgrouping, enhancing drug development, advancing gene-based therapies, personalizing neuromodulation, implementing adaptive clinical trial designs, and ensuring equitable access to precision therapeutic approaches. While significant challenges remain, integrating biological insights with innovative clinical strategies offers new hope for transforming LGS treatment from symptomatic management to targeted disease modification.

[16] Renal ciliopathies: promising drug targets and prospects for clinical trials

  • Authors: L. Devlin, Praveen Dhondurao Sudhindar, J. Sayer
  • Year: 2023
  • Venue: Expert Opinion on Therapeutic Targets
  • URL: https://www.semanticscholar.org/paper/ab2155b6e12caba53d57ac0e8ce28860d69ec9fd
  • DOI: 10.1080/14728222.2023.2218616
  • PMID: 37243567
  • Citations: 10
  • Summary: The advances in basic science and clinical research into renal ciliopathies which have yielded promising small compounds and drug targets are reviewed, within both preclinical studies and clinical trials.
  • Evidence snippets:
  • Snippet 1 (score: 0.361) > Although renal ciliopathies can be classified into distinct syndromes, causative mutations in genes encoding proteins involved in the primary cilium or centrosome mean they may share overlapping mechanisms of disease, which may be amenable for therapeutic intervention (Figure 2). Abnormal functioning of proteins involved in ciliogenesis, such as CEP164, can prevent proper cilia formation, which will effect a myriad of downstream ciliary signaling pathways. Additionally, mutations in genes encoding for proteins involved in cargo trafficking or regulation, such as CEP290, will have implications for signal pathway transduction, as well as mutations in components of signaling pathways themselves, such as PKD1. In regard to renal ciliopathies, abnormalities in signaling pathways such as cAMP, Shh, Wnt, mTOR, and AMPK, likely cause misoriented cellular divisions, increased proliferation, increased fluid secretion and subsequent cystogenesis, consequently leading to further kidney damage. Ciliary and centriolar proteins which have roles in DDR and cell cycle regulation may also be driving a renal cystogenesis phenotype alongside increased fibrosis and apoptosis. Increased inflammation and dysfunctional mitochondria are also byproducts of dysregulated signaling pathways have been shown to contribute to the progression of renal ciliopathies. Extensive reviews of mechanisms of renal ciliopathy diseases have recently been performed [23,24]. Importantly, due to the wide range of cellular processes that primary cilia regulate, it is likely that in each syndrome there are multiple pathogenic drivers of disease. In some ways, this is advantageous as it offers many points for potential therapeutic targets. However, the cross talk between pathways and feedback loops introduces complications of changing one pathway without negatively affecting another. Further challenges arise with core biological pathways, such as Shh signaling, in which modification in vitro may be beneficial, but systemic treatment is unrealistic due to the expected severe side effects [18,24,116].

[17] Human Dermal Fibroblast: A Promising Cellular Model to Study Biological Mechanisms of Major Depression and Antidepressant Drug Response

  • Authors: P. Mesdom, R. Colle, É. Lebigot, S. Trabado, Eric Deflesselle et al.
  • Year: 2020
  • Venue: Current Neuropharmacology
  • URL: https://www.semanticscholar.org/paper/79368e365458486de96794333613c12a6063bf54
  • DOI: 10.2174/1570159X17666191021141057
  • PMID: 31631822
  • PMCID: 7327943
  • Citations: 12
  • Summary: This review highlights the great and still underused potential of HDF, which stands out as a very promising tool in the understanding of MDD and AD mechanisms of action.
  • Evidence snippets:
  • Snippet 1 (score: 0.360) > Background: Human dermal fibroblasts (HDF) can be used as a cellular model relatively easily and without genetic engineering. Therefore, HDF represent an interesting tool to study several human diseases including psychiatric disorders. Despite major depressive disorder (MDD) being the second cause of disability in the world, the efficacy of antidepressant drug (AD) treatment is not sufficient and the underlying mechanisms of MDD and the mechanisms of action of AD are poorly understood. Objective The aim of this review is to highlight the potential of HDF in the study of cellular mechanisms involved in MDD pathophysiology and in the action of AD response. Methods The first part is a systematic review following PRISMA guidelines on the use of HDF in MDD research. The second part reports the mechanisms and molecules both present in HDF and relevant regarding MDD pathophysiology and AD mechanisms of action. Results HDFs from MDD patients have been investigated in a relatively small number of works and most of them focused on the adrenergic pathway and metabolism-related gene expression as compared to HDF from healthy controls. The second part listed an important number of papers demonstrating the presence of many molecular processes in HDF, involved in MDD and AD mechanisms of action. Conclusion The imbalance in the number of papers between the two parts highlights the great and still underused potential of HDF, which stands out as a very promising tool in our understanding of MDD and AD mechanisms of action

[18] Clinical features and genetic analysis of a family with t(5;9) (p15;p24) balanced translocation leading to Cri-du-chat syndrome in offspring

  • Authors: Jing Zhao, Ping Chen, Yijia Ren, Shurong Li, Weiyi Zhang et al.
  • Year: 2025
  • Venue: Frontiers in Genetics
  • URL: https://www.semanticscholar.org/paper/5caf88001c66b473b6565f9e75eb6a4f1a8c4a0a
  • DOI: 10.3389/fgene.2025.1550937
  • PMID: 40406061
  • PMCID: 12094932
  • Citations: 1
  • Summary: This study reports a rare familial balanced translocation pedigree, particularly noting that the offspring can suffer from Cri-du-chat syndrome, which suggests a potential new genetic model for this syndrome.
  • Evidence snippets:
  • Snippet 1 (score: 0.359) > Using the Metascape database for GO enrichment analysis of the region containing 60 OMIM genes from 5p15.33p14.1 revealed the potential molecular mechanisms of the disease. The results showed that OMIM genes in the 5p15.33p14.1 region are mainly enriched in Na+/Cl-dependent neurotransmitter transporters, cell-cell adhesion mediated by cadherin, nephron epithelium development, and other signaling pathways (Figure 5A). Disease enrichment analysis showed that genes in this region are mainly associated with Cri-du-chat syndrome (Figure 5B) . Cri-du-chat syndrome is closely related to developmental abnormalities, neurological defects, and craniofacial malformations. Enrichment analysis supports the involvement of molecular mechanisms related to Wnt signaling, neurotransmitter transport, ubiquitination pathways, particularly through diseasegene associations from DisGeNET and GO functional enrichment. These results provide clues for revealing the molecular network of the disease and guide future research. > Using the Metascape database, GO enrichment analysis of 45 OMIM genes located in the 9p24.3-p22.3 region was performed. The results showed that OMIM genes in the 9p24.3-p22.3 region are mainly enriched in signaling pathways such as positive regulation of leukocyte activation, response to amine, cell population proliferation, positive regulation of cell development, etc. (Figure 5C). Disease enrichment analysis revealed that genes in this region are mainly associated with Chromosome 9p deletion syndrome (Figure 5D). This study, through multidimensional bioinformatics analysis, not only clarified the core biological functions of genes in the 9p24.3-p22.3 region, but also revealed their potential association mechanisms with major diseases, providing important theoretical basis and directional guidance for subsequent gene function validation, molecular mechanism research, and clinical translation. Balanced translocation carriers have the opportunity to produce phenotypically normal offspring, but they are at a higher risk of recurrent miscarriages and offspring with chromosomal abnormalities.

[19] Heat Shock Proteins in Oxidative Stress and Ischemia/Reperfusion Injury and Benefits from Physical Exercises: A Review to the Current Knowledge

  • Authors: Jakub Szyller, I. Bil-Lula
  • Year: 2021
  • Venue: Oxidative Medicine and Cellular Longevity
  • URL: https://www.semanticscholar.org/paper/4ec4bee9f1b89cdf5a3c513d847990f3cfc18bb8
  • DOI: 10.1155/2021/6678457
  • PMID: 33603951
  • PMCID: 7868165
  • Citations: 112
  • Influential citations: 2
  • Summary: The latest research focuses on determining the role of H SPs in OS, their antioxidant activity, and the possibility of using HSPs in the treatment of I/R consequences, where reactive oxygen species play a major role.
  • Evidence snippets:
  • Snippet 1 (score: 0.358) > Heat shock proteins play a cytoprotective role under pathological conditions such as cardiovascular diseases. The knowledge about cellular and molecular mechanisms underlying ROS-mediated modulation of HSP expression can help to better understand the pathophysiology of OS, which is associated with the development of many diseases (cardiovascular, neurodegenerative, etc.). I/R injury is considered a major contributor to tissue damage in multiple clinical situations such as myocardial infarction, stroke, and organ transplantation. Oxidative damage is a key factor in the initiation of I/R. HSP expression is highly sensitive to I/R injury. > Understanding the exact mechanisms of HSP and the structure of the protein interaction network can help to better understand the pathophysiology and treatment of many diseases, as well as to develop new drugs. There is a need to understand the relationship between cell pathways-signaling, metabolism, etc. The relationships between HSP and OS discussed in this work seem to be very complicated and not yet fully understood. Data showed that modulation of HSP expression in reperfusion injuries may result in better treatment of myocardial infarction. This can also help to prepare organs for the transplantation.

[20] Hyper-IgD syndrome/mevalonate kinase deficiency: what is new?

  • Authors: C. Mulders-Manders, A. Simon
  • Year: 2015
  • Venue: Seminars in Immunopathology
  • URL: https://www.semanticscholar.org/paper/b0c6a9943fcdf22c8aece6bd26c62c9c7e9d31f7
  • DOI: 10.1007/s00281-015-0492-6
  • PMID: 25990874
  • PMCID: 4491100
  • Citations: 56
  • Influential citations: 2
  • Summary: New findings in this disorder that have been published in the last 2 years are discussed, including new insights into pathophysiology, treatment, and the clinical phenotype linked to the genetic defect.
  • Evidence snippets:
  • Snippet 1 (score: 0.356) > valonate aciduria, a severe disease characterized by neurologic involvement with psychomotor retardation, cerebellar ataxia, and facial dysmorphy besides the inflammatory symptoms, leading to early death. MKD forms a continuous spectrum of disease between these two clinical entities. Overlapping clinical syndromes are seen with increasing frequency. As there is no clear border between phenotypes, we will use the term mevalonate kinase deficiency, which encompasses both HIDS and mevalonate aciduria, to describe the disease in this paper. > In this review, we will discuss new findings in MKD that have been published between January 1, 2012 and December 31, 2014. > What is new on the pathophysiological mechanism of MKD? > In the past 30 years, MKD has been proven to be a typical monogenetic autoinflammatory disease with overproduction This article is a contribution to the Special Issue on The Inflammasome and Autoinflammatory Diseases -Guest Editors: Seth L. Masters, Tilmann Kallinich and Seza Ozen of the inflammatory cytokine interleukin-1 beta (IL-1β) as prominent pathophysiological mechanism [3][4][5][6][7]. The importance of this cytokine in MKD is backed up by the beneficial effects of IL-1β-targeting drugs such as anakinra in patients with this disease [8][9][10][11]. > Most studies on the pathophysiology of MKD are based on in vitro cellular models with murine [12][13][14] or human cells with drug-induced block of the mevalonate kinase pathway w i t h e i t h e r H M G -C o A r e d u c t a s e i n h i b i t o r s o r bisphosphonates (Fig. 1). In these models, LPS or other bacterial components are used to mimic the inflammatory stimulus needed for the production of IL-1β. Stimulation of monocytes with LPS leads to increased pro-IL-1β transcription via activation of transcription factor NF-kB [5]. The effects of bisphosphonates

Notes

  • This provider combines search_papers_by_relevance with snippet_search.
  • No synthesis or second-stage model call is performed.
{ }

Source YAML

click to show
name: Kufor-Rakeb syndrome
creation_date: '2026-04-11T17:28:00Z'
updated_date: '2026-04-11T18:31:00Z'
category: Mendelian
description: >-
  Kufor-Rakeb syndrome is a rare autosomal recessive ATP13A2-related disorder
  characterized by juvenile-onset parkinsonism with pyramidal features. Core
  manifestations include young-onset parkinsonism, spastic paraparesis,
  supranuclear eye movement abnormalities, and progressive cognitive decline;
  psychosis may occur as a complication. ATP13A2 encodes a lysosomal P5B-ATPase
  that transports polyamines. Loss of ATP13A2 function disrupts lysosomal
  homeostasis, impairs mitochondrial quality control, and contributes to
  alpha-synuclein accumulation and neurodegeneration.
disease_term:
  preferred_term: Kufor-Rakeb syndrome
  term:
    id: MONDO:0011706
    label: Kufor-Rakeb syndrome
mappings:
  mondo_mappings:
  - term:
      id: MONDO:0011706
      label: Kufor-Rakeb syndrome
    mapping_predicate: skos:exactMatch
    mapping_source: MONDO
parents:
- Early-onset parkinsonism
- Lysosomal disorder
synonyms:
- PARK9
- ATP13A2-related juvenile parkinsonism
inheritance:
- name: Autosomal recessive inheritance
  inheritance_term:
    preferred_term: Autosomal recessive inheritance
    term:
      id: HP:0000007
      label: Autosomal recessive inheritance
  description: >-
    Kufor-Rakeb syndrome is inherited in an autosomal recessive pattern and is
    caused by biallelic inactivating ATP13A2 variants.
  evidence:
  - reference: PMID:29966207
    reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
    explanation: >-
      This directly establishes autosomal recessive inheritance for Kufor-Rakeb
      syndrome.
pathophysiology:
- name: ATP13A2 loss impairs lysosomal polyamine transport
  description: >-
    ATP13A2 is a lysosomal P5B-ATPase that transports polyamines. In Kufor-Rakeb
    syndrome, loss-of-function ATP13A2 variants impair endolysosomal polyamine
    transport, producing lysosomal dysfunction and creating a mechanistic basis
    for neurodegeneration.
  cell_types:
  - preferred_term: neuron
    term:
      id: CL:0000540
      label: neuron
  biological_processes:
  - preferred_term: lysosomal transport
    term:
      id: GO:0007041
      label: lysosomal transport
  evidence:
  - reference: PMID:34715013
    reference_title: "Structural basis of polyamine transport by human ATP13A2 (PARK9)."
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Recent studies have suggested that ATP13A2 and its close homologs, collectively known as P5B-ATPases, are polyamine transporters at endo-/lysosomes.
    explanation: >-
      This mechanistic study identifies ATP13A2 as an endolysosomal polyamine
      transporter, defining the core molecular function lost in disease.
  - reference: PMID:40848257
    reference_title: "Lysosomal polyamine storage upon ATP13A2 loss impairs β-glucocerebrosidase via altered lysosomal pH and electrostatic hydrolase-lipid interactions."
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
    explanation: >-
      This directly shows that ATP13A2 loss causes lysosomal polyamine storage in
      relevant cell models.
  downstream:
  - target: Lysosomal hydrolase dysfunction
    description: Lysosomal polyamine accumulation perturbs hydrolase activity and lysosomal homeostasis
- name: Lysosomal hydrolase dysfunction
  description: >-
    ATP13A2 deficiency causes lysosomal polyamine accumulation that disrupts
    lysosomal pH and impairs β-glucocerebrosidase-mediated substrate hydrolysis.
  cell_types:
  - preferred_term: dopaminergic neuron
    term:
      id: CL:0000700
      label: dopaminergic neuron
  cellular_components:
  - preferred_term: lysosome
    term:
      id: GO:0005764
      label: lysosome
  evidence:
  - reference: PMID:40848257
    reference_title: "Lysosomal polyamine storage upon ATP13A2 loss impairs β-glucocerebrosidase via altered lysosomal pH and electrostatic hydrolase-lipid interactions."
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Therefore, excess polyamine compromises lysosomes by disrupting pH and electrostatic interactions between GCase and BMP that enable efficient substrate hydrolysis, potentially clarifying pathogenic mechanisms and suggesting convergence on PD-relevant pathways.
    explanation: >-
      This supports a downstream lysosomal hydrolase defect caused by ATP13A2
      loss and links Kufor-Rakeb syndrome to broader Parkinson-relevant lysosomal
      biology.
  downstream:
  - target: Mitochondrial quality-control failure
    description: Lysosomal dysfunction converges with impaired mitochondrial maintenance and clearance
- name: Mitochondrial quality-control failure
  description: >-
    ATP13A2 deficiency impairs maintenance of a healthy mitochondrial pool and
    likely compromises mitochondrial clearance, contributing to progressive
    neuronal dysfunction.
  cell_types:
  - preferred_term: fibroblast
    term:
      id: CL:0000057
      label: fibroblast
  - preferred_term: dopaminergic neuron
    term:
      id: CL:0000700
      label: dopaminergic neuron
  biological_processes:
  - preferred_term: mitophagy
    modifier: ABNORMAL
    term:
      id: GO:0000423
      label: mitophagy
  - preferred_term: autophagy
    modifier: ABNORMAL
    term:
      id: GO:0006914
      label: autophagy
  evidence:
  - reference: PMID:22296644
    reference_title: "ATP13A2 mutations impair mitochondrial function in fibroblasts from patients with Kufor-Rakeb syndrome."
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      These findings collectively suggest that ATP13A2 contributes to the maintenance of a healthy mitochondrial pool, supporting the hypothesis that impaired mitochondrial clearance represents an important pathogenic mechanism underlying KRS.
    explanation: >-
      Patient-derived fibroblasts directly support mitochondrial quality-control
      failure as a pathogenic mechanism in Kufor-Rakeb syndrome.
  - reference: PMID:41306646
    reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      This P5B-ATPase dysfunction impairs lysosomal processing, leading to the accumulation of α-synuclein.
    explanation: >-
      The case report summarizes the accepted disease model linking ATP13A2
      dysfunction to impaired lysosomal processing and alpha-synuclein buildup.
phenotypes:
- name: Parkinsonism
  category: Neurologic
  description: >-
    Juvenile- or young-onset parkinsonism is the defining motor syndrome of
    Kufor-Rakeb disease.
  phenotype_term:
    preferred_term: Parkinsonism
    term:
      id: HP:0001300
      label: Parkinsonism
  evidence:
  - reference: PMID:29966207
    reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
    explanation: >-
      This directly identifies young-onset parkinsonism as the core motor
      phenotype of Kufor-Rakeb syndrome.
- name: Spastic paraparesis
  category: Neurologic
  description: >-
    Pyramidal involvement with lower-extremity spastic paraparesis is a classic
    accompanying motor feature.
  phenotype_term:
    preferred_term: Spastic paraparesis
    term:
      id: HP:0002313
      label: Spastic paraparesis
  evidence:
  - reference: PMID:29966207
    reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
    explanation: >-
      This directly lists spastic paraparesis as part of the syndrome phenotype.
- name: Vertical supranuclear gaze palsy
  category: Neurologic
  description: >-
    Supranuclear ocular motility abnormalities are part of the characteristic
    Kufor-Rakeb syndrome presentation.
  phenotype_term:
    preferred_term: Vertical supranuclear gaze palsy
    term:
      id: HP:0000511
      label: Vertical supranuclear gaze palsy
  evidence:
  - reference: PMID:29966207
    reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
    explanation: >-
      The abstract supports abnormal supranuclear ocular motility generally but
      does not specify the vertical subtype, so support is partial.
- name: Cognitive impairment
  category: Neurologic
  description: >-
    Progressive cognitive decline is part of the neurodegenerative phenotype of
    Kufor-Rakeb syndrome.
  phenotype_term:
    preferred_term: Cognitive impairment
    term:
      id: HP:0100543
      label: Cognitive impairment
  evidence:
  - reference: PMID:41306646
    reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Here, we present the first documented Guatemalan case of KRS, a young woman with progressive motor and cognitive decline.
    explanation: >-
      This directly supports progressive cognitive impairment as part of the
      clinical phenotype.
- name: Psychosis
  category: Psychiatric
  description: >-
    Psychosis can complicate Kufor-Rakeb syndrome in some patients.
  phenotype_term:
    preferred_term: Psychosis
    term:
      id: HP:0000709
      label: Psychosis
  evidence:
  - reference: PMID:31232173
    reference_title: "Successful treatment of psychosis in a patient with Kufor-Rakeb syndrome with low dose aripiprazole: a case report."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      We present a case of a 32-year-old male with Kufor-Rakeb syndrome (KRS), a form of juvenile parkinsonism due to mutations of the ATP13A2 gene at PARK9 locus. The patient was seen for daily behavioral outbursts and psychotic symptoms.
    explanation: >-
      This directly documents psychosis as a neuropsychiatric complication in a
      patient with Kufor-Rakeb syndrome.
genetic:
- name: ATP13A2
  association: Loss-of-function
  gene_term:
    preferred_term: ATP13A2
    term:
      id: hgnc:30213
      label: ATP13A2
  notes: >-
    Kufor-Rakeb syndrome is caused by biallelic inactivating ATP13A2 variants.
    ATP13A2 encodes the lysosomal P5B-ATPase also known as PARK9.
  evidence:
  - reference: PMID:29966207
    reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      KRS is caused by homozygous/compound heterozygous inactivating mutations in ATP13A2.
    explanation: >-
      This directly states the causal genetic mechanism for Kufor-Rakeb syndrome.
treatments:
- name: Pharmacotherapy for psychosis
  description: >-
    Low-dose aripiprazole can be used to control psychotic symptoms in Kufor-Rakeb
    syndrome without major motor worsening in at least isolated reported cases.
  treatment_term:
    preferred_term: pharmacotherapy
    term:
      id: MAXO:0000058
      label: pharmacotherapy
    therapeutic_agent:
    - preferred_term: aripiprazole
      term:
        id: CHEBI:31236
        label: aripiprazole
  evidence:
  - reference: PMID:31232173
    reference_title: "Successful treatment of psychosis in a patient with Kufor-Rakeb syndrome with low dose aripiprazole: a case report."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      This significant improvement without drug-induced motor side effects suggests that aripiprazole at low doses (2-5 mg) is effective and tolerated in patients with KRS.
    explanation: >-
      This directly supports low-dose aripiprazole as a symptomatic treatment
      option for psychosis in Kufor-Rakeb syndrome.
- name: Multidisciplinary supportive care
  description: >-
    Management relies on genetic diagnosis, counseling, and multidisciplinary
    supportive care for progressive motor and cognitive disability.
  treatment_term:
    preferred_term: supportive care
    term:
      id: MAXO:0000950
      label: supportive care
  evidence:
  - reference: PMID:41306646
    reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      This report underscores the importance of recognizing KRS in diverse populations and of using gene-based testing to guide diagnosis, counseling, and multidisciplinary supportive care.
    explanation: >-
      The case report explicitly frames multidisciplinary supportive care as part
      of current management.
differential_diagnoses:
- name: Wilson disease
  description: >-
    Wilson disease can mimic juvenile parkinsonism with cognitive or psychiatric
    features but is distinguished by copper metabolism abnormalities and
    hepatic involvement.
  distinguishing_features:
  - Abnormal copper studies, Kayser-Fleischer rings, and hepatic disease favor Wilson disease.
  - Biallelic ATP13A2 variants with spastic paraparesis and supranuclear gaze abnormalities favor Kufor-Rakeb syndrome.
  disease_term:
    preferred_term: Wilson disease
    term:
      id: MONDO:0010200
      label: Wilson disease
- name: Hereditary spastic paraplegia
  description: >-
    Hereditary spastic paraplegia may resemble Kufor-Rakeb syndrome when lower
    limb spasticity predominates, but typically lacks the characteristic
    juvenile parkinsonism syndrome.
  distinguishing_features:
  - Predominant progressive lower-extremity spasticity without parkinsonism favors hereditary spastic paraplegia.
  - Early parkinsonism, supranuclear gaze palsy, and ATP13A2-associated lysosomal dysfunction favor Kufor-Rakeb syndrome.
  disease_term:
    preferred_term: hereditary spastic paraplegia
    term:
      id: MONDO:0019064
      label: hereditary spastic paraplegia
clinical_trials: []
datasets: []
notes: >-
  Asta deep research was run as requested, but most of its retrievals were not
  specific to Kufor-Rakeb syndrome. Primary curation therefore relied on direct
  ATP13A2 syndrome papers and mechanistic studies reviewed from PubMed.