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- Title
Metachromatic leukodystrophy and transplantation: remyelination, no cross‐correction.
- Authors
Wolf, Nicole I.; Breur, Marjolein; Plug, Bonnie; Beerepoot, Shanice; Westerveld, Aimee S. R.; van Rappard, Diane F.; de Vries, Sharon I.; Kole, Maarten H. P.; Vanderver, Adeline; van der Knaap, Marjo S.; Lindemans, Caroline A.; van Hasselt, Peter M.; Boelens, Jaap J.; Matzner, Ulrich; Gieselmann, Volkmar; Bugiani, Marianna
- Abstract
Objective: In metachromatic leukodystrophy, a lysosomal storage disorder due to decreased arylsulfatase A activity, hematopoietic stem cell transplantation may stop brain demyelination and allow remyelination, thereby halting white matter degeneration. This is the first study to define the effects and therapeutic mechanisms of hematopoietic stem cell transplantation on brain tissue of transplanted metachromatic leukodystrophy patients. Methods: Autopsy brain tissue was obtained from eight (two transplanted and six nontransplanted) metachromatic leukodystrophy patients, and two age‐matched controls. We examined the presence of donor cells by immunohistochemistry and microscopy. In addition, we assessed myelin content, oligodendrocyte numbers, and macrophage phenotypes. An unpaired t‐test, linear regression or the nonparametric Mann–Whitney U‐test was performed to evaluate differences between the transplanted, nontransplanted, and control group. Results: In brain tissue of transplanted patients, we found metabolically competent donor macrophages expressing arylsulfatase A distributed throughout the entire white matter. Compared to nontransplanted patients, these macrophages preferentially expressed markers of alternatively activated, anti‐inflammatory cells that may support oligodendrocyte survival and differentiation. Additionally, transplanted patients showed higher numbers of oligodendrocytes and evidence for remyelination. Contrary to the current hypothesis on therapeutic mechanism of hematopoietic cell transplantation in metachromatic leukodystrophy, we detected no enzymatic cross‐correction to resident astrocytes and oligodendrocytes. Interpretation: In conclusion, donor macrophages are able to digest accumulated sulfatides and may play a neuroprotective role for resident oligodendrocytes, thereby enabling remyelination, albeit without evidence of cross‐correction of oligo‐ and astroglia. These results emphasize the importance of immunomodulation in addition to the metabolic correction, which might be exploited for improved outcomes.
- Subjects
INTRACEREBRAL transplantation; HEMATOPOIETIC stem cell transplantation; LEUKODYSTROPHY; NEURAL stem cells; CELL transplantation
- Publication
Annals of Clinical & Translational Neurology, 2020, Vol 7, Issue 2, p169
- ISSN
2328-9503
- Publication type
Article
- DOI
10.1002/acn3.50975