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Volume 17, Number 12,
Issue of June 15, 1997
pp. 4545-4551
Copyright ©1997 Society for Neuroscience
Structural Abnormalities and Deficient Maintenance of Peripheral
Nerve Myelin in Mice Lacking the Gap Junction Protein Connexin
32
Patrizia Anzini1,
Dirk H.-H. Neuberg2,
Melitta Schachner1, 3,
Eric Nelles4,
Klaus Willecke4,
Jürgen Zielasek5,
Klaus V. Toyka5,
Ueli Suter2, and
Rudolf Martini1, 5
Departments of 1 Neurobiology and 2 Cell
Biology, Swiss Federal Institute of Technology, CH-8093 Zurich,
Switzerland, 3 Institute of Biosynthesis of Neural
Structures, Center for Molecular Neurobiology Hamburg, University of
Hamburg, D-20246 Hamburg, Germany, 4 Institute of Genetics,
University of Bonn, D-53117 Bonn, Germany, and 5 Department
of Neurology, University of Würzburg, D-97080 Würzburg,
Germany
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
FOOTNOTES
REFERENCES
ABSTRACT
Mutations affecting the connexin 32 (Cx32) gene are associated with
the X-linked form of the hereditary peripheral neuropathy Charcot-Marie-Tooth disease (CMTX). We show that
Cx32-deficient mice develop a late-onset progressive peripheral
neuropathy with abnormalities comparable to those associated with CMTX,
thus providing proof of the critical role of Cx32 in the maintenance of
peripheral nerve myelin and an animal model for CMTX. Frequently
observed features include abnormally thin myelin sheaths, cellular
onion bulb formation reflecting myelin degeneration-induced Schwann cell proliferation, and enlarged periaxonal collars while nerve conductance properties are altered only slightly. These observations are consistent with earlier hypotheses suggesting a function of Cx32 as
a channel-forming protein that facilitates the communication between
the abaxonal and adaxonal aspects of Schwann cell cytoplasm.
Key words:
connexin 32;
myelin;
Schwann cell;
demyelination;
Charcot-Marie-Tooth disease;
transgenic mouse
INTRODUCTION
Connexins are members of a large gene family
encoding subunit proteins of gap junctions (for review, see Bruzzone et
al., 1996 ; Kumar and Gilula, 1996 ; Bruzzone and Ressot, 1997 ). These structures consist of oligomerized connexin proteins that form intercellular channels to allow the exchange of small molecules (<1000
Da) like ions, second messengers, and metabolites. This communication
among neighboring cells is thought to be important for the propagation
of signals among electrically excitable cells and for the regulation of
cell proliferation and differentiation during tissue development and in
carcinogenesis.
Defective connexin genes have been suggested to cause two human
genetic diseases. First, single nucleotide mutations in the connexin 43 (Cx43) gene have been described to occur frequently in patients
exhibiting familial cardiac malformation (Britz-Cunningham et al.,
1995 ), and genetically engineered mice with deleted Cx43 gene show
heart malformations as well (Reaume et al., 1995 ). Second, mutations in
the human Cx32 gene have been linked to the X-linked hereditary motor
and sensory neuropathy Charcot-Marie-Tooth disease (CMTX; Bergoffen
et al., 1993 ) (for review, see Ionasescu et al., 1996 ), which is
characterized by distal muscle weakness, muscle atrophy, areflexia, and
foot deformities (for review, see Suter and Snipes, 1995 ). In concord
with the demyelinating phenotype of CMTX patients, Cx32 is highly
expressed by myelinating Schwann cells in the PNS and is regulated
comparably to other myelin proteins (Scherer et al., 1995 ). Two of
these proteins, protein zero (P0) and peripheral myelin protein 22 (PMP22), are affected in alterna-tive forms of CMT, exhibiting
demyelinating phenotypes as well (for review, see Snipes and Suter,
1995 ; Suter and Snipes, 1995 ; Murakami et al., 1996 ). However, in
contrast to P0 and PMP22, which are components of compact myelin, Cx32
is found mainly in noncompacted domains, the paranodal loops, and
Schmidt-Lanterman incisures (Bergoffen et al., 1993 ; Scherer et al.,
1995 ; Spray and Dermietzel, 1995 ). On the basis of this localization,
it has been hypothesized that Cx32 may be a component of reflexive
intracellular gap junctions established between different, noncompacted
myelin membrane leaflets to provide a direct diffusion pathway
transversing the myelin sheath (Paul, 1995 ; Scherer et al., 1995 ).
Because some Cx32 mutations of CMTX patients interrupt the formation of
functional gap junctions in vitro (Bruzzone et al., 1994 ;
Rabadan-Diehl et al., 1994 ; Omori et al., 1996 ), they probably lead to
a blockade of the direct diffusion pathway within the myelin sheath,
leading to pathological alterations in the peripheral nerve.
In this report we show that Cx32-deficient mice display a
late-onset peripheral neuropathy with features similar to those of CMTX
patients, hence strongly supporting the causative role of Cx32
mutations in CMTX. The demyelinating phenotype of the neuropathy is
accompanied by mild changes of the conduction properties of peripheral
nerves. Additionally observed abnormalities, i.e., enlarged periaxonal
collars and noncompacted regions of myelin, are consistent with a role
of Cx32 in transport processes, in particular ionic homeostasis, in and
across myelin sheaths.
MATERIALS AND METHODS
Genotyping. The presence of wild-type or mutant Cx32
alleles was detected simultaneously by using a set of three specific primers in the PCR. The wild-type Cx32 allele was represented as a 881 bp fragment, using two primers that were complementary to sequences in
the Cx32 gene initially published by Hennemann et al. (1992)
(oligonucleotide sequences: 5 -CCATAAGTCAGGTGTAAAGGAGC-3 and
5 -GAGCATAA- AGACAGTGAAGACGG-3 ). Additional use of an
oligonucleotide primer complementary to the neo resistance cassette
sequences amplified a 414 bp fragment specific for the disrupted allele (5 -ATCATGCGAAAC-GATCCTCATCC-3 ). The PCR was performed in a final volume of 25 µl (2.5 mM MgCl2, 1× PCR
buffer, 0.4 mM dGTP, dATP, dCTP, dTTP, 4 µM
of each of the three primers, 1 U Taq DNA polymerase, and
1-3 µg genomic DNA). The reaction product was denatured at 93°C
for 2 min, followed by 40 cycles (93°C, 30 sec; 66°C, 45 sec;
72°C, 90 sec) and a final extension at 72°C for 10 min with an MWG
Biotech thermal cycler.
Tissue preservation for electron microscopy. Electron
microscopy of femoral nerves (comprising the quadriceps muscle and
saphenous nerve branches) of transcardially perfused Cx32-deficient and wild-type mice (2% paraformaldehyde and 2% glutaraldehyde in 0.1 M cacodylate buffer) was performed as described (Martini et
al., 1995a ,b ).
Morphometry. Onion bulbs, unusually thin myelin, and
other abnormalities (e.g., abnormally enlarged periaxonal collars) were quantified at the electron microscopic level by scoring their numbers
in cross sections of femoral quadriceps and saphenous nerves (Carenini
et al., 1997 ). For each developmental stage two to four wild-type and
three Cx32-deficient mice were investigated (see Fig. 2). No detectable
differences in the morphological abnormalities between homozygous
female and hemizygous male mice were observed. Significance of
differences between mean values of each developmental stage
investigated was determined by a one-way ANOVA, followed by
Spjotvoll-Stoline post hoc tests using a commercially
available statistical software (Superanova). The Spjotvoll-Stoline
test was only performed when the one-way ANOVA indicated overall
statistical significance (p < 0.01).
Fig. 2.
Schematic representation of the number of onion
bulbs (A) and abnormally enlarged periaxonal collars
(B, C) in femoral nerves of
Cx32-deficient and wild-type mice at 4 weeks, 4 and 6 months, and 1 year of age. a, Note that onion bulbs develop only in
the quadriceps nerve of Cx32-deficient mice (Cx32/Q)
older than 4 months, whereas such structures are absent or found only
very rarely in the saphenous nerve of the mutant
(Cx32/S) and in the quadriceps (w.t./Q)
and saphenous nerves (w.t./S) of the wild-type mice.
*Significantly different compared with wild-type mice
(p < 0.05); **significantly different
compared with wild-type mice (p < 0.01).
n indicates the number of mice investigated.
B, C, At 6 months of age, both in
quadriceps (B) and saphenous nerves (C),
the number of abnormally enlarged periaxonal collars is elevated significantly in Cx32-deficient mice when compared with values from
wild-type mice. The lack of significance in saphenous nerves of
1-year-old mice possibly can be explained by the large SDs. *Significantly different compared with wild-type mice
(p < 0.05); **significantly different
compared with wild-type mice (p < 0.01). n indicates the number of mice investigated.
[View Larger Version of this Image (36K GIF file)]
Electrophysiological measurements. The determination of
nerve conduction properties was performed in six hemizygous
Cx32-deficient male mice (142-181 d old), seven age-matched wild-type
mice (123-150 d old), seven homozygous Cx32-deficient female mice
(351-387 d old), and four female and six male wild-type mice (358-396
d old). Determination of latencies, amplitudes, and duration of the
compound muscle action potentials (M-latencies, M-amplitudes, CMAP) and the determination of the elicitability, latency, and duration of the
F-waves (which are late motor responses sensitive to myelin dysfunction) and of mixed afferent sciatic nerve potential latencies was performed as described in detail (Zielasek et al., 1996 ). Statistical analysis was performed by using the one-sided U
test at a significance level of 0.05 to assess the statistical
significance of differences in the nerve conduction studies between
Cx32-deficient mice and control mice (Instat, GraphPad, San Diego,
CA).
RESULTS
Genotyping of Cx32-deficient animals
The construction of Cx32-deficient mice has been described
(Nelles et al., 1996 ). To establish a fast method for genotyping and
the identification of mutant animals, we devised a PCR-based strategy
(Fig. 1A). Using in the same PCR
simultaneously three oligonucleotide primers specific for (1) the neo
expression cassette, (2) sequences 5 upstream of the neo cassette
insertion into exon 2 of the Cx32 gene, and (3) sequences 3 downstream
of the insertion, we were able to genotype the animals conveniently and
reliably (Fig. 1B).
Fig. 1.
Genotyping of Cx32 mutant mice. A,
Partial restriction map of the Cx32 locus and schematic representation
of the targeting construct and the targeting event. Homologous
recombination resulted in an "in frame" insertion of the
promoterless neo cassette and the concomitant disruption of the
translated exon (exon 2). Exons are indicated as filled
boxes. The neo cassette (NEO) is represented by
an open box. E, EcoRI;
P, PstI; S,
SacII. Amplified PCR fragments are indicated with a
thick line. B, PCR analysis of the Cx32
locus and the targeting event in transgenic animals
(control, no DNA added).
[View Larger Version of this Image (20K GIF file)]
Behavior of Cx32-deficient animals
Cx32-deficient animals were viable, bred normally, and had usual
life spans. No obvious behavioral abnormalities could be observed up to
15 months of age (data not shown). In particular, no signs of
peripheral neuropathies were detectable, if these animals were compared
with mice with severe myelin abnormalities (Giese et al., 1992 ; Suter
et al., 1992a ,b ; Adlkofer et al., 1995 ; Martini et al., 1995a ,b ; Magyar
et al., 1996 ).
Conduction properties of peripheral nerves
The electrophysiological evaluation revealed only mild
abnormalities (Table 1). In 4- to 6-month-old mutants
the only detectable changes were a slight conduction slowing and an
increase of the latency of the muscle response (M-latency) after distal
stimulation of the sciatic nerve. Another statistically significant
change in mutant mice was a reduction of the M-amplitude after proximal sciatic nerve stimulation. These changes indicate a mild mixed axonal
and demyelinating pathology as represented by a reduction of
M-amplitudes and delayed muscle responses, respectively.
Table 1.
Electrophysiological investigations in Cx32-deficient
mice
|
|
|
| Genotype |
Cx32-deficient |
wild
type |
Cx32-deficient |
Wild
type |
| n |
6 |
7 |
7 |
10 |
| Age |
4-6 months |
4-6
months |
1 year |
1 year |
|
| Facial nerve |
| M-latency
(msec) |
1.0 ± 0.1 |
1.1
± 0.1 |
1.0 ± 0.1 |
1.1 ± 0.2 |
| M-amplitude
(mV) |
15 ± 2 |
12 ± 4 |
11 ± 2* |
14
± 3 |
|
| Sciatic nerve |
| Proximal stimulation |
| M-latency
(msec) |
1.7 ± 0.2ns |
1.5 ± 0.2 |
1.5
± 0.2 |
1.6 ± 0.2 |
| M-amplitude (mV) |
8 ± 3* |
12
± 3 |
10 ± 6 |
11 ± 4 |
| M-duration (msec) |
2.2
± 0.2ns |
1.8 ± 0.5 |
2.0
± 0.5ns |
2.2 ± 0.5 |
| F-latency (msec) |
4.2
± 0.2 |
4.1 ± 0.2 |
4.4 ± 0.4 |
4.4 ± 0.5 |
| Distal
stimulation |
| M-latency (msec) |
1.0 ± 0.1* |
0.8
± 0.1 |
0.8 ± 0.1 |
1.0 ± 0.2 |
| M-amplitude
(mV) |
11 ± 4ns |
15 ± 5 |
12 ± 3 |
12
± 4 |
| M-duration (msec) |
2.1 ± 0.2 |
1.5
± 0.3 |
1.9 ± 0.6ns |
2.2
± 0.5 |
| F-latency (msec) |
4.8 ± 0.5 |
4.8
± 0.2 |
5.1 ± 0.4ns |
4.8 ± 0.5 |
| Motor nerve
conduction velocity (m/sec) |
32 ± 9 |
35 ± 9 |
35
± 10ns |
40 ± 12 |
| Mixed afferent nerve conduction
velocity (m/sec) |
42 ± 6 |
45 ± 3 |
49 ± 8 |
49
± 9 |
|
|
M-latency, M-amplitude, and M-duration are components of the muscle
response, the earliest response to nerve stimulation that travels
orthogradely to elicit a compound muscle action potential. F-responses
are late muscle responses. After the stimulation the stimulus first is
transmitted retrogradely, eliciting a secondary response in motor
neurons that is transmitted orthogradely to the muscle, thus arriving
later than the M-response.
*
p < 0.05, one-sided U test; ns, not
significant.
|
|
Unexpectedly, in 1-year-old mice the abnormalities were even milder
than in the 4- to 6-month-old mutants, with a decrease of M-amplitudes
only in the facial nerve and a tendency toward a mild conduction
slowing in the sciatic nerve (Table 1).
Ultrastructure of peripheral nerves
We chose to investigate the quadriceps muscle and the
cutaneous saphenous branches of the femoral nerve to distinguish the effects of Cx32 deficiency on motor and sensory nerves. Axon-Schwann cell units of 4-week-old Cx32-deficient mice were morphologically not
distinguishable from those of wild-type littermates (Fig. 2). However, in the quadriceps nerves of 4-month-old
mutants, ~25% of myelinated axon-Schwann cell units were associated
with small Schwann cells and Schwann cell processes not in contact with
axons and surrounded by a basal lamina (Figs. 2a,
3a-d). Such structures are indicative of myelin
degeneration-induced Schwann cell proliferation in peripheral
neuropathies and are, because of their concentric arrangement around
the myelinating axon-Schwann cell units, called onion bulbs (Dyck et
al., 1993 ). The corresponding myelinating axon-Schwann cell units in
the center of the onion bulbs were usually thinly myelinated in
comparison to the axon caliber (Fig.
3a-d), suggesting remyelination after myelin degeneration (Dyck et al., 1993 ). In quadriceps nerves of
6-month-old and 1-year-old Cx32-deficient mice, onion bulbs and thinly
myelinated axons were more frequent than in 4-month-old mutants,
reflecting a progressive course of myelin degeneration (Fig.
2a). Occasionally in 1-year-old mice, onion bulb cells
collectively surrounded two or more axon-Schwann cell units as a group
(Fig. 3c). Such profiles were not seen in other myelin
mutants such as P0- and PMP22-deficient mice and are reminiscent of
"regenerating units" usually found in proximal stumps of transected
nerves (Morris et al., 1972 ). Interestingly, onion bulbs and thinly
myelinated axon-Schwann cell units were seen only very rarely in the
saphenous nerves of 4- and 6-month-old and 1-year-old mutants, and
their numbers were not significantly different from those seen in the corresponding nerves of wild-type mice (Fig. 2a).
Fig. 3.
Electron migrographs of axon-Schwann cell
units of wild-type (a) and connexin 32-deficient mice
(b-g) at 4 (a, b)
and 6 (e-g) months and 1 year of age (c,
d). a, This axon (A) is enveloped by a sheath of compacted myelin (M). A basal
lamina around the myelinating Schwann cell (arrow) and
endoneurial collagen (C) separates the axon-Schwann
cell unit from neighboring nerve fibers. b, This
myelinated axon-Schwann cell unit is characterized by thin, compacted
myelin surrounded by basal lamina-covered processes of Schwann cells
forming an onion bulb (arrows). c, This
onion bulb contains two myelinated axon-Schwann units.
Large and small arrows point to a process
and cell body of onion bulb cells, respectively. d,
Axon-Schwann cell unit surrounded by processes of onion bulb cells
(arrows). Note the expanded periaxonal collar containing vesicular inclusions (asterisks). e,
f, Intimate interdigitations between the inner aspect of
the Schwann cell and the axon (A). In e,
the small arrows delineate a slender, loop-shaped
protrusion of the axon (A) engulfing Schwann cell and/or
axonal cytoplasm. In f, a cytoplasmic extension of the
Schwann cell collar (arrow) protrudes into the axon.
g, Abnormally organized noncompacted aspect of a
myelinating Schwann cell (asterisk). Note the numerous vesicular inclusions and the expanded periaxonal collar of high electron density. Scale bars, 0.5 µm.
[View Larger Version of this Image (160K GIF file)]
In addition to onion bulbs and thinly myelinated axons, other
abnormalities were seen in the Cx32-deficient mice. Particularly striking was the occurrence of axon-myelin units with abnormally thick
periaxonal collars (Fig. 3d,g). Either they were of high electron density (Fig. 3g), or they contained many vesicular
inclusions (Fig. 3d). In addition, they often showed
intimate interdigitations with the axon reminiscent of the paranodal
axon-Schwann cell network (for literature, see Gatzinsky, 1996 ) (Fig.
3e,f). At 4 months of age, the numbers of enlarged
periaxonal collars were slightly, but not significantly, elevated in
the quadriceps nerve of the mutants (Fig. 2b), whereas in
the saphenous nerve the numbers of enlarged periaxonal collars were not
elevated (Fig. 2c). In 6-month-old mice the numbers of
enlarged periaxonal collars were elevated significantly in the mutants
in comparison with wild-type mice in both the quadriceps nerve and the
saphenous nerve (Fig. 2b,c). At 1 year of age, the numbers
of enlarged periaxonal collars still were elevated significantly in
quadriceps nerves (Fig. 2b), whereas the higher numbers in
the saphenous nerves of the mutants were no longer statistically
significant (Fig. 2c), possibly because of the relatively
high SDs.
Morphological alterations, less frequently observed than enlarged
periaxonal collars, were abnormally organized noncompacted aspects of
myelinating Schwann cells. They usually consisted of blown-up cytoplasm
containing lysosomes, multivesicular bodies, and other vesicular
structures and were characterized by numerous infoldings (Fig.
3g).
In contrast to myelinating axon-Schwann cell units, nonmyelinating
axon-Schwann cell units showed no abnormalities in the mutants at any
age investigated (data not shown).
DISCUSSION
In the present study we demonstrate that Cx32-deficient mice
develop a late-onset and progressive peripheral neuropathy with features indicative of demyelination and remyelination, such as onion
bulbs and abnormally thin myelin. Noncompacted aspects of myelin, such
as periaxonal collars, were unusually enlarged. The abnormalities in
conduction properties were only mild, in keeping with a normally
appearing phenotype and lack of detectable muscle weakness.
In the past, strains of mice deficient in the myelin proteins P0,
PMP22, and MAG have been generated. Mice homozygously mutated in P0 are
characterized by severely compromised myelination and progressive
demyelination (Giese et al., 1992 ; Martini et al., 1995b ). Similarly,
homozygous PMP22-deficient mutants show abundant focal hypermyelination
in the form of myelin tomacula at a young age, followed by severe
demyelination (Adlkofer et al., 1995 ). These findings are in contrast
to the phenotype of the Cx32-deficient mice, which show normal myelin
formation and nerve conduction at younger ages (Nelles et al., 1996 ;
this study), followed by a mild demyelinating and remyelinating
phenotype (this study). Similar progress in demyelination has been
described in mice heterozygously deficient in P0 (P0+/
mice) or homozygously deficient in MAG (MAG / mice). In
P0+/ mice normal myelin formation is found until
postnatal week 10, followed by abnormal myelin folding in the paranodal
aspects of the myelin and onion bulb formation at postnatal week 16 (Martini et al., 1995b ). In MAG / mutants the first
abnormalities occur at postnatal week 12, when both myelin tomacula and
features characteristic of degeneration of myelin and axons are
detectable (Fruttiger et al., 1995 ; Carenini et al., 1997 ). Thus, these
mutants form normal myelin from the outset, followed by
genotype-specific alterations (e.g., paranodal foldings, tomacula
formation) that probably lead to, or are concomitant with,
demyelination. Consequently, the formation of myelin appears to be
considerably less sensitive to molecular alterations of myelin genes
than the maintenance of myelin.
Possible mechanisms leading to peripheral neuropathies in
Cx32-deficient mice
A genotype-specific characteristic feature in the Cx32-deficient
mice is the elaboration of abnormally thick periaxonal collars and
cytoplasmic thickenings of other noncompacted compartments, such as
Schmidt-Lanterman incisures and paranodal loops. How can the
occurrence of cytoplasmic swellings be linked to the absence of a gap
junction protein? In wild-type mice Cx32 is expressed at apposing
membranes of Schmidt-Lanterman incisures that potentially could be
used as rapid pathways for ions and small molecules to move between the
cell body and inner myelin compartments. Thus, the disorganization of
the inner Schwann cell compartment in Cx32-deficient mice might reflect
poor communication between the outer and inner cytoplasmic aspects of
myelinating Schwann cells that eventually leads to cytoplasmic
abnormalities (see also the discussion by Scherer et al., 1995 ).
Alternatively, or in addition, the cytoplasmic swelling may represent
pathological alterations caused by a compromised homeostasis of ions as
a result of reduced "spatial buffering" of ions after neuronal
activity (Spray and Dermietzel, 1995 ).
The observed abnormalities might represent a pathological state of a
Schwann cell that is prone to demyelination. However, not all Schwann
cells with cytoplasmic thickenings undergo demyelination, because in
the saphenous nerve branch no signs of demyelinations could be found,
although cytoplasmic thickenings were present. The much lower liability
to myelin degeneration in the cutaneous sensory nerves and dorsal roots
versus muscle nerves and ventral roots also has been described for
P0+/ , PMP22+/ , MAG / mice
and in rats overexpressing PMP22 (Adlkofer et al., 1995 ; Fruttiger et
al., 1995 ; Martini et al., 1995b ; Sereda et al., 1996 ; Carenini et al.,
1997 ). However, the underlying cellular and molecular differences
between sensory and motor fibers have not yet been determined.
Cx32-deficient mice show abnormalities similar to those in
CMTX patients
Unlike P0, MAG, and PMP22, Cx32 originally had not been
described as a typical myelin component, because it had been detected in liver, kidney, pancreas, and brain (Spray and Dermietzel, 1995 ). Cx32 emerged into prominence as a myelin protein when mutations in this X-linked gene were found to be linked to the dominantly inherited form of CMTX (Bergoffen et al., 1993 ), the most common nonduplication form of CMT1 (Ionasescu et al., 1996 ). Meanwhile, more
than 80 mutations are known to be associated with CMTX (Scherer et al.,
1997 ). The various mutations are dispersed throughout the coding region
of the Cx32 gene and lead to amino acid substitutions, codon deletions,
frameshift, and nonsense mutations (Sherer et al., 1997). The products
of three Cx32 mutations (two different amino acid substitutions and a
frameshift mutation) cause a loss of function in that the gene products
are unable to form functional channels (Bruzzone et al., 1994 ).
Additionally, these mutations lead to the inability to form channels
with Cx26, indicating also a dominant-negative effect on Cx26
proteins that might associate with mutant Cx32 molecules (Bruzzone et
al., 1994 ). However, because Cx26 is not or only very scarcely
expressed by myelinating Schwann cells (Scherer et al., 1995 ), faulty
interactions of mutant Cx32 with Cx26 are probably not relevant for the
severity of CMTX. Together with investigations on the functional
consequences of Cx32 mutations in vivo, the search for other
possible partners of Cx32 in peripheral nerves might be relevant to
understand the significant variability in the clinical profile of CMTX
patients (Ionasescu et al., 1996 ; Timmerman et al., 1996 ; Yoshimura et al., 1996 ; Scherer et al., 1997 ).
Mice deficient in Cx32 are affected by a mild phenotype in that
myelination occurs normally and on schedule. The late onset of the
neuropathy is reminiscent of the situation in CMTX patients who reveal
clinical symptoms in the second or third decade of life (Ionasescu et
al, 1996). However, because the behavior of the mutant mice is not
distinguishable from that of wild-type mice, one could argue that the
mice do not mirror exactly the phenotype of CMTX patients. It should,
however, be considered that small organisms with relatively short
nerves might be less susceptible to impaired conductance properties
than humans are.
A typical electrophysiological feature of Cx32-deficient mice is
the mild, but significant, axonal component of the abnormality as
reflected by a decrease in the M-amplitude. Similar
electrophysiological alterations are one of the hallmark symptoms of
patients suffering from CMTX, causing some difficulties in
distinguishing them from patients with CMT2, the axonal form of CMT
(Timmerman et al., 1996 ) (for review, see Dyck et al., 1993 ). Our
electron microscopic analysis provided no evidence for a massive loss
of axons in Cx32-deficient mice, in contrast to the results of the
electrophysiological investigations. However, it is possible that the
lowering of the M-response is the physiological consequence of
axon-related alterations, such as periaxonal swellings and
axon-Schwann cell interdigitations, rather than of demyelination. In
addition, a mild and transient axonal damage cannot be ruled out and
might contribute to the axon-related electrophysiological changes. It
is not clear why the decrease in amplitude was visible only at younger
age. It is, however, conceivable that the regenerating units that have been seen occasionally in the nerves of 1-year-old, but not of 4- to
6-month-old, mutant mice cause or contribute to the amelioration of the
electrophysiological properties. Further studies are needed to learn
whether and how the nervous system can compensate for the impaired
myelin maintenance in some inherited neuropathies.
FOOTNOTES
Received Jan. 27, 1997; revised March 19, 1997; accepted March 31, 1997.
P.A. was supported by the Associazione per la Promozione delle
Ricerche Neurologiche (Italy). The laboratory of K.W. was supported by
the Deutsche Forschungsgemeinschaft (SFB 284, C1) and the Dr. Mildred
Scheel Foundation for Cancer Research. The laboratory of U.S. was
supported by the Swiss National Science Foundation.
Correspondence should be addressed to Dr. Rudolf Martini, Department of
Neurology, Section of Developmental Neurobiology, University of
Würzburg, Josef Schneider Strasse 11, D-97080 Würzburg, Germany.
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