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Ceruloplasmin gene variations and substantia nigra hyperechogenicity in Parkinson disease

H. Hochstrasser, MSc, P. Bauer, MD, U. Walter, MD, S. Behnke, MD, J. Spiegel, MD, I. Csoti, MD, B. Zeiler, MD, A. Bornemann, MD, J. Pahnke, MD, G. Becker, MD, O. Riess, MD and D. Berg, MD

From the Institutes for Medical Genetics (Drs. Bauer, Riess, and Berg, H. Hochstrasser) and Brain Research (Dr. Bornemann) and Hertie Institute for Brain Research (Dr. Berg), University of Tuebingen, Department of Neurology (Dr. Walter), University of Rostock, Department of Neurology (Drs. Behnke, Spiegel, and Zeiler), University of Homburg/Saar, and Gertrudis Parkinson Klinik (Dr. Csoti), Biskirchen, Germany; and Institute for Neuropathology (Dr. Pahnke), University of Zurich, Switzerland.

Address correspondence and reprint requests to Dr. D. Berg, Institute for Medical Genetics, Calwerstr. 7, 72076 Tuebingen, Germany; e-mail: daniela.berg{at}uni-tuebingen.de

Background: Transcranial ultrasound may be used to detect increased iron levels of the substantia nigra (SN) in patients with Parkinson disease (PD) and in control subjects. It is not known whether iron accumulation in PD is a primary or secondary phenomenon. However, sequence variations in genes involved in iron metabolism have been linked to basal ganglia disorders. One of these is ceruloplasmin (Cp), which is vitally involved in iron transport across the cell membrane.

Methods: One hundred seventy-six patients with PD according to the UK Brain Bank criteria and 180 ethnically matched control subjects, who were previously examined for SN iron signal changes by transcranial ultrasound, were examined for mutations in the Cp gene using denaturing high-performance liquid chromatography and subsequent sequencing for verification of unequivocal signals. Immunohistochemistry of PD midbrains was performed to examine the presence of Cp in Lewy bodies.

Results: Five novel missense variations were detected. One of these (I63T) was found in a single PD patient. A known variation (D554E) was significantly associated with PD and the ultrasound marker for increased SN iron levels. Moreover, a third sequence variation (R793H) was found to segregate with the ultrasound marker for increased iron levels in patients and control subjects. Immunohistochemistry demonstrated that Cp co-localizes with Lewy bodies in PD.

Conclusions: Detection of sequence variations in a single Parkinson disease (PD) patient or associated with the ultrasound marker for increased substantia nigra iron levels and the presence of ceruloplasmin (Cp) immunoreactivity in Lewy bodies underline a suspected role for Cp in the pathogenesis of PD. Further functional analyses are warranted to investigate whether these variations are causally linked to the complex pathogenesis of PD in a subset of cases.

Received March 30, 2004. Accepted in final form July 15, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 23 issue to find the title link for this article.

Deceased.