(American Journal of Pathology. 1998;153:1293-1300.)
© 1998 American Society for Investigative Pathology
Progressive Neurodegeneration in Aspartylglycosaminuria Mice
Ignacio Gonzalez-Gomez*
,
Ilkka Mononen
,
Nora Heisterkamp*
,
John Groffen*
and
Vesa Kaartinen*
From the Section of Molecular Carcinogenesis,*
Department of Pathology, Childrens Hospital Los Angeles Research
Institute and University of Southern California, School of Medicine,
Los Angeles, California, and Department of Clinical
Chemistry,
Kuopio University Hospital,
Kuopio, Finland
 |
Abstract
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Aspartylglycosaminuria (AGU) is one of the most common lysosomal
storage disorders in humans. A mouse model for AGU has been recently
generated through targeted disruption of the glycosylasparaginase
gene, and at a young age the glycosyl
asparaginase-deficient mice demonstrated many pathological
changes found in human AGU patients (Kaartinen V, Mononen
I, Voncken J-W, Gonzalez-Gomez I, Heisterkamp
N, Groffen J: A mouse model for aspartylglycosaminuria. Nat Med
1996, 2:13751378). Our current findings demonstrate that
after the age of 10 months, the general condition of null
mutant mice gradually deteriorated. They suffered from a progressive
motoric impairment and impaired bladder function and died prematurely.
A widespread lysosomal hypertrophy in the central nervous system was
detected. This neuronal vacuolation was particularly severe in the
lateral thalamic nuclei, medullary reticular nuclei,
vestibular nuclei, inferior olivary complex, and deep
cerebellar nuclei. The oldest animals (20 months old) displayed a clear
neuronal loss and gliosis, particularly in those
regions, where the most severe vacuolation was found. The
severe ataxic gait of the older mice was likely due to the dramatic
loss of Purkinje cells, intensive astrogliosis and vacuolation
of neurons in the deep cerebellar nuclei, and the severe
vacuolation of the cells in vestibular and cochlear nuclei. The
impaired bladder function and subsequent hydronephrosis were secondary
to involvement of the central nervous system. These findings
demonstrate that the glycosylasparaginase-deficient mice share many
neuropathological features with human AGU patients, providing a
suitable animal model to test therapeutic strategies in the treatment
of the central nervous system effects in AGU.
 |
Introduction
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Aspartylglycosaminuria (AGU), which
is the most common disorder of glycoprotein degradation, is an
autosomal recessively inherited lysosomal storage
disease.1,2
AGU is caused by mutations in the
glycosylasparaginase gene, which result in deficient
glycosylasparaginase activity. Recent isolation and characterization of
human glycosylasparaginase and cloning and sequencing of its cDNA
revealed that glycosylasparaginase is a 346-amino acid residue
glycoprotein.3
The precursor polypeptide undergoes a unique
posttranslational autocatalytic activation step in the endoplasmic
reticulum.4
The generated subunits are further processed in
lysosomes, in which a mature, biologically active heterotetrameric
glycosylasparaginase is formed.5
Glycosylasparaginase is a ubiquitously expressed enzyme, which
hydrolyzes the N-glycosidic linkage between
N-acetylglucosamine and L-asparagine during the
lysosomal degradation of Asn-linked glycoproteins.6
In AGU,
as a consequence of lacking glycosylasparaginase activity,
aspartylglucosamine and other glycoasparagines accumulate in tissues
and body fluids.7
Histological findings include
hypertrophied storage lysosomes, which can be found in multiple tissues
and cell types.8,9
The clinical course of AGU is characterized by a relatively normal
early development followed by the progressive psychomotor
degeneration.10
Other clinical manifestations include
coarse facial features, short stature, and connective tissue lesions.
The exact pathophysiology of AGU, is not known and currently there is
no therapy for this ultimately fatal disease. Recently, we generated a
mouse model for AGU using gene targeting and embryo transfer
techniques.11
Here, we report novel neuropathological
findings of the glycosylasparaginase-deficient mice, which demonstrate
that in many aspects, this mouse model accurately mimics the human
disease. Moreover, the results presented in this article explain some
unique phenotypic features of the glycosylasparaginase-deficient mice.
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Materials and Methods
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Animals
The glycosylasparaginase gene was disrupted in R1 embryonic stem
cells by homologous recombination, and the cells were injected into
recipient blastocysts from C57BL/6J mice as described.11
Two independently targeted clones were used to generate the null mice.
Mice were genotyped by Southern blot analysis of tail DNA collected
from pups at 10 days of age as described.11
Footprint
analyses were carried out as described.12
All mice were
housed under standard conditions.
Pathology
For gross pathology, mice were euthanized and necropsies were
performed. For histopathological analysis, tissues were fixed by
intracardiac perfusion with 10% buffered formalin or 2.5%
glutaraldehyde. The brain, spinal cord, and visceral organs were
removed, processed, and embedded in paraffin or epoxy resin.
Paraffin-embedded tissues were cut to 5 µm and stained with
hematoxylin and eosin, whereas epoxy resin-embedded tissues were cut to
1 µm and stained with toluidine blue. A total of three knockout and
three wild-type control mice were used for each histological study.
Urine specimens were analyzed for bacterial growth using standard
procedures at the Department of Pathology and Laboratory Medicine,
Childrens Hospital Los Angeles.
Immunohistochemistry
The sections were deparaffinized and hydrated, and the endogenous
peroxidase activity was eliminated by incubating the sections with 3%
H2O2 for 30 minutes. Immunostaining was done
using a HistoMouse kit (Zymed Laboratories Inc., San Francisco, CA)
according to the manufacturer's instructions. Monoclonal rat
anti-glial fibrillary acidic protein (GFAP) antibody also was from
Zymed.
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Results
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Lifespan and External Phenotypes
Early development of the AGU mice was indistinguishable from that
of their wild-type littermates.11
First external signs of
deterioration were noticed at approximately 5 months of age, when the
null mutant mice started to display a general scruffiness, easily
recognizable from the disheveled coat. First spontaneous deaths among
null mutants occurred at the age of 10 months, and the average lifespan
of AGU mice was 19 months (n = 6), which is
significantly shorter than the average lifespan of their wild-type
littermates (>28 months; n = 10). All of the AGU mice
that reached the age of 18 months or more had significant difficulty
moving, and they had poor balance and coordination. The steps were
short, and the gait was often straddle legged (Figure 1
, lane 3). In addition, AGU mice were
often dragging their hind legs while they were walking, which can also
be seen in a footprint assay (Figure 1
, lane 3).

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Figure 1. AGU mice show an abnormal gait pattern. Hind footprint patterns of two
AGU mice at 22 months of age (lanes 2 and
3) were compared with the footprint
pattern of a wild-type littermate (lane 1). The AGU mouse
(lane 2) walked with steps two times shorter than those of the
control mouse (lane 1). In addition to short steps, the knockout
mouse (lane 3) was walking straddle-legged, dragging its hind
limbs.
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Histology of the Central Nervous System
Because AGU is mainly a neurological disease, we studied the
histopathology of the central nervous system (CNS) in detail. Whereas
gross external examination showed no differences in the CNS between the
controls and knockouts, more detailed studies revealed several
impairments typical for AGU mice.
Cytoplasmic Vacuolation
In the null mutant mice, progressive cytoplasmic vacuolation could
be clearly detected (Tables 1 and 2)
. In the cerebral cortex, fine or
coarse cytoplasmic vacuoles were found in a moderate number of neurons,
particularly in those of the lower cortical layers (Table 1
, Figure 2
). In general, the small neurons were
much less affected than large neurons. In the hippocampus of the
6-month-old glycosylasparaginase (-/-) mice, granular cells of the
dentate gyrus appeared to be unaffected, whereas the larger neurons of
the Amnon's horn displayed some hypertrophic storage lysosomes (Table 1)
. In the few surviving older glycosylasparaginase-deficient mice
(>20 months old), all of the neurons both in the dentate gyrus and
Amnon's horn displayed moderate to severe vacuolation. The thalamus
showed marked neuronal vacuolation, particularly in the lateral nuclei
(Table 1)
. In contrast, the neuronal population of the basal ganglia
appeared to be only slightly vacuolated. In the brainstem, all of the
major neuronal aggregates displayed moderate to severe cytoplasmic
vacuolation (Table 2)
. Similar to the supratentorial structures, the
large neurons were more severely affected. Particularly involved were
the tegmental nuclei and substantia nigra, medullary reticular nuclei,
vestibular and cochlear nuclei, and inferior olivary complex (Table 2)
.
The neurons of the deep cerebellar nuclei showed massive vacuolation
(Figure 2B)
, whereas in the cerebellar cortex, Purkinje cells were less
affected, and the internal granular cells did not show any detectable
vacuolation (Table 2)
. In addition to neurons, glial cells in the
glycosylasparaginase-deficient mice contained hypertrophic storage
lysosomes. However, this vacuolation was fine and less extensive than
in neurons.
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Table 1. Distribution of Vacuolized Cells in the CNS of
Glycosylasparaginase-Deficient Mice (n = 3 in
Each Age Group) at 6 Months, 10 Months, and 20 Months of Age (Cerebral
Cortex, Hippocampus, Thalamus, Hypothalamus, Amygdala Complex, Septal
Nuclei, and Caudate/Putamen)
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Table 2. Distribution of Vacuolized Cells in the CNS of
Glycosylasparaginase-Deficient Mice (n = 3) at 6
Months, 10 Months, and 20 Months of Age (Cerebellum, Midbrain, Pons,
and Medulla)
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Figure 2. Neurons in the CNS of the glycosylasparaginase-deficient mice
demonstrate extensive cytoplasmic vacuolization. A: A
transverse section through the isocortex shows extensive cytoplasmic
vacuolization (arrows), which involves the neurons of all layers
(toluidine blue staining; semithin 1-µm
section; magnification, x250). B: A
section of the deep cerebellar nucleus displays clusters of large
neurons separated by tortuous myelinated fibers. The fine vacuoles are
dispersed throughout the cytoplasm of the neurons (arrows)
(toluidine blue staining; semithin 1-µm
section; magnification, x250).
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Neuronal Loss and Astrogliosis
In addition to severe neuronal vacuolation, all older AGU mice
(>18 months) displayed a scattered neuronal loss, which was severe in
the lower cortical neurons and in the medial and lateral thalamic
nuclei. In the cerebellar cortex, the loss of Purkinje cells was
striking (70 to 80%) when compared with age-matched controls (Figure 3, A and B)
. Immunostaining with GFAP
antibody demonstrated significant gliosis with hypertrophic astrocytes
in areas where profound neuronal loss and vacuolation could be
detected, such as in the thalamic lateral nuclei (Figure 4, C and D)
. Moreover, hypertrophic
astrocytes could be seen in the subcortical white matter, white matter
tracts, and commissures (Figure 4, A and B)
in the null mutant mice. In
the cerebellum, remarkable gliosis and hypertrophic astrocytes were
demonstrated in the deep cerebellar white matter and between neurons in
the deep cerebellar nuclei (Figure 3, E and F)
. The molecular layer of
the knockout cerebellum also displayed a clear increase of the
GFAP-positive Bergmann glial radial processes (Figure 3, C and D)
. In
concordance with the neuronal loss, the bulk of white matter was
smaller in the AGU mice than in controls (data not shown).

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Figure 3. Cerebellum is severely affected in the AGU mice. A knockout cerebellar
lobe (B) shows a complete loss of Purkinje cells (arrow),
whereas an age-matched control displays a normal number of Purkinje
cells (A). Knockout sections also demonstrate a clear increase
in the number of GFAP-positive Bergmann glial processes
(red) in the molecular
layer (D, arrow) when
compared with a wild-type control (C). In a wild-type section
(E), the normal focal meshwork of GFAP-positive glia is limited
to the subcortical white matter near the fourth ventricle
(arrow), whereas a knockout displays a marked gliosis
(asterisk) with
hypertrophic astrocytes extending into the cerebellar white matter and
between neurons of the cerebellar nuclei (F). A and
B, H&E staining; magnification, x100. C through
F, immunostaining for GFAP; magnification, x100.
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Figure 4. Extensive gliosis in the CNS of the glycosylasparaginase-deficient
mice. The glial density and size of their cytoplasmic processes
(red staining) is
markedly increased throughout the corpus callosum and deep white matter
in AGU mice 22 months old (B). For comparison, the wild-type
control (A) shows a moderate number of astrocytes evenly
distributed along the corpus callosum
(asterisk) and few
isolated astrocytes or glial fibrils in the deep white matter
(star). In the wild-type
sample, only a few isolated astrocytes can be seen in thalamus
(lateral nuclei)
(C), whereas a knockout sample displays a marked proliferation
of hypertrophic astrocytes with long processes (D).
Immunostaining for GFAP; magnification, x100.
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Terminally Ill Mice
All AGU mice that reached the age of 18 months or more suffered
from severe ataxia, as described above. Another consistent phenotype of
these mice was a failure to urinate, which led to a massive expansion
of the bladder (approximately 30 times the volume of a normal filled
bladder), as shown in Figure 5
. This
phenotype was already detectable at the age of 5 to 6 months, and it
showed slow but steady progression, culminating in extreme bladder
dilation, as shown in Figure 5
. As a consequence, the urothelium was
stretched to a thickness of two cells in the most distended area
(Figure 6, A and B)
. However, the
peripheral nerves around the neck of the expanded bladder showed no
pathological changes (Figure 6, C and D)
, suggesting that this
phenotype was caused by the degeneration of the CNS. As a consequence
of the marked bladder dilation, kidneys showed clear signs of
hydronephrosis as demonstrated by tubular atrophy, glomerular loss, and
interstitial fibrosis (Figure 7A)
. The
urine inside dilatated bladders was clear, and analyses for bacterial
growth were negative, clearly demonstrating that this phenotype was not
due to bacterial infections. Many terminally ill AGU mice also suffered
from massive coagulative hepatic necrosis (Figure 7B)
, with the
residual hepatocytes forming an irregular periportal rim. Moreover, a
band of acute inflammatory infiltrate could be seen at the interface
between residual and necrotic parenchyma, as well as sinusoidal fibrin
thrombi and occasional organizing thrombi in portal and central veins.

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Figure 5. AGU mice display massively swollen urinary bladders that lack
detectable neuronal abnormalities. The diameter of the bladder of this
female mouse (26 g) at
the age of 18 months exceeded 3 cm.
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Figure 6. Urinary bladder of the glycosylasparaginase-deficient mouse lacks
detectable neuronal abnormalities. Full-thickness section of the
urinary bladder of a distended (A,
fundus) and less distended (B,
neck) area of the bladder wall. The thickness of
the urothelium varies with the degree of bladder distention, stretching
to a thickness of two cells in the most distended area (arrow).
The lamina propria and muscularis are also thin, with the latter
reduced to a few thin parallel fascicles. C: Section through
the serosa of the urinary bladder. A portion of a normal autonomic
ganglion (asterisk) and adjacent nerve fibers (arrow) are
shown. The endothelial cells of a vascular sinusoid (arrowhead)
and mesothelial cells (star) are also normal. D:
Transverse section through the bladder neck showing normal unmyelinated
nerve twigs (arrow) and blood vessels in a loose connective
tissue stroma. Scattered fibroblasts exhibit foamy cytoplasmic changes
(asterisk). Magnification: A and B, x100;
C and D, x250.
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Figure 7. Terminally ill AGU mice display pathological changes in kidney
(A) and liver (B). A: Renal parenchyma is thin
with associated glomerular loss, tubular atrophy, and interstitial
fibrosis. The caliceal mucosa is distended to one or two urothelial
cells (arrow). B: The portal tract is expanded because
of marked dilation of the terminal sinusoids and portal vein
(arrows). Most of the hepatic parenchyma has undergone
coagulative necrosis; there is only an irregular periportal rim of
hepatocytes remaining (asterisk). A band of acute inflammatory
infiltrate is present at the interface between residual and necrotic
parenchyma (arrowhead). Magnification, x40.
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Discussion
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Previously, we have demonstrated that mice homozygous for the
disrupted glycosylasparaginase locus exhibit a complete absence of
glycosylasparaginase activity, which leads to the accumulation of
aspartylglucosamine in their tissues and urine.11
In the
present study, we analyzed the neuropathology of the AGU mice in
detail. The results presented here will be important in assessment of
the value of the glycosylasparaginase-deficient mouse as a model for
the human AGU disease. Moreover, the detailed histological
characterization of these knockout mice is an important step in
understanding the etiology of this progressive neurodegenerative
disease.
Histological studies of tissues of human AGU patients have shown that
hypertrophic storage lysosomes can be found both in the CNS as well as
in visceral organs.8,9
It has been reported that in the
CNS, the cerebral cortex, thalamus, and substantia nigra are all
heavily affected. In the cerebellum, a diffuse loss of Purkinje cells
has been reported as well as some proliferation and hypertrophy of
Bergmann glia.9
The dentate, red, inferior olivary,
pontine, and cranial nerve nuclei of the brainstem have been found to
be less affected. Unlike the CNS, visceral organs such as kidneys and
liver of human AGU patients are able to maintain their functionality
despite the extensive vacuolation of cells.
As our present results show, glycosylasparaginase-deficient mice share
many similarities with human AGU patients. Like the human AGU patients,
the null mutant mice also display widely distributed vacuolation of
cells both in the CNS and in visceral organs, astrogliosis in the CNS,
shortened lifespan, and motoric impairment. Some features of AGU mice
are unique and have not been reported in humans. Our results clearly
demonstrate that in AGU mice, neuronal vacuolation is a progressive
event and that in old mice, severe vacuolation is often associated with
a neuronal loss. All of the aging AGU mice (>18 months) suffered from
impaired bladder function, often associated with a reflux nephropathy.
Because the peripheral nerves were unaffected, we concluded that this
"neurogenic bladder" phenotype was presumably secondary to the CNS
involvement.
Older mice (>18 months) showed a severe ataxic gait. This was likely
due to the significant damage found in the cerebellum, as demonstrated
by the dramatic loss of Purkinje cells, intensive astrogliosis, and
vacuolation of neurons in deep cerebellar nuclei. Especially the loss
of Purkinje cells, which form excitatory synapses with parallel and
climbing fibers and play a prominent role in motor plasticity, may have
largely contributed to this phenotype. Unlike in human AGU patients,
for whom scattered loss of Purkinje cells has been described, in AGU
mice the loss of Purkinje cells is widespread. In addition to the
damage in the cerebellum, the severe vacuolation of cells in vestibular
and cochlear nuclei may have contributed to the development of this
motoric phenotype as well.
Human AGU patients die prematurely. The expected life span is most
often less than 45 years, bacterial infections being the most common
cause of death.10
The hepatic necrosis found in some of the
terminally ill AGU mice was also caused by bacterial infections, and
therefore it is likely that the loss of glycosylasparaginase activity
both in humans and in mice impairs defense mechanisms toward bacterial
infections.
Our present results further confirm our previous data that the
glycosylasparaginase-deficient mouse develops a progressive disease
with biochemical and histopathological hallmarks of human AGU, and
therefore it can be used as a model for this disease. An interesting
question remains whether the vacuolation of cells in the CNS is enough
to cause the development of this progressive neurodegenerative disease
or whether the loss of glycosylasparaginase will also influence other,
currently unknown aspects of metabolism in the CNS. The finding that
both the neuronal loss and astrogliosis colocalize with the neuronal
vacuolation suggests that accumulation of hypertrophic storage
vacuoles is capable of inducing pronounced neuronal damage, and thus
neuronal vacuolation alone could significantly contribute to the
development of AGU. The glycosylasparaginase-deficient mice provide a
valuable tool for further characterization of the pathogenesis of AGU
and testing the efficacy of different therapeutic approaches such as
gene therapy and enzyme replacement therapy to reverse the CNS changes
in AGU.
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Footnotes
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Address reprint requests to Vesa Kaartinen, Department of Pathology, MS no. 103, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027.
Supported by Sigrid Juselius Foundation and Pediatric Research Foundation (Ulla Hjelt Fund) (to IM).
Accepted for publication June 25, 1998.
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