Skip to main content
Journal of Medical Genetics logoLink to Journal of Medical Genetics
. 1999 Jan;36(1):1–8.

Spinal muscular atrophy: untangling the knot?

I Biros 1, S Forrest 1
PMCID: PMC1762953  PMID: 9950358

Abstract

Spinal muscular atrophy (SMA), a clinically and genetically heterogeneous group of neuromuscular diseases, is a disorder of motor neurones characterised by degeneration of spinal cord anterior horn cells and muscular atrophy.
SMA is an autosomal recessive disorder with a carrier frequency of about 1/50. Three candidate genes, the survival motor neurone (SMN) gene, the neuronal inhibitory protein (NAIP) gene, and the p44 (subunit of basal transcription factor TFIIH) gene, have been considered as genes involved in this condition. The region spanning these genes has a complex organisation including duplications, repetitive sequences, truncated genes, and pseudogenes, which makes molecular analysis of this condition difficult. Although deletions have been found in the majority of SMA patients, a few microrearrangements (like duplications, missense mutations, microdeletions, and gene conversions) localised in the telomeric form of the SMN gene have also been reported.
The function of the protein encoded by the SMN gene is still not fully understood but recent studies have indicated that it is found intracellularly in gems, novel nuclear structures. Its interaction with other proteins suggests a role in mRNA processing and metabolism. Whether the NAIP gene protein and other apoptosis associated proteins are directly involved in the initial stages of neurone degeneration and apoptosis, or acting downstream on the pathological pathway, has been difficult to determine. Further studies will be required to elucidate possible functional interactions between these proteins.


Keywords: SMA; SMN; NAIP

Full Text

The Full Text of this article is available as a PDF (143.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Battaglia G., Princivalle A., Forti F., Lizier C., Zeviani M. Expression of the SMN gene, the spinal muscular atrophy determining gene, in the mammalian central nervous system. Hum Mol Genet. 1997 Oct;6(11):1961–1971. doi: 10.1093/hmg/6.11.1961. [DOI] [PubMed] [Google Scholar]
  2. Brahe C., Bertini E. Spinal muscular atrophies: recent insights and impact on molecular diagnosis. J Mol Med (Berl) 1996 Oct;74(10):555–562. doi: 10.1007/s001090050059. [DOI] [PubMed] [Google Scholar]
  3. Brahe C., Clermont O., Zappata S., Tiziano F., Melki J., Neri G. Frameshift mutation in the survival motor neuron gene in a severe case of SMA type I. Hum Mol Genet. 1996 Dec;5(12):1971–1976. doi: 10.1093/hmg/5.12.1971. [DOI] [PubMed] [Google Scholar]
  4. Brzustowicz L. M., Lehner T., Castilla L. H., Penchaszadeh G. K., Wilhelmsen K. C., Daniels R., Davies K. E., Leppert M., Ziter F., Wood D. Genetic mapping of chronic childhood-onset spinal muscular atrophy to chromosome 5q11.2-13.3. Nature. 1990 Apr 5;344(6266):540–541. doi: 10.1038/344540a0. [DOI] [PubMed] [Google Scholar]
  5. Burghes A. H. When is a deletion not a deletion? When it is converted. Am J Hum Genet. 1997 Jul;61(1):9–15. doi: 10.1086/513913. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bussaglia E., Clermont O., Tizzano E., Lefebvre S., Bürglen L., Cruaud C., Urtizberea J. A., Colomer J., Munnich A., Baiget M. A frame-shift deletion in the survival motor neuron gene in Spanish spinal muscular atrophy patients. Nat Genet. 1995 Nov;11(3):335–337. doi: 10.1038/ng1195-335. [DOI] [PubMed] [Google Scholar]
  7. Bürglen L., Lefebvre S., Clermont O., Burlet P., Viollet L., Cruaud C., Munnich A., Melki J. Structure and organization of the human survival motor neurone (SMN) gene. Genomics. 1996 Mar 15;32(3):479–482. doi: 10.1006/geno.1996.0147. [DOI] [PubMed] [Google Scholar]
  8. Bürglen L., Seroz T., Miniou P., Lefebvre S., Burlet P., Munnich A., Pequignot E. V., Egly J. M., Melki J. The gene encoding p44, a subunit of the transcription factor TFIIH, is involved in large-scale deletions associated with Werdnig-Hoffmann disease. Am J Hum Genet. 1997 Jan;60(1):72–79. [PMC free article] [PubMed] [Google Scholar]
  9. Campbell L., Potter A., Ignatius J., Dubowitz V., Davies K. Genomic variation and gene conversion in spinal muscular atrophy: implications for disease process and clinical phenotype. Am J Hum Genet. 1997 Jul;61(1):40–50. doi: 10.1086/513886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Carter T. A., Bönnemann C. G., Wang C. H., Obici S., Parano E., De Fatima Bonaldo M., Ross B. M., Penchaszadeh G. K., Mackenzie A., Soares M. B. A multicopy transcription-repair gene, BTF2p44, maps to the SMA region and demonstrates SMA associated deletions. Hum Mol Genet. 1997 Feb;6(2):229–236. doi: 10.1093/hmg/6.2.229. [DOI] [PubMed] [Google Scholar]
  11. Chen Q., Baird S. D., Mahadevan M., Besner-Johnston A., Farahani R., Xuan J., Kang X., Lefebvre C., Ikeda J. E., Korneluk R. G. Sequence of a 131-kb region of 5q13.1 containing the spinal muscular atrophy candidate genes SMN and NAIP. Genomics. 1998 Feb 15;48(1):121–127. doi: 10.1006/geno.1997.5141. [DOI] [PubMed] [Google Scholar]
  12. Cobben J. M., van der Steege G., Grootscholten P., de Visser M., Scheffer H., Buys C. H. Deletions of the survival motor neuron gene in unaffected siblings of patients with spinal muscular atrophy. Am J Hum Genet. 1995 Oct;57(4):805–808. [PMC free article] [PubMed] [Google Scholar]
  13. Coovert D. D., Le T. T., McAndrew P. E., Strasswimmer J., Crawford T. O., Mendell J. R., Coulson S. E., Androphy E. J., Prior T. W., Burghes A. H. The survival motor neuron protein in spinal muscular atrophy. Hum Mol Genet. 1997 Aug;6(8):1205–1214. doi: 10.1093/hmg/6.8.1205. [DOI] [PubMed] [Google Scholar]
  14. Deconinck A. E., Rafael J. A., Skinner J. A., Brown S. C., Potter A. C., Metzinger L., Watt D. J., Dickson J. G., Tinsley J. M., Davies K. E. Utrophin-dystrophin-deficient mice as a model for Duchenne muscular dystrophy. Cell. 1997 Aug 22;90(4):717–727. doi: 10.1016/s0092-8674(00)80532-2. [DOI] [PubMed] [Google Scholar]
  15. DiDonato C. J., Chen X. N., Noya D., Korenberg J. R., Nadeau J. H., Simard L. R. Cloning, characterization, and copy number of the murine survival motor neuron gene: homolog of the spinal muscular atrophy-determining gene. Genome Res. 1997 Apr;7(4):339–352. doi: 10.1101/gr.7.4.339. [DOI] [PubMed] [Google Scholar]
  16. Emery A. E. The nosology of the spinal muscular atrophies. J Med Genet. 1971 Dec;8(4):481–495. doi: 10.1136/jmg.8.4.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fischer U., Liu Q., Dreyfuss G. The SMN-SIP1 complex has an essential role in spliceosomal snRNP biogenesis. Cell. 1997 Sep 19;90(6):1023–1029. doi: 10.1016/s0092-8674(00)80368-2. [DOI] [PubMed] [Google Scholar]
  18. Francis M. J., Morrison K. E., Campbell L., Grewal P. K., Christodoulou Z., Daniels R. J., Monaco A. P., Frischauf A. M., McPherson J., Wasmuth J. A contig of non-chimaeric YACs containing the spinal muscular atrophy gene in 5q13. Hum Mol Genet. 1993 Aug;2(8):1161–1167. doi: 10.1093/hmg/2.8.1161. [DOI] [PubMed] [Google Scholar]
  19. Francis M. J., Nesbit M. A., Theodosiou A. M., Rodrigues N. R., Campbell L., Christodoulou Z., Qureshi S. J., Porteous D. J., Brookes A. J., Davies K. E. Mapping of retrotransposon sequences in the unstable region surrounding the spinal muscular atrophy locus in 5q13. Genomics. 1995 May 20;27(2):366–369. doi: 10.1006/geno.1995.1059. [DOI] [PubMed] [Google Scholar]
  20. Gennarelli M., Lucarelli M., Capon F., Pizzuti A., Merlini L., Angelini C., Novelli G., Dallapiccola B. Survival motor neuron gene transcript analysis in muscles from spinal muscular atrophy patients. Biochem Biophys Res Commun. 1995 Aug 4;213(1):342–348. doi: 10.1006/bbrc.1995.2135. [DOI] [PubMed] [Google Scholar]
  21. Gilliam T. C., Brzustowicz L. M., Castilla L. H., Lehner T., Penchaszadeh G. K., Daniels R. J., Byth B. C., Knowles J., Hislop J. E., Shapira Y. Genetic homogeneity between acute and chronic forms of spinal muscular atrophy. Nature. 1990 Jun 28;345(6278):823–825. doi: 10.1038/345823a0. [DOI] [PubMed] [Google Scholar]
  22. Hahnen E., Forkert R., Marke C., Rudnik-Schöneborn S., Schönling J., Zerres K., Wirth B. Molecular analysis of candidate genes on chromosome 5q13 in autosomal recessive spinal muscular atrophy: evidence of homozygous deletions of the SMN gene in unaffected individuals. Hum Mol Genet. 1995 Oct;4(10):1927–1933. doi: 10.1093/hmg/4.10.1927. [DOI] [PubMed] [Google Scholar]
  23. Hahnen E., Schönling J., Rudnik-Schöneborn S., Raschke H., Zerres K., Wirth B. Missense mutations in exon 6 of the survival motor neuron gene in patients with spinal muscular atrophy (SMA). Hum Mol Genet. 1997 May;6(5):821–825. doi: 10.1093/hmg/6.5.821. [DOI] [PubMed] [Google Scholar]
  24. Humbert S., van Vuuren H., Lutz Y., Hoeijmakers J. H., Egly J. M., Moncollin V. p44 and p34 subunits of the BTF2/TFIIH transcription factor have homologies with SSL1, a yeast protein involved in DNA repair. EMBO J. 1994 May 15;13(10):2393–2398. doi: 10.1002/j.1460-2075.1994.tb06523.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Iwahashi H., Eguchi Y., Yasuhara N., Hanafusa T., Matsuzawa Y., Tsujimoto Y. Synergistic anti-apoptotic activity between Bcl-2 and SMN implicated in spinal muscular atrophy. Nature. 1997 Nov 27;390(6658):413–417. doi: 10.1038/37144. [DOI] [PubMed] [Google Scholar]
  26. KUGELBERG E., WELANDER L. Heredofamilial juvenile muscular atrophy simulating muscular dystrophy. AMA Arch Neurol Psychiatry. 1956 May;75(5):500–509. doi: 10.1001/archneurpsyc.1956.02330230050005. [DOI] [PubMed] [Google Scholar]
  27. Kleyn P. W., Wang C. H., Lien L. L., Vitale E., Pan J., Ross B. M., Grunn A., Palmer D. A., Warburton D., Brzustowicz L. M. Construction of a yeast artificial chromosome contig spanning the spinal muscular atrophy disease gene region. Proc Natl Acad Sci U S A. 1993 Jul 15;90(14):6801–6805. doi: 10.1073/pnas.90.14.6801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Lefebvre S., Burlet P., Liu Q., Bertrandy S., Clermont O., Munnich A., Dreyfuss G., Melki J. Correlation between severity and SMN protein level in spinal muscular atrophy. Nat Genet. 1997 Jul;16(3):265–269. doi: 10.1038/ng0797-265. [DOI] [PubMed] [Google Scholar]
  29. Lefebvre S., Bürglen L., Reboullet S., Clermont O., Burlet P., Viollet L., Benichou B., Cruaud C., Millasseau P., Zeviani M. Identification and characterization of a spinal muscular atrophy-determining gene. Cell. 1995 Jan 13;80(1):155–165. doi: 10.1016/0092-8674(95)90460-3. [DOI] [PubMed] [Google Scholar]
  30. Liston P., Roy N., Tamai K., Lefebvre C., Baird S., Cherton-Horvat G., Farahani R., McLean M., Ikeda J. E., MacKenzie A. Suppression of apoptosis in mammalian cells by NAIP and a related family of IAP genes. Nature. 1996 Jan 25;379(6563):349–353. doi: 10.1038/379349a0. [DOI] [PubMed] [Google Scholar]
  31. Liu Q., Dreyfuss G. A novel nuclear structure containing the survival of motor neurons protein. EMBO J. 1996 Jul 15;15(14):3555–3565. [PMC free article] [PubMed] [Google Scholar]
  32. Liu Q., Fischer U., Wang F., Dreyfuss G. The spinal muscular atrophy disease gene product, SMN, and its associated protein SIP1 are in a complex with spliceosomal snRNP proteins. Cell. 1997 Sep 19;90(6):1013–1021. doi: 10.1016/s0092-8674(00)80367-0. [DOI] [PubMed] [Google Scholar]
  33. Lorson C. L., Androphy E. J. The domain encoded by exon 2 of the survival motor neuron protein mediates nucleic acid binding. Hum Mol Genet. 1998 Aug;7(8):1269–1275. doi: 10.1093/hmg/7.8.1269. [DOI] [PubMed] [Google Scholar]
  34. Lorson C. L., Strasswimmer J., Yao J. M., Baleja J. D., Hahnen E., Wirth B., Le T., Burghes A. H., Androphy E. J. SMN oligomerization defect correlates with spinal muscular atrophy severity. Nat Genet. 1998 May;19(1):63–66. doi: 10.1038/ng0598-63. [DOI] [PubMed] [Google Scholar]
  35. Matthijs G., Schollen E., Legius E., Devriendt K., Goemans N., Kayserili H., Apäk M. Y., Cassiman J. J. Unusual molecular findings in autosomal recessive spinal muscular atrophy. J Med Genet. 1996 Jun;33(6):469–474. doi: 10.1136/jmg.33.6.469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. McAndrew P. E., Parsons D. W., Simard L. R., Rochette C., Ray P. N., Mendell J. R., Prior T. W., Burghes A. H. Identification of proximal spinal muscular atrophy carriers and patients by analysis of SMNT and SMNC gene copy number. Am J Hum Genet. 1997 Jun;60(6):1411–1422. doi: 10.1086/515465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Melki J., Abdelhak S., Sheth P., Bachelot M. F., Burlet P., Marcadet A., Aicardi J., Barois A., Carriere J. P., Fardeau M. Gene for chronic proximal spinal muscular atrophies maps to chromosome 5q. Nature. 1990 Apr 19;344(6268):767–768. doi: 10.1038/344767a0. [DOI] [PubMed] [Google Scholar]
  38. Melki J., Sheth P., Abdelhak S., Burlet P., Bachelot M. F., Lathrop M. G., Frezal J., Munnich A. Mapping of acute (type I) spinal muscular atrophy to chromosome 5q12-q14. The French Spinal Muscular Atrophy Investigators. Lancet. 1990 Aug 4;336(8710):271–273. doi: 10.1016/0140-6736(90)91803-i. [DOI] [PubMed] [Google Scholar]
  39. Melki J. Spinal muscular atrophy. Curr Opin Neurol. 1997 Oct;10(5):381–385. doi: 10.1097/00019052-199710000-00005. [DOI] [PubMed] [Google Scholar]
  40. Parsons D. W., McAndrew P. E., Allinson P. S., Parker W. D., Jr, Burghes A. H., Prior T. W. Diagnosis of spinal muscular atrophy in an SMN non-deletion patient using a quantitative PCR screen and mutation analysis. J Med Genet. 1998 Aug;35(8):674–676. doi: 10.1136/jmg.35.8.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Parsons D. W., McAndrew P. E., Monani U. R., Mendell J. R., Burghes A. H., Prior T. W. An 11 base pair duplication in exon 6 of the SMN gene produces a type I spinal muscular atrophy (SMA) phenotype: further evidence for SMN as the primary SMA-determining gene. Hum Mol Genet. 1996 Nov;5(11):1727–1732. doi: 10.1093/hmg/5.11.1727. [DOI] [PubMed] [Google Scholar]
  42. Pearn J. Classification of spinal muscular atrophies. Lancet. 1980 Apr 26;1(8174):919–922. doi: 10.1016/s0140-6736(80)90847-8. [DOI] [PubMed] [Google Scholar]
  43. Rochette C. F., Surh L. C., Ray P. N., McAndrew P. E., Prior T. W., Burghes A. H., Vanasse M., Simard L. R. Molecular diagnosis of non-deletion SMA patients using quantitative PCR of SMN exon 7. Neurogenetics. 1997 Sep;1(2):141–147. doi: 10.1007/s100480050021. [DOI] [PubMed] [Google Scholar]
  44. Rodrigues N. R., Owen N., Talbot K., Ignatius J., Dubowitz V., Davies K. E. Deletions in the survival motor neuron gene on 5q13 in autosomal recessive spinal muscular atrophy. Hum Mol Genet. 1995 Apr;4(4):631–634. doi: 10.1093/hmg/4.4.631. [DOI] [PubMed] [Google Scholar]
  45. Rodrigues N. R., Owen N., Talbot K., Patel S., Muntoni F., Ignatius J., Dubowitz V., Davies K. E. Gene deletions in spinal muscular atrophy. J Med Genet. 1996 Feb;33(2):93–96. doi: 10.1136/jmg.33.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Roy N., McLean M. D., Besner-Johnston A., Lefebvre C., Salih M., Carpten J. D., Burghes A. H., Yaraghi Z., Ikeda J. E., Korneluk R. G. Refined physical map of the spinal muscular atrophy gene (SMA) region at 5q13 based on YAC and cosmid contiguous arrays. Genomics. 1995 Apr 10;26(3):451–460. doi: 10.1016/0888-7543(95)80162-f. [DOI] [PubMed] [Google Scholar]
  47. Sargent C. A., Chalmers I. J., Leversha M., Affara N. A. A rearrangement on chromosome 5 of an expressed human beta-glucuronidase pseudogene. Mamm Genome. 1994 Dec;5(12):791–796. doi: 10.1007/BF00292015. [DOI] [PubMed] [Google Scholar]
  48. Scharf J. M., Endrizzi M. G., Wetter A., Huang S., Thompson T. G., Zerres K., Dietrich W. F., Wirth B., Kunkel L. M. Identification of a candidate modifying gene for spinal muscular atrophy by comparative genomics. Nat Genet. 1998 Sep;20(1):83–86. doi: 10.1038/1753. [DOI] [PubMed] [Google Scholar]
  49. Schwartz M., Sørensen N., Hansen F. J., Hertz J. M., Nørby S., Tranebjaerg L., Skovby F. Quantification, by solid-phase minisequencing, of the telomeric and centromeric copies of the survival motor neuron gene in families with spinal muscular atrophy. Hum Mol Genet. 1997 Jan;6(1):99–104. doi: 10.1093/hmg/6.1.99. [DOI] [PubMed] [Google Scholar]
  50. Selig S., Bruno S., Scharf J. M., Wang C. H., Vitale E., Gilliam T. C., Kunkel L. M. Expressed cadherin pseudogenes are localized to the critical region of the spinal muscular atrophy gene. Proc Natl Acad Sci U S A. 1995 Apr 25;92(9):3702–3706. doi: 10.1073/pnas.92.9.3702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Somerville M. J., Hunter A. G., Aubry H. L., Korneluk R. G., MacKenzie A. E., Surh L. C. Clinical application of the molecular diagnosis of spinal muscular atrophy: deletions of neuronal apoptosis inhibitor protein and survival motor neuron genes. Am J Med Genet. 1997 Mar 17;69(2):159–165. [PubMed] [Google Scholar]
  52. Talbot K., Ponting C. P., Theodosiou A. M., Rodrigues N. R., Surtees R., Mountford R., Davies K. E. Missense mutation clustering in the survival motor neuron gene: a role for a conserved tyrosine and glycine rich region of the protein in RNA metabolism? Hum Mol Genet. 1997 Mar;6(3):497–500. doi: 10.1093/hmg/6.3.497. [DOI] [PubMed] [Google Scholar]
  53. Thompson T. G., Morrison K. E., Kleyn P., Bengtsson U., Gilliam T. C., Davies K. E., Wasmuth J. J., McPherson J. D. High resolution physical map of the region surrounding the spinal muscular atrophy gene. Hum Mol Genet. 1993 Aug;2(8):1169–1176. doi: 10.1093/hmg/2.8.1169. [DOI] [PubMed] [Google Scholar]
  54. Velasco E., Valero C., Valero A., Moreno F., Hernández-Chico C. Molecular analysis of the SMN and NAIP genes in Spanish spinal muscular atrophy (SMA) families and correlation between number of copies of cBCD541 and SMA phenotype. Hum Mol Genet. 1996 Feb;5(2):257–263. doi: 10.1093/hmg/5.2.257. [DOI] [PubMed] [Google Scholar]
  55. Wang C. H., Xu J., Carter T. A., Ross B. M., Dominski M. K., Bellcross C. A., Penchaszadeh G. K., Munsat T. L., Gilliam T. C. Characterization of survival motor neuron (SMNT) gene deletions in asymptomatic carriers of spinal muscular atrophy. Hum Mol Genet. 1996 Mar;5(3):359–365. doi: 10.1093/hmg/5.3.359. [DOI] [PubMed] [Google Scholar]
  56. Xu D. G., Crocker S. J., Doucet J. P., St-Jean M., Tamai K., Hakim A. M., Ikeda J. E., Liston P., Thompson C. S., Korneluk R. G. Elevation of neuronal expression of NAIP reduces ischemic damage in the rat hippocampus. Nat Med. 1997 Sep;3(9):997–1004. doi: 10.1038/nm0997-997. [DOI] [PubMed] [Google Scholar]
  57. Zerres K., Wirth B., Rudnik-Schöneborn S. Spinal muscular atrophy--clinical and genetic correlations. Neuromuscul Disord. 1997 May;7(3):202–207. doi: 10.1016/s0960-8966(97)00459-8. [DOI] [PubMed] [Google Scholar]
  58. van der Steege G., Draaijers T. G., Grootscholten P. M., Osinga J., Anzevino R., Velonà I., Den Dunnen J. T., Scheffer H., Brahe C., van Ommen G. J. A provisional transcript map of the spinal muscular atrophy (SMA) critical region. Eur J Hum Genet. 1995;3(2):87–95. doi: 10.1159/000472281. [DOI] [PubMed] [Google Scholar]
  59. van der Steege G., Grootscholten P. M., van der Vlies P., Draaijers T. G., Osinga J., Cobben J. M., Scheffer H., Buys C. H. PCR-based DNA test to confirm clinical diagnosis of autosomal recessive spinal muscular atrophy. Lancet. 1995 Apr 15;345(8955):985–986. [PubMed] [Google Scholar]

Articles from Journal of Medical Genetics are provided here courtesy of BMJ Publishing Group

RESOURCES