title: Deciphering amyotrophic lateral sclerosis: what phenotype, neuropathology and genetics are telling us about pathogenesis.
abstract: Amyotrophic lateral sclerosis (ALS) is characterized phenotypically by progressive weakness and neuropathologically by loss of motor neurons. Phenotypically, there is marked heterogeneity. Typical ALS has mixed upper motor neuron (UMN) and lower motor neuron (LMN) involvement. Primary lateral sclerosis has predominant UMN involvement. Progressive muscular atrophy has predominant LMN involvement. Bulbar and limb ALS have predominant regional involvement. Frontotemporal dementia has significant cognitive and behavioral involvement. These phenotypes can be so distinctive that they would seem to have differing biology. However, they cannot be distinguished, at least neuropathologically or genetically. In sporadic ALS (SALS), they are mostly characterized by ubiquitinated cytoplasmic inclusions of TDP-43. In familial ALS (FALS), where phenotypes are indistinguishable from SALS and similarly heterogeneous, each mutated gene has its own genetic and molecular signature. Overall, since the same phenotypes can have multiple causes including different gene mutations, there must be multiple molecular mechanisms causing ALS - and ALS is a syndrome. Since, however, multiple phenotypes can be caused by one single gene mutation, a single molecular mechanism can cause heterogeneity. What the mechanisms are remain unknown, but active propagation of the pathology neuroanatomically seems to be a principal component. Leading candidate mechanisms include RNA processing, cell-cell interactions between neurons and non-neuronal neighbors, focal seeding from a misfolded protein that has prion-like propagation, and fatal errors introduced during neurodevelopment of the motor system. If fundamental mechanisms could be identified and understood, ALS therapy could rationally target progression and stop the disease - a goal that seems increasingly achievable.
authors.affiliation: Department of Neurosciences, University of California, San Diego, La Jolla, California 92093, USA. jravits@ucsd.edu
authors.forename: John
authors.initials: J
authors.lastname: Ravits
authors.forename: Stanley
authors.initials: S
authors.lastname: Appel
authors.forename: Robert H
authors.initials: RH
authors.lastname: Baloh
authors.forename: Richard
authors.initials: R
authors.lastname: Barohn
authors.forename: Benjamin Rix
authors.initials: BR
authors.lastname: Brooks
authors.forename: Lauren
authors.initials: L
authors.lastname: Elman
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Floeter
authors.forename: Christopher
authors.initials: C
authors.lastname: Henderson
authors.forename: Catherine
authors.initials: C
authors.lastname: Lomen-Hoerth
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Macklis
authors.forename: Leo
authors.initials: L
authors.lastname: McCluskey
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsumoto
authors.forename: Serge
authors.initials: S
authors.lastname: Przedborski
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rothstein
authors.forename: John Q
authors.initials: JQ
authors.lastname: Trojanowski
authors.forename: Leonard H
authors.initials: LH
authors.lastname: van den Berg
authors.forename: Steven
authors.initials: S
authors.lastname: Ringel
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D004268:DNA-Binding Proteins / Q000235:genetics; D018450:Disease Progression; D005121:Extremities / Q000503:physiopathology; D006801:Humans; D009046:Motor Neurons / Q000473:pathology*; D009154:Mutation / Q000235:genetics; D010641:Phenotype
chemical_list: D004268:DNA-Binding Proteins