PT  - JOURNAL ARTICLE
AU  - Marshall Lukacs
AU  - Jonathan Gilley
AU  - Yi Zhu
AU  - Giuseppe Orsomando
AU  - Carlo Angeletti
AU  - Jiaqi Liu
AU  - Xiuna Yang
AU  - Joun Park
AU  - Robert J. Hopkin
AU  - Michael P. Coleman
AU  - R. Grace Zhai
AU  - Rolf W. Stottmann
TI  - Severe Biallelic Loss-of-function Mutations in <em>Nicotinamide Mononucleotide Adenylyltransferase 2 (NMNAT2)</em> in Two Fetuses with Fetal Akinesia Deformation Sequence
AID  - 10.1101/610899
DP  - 2019 Jan 01
TA  - bioRxiv
PG  - 610899
4099  - http://biorxiv.org/content/early/2019/04/20/610899.short
4100  - http://biorxiv.org/content/early/2019/04/20/610899.full
AB  - The three nicotinamide mononucleotide adenylyltransferase (NMNAT) family members synthesize the electron carrier nicotinamide adenine dinucleotide (NAD+) and are essential for cellular metabolism. In mammalian axons, NMNAT activity appears to be required for axon survival and is predominantly provided by NMNAT2. NMNAT2 has recently been shown to also function as a chaperone to aid in the refolding of misfolded proteins. Nmnat2 deficiency in mice, or in its ortholog dNmnat in Drosophila, results in axon outgrowth and survival defects. Peripheral nerve axons in NMNAT2-deficient mice fail to extend and innervate targets, and skeletal muscle is severely underdeveloped. In addition, removing NMNAT2 from established axons initiates axon death by Wallerian degeneration. We report here on two stillborn siblings with fetal akinesia deformation sequence (FADS), severely reduced skeletal muscle mass and hydrops fetalis. Clinical exome sequencing identified compound heterozygous NMNAT2 variant alleles in both cases. Both protein variants are incapable of supporting axon survival in mouse primary neuron cultures when overexpressed. In vitro assays demonstrate altered protein stability and/or defects in NAD+ synthesis and chaperone functions. Thus, both patient NMNAT2 alleles are null or severely hypo-morphic. These data indicate a previously unknown role for NMNAT2 in human neurological development and provide the first direct molecular evidence to support the involvement of Wallerian degeneration in a human axonal disorder.