Cure Dystonia Now and the Dystonia Medical Research Foundation (DMRF) have teamed up again for a Collaborative Grant in 2020:

“Genetic modifiers of penetrance in DYT1 dystonia”

David Arkadir
Hadassah Medical Center and the Hebrew University of Jerusalem


Dystonia is a movement disorder characterized by involuntary muscle contractions. Some forms of dystonia, such as DYT1 dystonia that is caused by mutation in the TOR1A gene, are hereditary. It is not clear, however, why two individuals, with the same genetic mutation, have dystonia at different severities. On the extremes, one individual experiences severe dystonia that starts in childhood and leads to significant motor disability while other individual is totally asymptomatic, and in many cases is even not aware of having the genetic mutation. We believe that other genes, yet unknown, determine wither an individual carrying a genetic mutation potentially causing dystonia will develop this movement disorder or not. Here we propose research aimed at finding this gene. For this aim, we will study individuals having mutation in the TOR1A gene, with or without apparent dystonia. We will compare the genome of these two groups in order to find the genes that protect some individuals from developing dystonia, even in the presence of the mutated gene.

“Striatal microcircuit defects in DYT1 dystonia”

Ellen J. Hess, PhD
Emory University Departments of Pharmacology and Neurology

Antonio Pisani, MD, PhD
Direzione Scientifica
Fondazione Santa Lucia IRCCS


Dystonia, the third most common movement disorder after tremor and Parkinson’s disease, is characterized by involuntary muscle contractions that cause debilitating twisting movements and postures. The most common genetic form of dystonia is DYT1 dystonia, a devastating dominantly inherited disorder that affects muscles throughout the body. DYT1 dystonia is caused by a GAG deletion (ΔE) in the TOR1A gene (referred to as DYT1 ΔE throughout), which encodes TorsinA. There is immense need for novel therapeutics for dystonia and this grant provides a framework for target identification and therapeutic innovation for the treatment of dystonia. Because dystonia is caused by neuronal dysfunction, rather than degeneration, therapeutics that modify abnormal neuronal signaling could provide significant benefit. The goal of this translational grant is to determine whether defects in the striatal DA release in DYT1 are intrinsic to DA neurons and/or result from cholinergic interneuron dysfunction.


Cure Dystonia Now and the Dystonia Medical Research Foundation (DMRF) have teamed up once again, announcing the latest grants to advance research toward improved dystonia treatment options and ultimately a cure. This marks the latest in an ongoing collaboration between CDN and DMRF to push the envelope of what is known about dystonia by funding innovative research projects, with a focus on incentivizing collaborative, cross-disciplinary investigations. Dystonia is not caused by pathology in a specific brain structure, but by dysfunctional circuits of communication between multiple brain areas responsible for coordinating and controlling body movement. This year’s grants reflect holistic and modular approaches to exploring dystonia brain networks.
Awardees are as follows:

“Using Functional Connectivity to Optimize Deep Brain Stimulation in Dystonia”

Andrea Kühn, MD
University Medicine Berlin


Deep brain stimulation is a neurosurgical therapy that uses an implanted medical device to treat dystonia and other neurological disorders. The medical device delivers electrical stimulation to the areas of the brain responsible for dystonia symptoms. Many dystonia patients respond dramatically to deep brain stimulation therapy, but not all. Dr. Kühn and her team seek to clarify the underlying mechanisms of deep brain stimulation in order to better understand why some patients benefit from this therapy while others do not.

“Unraveling Hierarchical Network Loops in Isolated Dystonia”

Xin Jin, PhD
The Salk Institute for Biological Studies


The intricate networks in the human brain responsible for controlling body movement are comprised of many millions of neurons across dozens of brain areas. Dr. Jin and his team are working to understand the network activity that underlies dystonia symptoms, and to possibly prevent symptoms from developing. This grant is focusing on blepharospasm, a focal dystonia of the eyelid and brow muscles, as a model to understand dystonia networks more broadly.

“Investigating Multimodal Neuroimaging for Probing Brain Networks in Cervical Dystonia”

Richard Reilly, PhD
Trinity College Dublin


Dr. Reilly and his team are in search of biomarkers in the brain for cervical dystonia, a focal dystonia that causes involuntary head movements and neck postures. To do so, they will use multimodal analysis on a dataset from structural, resting state, and functional MRI (magnetic resonance imaging) in a group of cervical dystonia patients. They will compare results against a group of patients with spasmodic dysphonia, a focal dystonia of the vocal cords muscles. The goal is to advance understanding of the structural and functional brain differences in cervical dystonia.

“Interregional Brain Connectivity in a Mouse Model of Cerebellar-Induced Dystonia”

Roy Sillitoe, PhD
Baylor College of Medicine


This project uses a unique genetic mouse model of dystonia and diffusor tensor imaging, a type of magnetic resonance imaging (MRI), to define how specific brain network changes result in dystonia symptoms. This work also seeks to better understand developmental aspects of dystonia, namely why and how dystonia progresses over time. Dr. Sillitoe and team are ultimately seeking to define the functional brain network of dystonia as a way to better target therapies such as oral medications and deep brain stimulation.




“Validation of the Communicative Participation Item Bank as an outcome measure for Spasmodic Dysphonia”

Principal Investigator: Michael Pittman, MD
Columbia University Medical Center


A team of American and European investigators is conducting the study which could have far reaching impacts for many afflicted with Dystonia. Cure Dystonia Now and the National Spasmodic Dysphonia Association (NSDA) are collaborating to co-support the grant, which is designed to validate the use of the Communication Participation Item Bank (CPIB) as an outcome measure for Spasmodic Dysphonia. If successful, it could impact current treatment options and the evaluation of novel therapies.

Click here to learn more about this important collaboration with NSDA




“Animal Modeling of eIF2a Pathway Dysfunction in Dystonia”

Nicole Calakos, M.D., Ph.D
Associate Professor of Neurology and Neurobiology and PI, Calakos Laboratory
Duke University


Dystonia is a motor system disease characterized by involuntary postures and twisting movements. The disorder can incur significant lifelong disability to those affected and is among the top 3 conditions evaluated in neurological movement disorder specialty clinics. As yet, the precise mechanisms for dystonia are poorly understood and there are no known disease modifying treatments. Recently, we identified eIF2α signaling for a potential role in dystonia as a result of an unbiased genome-wide RNAi screen using a novel high-throughput DYT1 dystonia assay we developed. Excitingly, in subsequent mechanistic investigations, human genetics strongly supported the significance of this pathway for dystonia. Mutations in two other forms of dystonia are predicted to cause convergent eIF2α pathway signaling deficits with the mechanism we identified in DYT1 dystonia. These preliminary results lead to the overarching hypothesis that eIF2α signaling contributes to dystonia pathogenesis and enhancing its activity will be therapeutic. To test these novel hypotheses, we propose to test whether eIF2α signaling dysfunction underlies dystonia-like phenotypes in mice. Successful completion of this series of experiments has the potential to provide strong experimental support for a new signaling pathway in either or both the pathogenesis and treatment of DYT1 dystonia. Apart from knowledge that dopamine deficiency is a cellular mechanism for dystonia, few other pathway mechanisms are clearly established. The eIF2α pathway offers a number of novel druggable targets. Specific pharmacological treatments for dystonia are dearly needed. In addition, insights gained here are likely to have relevance for other forms of dystonia and ER stress-related brain diseases.


“Understanding Neuronal Dysfunctionin DYT1 Dystonia Using an Unbiased Proteomics Approach and Human Induced Pluripotent Stem Cells”

H. A. Jinnah, M.D., Ph.D
Professor Departments of Neurology, Human Genetics and Pediatrics
Emory University School of Medicine


DYT1 dystonia is a neurological disorder characterized by involuntary twisting and jerking movements that usually begin in childhood. It is extremely debilitating and there is no cure. It is caused by an in-frame GAG deletion in the TOR1A gene, leading to deletion of a single amino acid in a ubiquitously expressed protein, torsinA. Although the exact functions of torsinA remain uncertain, several prior studies have suggested that it has a role as a protein chaperone in the endoplasmic reticulum. Normal torsinA interacts with many proteins and the mutation has been reported to affect multiple biological pathways. Exactly which of these biological pathways is most relevant for causing disease remains uncertain, in part because of the varying results from different experimental models with uncertain translational relevance to the disease. In this proposal, we describe the development of novel induced pluripotent stem cells (iPSCs) from fibroblasts obtained from symptomatic DYT1 dystonia patients. We also describe the differentiation of these cells into dopamine neurons, which are thought to play a key role in disease pathogenesis. Among the many different ways in which this novel resource could be exploited, one of the most valuable first steps is a comprehensive proteomics survey to delineate the spectrum of proteins and biological pathways most affected in dopamine neurons. This strategy, which is unencumbered by any specific “favorite” hypothesis regarding the most relevant proteins or pathways, is important for identifying the biological processes that are most relevant to the disease in an unbiased way.




Cure Dystonia Now and the Dystonia Medical Research Foundation have teamed up once again, this time to better understand why a protein in the brain called TorsinA causes dystonia when abnormal due to a mutation in the DYT1 gene. Understanding the role of torsinA in dystonia may lead to new therapeutic strategies to provide relief to affected patients. We have collaborated to fund the following two research grants:

“Structural and Biochemical Analysis of TorsinA and TorsinA (ΔE)”

Thomas U. Schwartz, Ph.D
Professor of Biology and Chair of the Schwartz Lab, Structural Cell Biology
Massachusetts Institute of Technology


This project aims to determine a high-resolution structure of TorsinA and find yet undiscovered binding partners of TorsinA. This knowledge is necessary for rational design and development of drug candidates that specifically target TorsinA in DYT1 dystonia.

Early onset dystonia is a devastating neurological disorder that results in a range of involuntary muscle movements. According to latest estimates, about 50,000 US citizens have the disease, many of which likely undiagnosed. So far no cure has been discovered. At the root of this hereditary disease lies the enzyme TorsinA, which is subtly mutated in the patient. The goal of this proposal is to determine the atomic structure of the healthy enzyme and its mutated variant. Because an enzyme measures only a few nanometers in size (less than 1 millionth of an inch), it cannot be visualized by microscopy. Instead, it will be crystallized and measured by X-ray diffraction. The three-dimensional atomic structure will then be calculated and modeled. Visualization of the atomic structure allows for full understanding of TorsinA function and the ability to influence this function by developing specific drugs. TorsinA is an enzyme typically involved in the folding (acquiring the right structure) and/or degradation of other proteins. Curiously, the proteins on which TorsinA presumably acts are not known. In this study a novel protein labeling approach will be used; it will be dramatically more sensitive and should detect TorsinA binding partners. This exciting research project should result in the long sought-after understanding of molecular basis for the disease, the prerequisite for targeted drug design.


“Dissecting the Function and Regulation of the TorsinA-LAP1 Holoenzyme”

G.W. Gant Luxton, Ph.D
Assistant Professor, Genetics, Cell Biology and Development
University of Minnesota


This proposal aims to define the molecular mechanism of torsinA assembly in the cell and identify potential torsinA binding partners using a novel method called BioID. Understanding of the molecular mechanism of DYT1 dystonia is critical for any future therapeutic interventions based on pharmacological agents that target torsinA.

The most common and severe inherited form of dystonia is DYT1 dystonia. DYT1 dystonia is caused by a mutation in the torsinA protein. This mutation is thought to inhibit the function of torsinA in nerve cells; however, the exact function of torsinA remains unknown. TorsinA resides within the nuclear envelope and is a member of a large family of protein machines that interact with other proteins. TorsinA works together with another nuclear envelope protein called LAP1, but how they function together and what other proteins interact with torsinA and LAP1 remains unknown. This is necessary to understand the mechanism of torsinA function and its role in DYT1 dystonia. To define the mechanism of torsinA function these investigators are using a sophisticated imaging technique developed to monitor single molecules in living cells. The proposed imaging experiments will allow these investigators to evaluate models of torsinA assembly and function. To identify potential partners of torsinA and LAP1 the investigators are using a recently developed method known as BioID, a method for detecting proteins that are close to each other in the cell. This project establishes a long-term interdisciplinary and collaborative effort towards understanding how torsinA works in the cell with the goal of developing potential therapeutics for DYT1 dystonia aiming at restoring torsinA function in patients.




“Evaluation of the effects of a novel nicotinic agonist, AZD1446, on neurochemical and electrophysiologic endpoints in DYT1 mouse models”

David Standaert, MD, PhD
Professor and Neurology Chair
University of Alabama

Antonio Pisani, MD, PhD
Associate Professor of Neurology
University of Rome Tor Vergata


* Collaborative Funding with the Dystonia Medical Research Foundation (DMRF)

A team of American and European investigators is exploring whether a drug called AZD1446 could potentially provide relief for dystonia patients without the unintended effects frequently caused by existing pharmacological therapies. Dystonia results from improper signals in the nervous system that instruct muscles to contract excessively. Experts do not yet fully understand the neurological mechanism that causes the abnormal muscle contractions, but the origins appear to stem from an imbalance of neurotransmitters in the brain and changes in brain cell synapses. Standaert and team are using a genetically engineered mouse with abnormal neuronal signaling to examine whether AZD1446 can correct the abnormal signaling and restore the balance of neurotransmitters.


Click here to learn more about this important collaboration with the DMRF




“Does Interfering Abnormal Brain Network in Dystonia Ameliorate Symptom”

David Eidelberg, MD, Director, Center of Neurosciences
Ji Hyun Kio, Ph.D, Research Scientist, Center for Neurosciences
The Feinstein Institute for Medical Research


Modern brain imaging techniques have provided substantial insight into the circuit abnormalities that underlie the genetic and phenotypic features of DYT1 dystonia. More recently, localized deficits in anatomic connectivity have been detected and quantified in DYT1 carriers using magnetic resonance (MR) diffusion tensor imaging (DTI) to assess fiber tract integrity in specific projection pathways. This microstructural approach, however, cannot be used to evaluate abnormal brain function at the network level. Rather, metabolic brain imaging in the resting state in conjunction with mathematical modeling can provide a useful means of identifying brain networks associated with disease processes, clinical symptoms, or both.


In this study, we aim to characterize a significant metabolic network associated with the severity of clinical signs in DYT1 dystonia patients. We will additionally define the relative importance of the component nodes of the brain network. Lastly, we will explore the therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) applied at one or more nodal targets to suppress the activity this abnormal network.


“Induced Pluripotent Stem Cells in DYT1 Dystonia”

H. A. Jinnah. M.D, Ph.D
Professor Departments of Neurology, Human Genetics & Pediatrics
Emory University School of Medicine


Although dystonia is characterized by involuntary contractions of muscles, the problem is not in the muscles themselves. Instead, the problem comes from the brain. For reasons that are not well understood, neurons in the brain send the wrong signals to the muscles, causing them to contract excessively. Understanding what is wrong with the signals coming from these neurons is difficult, because they are in the brain and cannot be taken out for direct examination. Very recently, new methods have been developed to study neurons outside of the human brain. This technology involves taking a small skin sample from people with dystonia, growing living fibroblasts from the skin in a dish, and then converting the fibroblasts into stem cells. The stem cells can then be used to make a variety of different types of cells, including neurons. It therefore is possible to have an unlimited quantity of different types of neurons to study for different purposes. Since these cells can be made from dystonia patients, they contain the genetic defects responsible for causing the disorder. So far we have already made these stem cells from several people with DYT1 dystonia. Our plan is to use these stem cells to make neurons, and then evaluate the biochemical and cellular processes responsible for causing them to send wrong signals. Understanding these processes will make it possible to begin to look for medications that can correct the abnormal signals.


2013 Cure Dystonia Now Foundation Grant

“Promising Treatments for Dystonia: Preclinical Testing”

Ellen J. Hess, Ph.D.
Professor of Pharmacology and Neurology
Emory University School of Medicine


Therapies for dystonia are largely unsatisfactory or palliative. Therefore, there is a tremendous need for new drugs that are truly effective for the treatment of the dystonias. Although drug discovery for dystonia was unimaginable just a few years ago, this is, fortunately, now possible in light of major advances in dystonia research. Therefore, we performed preclinical testing of several FDA-approved drugs that have promise as treatments for DYT1 dystonia. These drugs were first identified using cell-based models to find drugs with the potential to correct cell abnormalities associated with DYT1 dystonia and we then tested these drugs in mouse models of dystonia. Testing in animals helps determine if the drugs have antidystonic properties; testing in animals is also necessary to advance a drug to clinical trial. The goal of this study was to identify 1-2 promising candidates that could be used for clinical trials in patients with DYT1 or other forms of dystonia. Of the nine drugs tested, three drugs had antidystonic effects in mice. Although much work needs to be done before these drugs are useful for patients with dystonia, these drugs appear to be promising candidates for advancement to clinical trial.


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