Neurodegeneration in Niemann-Pick Type C Disease: An Updated Review on Pharmacological and Non-Pharmacological Approaches to Counteract Brain and Cognitive Impairment

Int J Mol Sci. 2021 Jun 20;22(12):6600. doi: 10.3390/ijms22126600.

Abstract

Niemann-Pick type C (NPC) disease is an autosomal recessive storage disorder, characterized by abnormal sequestration of unesterified cholesterol in the late endo-lysosomal system of cells. Progressive neurological deterioration and the onset of symptoms, such as ataxia, seizures, cognitive decline, and severe dementia, are pathognomonic features of the disease. In addition, different pathological similarities, including degeneration of hippocampal and cortical neurons, hyperphosphorylated tau, and neurofibrillary tangle formation, have been identified between NPC disease and other neurodegenerative pathologies. However, the underlying pathophysiological mechanisms are not yet well understood, and even a real cure to counteract neurodegeneration has not been identified. Therefore, the combination of current pharmacological therapies, represented by miglustat and cyclodextrin, and non-pharmacological approaches, such as physical exercise and appropriate diet, could represent a strategy to improve the quality of life of NPC patients. Based on this evidence, in our review we focused on the neurodegenerative aspects of NPC disease, summarizing the current knowledge on the molecular and biochemical mechanisms responsible for cognitive impairment, and suggesting physical exercise and nutritional treatments as additional non-pharmacologic approaches to reduce the progression and neurodegenerative course of NPC disease.

Keywords: Niemann–Pick type C; cognitive decline; lipid trafficking; neurodegeneration; nutritional approach; pharmacological treatment; physical exercise.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain / metabolism
  • Brain / pathology
  • Brain / physiopathology
  • Clinical Decision-Making
  • Cognitive Dysfunction / diagnosis
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / therapy
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Disease Management
  • Disease Susceptibility*
  • Humans
  • Nerve Degeneration / diagnosis
  • Nerve Degeneration / etiology*
  • Niemann-Pick Disease, Type C / diagnosis
  • Niemann-Pick Disease, Type C / drug therapy
  • Niemann-Pick Disease, Type C / etiology*
  • Niemann-Pick Disease, Type C / therapy*
  • Treatment Outcome