Niemann-Pick type C (NPC) disease is a panethnic lysosomal lipidosis, which results in severe cerebellar impairment and death, and is proposed to be a consequence of defective metabolite transport. Numerous models of this disorder have defined the phenotypic impact of misfunction of the NPC proteins, however, their mechanism of action and definition of substrate(s) remain vague and disputed. The proteins may be lipid chaperones, nonspecific transporters, orphan transporters or membrane-sensing regulators ('rheostats') of other transport reactions. These issues pertain to the nature or even existence of a toxic metabolite as causative to this disorder and thus ultimately to treatment of the disease. This review will present the issues that underpin NPC disease and current or future avenues of treatment.
Keywordscholesterol; gangliosides; lysosome; Niemann-Pick; Niemann-Pick type C1; Niemann-Pick type C2; rheostat; resistance-nodulation-division-transporter Our understanding of the factors that determine vesicular transport of proteins is both clear and detailed [1]. By marked contrast, lipid movement between organelles, a critical component of eukaryotic membrane homeostasis, has very few known molecular players. Niemann-Pick type C (NPC) disease is a monogenic, autosomal recessive, fatal, neurodegenerative disorder caused by independent defects in two genes, NPC1 and NPC2 [2][3][4]. As the disease progresses, lipid accumulation in the lysosomes of a variety of cells leads to neurological, gastrointestinal, liver and respiratory problems, consistent with a role of NPC1 and NPC2 in lipid transport. Studies on NPC disease have exponentially increased our understanding of intracellular lipid transport that reaches beyond this devastating rare disorder to other forms of neuronal dysfunction such as Alzheimer's or Huntingtons disease [5,6]. However, surprisingly little is known about the precise mechanisms of action or substrates of the NPC pathways. In electrical circuits, a rheostat allows for and adjusts to variation in resistance; we hypothesize that NPC1 †Author for correspondence Columbia University Medical Center, is a membrane rheostat that senses and adjusts the fluidity of membranes in which it resides by increasing or decreasing the flux of appropriate lipids. In this review, we will describe the basis for this theory and the manner in which our knowledge of this process may guide future treatments of this devastating disorder.
Human Niemann-Pick type C disease: a transport disorder?The accepted biochemical hallmark of NPC disease is the lysosomal accumulation of lowdensity lipoprotein-derived, unesterified cholesterol in fibroblasts. Consequently, the reactions responsible for sterol biosynthesis, uptake and esterification are misregulated. Although the defect in egress of cholesterol from the endosomal/lysosomal system is the predominant mutant phenotype, NPC disease is also typified by the subcellular accumulation of sphingomyelin, sphingosine and complex glycosphingolipids [7]. In balance, the w...