Imperial College London

Professor Paul M. Matthews

Faculty of MedicineDepartment of Brain Sciences

Edmond and Lily Safra Chair, Head of Department



+44 (0)20 7594 2855p.matthews




Ms Siobhan Dillon +44 (0)20 7594 2855




E502Burlington DanesHammersmith Campus






BibTex format

author = {Faergeman, SL and Evans, H and Attfield, KE and Desel, C and Kuttikkatte, SB and Sommerlund, M and Jensen, LT and Frokiaer, J and Friese, MA and Matthews, PM and Luchtenborg, C and Brügger, B and Oturai, AB and Dendrou, CA and Fugger, L},
doi = {10.1038/s41419-020-2494-0},
journal = {Cell Death and Disease},
title = {A novel neurodegenerative spectrum disorder in patients with MLKL deficiency},
url = {},
volume = {11},
year = {2020}

RIS format (EndNote, RefMan)

AB - Mixed lineage kinase domain-like (MLKL) is the main executor of necroptosis, an inflammatory form of programmed cell death. Necroptosis is implicated in combating infections, but also in contributing to numerous other clinical conditions, including cardiovascular diseases and neurodegenerative disorders. Inhibition of necroptosis is therefore of therapeutic interest. Here we report two siblings both of whom over the course of 35 years developed a similar progressive, neurodegenerative spectrum disorder characterized by paresis, ataxia and dysarthria. Magnetic resonance imaging of their central nervous system (CNS) revealed severe global cerebral volume loss and atrophy of the cerebellum and brainstem. These brothers are homozygous for a rare haplotype identified by whole genome sequencing carrying a frameshift variant in MLKL, as well as an in-frame deletion of one amino acid in the adjacent fatty acid 2-hydroxylase (FA2H) gene. Functional studies of patient-derived primary cells demonstrated that the variant in MLKL leads to a deficiency of MLKL protein resulting in impairment of necroptosis. Conversely, shotgun lipidomic analysis of the variant in FA2H shows no impact on either the abundance or the enzymatic activity of the encoded hydroxylase. To our knowledge, this is the first report of complete necroptosis deficiency in humans. The findings may suggest that impaired necroptosis is a novel mechanism of neurodegeneration, promoting a disorder that shares some clinical features with primary progressive multiple sclerosis (PPMS) and other neurodegenerative diseases. Importantly, the necroptotic deficiency does not cause symptoms outside the nervous system, nor does it confer susceptibility to infections. Given the current interest in pharmacological inhibition of necroptosis by targeting MLKL and its associated pathways, this strategy should be developed with caution, with careful consideration of the possible development of adverse neurological effects.
AU - Faergeman,SL
AU - Evans,H
AU - Attfield,KE
AU - Desel,C
AU - Kuttikkatte,SB
AU - Sommerlund,M
AU - Jensen,LT
AU - Frokiaer,J
AU - Friese,MA
AU - Matthews,PM
AU - Luchtenborg,C
AU - Brügger,B
AU - Oturai,AB
AU - Dendrou,CA
AU - Fugger,L
DO - 10.1038/s41419-020-2494-0
PY - 2020///
SN - 2041-4889
TI - A novel neurodegenerative spectrum disorder in patients with MLKL deficiency
T2 - Cell Death and Disease
UR -
UR -
UR -
VL - 11
ER -