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Die proximale spinale Muskelatrophie (SMA) ist eine autosomal rezessive Erb-krankheit, welche durch fortschreitende Muskelatrophie mit Betonung der pro-ximalen Extremitäten, sowie zunehmende motorische Lähmungen charakterisiert wird. Bedingt wird diese neurodegenerative Erkrankung durch Mutation bzw. Deletion des SMN1-Gens auf Chromosom 5q13. Dies führt zu reduzierten Mengen des ubiquitär exprimierten SMN-Proteins, da der Verlust des SMN1-Gens nicht durch das noch verbleibende SMN2-Gen kompensiert werden kann. Die SMN-Promotor-Region enthält ein CRE II bindendes Element, welches Effekte von zyklischem Adenosinmonophosphat (cAMP) vermittelt und so die SMN-Transkription in untersuchten Zellen stimuliert. Ausgehend von diesem Befund stellte sich die Frage, ob cAMP dem Mangel an volllängen SMN bei der SMA entgegen wirkt. Daher wurden für diese Dissertation neurosphärenbildende kortikale Vorläuferzellen und primär kultivierte Motoneuronen von Smn+/+; SMN2- und Smn–/–;SMN2-Mausembryonen untersucht, um zu klären, ob die cAMP-Behandlung der Zellen zu einer Hochregulierung des SMN2-Transkripts führt, und durch die resultierende Erhöhung des SMN-Proteingehalts morphologische und funktionelle Defekte kompensiert werden. Die Untersuchung zeigte eine signifikante Zunahme des SMN2-Transkriptgehalts in Anwesenheit von cAMP. Dadurch kam es zu einem Anstieg der SMN-Proteinmenge im Soma, Axon und Wachstumskegel von Smn–/–;SMN2-Motoneuronen. Die Verteilungs-störung des SMN-Interaktionspartners hnRNP R mit fehlender kontrolltypischer Anreicherung im distalen Axon und Wachstumskegel von Smn–/–;SMN2-Motoneuronen wurde ebenfalls durch cAMP kompensiert. Smn-defiziente Mo-toneurone zeigten im Vergleich zu Kontrollzellen kleinere Wachstumskegel sowie ein Defizit an β-Aktin im distalen Axon. Zudem fehlte in Smn–/–;SMN2-Motoneuronen die bei Kontrollen ausgeprägte Zusammenlagerung von N-Typ spezifischen Ca2+-Kanälen in der Präsynapse, die nach Kontakt mit der β2-Kette des endplattenspezifischen Laminin-221 spontan öffnen und so einen in-trazellulären Kalziumanstieg bewirken, wodurch es zu Erregbarkeitsstörungen und Axonelongationsdefekten bei Smn-defizienten Motoneuronen kommt. Die Behandlung der Smn-defizienten Motoneuronen mit cAMP führte zur Vergrößerung der Wachstumskegelfläche und zu einer im Verlauf des Axons zunehmenden Anfärbung mit β-Aktin. Außerdem kam es zu einer Erhöhung der Menge an Cav2.2-Kanalprotein in den Wachstumskegeln Smn-defizienter Motoneurone, was mit einer erhöhten Erregbarkeit korrelierte und zu einer Normalisierung der Axonlänge von Smn–/–;SMN2-Motoneuronen auf Laminin-221 führte. Die Ergebnisse dieser Arbeit lassen die Vermutung zu, dass Smn-defiziente Motoneurone in vivo Defekte im präsynaptischen Bereich der Motorendplatte aufweisen. In Zukunft können mit dem beschriebenen in vitro Assay weitere Substanzen, welche die SMN2-Traskription stimulieren, auf ihr kompensatorisches Potential getestet werden.
Spinal muscular atrophy and amyotrophic lateral sclerosis are the two most common devastating motoneuron diseases. The mechanisms leading to motoneuron degeneration are not resolved so far, although different hypotheses have been built on existing data. One possible mechanism is disturbed axonal transport of RNAs in the affected motoneurons. The underlying question of this study was therefore to characterize changes in transcript levels of distinct RNAs in cell culture models of spinal muscular atrophy and amyotrophic lateral sclerosis, especially in the axonal compartment of primary motoneurons.
To investigate this in detail we first established compartmentalized cultures of Primary mouse motoneurons. Subsequently, total RNA of both compartments was extracted
separately and either linearly amplified and subjected to microarray profiling or whole transcriptome amplification followed by RNA-Sequencing was performed. To make
the whole transcriptome amplification method suitable for compartmentalized cultures, we adapted a double-random priming strategy. First, we applied this method
for initial optimization onto serial dilutions of spinal cord RNA and later on to the compartmentalized motoneurons.
Analysis of the data obtained from wildtype cultures already revealed interesting results. First, the RNA composition of axons turned out to be highly similar to the somatodendritic compartment. Second, axons seem to be particularly enriched for transcripts related to protein synthesis and energy production. In a next step we
repeated the experiments by using knockdown cultures. The proteins depleted hereby are Smn, Tdp-43 and hnRNP R. Another experiment was performed by knocking down the non-coding RNA 7SK, the main interacting RNA of hnRNP R.
Depletion of Smn led to a vast number of deregulated transcripts in the axonal and somatodendritic compartment. Transcripts downregulated in the axons upon Smn depletion were especially enriched for GOterms related to RNA processing and encode proteins located in neuron projections including axons and growth cones.
Strinkingly, among the upregulated transcripts in the somatodendritic compartment we mainly found MHC class I transcripts suggesting a potential neuroprotective role.
In contrast, although knockdown of Tdp-43 also revealed a large number of downregulated transcripts in the axonal compartment, these transcripts were mainly
associated with functions in transcriptional regulation and RNA splicing. For the hnRNP R knockdown our results were again different. Here, we observed
downregulated transcripts in the axonal compartment mainly associated with regulation of synaptic transmission and nerve impulses. Interestingly, a comparison between deregulated transcripts in the axonal compartment of both hnRNP R and 7SK knockdown presented a significant overlap of several transcripts suggesting
some common mechanism for both knockdowns.
Thus, our data indicate that a loss of disease-associated proteins involved in axonal RNA transport causes distinct transcriptome alterations in motor axons.
Die proximale spinale Muskelatrophie (SMA) stellt eine der häufigsten erblichen Ursachen für den Tod im Kindesalter dar. Die Patienten leiden unter symmetrischer, langsam progredienter Muskelschwäche und in schweren Fällen auch an sensiblen Ausfällen. Die neurodegenerative Erkrankung wird autosomal-rezessiv durch Deletion bzw. Mutationen des SMN1-Gens (survival motor neuron 1-Gens) auf Chromosom 5q13 vererbt. Das SMN-Protein wird ubiquitär exprimiert und findet sich in allen untersuchten Geweben in einem Multiproteinkomplex, dem sogenannten SMN-Komplex, der die Zusammenlagerung von spleißosomalen Komplexen koordiniert. Die Funktion solcher Komplexe ist für alle Zelltypen essentiell. Deshalb stellt sich die Frage, welcher Pathomechanismus für die Erkrankung SMA verantwortlich ist. Die vorliegende Arbeit zeigt, dass die Überlebensraten der Smn–/–;SMN2-Motoneurone 14 Tage alter Mausembryonen gegenüber Smn+/+;SMN2-Motoneuronen (Kontrollen) nicht reduziert waren. Bei der morphologischen Untersuchung der Zellen zum gleichen Entwicklungszeitpunkt zeigten sich jedoch deutliche Unterschiede. Die Axonlängen der Smn-defizienten Motoneurone waren gegenüber Kontrollen signifikant verringert. Das Dendritenwachstum war nicht beeinträchtigt. Die Untersuchung der Wachstumskegel ergab bei den Smn–/–;SMN2 Motoneuronen eine signifikante Verminderung der Fläche gegenüber Kontrollen. Weiterhin zeigten sich Defekte im Zytoskelett. In den Motoneuronen von Kontrolltieren fand sich eine Anreicherung von beta-Aktin in perinukleären Kompartimenten sowie besonders stark in den Wachstumskegeln. Die beta-Aktin-Anreicherung nahm im Verlauf des Axons zu. In Smn–/–;SMN2-Motoneuronen war keine Anreicherung im distalen Axon oder in den Wachstumskegeln detektierbar. Eine gleichartige Verteilungsstörung fand sich für das SMN-Interaktionsprotein hnRNP R (heterogenous nuclear ribonucleoprotein R) und, wie andere Arbeiten zeigen konnten, auch für die beta-Aktin-mRNA, die spezifisch an hnRNP R bindet. In gleicher Weise wurden auch Veränderungen in den sensorischen Neuronen aus den Hinterwurzelganglien 14 Tage alter Mausembryonen untersucht. Bei Smn–/–;SMN2-Mäusen war die Neuritenlänge sensorischer Neurone im Vergleich zur Kontrolle gering, jedoch signifikant verkürzt und die Fläche der Wachstumskegel hochsignifikant verringert. Im Smn–/–;SMN2 Mausmodell für eine schwere Form der SMA fanden sich in den sensorischen Nervenzellen im Vergleich zu den Motoneuronen geringer ausgeprägte, jedoch gleichartige Veränderungen, was auf einen ähnlichen Pathomechanismus in beiden Zelltypen hinweist.
During development of the nervous system, spontaneous Ca2+ transients are observed that regulate the axon growth of motoneurons. This form of spontaneous neuronal activity is reduced in motoneurons from a mouse model of spinal muscular atrophy and this defect correlates with reduced axon elongation. Experiments from our group demonstrated that voltage-gated sodium channel pore blockers decrease spontaneous neuronal activity and
axon growth in cultured motoneurons, too. In these experiments, saxitoxin was more potent than tetrodotoxin. We identified the saxitoxin-sensitive/tetrodotoxin-insensitive voltage-gated sodium channel NaV1.9 as trigger for the opening of voltage-gated calcium channels. In motoneurons, expression of NaV1.9 was verified via quantitative RT-PCR. Immuno labelling
experiments revealed enrichment of the channel in axonal growth cones and at the nodes of Ranvier of isolated nerve fibres from wild type mice. Motoneurons from NaV1.9 knock-out mice show decreased spontaneous activity and reduced axonal elongation. This growth defect can be rescued by NaV1.9 overexpression. In motoneurons from Smn-deficient mice, NaV1.9 distribution appeared to be normal.
Recently, patients carrying a missense mutation in the NaV1.9-encoding gene SCN11A were identified. These patients are not able to feel pain and suffer from muscular weakness and a delayed motor development. Molecular biological work during this dissertation supported the analysis of this mutation in a mouse model carrying the orthologous alteration in the Scn11a
locus. The cooperation study confirmed that a gain-of-function mechanism underlies the NaV1.9-mediated channelopathy, thus suggesting a functional role of NaV1.9 in human motoneurons.
An earlier study showed in hippocampal neurons that the receptor tyrosine kinase tropomyosin receptor kinase B (TrkB) can open the NaV1.9 channel. TrkB is localized in
growth cones of motoneurons and subsequently found in close proximity to NaV1.9. In order to proof whether TrkB is involved in spontaneous excitability in motoneurons, TrkB knock-out mice were analysed. Isolated motoneurons from TrkB knock-out mice show a reduced spontaneous activity and axon elongation. It remains to be studied whether TrkB and NaV1.9 are functionally connected.
Motoneuron diseases form a heterogeneous group of pathologies characterized by the progressive degeneration of motoneurons. More and more genetic factors associated with motoneuron diseases encode proteins that have a function in RNA metabolism, suggesting that disturbed RNA metabolism could be a common underlying problem in several, perhaps all, forms of motoneuron diseases. Recent results suggest that SMN interacts with hnRNP R and TDP-43 in neuronal processes, which are not part of the classical SMN complex. This point to an additional function of SMN, which could contribute to the high vulnerability of spinal motoneurons in spinal muscular atrophy (SMA) and amyotrophic lateral sclerosis (ALS). The current study elucidates functional links between SMN, the causative factor of SMA (spinal muscular atrophy), hnRNP R, and TDP-43, a genetic factor in ALS (amyotrophic lateral sclerosis). In order to characterize the functional interaction of SMN with hnRNP R and TDP-43, we produced recombinant proteins and investigated their interaction by co-immunoprecipitation. These proteins bind directly to each other, indicating that no other co-factors are needed for this interaction. SMN potentiates the ability of hnRNP R and TDP-43 to bind to ß-actin mRNA. Depletion of SMN alters the subcellular distribution of hnRNP R in motoneurons both in SMN-knockdown motoneurons and SMA mutant mouse (delta7 SMA). These data point to functions of SMN beyond snRNP assembly which could be crucial for recruitment and transport of RNA particles into axons and axon terminals, a mechanism which may contribute to SMA pathogenesis and ALS.
ALS and FTLD (frontotemporal lobar degeneration) are linked by several lines of evidence with respect to clinical and pathological characteristics. Both sporadic and familial forms are a feature of the ALS-FTLD spectrum, with numerous genes having been associated with these pathological conditions. Both diseases are characterized by the pathological cellular aggregation of proteins. Interestingly, some of these proteins such as TDP-43 and FUS have also common relations not only with ALS-FTLD but also with SMA. Intronic hexanucleotide expansions in C9ORF72 are common in ALS and FTLD but it is unknown whether loss of function, toxicity by the expanded RNA or dipeptides from non ATG-initiated translation is responsible for the pathophysiology. This study tries to characterize the cellular function of C9ORF72 protein. To address this, lentiviral based knockdown and overexpression of C9ORF72 was used in isolated mouse motoneurons. The results clearly show that survival of these motoneurons was not affected by altered C9ORF72 levels, whereas adverse effects on axon growth and growth cone size became apparent after C9ORF72 suppression. Determining the protein interactome revealed several proteins in complexes with C9ORF72. Interestingly, C9ORF72 is present in a complex with cofilin and other actin binding proteins that modulate actin dynamics. These interactions were confirmed both by co-precipitation analyses and in particular by functional studies showing altered actin dynamics in motoneurons with reduced levels of C9ORF72. Importantly, the phosphorylation of cofilin is enhanced in C9ORF72 depleted motoneurons and patient derived lymphoblastoid cells with reduced C9ORF72 levels. These findings indicate that C9ORF72 regulates axonal actin dynamics and the loss of this function could contribute to disease pathomechanisms in ALS and FTLD.
The transmission of proliferative and developmental signals from activated cell-surface receptors to initiation of cellular responses in the nucleus is synergically controlled by the coordinated action of a diverse set of intracellular signalling proteins. The Ras/Raf/MEK/MAPK signalling pathway has been shown to control the expression of genes which are crucial for the physiological regulation of cell proliferation, differentiation and apoptosis. Within this signalling cascade, the Raf protein family of serine/threonine kinases serves as a central intermediate which connects to many of other signal transduction pathways. To elucidate the signalling functions of the different Raf kinases in motoneurons during development, the expression, distribution and subcellular localization of Rafs in the spinal cord and the facial nucleus in brainstem of mice at various embryonic and postnatal stages were investigated. Moreover, we have investigated the intracellular redistribution of Raf molecules in isolated motoneurons from 13 or 14 day old mouse embryos, after addition or withdrawal of neurotrophic factors to induce Raf kinases activation in vitro. Furthermore, in order to investigate the potential anti-apoptotic function of Raf kinases on motoneurons, we isolated motoneurons from B-raf-/- and c-raf-1-/- mouse embryos and analysed the survival and differentiation effects of neurotrophic factors in motoneurons lacking B-Raf and c-Raf-1. We provide evidence here that all three Raf kinases are expressed in mouse spinal motoneurons. Their expression increases during the period of naturally occurring cell death of motoneurons. In sections of embryonic and postnatal spinal cord, motoneurons express exclusively B-Raf and c-Raf-1, but not A-Raf, and subcellularly Raf kinases are obviously colocalized with mitochondria. In isolated motoneurons, most of the B-Raf or c-Raf-1 immunoreactivity is located in the perinuclear space but also in the nucleus, especially after activation by addition of CNTF and BDNF in vitro. We found that c-Raf-1 translocation from the cytosol into the nucleus of motoneurons after its activation by neurotrophic factors is a distinct event. As a central finding of our study, we observed that the viability of isolated motoneurons from B-raf but not c-raf-1 knockout mice is lost even in the presence of CNTF and other neurotrophic factors. This indicates that B-Raf but not c-Raf-1, which is still present in B-raf deficient motoneurons, plays a crucial role in mediating the survival effect of neurotrophic factors during development. In order to prove that B-Raf is an essential player in this scenario, we have re-expressed B-Raf in mutant sensory and motor neurons by transfection. The motoneurons and the sensory neurons from B-raf knockout mouse which were transfected with exogenous B-raf gene revealed the same viability in the presence of neurotrophic factors as primary neurons from wild-type mice. Our results suggest that Raf kinases have important signalling functions in motoneurons in mouse CNS. In vitro, activation causes redistribution of Raf protein kinases, particularly for c-Raf-1, from motoneuronal cytoplasm into the nucleus. This redistribution of c-Raf-1, however, is not necessary for the survival effect of neurotrophic factors, given that B-raf-/- motor and sensory neurons can not survive despite the presence of c-Raf-1. We hypothesize that c-Raf-1 nuclear translocation may play a direct role in transcriptional regulation as a consequence of neurotrophic factor induced phosphorylation and activation of c-Raf-1 in motoneurons. Moreover, the identification of target genes for nuclear translocated c-Raf-1 and of specific cellular functions initiated by this mechanism awaits its characterization.
In cultured motoneurons of a mouse model for the motoneuron disease spinal muscular atrophy (SMA), reduced levels of the protein SMN (survival of motoneurons) cause defects in axonal growth. This correlates with reduced β-actin mRNA and protein in growth cones, indicating that anterograde transport and local translation of β-actin mRNA are crucial for motoneuron function. However, direct evidence that indeed local translation is a physiological phenomenon in growth cones of motoneurons was missing. Here, a lentiviral GFP-based reporter construct was established to monitor local protein synthesis of β-actin mRNA. Time-lapse imaging of fluorescence recovery after photobleaching (FRAP) in living motoneurons revealed that β-actin is locally translated in the growth cones of embryonic motoneurons. Interestingly, local translation of the β-actin reporter construct was differentially regulated by different laminin isoforms, indicating that laminins provide extracellular cues for the regulation of local translation in growth cones. Notably, local translation of β-actin mRNA was deregulated when motoneurons of a mouse model for type I SMA (Smn-/-; SMN2) were analyzed. In situ hybridization revealed reduced levels of β-actin mRNA in the axons of Smn-/-; SMN2 motoneurons. The distribution of the β-actin mRNA was not modified by different laminin isoforms as revealed by in situ hybridization against the mRNA of the eGFP encoding element of the β-actin reporter. In case of the mRNA of α-actin and γ-actin isoforms, the endogenous mRNA did not localize to the axons and the localization pattern was not affected by the SMN levels expressed in the cell. Taken together our findings suggest that regulation of local translation of β-actin in growth cones of motoneurons critically depends on laminin signaling and the amount of SMN protein. Embryonic stem cell (ESC)-derived motoneurons are an excellent in vitro system to sort out biochemical and cellular pathways which are defective in neurodegenerative diseases like SMA. Here, a protocol for the differentiation and antibody-mediated enrichment of ESC-derived motoneurons is presented, which was optimized during the course of this study. Notably, this study contributes the production and purification of highly active recombinant sonic hedgehog (Shh), which was needed for the efficient differentiation of mouse ESCs to motoneurons. ESC-derived motoneurons will now offer high amounts of cellular material to allow the biochemical identification of disease-relevant molecular components involved in regulated local protein synthesis in axons and growth cones of motoneurons.
Spontaneous neural activity has been shown to regulate crucial events in neurite growth including axonal branching and path finding. In animal models of spinal muscular atrophy (SMA) cultured embryonic mouse motoneurons show distinct defect in axon elongation and neural activity. This defect is governed by abnormal clustering of Ca2+ channels in the axonal regions and the protruding growth cone area. The mechanisms that regulate the opening of calcium channels in developing motoneurons are not yet clear. The question was addressed by blocking neural activity in embryonic cultured motoneurons by pharmacological inhibition of voltage-gated sodium channels (VGSC) by saxitoxin (STX) and tetrodotoxin (TTX). Low dosages of STX resulted in significant reduction of axon growth and neural activity in cultured motoneurons. This pharmacological treatment did not affect survival of motoneurons in comparison to control motoneurons that was grown in the presence of survival neurotrophic factors BDNF and CNTF. It was also found that STX was 10 times more potent than TTX a common inhibitor of VGSC with a reduced activity on the TTX-insensitive sodium channels NaV1.5, NaV1.8 and NaV1.9. Reverse Transcriptase-PCR experiments revealed the presence of NaV1.9 as the likely candidate that begins to express from embryonic stage sixteen in the mouse spinal cord. Immunolabelling experiments showed that the channel is expressed in the axonal compartments and axonal growth cones in cultured motoneurons. Suppression of NaV1.9 in cultured motoneurons by lentivirus mediated short hairpin-RNA (shRNA) resulted in shorter axon length in comparison with uninfected and scrambled constructs. Further, embryonic motoneurons cultured from NaV1.9 knockout mice also showed a significant reduction in neural activity and axon growth. The findings of this work highlight the role of NaV1.9 as an important contender in regulating activity dependent axon growth in embryonic cultured motoneurons. NaV1.9 could therefore be considered as a prospective molecule that could play an important role in regulating axon growth in motoneuron disease models like spinal muscular atrophy (SMA).
Neurotrophic factor signaling modulates differentiation, axon growth and maintenance, synaptic plasticity and regeneration of neurons after injury. Ciliary neurotrophic factor (CNTF), a Schwann cell derived neurotrophic factor, has an exclusive role in axon maintenance, sprouting and synaptic preservation. CNTF, but not GDNF, has been shown to alleviate motoneuron degeneration in pmn mutant mice carrying a missense mutation in Tbce gene, a model for Amyotrophic Lateral Sclerosis (ALS). This current study elucidates the distinct signaling mechanism by which CNTF rescues the axonal degeneration in pmn mutant mice. ...
Die Spinale Muskelatrophie (SMA) ist eine häufige autosomal-rezessiv vererbte Erkrankung des motorischen Nervensystems bei Kindern. Ursache der Degeneration von spinalen Motoneuronen ist der homozygote Verlust des SMN- (survival of motoneuron) Gens und ein dadurch bedingter Mangel an SMN-Protein. Untersuchungen an Motoneuronen von Smn-defizienten Mäusen ergaben Störungen des axonalen Längenwachstums aufgrund einer Fehlverteilung des Zytoskelettproteins beta-Aktin und seiner mRNA in den Axonterminalen. Das Axonwachstum wird durch Aktin-Polymerisierung im Wachstumskegel gesteuert. beta-Aktin-mRNA findet sich auch in Axonen, und die lokale Proteinsynthese kann durch neuronale Aktivierung gesteigert werden. Das SMN-Protein ist am axonalen Transport von beta-Aktin beteiligt. In der vorliegenden Arbeit ergaben Western Blot-Analysen in neuralen Stammzellen (NSC) sowie spinalen Motoneuronen in vitro eine Steigerung der SMN-Proteinexpression durch 8-CPT-cAMP. Zur Untersuchung der Auswirkungen der erhöhten SMN-Proteinmenge auf die Pathologie der Motoneurone wurde ein in-vitro-Assay entwickelt, mit dessen Hilfe gezeigt werden konnte, dass eine Behandlung mit 100 µM 8-CPT-cAMP die axonalen Veränderungen isolierter embryonaler Smn-defizienter Motoneurone kompensieren kann. Motoneurone von 14 Tage alten Smn-defizienten und Kontroll-Mausembryonen wurden über sieben Tage hinweg auf einer Matrix aus Poly-Ornithin und Laminin-111 bzw. Laminin-121/221 kultiviert und mit 100µM cAMP und neurotrophen Faktoren behandelt. Nach Fixierung wurden die Zellen mit Antikörpern gegen Islet-1/2, tau und beta-Aktin gefärbt, mit Hilfe eines konfokalen Mikroskops fotografiert und digital vermessen. 8-CPT-cAMP erhöht den beta-Aktin-Gehalt in den axonalen Wachstumskegeln von Smn-defizienten Motoneuronen. Die Größe der Wachstumskegel nimmt durch die Behandlung um das 2-3fache zu und erreicht normale Werte. Auf Laminin-111 bleibt das Längenwachstum der Axone durch 100µM 8-CPT-cAMP unbeeinflusst, auf Laminin-121/221 wird das Längenwachstum normalisiert. Die beta-Aktin-Verteilung innerhalb der Axone und Wachstumskegel von Smn-defizienten Motoneuronen erscheint durch die cAMP-Behandlung nahezu normalisiert. Die Wiederherstellung der beta-Aktin-Verteilung in Wachstumskegeln durch cAMP kann große Auswirkungen auf die Funktionalität der Motoneurone haben. Die Ergebnisse sind möglicherweise ein erster Schritt auf dem Weg zu einer Therapie für die Spinale Muskelatrophie.