Evidence map›Paper›PMID 41491634›Full record

ArticleAnnals of clinical and translational neurology2026

Diagnostic Utility of the ATG9A Ratio in AP-4-Associated Hereditary Spastic Paraplegia.

Habibah A P Agianda, Hyo-Min Kim, Nicole Battaglia, Joshua Rong, Amy Tam, Enrique Gonzalez Saez-Diez, Cornelius F Boerkoel, Afshin Saffari, Vicente Quiroz, Luca Schierbaum and 3 more

4 registry-linked trialsAbstract read
In one paragraph

Article in Annals of clinical and translational neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04712812 recruitingnot on this map

Registry and Natural History Study for Early Onset Hereditary Spastic Paraplegia (HSP)

Typeobservational_patient_registrySponsorBoston Children's HospitalRan2020 to 2030Enrolled700ConditionsHereditary Spastic Paraplegia, SPG47, SPG50, SPG51
NCT05518188 phase1 / phase2recruitingnot on this map

A Phase 1/2 Open-label Intrathecal Administration of MELPIDA to Determine Its Safety and Efficacy for Patients With Spastic Paraplegia Type 50 (SPG50) Caused by Mutation in the AP4M1 Gene.

TypeinterventionalSponsorElpida Therapeutics SPCRan2023 to 2030Enrolled4ConditionsSpasticity, Muscle, Microcephaly, Intellectual Deficiency, Growth RetardationArmsMELPIDA
NCT06692712 phase3recruitingnot on this map

Intrathecal Administration of MELPIDA (AAV9/AP4M1) For Hereditary Spastic Paraplegia Type 50 (SPG50): A Phase 3, Open-Label Trial With Matched Prospective Concurrent Control Arm

TypeinterventionalSponsorElpida Therapeutics SPCRan2026 to 2032Enrolled24ConditionsHereditary Spastic Paraplegia Type 50ArmsMELPIDA
NCT06948019 phase1 / phase2not yet recruitingnot on this map

Safety and Efficacy of AAV9/AP4B1 For Patients With AP4B1-related Hereditary Spastic Paraplegia Type 47 (SPG47): A Phase 1/2 Single-Center, Open-Label Study of Stereotactic Intra-cisterna Magna Administration

TypeinterventionalSponsorBlackfinBio LtdRan2025 to 2032Enrolled5ConditionsHSP, Hereditary Spastic Paraplegia, Hereditary Spastic Paraparesis, Hereditary Spastic Paraplegia Type 50ArmsBFB-101 (AAV9-CBh-AP4B1)
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Habibah A P AgiandaMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Hyo-Min KimMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nicole BattagliaMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Joshua RongMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Amy TamMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0003-2072-3436
Enrique Gonzalez Saez-DiezMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0009-0008-0031-2756
Cornelius F BoerkoelDepartment of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
Afshin SaffariDivision of Child Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty Heidelberg, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
Vicente QuirozMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Luca SchierbaumMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Zainab ZamanMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Katerina BernardiMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Darius Ebrahimi-FakhariMovement Disorders Program, Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-0026-4714

Funding

Spastic Paraplegia Centers of Excellence Research Network (SP-CERN) - RDCRCU54NS148312 · NINDS · BOSTON CHILDREN'S HOSPITAL · PI Joshua Burns · 2025 to 2026
$5.0M
Development of a Translational Research Platform to Understand and treat Defective Protein Trafficking in Childhood-Onset Hereditary Spastic ParaplegiaK08NS123552 · NINDS · BOSTON CHILDREN'S HOSPITAL · PI EBRAHIMI-FAKHARI, DARIUS · 2021 to 2025
$1.1M
Boston Children's HospitalBoston Children's Hospital Translational Research ProgramCureAP4 FoundationCureSPG4 FoundationEURO-HSPLilly & Blair FoundationNew England Epilepsy FoundationNINDS NIH HHS 1U54NS148312NINDS NIH HHS 5K08NS123552NINDS NIH HHS K08 NS123552NINDS NIH HHS U54 NS148312Spastic Paraplegia Foundation
6 · The paper itself

Abstract

Adaptor protein complex 4-associated hereditary spastic paraplegia (AP-4-HSP), a childhood-onset neurogenetic disorder and frequent mimic of cerebral palsy, is caused by biallelic variants in the adaptor protein complex 4 (AP-4) subunit genes (AP4B1 [for SPG47], AP4M1 [for SPG50], AP4E1 [for SPG51], and AP4S1 [for SPG52]). Diagnosis is often confounded by variants of uncertain significance. We evaluated the ATG9A ratio, a measure of ATG9A mislocalization in patient-derived fibroblasts, as a functional assay of AP-4 deficiency. In six of eight individuals with suspected AP-4-HSP, the assay demonstrated loss of AP-4 function, establishing pathogenicity of novel variants. These findings support the ATG9A ratio as a clinically useful diagnostic tool for confirming AP-4-HSP and aiding the classification of novel variants. Trial Registration: ClinicalTrials.gov identifier: NCT06948019, NCT05518188, NCT06692712, NCT04712812.

Indexed as

Adaptor Protein Complex 4Autophagy-Related ProteinsMembrane ProteinsSpastic Paraplegia, HereditaryVesicular Transport ProteinsAdolescentAdultChildFemaleHumansMaleYoung AdultAdaptor Protein Complex 4ATG9A protein, humanAutophagy-Related ProteinsMembrane ProteinsVesicular Transport Proteinsadaptor protein complex 4ATG9A ratiofunctional diagnostic assayhereditary spastic paraplegiavariants of uncertain significance

Identifiers

PMID41491634
PMCPMC13071144

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.