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Liu J, He Y, Lwin C, Han M, Guan B, Naik A, Bender C, Moore N, Huryn LA, Sergeev YV, Qian H, Zeng Y, Dong L, Liu P, Lei J, Haugen CJ, Prasov L, Shi R, Dollfus H, Aristodemou P, Laich Y, Németh AH, Taylor J, Downes S, Krawczynski MR, Meunier I, Strassberg M, Tenney J, Gao J, Shear MA, Moore AT, Duncan JL, Menendez B, Hull S, Vincent AL, Siskind CE, Traboulsi EI, Blackstone C, Sisk RA, Miraldi Utz V, Webster AR, Michaelides M, Arno G, Synofzik M, Hufnagel RB. Neuropathy target esterase activity defines phenotypes among PNPLA6 disorders. Brain 2024:awae055. [PMID: 38735647 DOI: 10.1093/brain/awae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 05/14/2024] Open
Abstract
Biallelic pathogenic variants in the PNPLA6 gene cause a broad spectrum of disorders leading to gait disturbance, visual impairment, anterior hypopituitarism and hair anomalies. PNPLA6 encodes neuropathy target esterase (NTE), yet the role of NTE dysfunction on affected tissues in the large spectrum of associated disease remains unclear. We present a systematic evidence-based review of a novel cohort of 23 new patients along with 95 reported individuals with PNPLA6 variants that implicate missense variants as a driver of disease pathogenesis. Measuring esterase activity of 46 disease-associated and 20 common variants observed across PNPLA6-associated clinical diagnoses unambiguously reclassified 36 variants as pathogenic and 10 variants as likely pathogenic, establishing a robust functional assay for classifying PNPLA6 variants of unknown significance. Estimating the overall NTE activity of affected individuals revealed a striking inverse relationship between NTE activity and the presence of retinopathy and endocrinopathy. This phenomenon was recaptured in vivo in an allelic mouse series, where a similar NTE threshold for retinopathy exists. Thus, PNPLA6 disorders, previously considered allelic, are a continuous spectrum of pleiotropic phenotypes defined by an NTE genotype:activity:phenotype relationship. This relationship, and the generation of a preclinical animal model, pave the way for therapeutic trials, using NTE as a biomarker.
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Affiliation(s)
- James Liu
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yi He
- Fermentation Facility, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA
| | - Cara Lwin
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marina Han
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bin Guan
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amelia Naik
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chelsea Bender
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nia Moore
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Laryssa A Huryn
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yuri V Sergeev
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Haohua Qian
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yong Zeng
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lijin Dong
- Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pinghu Liu
- Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jingqi Lei
- Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carl J Haugen
- Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lev Prasov
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48105, USA
| | - Ruifang Shi
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 100730 Beijing, China
| | - Hélène Dollfus
- Centre de référence pour les Affections Rares Ophtalmologiques CARGO, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, UMRS_1112, Strasbourg 67091, France
| | - Petros Aristodemou
- Cyprus Institute of Neurology and Genetics, Nicosia 1683, Cyprus
- VRMCy Centre, Limassol 3025, Cyprus
| | - Yannik Laich
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Genetics, Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK
| | - Andrea H Németh
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, ACE Building, Nuffield Orthopaedic Centre, Oxford OX3 7HE, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - John Taylor
- Oxford Regional Genetics Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Susan Downes
- Nuffield Department of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Maciej R Krawczynski
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan 60-512, Poland
| | - Isabelle Meunier
- National Referent Centre for Rare Sensory Diseases, Montpellier University Hospital, Montpellier University, Montpellier 34295, France
| | | | - Jessica Tenney
- Division of Medical Genetics, Department of Pediatrics, UCSF School of Medicine, San Francisco, CA 94143, USA
| | - Josephine Gao
- Division of Medical Genetics, Department of Pediatrics, UCSF School of Medicine, San Francisco, CA 94143, USA
| | - Matthew A Shear
- Division of Medical Genetics, Department of Pediatrics, UCSF School of Medicine, San Francisco, CA 94143, USA
| | - Anthony T Moore
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, CA 94143, USA
| | - Jacque L Duncan
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, CA 94143, USA
| | - Beatriz Menendez
- Department of Pediatrics, University of Illinois School of Medicine, Chicago, IL 60612, USA
| | - Sarah Hull
- Department of Ophthalmology, University of Auckland, Auckland 1023, New Zealand
| | - Andrea L Vincent
- Department of Ophthalmology, University of Auckland, Auckland 1023, New Zealand
| | - Carly E Siskind
- Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Elias I Traboulsi
- The Center for Genetic Eye Diseases, The Cleveland Clinic Eye Institute, Cleveland, OH 44106, USA
| | - Craig Blackstone
- Movement Disorders Division, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Robert A Sisk
- Department of Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Virginia Miraldi Utz
- Department of Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Andrew R Webster
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Genetics, Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Genetics, Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK
| | - Gavin Arno
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Genetics, Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
- German Center of Neurodegenerative Diseases (DZNE), Tübingen 72076, Germany
| | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Genetics and Center for Integrated Healthcare Research, Kaiser Permanente Hawaii Region, Honolulu, HI 98619, USA
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De Michele G, Maione L, Cocozza S, Tranfa M, Pane C, Galatolo D, De Rosa A, De Michele G, Saccà F, Filla A. Ataxia and Hypogonadism: a Review of the Associated Genes and Syndromes. Cerebellum 2024; 23:688-701. [PMID: 36997834 DOI: 10.1007/s12311-023-01549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
The association of hypogonadism and cerebellar ataxia was first recognized in 1908 by Gordon Holmes. Since the seminal description, several heterogeneous phenotypes have been reported, differing for age at onset, associated features, and gonadotropins levels. In the last decade, the genetic bases of these disorders are being progressively uncovered. Here, we review the diseases associating ataxia and hypogonadism and the corresponding causative genes. In the first part of this study, we focus on clinical syndromes and genes (RNF216, STUB1, PNPLA6, AARS2, SIL1, SETX) predominantly associated with ataxia and hypogonadism as cardinal features. In the second part, we mention clinical syndromes and genes (POLR3A, CLPP, ERAL1, HARS, HSD17B4, LARS2, TWNK, POLG, ATM, WFS1, PMM2, FMR1) linked to complex phenotypes that include, among other features, ataxia and hypogonadism. We propose a diagnostic algorithm for patients with ataxia and hypogonadism, and we discuss the possible common etiopathogenetic mechanisms.
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Affiliation(s)
- Giovanna De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Luigi Maione
- Department of Endocrinology and Reproductive Diseases, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicetre, Paris, France
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Chiara Pane
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Daniele Galatolo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella Maris, Pisa, Italy
| | - Anna De Rosa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
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Liu J, He Y, Lwin C, Han M, Guan B, Naik A, Bender C, Moore N, Huryn LA, Sergeev Y, Qian H, Zeng Y, Dong L, Liu P, Lei J, Haugen CJ, Prasov L, Shi R, Dollfus H, Aristodemou P, Laich Y, Németh AH, Taylor J, Downes S, Krawczynski M, Meunier I, Strassberg M, Tenney J, Gao J, Shear MA, Moore AT, Duncan JL, Menendez B, Hull S, Vincent A, Siskind CE, Traboulsi EI, Blackstone C, Sisk R, Utz V, Webster AR, Michaelides M, Arno G, Synofzik M, Hufnagel RB. Neuropathy target esterase activity predicts retinopathy among PNPLA6 disorders. bioRxiv 2023:2023.06.09.544373. [PMID: 37333224 PMCID: PMC10274907 DOI: 10.1101/2023.06.09.544373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Biallelic pathogenic variants in the PNPLA6 gene cause a broad spectrum of disorders leading to gait disturbance, visual impairment, anterior hypopituitarism, and hair anomalies. PNPLA6 encodes Neuropathy target esterase (NTE), yet the role of NTE dysfunction on affected tissues in the large spectrum of associated disease remains unclear. We present a clinical meta-analysis of a novel cohort of 23 new patients along with 95 reported individuals with PNPLA6 variants that implicate missense variants as a driver of disease pathogenesis. Measuring esterase activity of 46 disease-associated and 20 common variants observed across PNPLA6 -associated clinical diagnoses unambiguously reclassified 10 variants as likely pathogenic and 36 variants as pathogenic, establishing a robust functional assay for classifying PNPLA6 variants of unknown significance. Estimating the overall NTE activity of affected individuals revealed a striking inverse relationship between NTE activity and the presence of retinopathy and endocrinopathy. This phenomenon was recaptured in vivo in an allelic mouse series, where a similar NTE threshold for retinopathy exists. Thus, PNPLA6 disorders, previously considered allelic, are a continuous spectrum of pleiotropic phenotypes defined by an NTE genotype:activity:phenotype relationship. This relationship and the generation of a preclinical animal model pave the way for therapeutic trials, using NTE as a biomarker.
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Durmaz Çelik N, Erzurumluoğlu E, Özben S, Toprak U, Yorulmaz G, Artan S, Özkan S. A novel mutation in RNF216 gene in a Turkish case with Gordon Holmes syndrome. BMC Med Genomics 2023; 16:98. [PMID: 37161390 PMCID: PMC10169457 DOI: 10.1186/s12920-023-01529-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Gordon Holmes syndrome (GHS) is a rare autosomal recessive disorder characterized by hypogonadotropic hypogonadism, cognitive decline, and cerebellar ataxia. Mutations in the Ring Finger Protein 216 (RNF216) gene have been known to be associated with GHS therewithal RNF216 mutations have been detected in cases with Huntington-like disease, 4H syndrome (hypodontia, hypomyelination, ataxia and hypogonadotropic hypogonadism), and congenital hypogonadotropic hypogonadism. CASE PRESENTATION Here we report a novel homozygous frameshift mutation in RNF216 gene c.1860_1861dupCT (p.Cys621SerfsTer56) in a patient with hypogonadotropic hypogonadism, ataxia, and cognitive decline diagnosed with GHS also co-occurrence of parkinsonism and dystonia which was not reported before. CONCLUSIONS We report an extremely rare case of GHS. The core features of GHS are well defined, but genotype-phenotype correlations are still limited. To understand the pathophysiology of different phenotypes, the type and localization of novel mutations need to be defined, and the effect of these different variants on clinical features needs to be determined. Further studies should explain the factors of phenotypic variability present in GHS patients with RNF216 mutations.
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Affiliation(s)
- Nazlı Durmaz Çelik
- Department of Neurology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
| | - Ebru Erzurumluoğlu
- Department of Medical Genetics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Serkan Özben
- Department of Neurology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Uğur Toprak
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Göknur Yorulmaz
- Department of Endocrinology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Sevilhan Artan
- Department of Medical Genetics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Serhat Özkan
- Department of Neurology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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King KA, Wegner DJ, Bucelli RC, Shapiro J, Paul AJ, Dickson PI, Wambach JA. Whole-Genome and Long-Read Sequencing Identify a Novel Mechanism in RFC1 Resulting in CANVAS Syndrome. Neurol Genet 2022; 8:e200036. [PMID: 36524104 PMCID: PMC9747150 DOI: 10.1212/nxg.0000000000200036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
Objectives Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) results from biallelic intronic pentanucleotide repeats in RFC1. We describe an adult male proband with progressive imbalance, cerebellar atrophy, somatosensory neuronopathy, and absence of peripheral vestibular function for whom clinical testing demonstrated a heterozygous RFC1 expansion consistent with an unaffected carrier. Methods We performed whole-genome sequencing (WGS) on peripheral blood DNA samples from the proband and his unaffected mother. We performed DNA long-read sequencing and synthesized complementary DNA from RNA using peripheral blood from the proband. Results WGS confirmed the maternally inherited RFC1 expansion and identified a rare, nonsense RFC1 variant: c.C1147T; p.R383X in the proband but not the maternal DNA sample. RFC1 variants were confirmed in trans with long-read sequencing. Functional studies demonstrated the absence of complementary DNA (cDNA) transcript from the c.C1147T; p.R383X variant supporting nonsense-mediated decay of this transcript. Discussion We report an adult with CANVAS due to compound heterozygous pathogenic RFC1 variants: the pathogenic intronic pentanucleotide expansion confirmed in trans with a nonsense variant. This report represents a novel molecular mechanism for CANVAS. Sequencing for RFC1 should be considered for adults meeting clinical criteria for the CANVAS phenotype if only a heterozygous pathogenic RFC1 expansion is identified.
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Affiliation(s)
- Katherine Abell King
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Daniel J Wegner
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Robert C Bucelli
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Jessica Shapiro
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Alexander J Paul
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Patricia I Dickson
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
| | - Jennifer A Wambach
- Edward Mallinckrodt Department of Pediatrics (K.A.K., D.J.W., J.S., P.I.D., J.A.W.); Department of Neurology (R.C.B.); and McDonnell Genome Institute (A.J.P.), Washington University School of Medicine, St. Louis, MO
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