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Stutterd CA, Vanderver A, Lockhart PJ, Helman G, Pope K, Uebergang E, Love C, Delatycki MB, Thorburn D, Mackay MT, Peters H, Kornberg AJ, Patel C, Rodriguez-Casero V, Waak M, Silberstein J, Sinclair A, Nolan M, Field M, Davis MR, Fahey M, Scheffer IE, Freeman JL, Wolf NI, Taft RJ, van der Knaap MS, Simons C, Leventer RJ. Unclassified white matter disorders: A diagnostic journey requiring close collaboration between clinical and laboratory services. Eur J Med Genet 2022; 65:104551. [PMID: 35803560 DOI: 10.1016/j.ejmg.2022.104551] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/27/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Next generation sequencing studies have revealed an ever-increasing number of causes for genetic disorders of central nervous system white matter. A substantial number of disorders are identifiable from their specific pattern of biochemical and/or imaging findings for which single gene testing may be indicated. Beyond this group, the causes of genetic white matter disorders are unclear and a broader approach to genomic testing is recommended. AIM This study aimed to identify the genetic causes for a group of individuals with unclassified white matter disorders with suspected genetic aetiology and highlight the investigations required when the initial testing is non-diagnostic. METHODS Twenty-six individuals from 22 families with unclassified white matter disorders underwent deep phenotyping and genome sequencing performed on trio, or larger, family groups. Functional studies and transcriptomics were used to resolve variants of uncertain significance with potential clinical relevance. RESULTS Causative or candidate variants were identified in 15/22 (68.2%) families. Six of the 15 implicated genes had been previously associated with white matter disease (COL4A1, NDUFV1, SLC17A5, TUBB4A, BOLA3, DARS2). Patients with variants in the latter two presented with an atypical phenotype. The other nine genes had not been specifically associated with white matter disease at the time of diagnosis and included genes associated with monogenic syndromes, developmental disorders, and developmental and epileptic encephalopathies (STAG2, LSS, FIG4, GLS, PMPCA, SPTBN1, AGO2, SCN2A, SCN8A). Consequently, only 46% of the diagnoses would have been made via a current leukodystrophy gene panel test. DISCUSSION These results confirm the importance of broad genomic testing for patients with white matter disorders. The high diagnostic yield reflects the integration of deep phenotyping, whole genome sequencing, trio analysis, functional studies, and transcriptomic analyses. CONCLUSIONS Genetic white matter disorders are genetically and phenotypically heterogeneous. Deep phenotyping together with a range of genomic technologies underpin the identification of causes of unclassified white matter disease. A molecular diagnosis is essential for prognostication, appropriate management, and accurate reproductive counseling.
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Affiliation(s)
- C A Stutterd
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - A Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - P J Lockhart
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - G Helman
- Institute for Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Australia
| | - K Pope
- Murdoch Children's Research Institute, Victoria, Australia
| | - E Uebergang
- Murdoch Children's Research Institute, Victoria, Australia
| | - C Love
- Murdoch Children's Research Institute, Victoria, Australia
| | - M B Delatycki
- Murdoch Children's Research Institute, Victoria, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - D Thorburn
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - M T Mackay
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - H Peters
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Department of Metabolic Medicine, Royal Children's Hospital, Victoria, Australia
| | - A J Kornberg
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - C Patel
- Genetic Health Queensland, Royal Brisbane and Women's Children's Hospital, South Brisbane Queensland, Australia; Centre for Children's Health Research, The University of Queensland, Queensland, Australia
| | - V Rodriguez-Casero
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - M Waak
- Centre for Children's Health Research, The University of Queensland, Queensland, Australia; Department of Neurosciences, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - J Silberstein
- Princess Margaret Hospital, Perth, Western Australia, Australia
| | - A Sinclair
- Department of Neurosciences, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - M Nolan
- Department of Paediatric Neurology, Starship Children's Health, Auckland, New Zealand
| | - M Field
- Genetics of Learning Disability (GOLD) Service, Hunter Genetics, Newcastle, New South Wales, Australia
| | - M R Davis
- Department of Diagnostic Genomics, Path West Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia
| | - M Fahey
- Department of Paediatrics, Monash University, Victoria, Australia
| | - I E Scheffer
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, 3084, Australia; The Florey Institute of Neuroscience and Mental Health and Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - J L Freeman
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - N I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, VU University, Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, the Netherlands
| | - R J Taft
- Illumina Inc, San Diego, CA, USA
| | - M S van der Knaap
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, VU University, Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, the Netherlands
| | - C Simons
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - R J Leventer
- Murdoch Children's Research Institute, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
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2
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Alves CAPF, Sherbini O, D'Arco F, Steel D, Kurian MA, Radio FC, Ferrero GB, Carli D, Tartaglia M, Balci TB, Powell-Hamilton NN, Schrier Vergano SA, Reutter H, Hoefele J, Günthner R, Roeder ER, Littlejohn RO, Lessel D, Lüttgen S, Kentros C, Anyane-Yeboa K, Catarino CB, Mercimek-Andrews S, Denecke J, Lyons MJ, Klopstock T, Bhoj EJ, Bryant L, Vanderver A. Brain Abnormalities in Patients with Germline Variants in H3F3: Novel Imaging Findings and Neurologic Symptoms Beyond Somatic Variants and Brain Tumors. AJNR Am J Neuroradiol 2022; 43:1048-1053. [PMID: 35772801 DOI: 10.3174/ajnr.a7555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pathogenic somatic variants affecting the genes Histone 3 Family 3A and 3B (H3F3) are extensively linked to the process of oncogenesis, in particular related to central nervous system tumors in children. Recently, H3F3 germline missense variants were described as the cause of a novel pediatric neurodevelopmental disorder. We aimed to investigate patterns of brain MR imaging of individuals carrying H3F3 germline variants. MATERIALS AND METHODS In this retrospective study, we included individuals with proved H3F3 causative genetic variants and available brain MR imaging scans. Clinical and demographic data were retrieved from available medical records. Molecular genetic testing results were classified using the American College of Medical Genetics criteria for variant curation. Brain MR imaging abnormalities were analyzed according to their location, signal intensity, and associated clinical symptoms. Numeric variables were described according to their distribution, with median and interquartile range. RESULTS Eighteen individuals (10 males, 56%) with H3F3 germline variants were included. Thirteen of 18 individuals (72%) presented with a small posterior fossa. Six individuals (33%) presented with reduced size and an internal rotational appearance of the heads of the caudate nuclei along with an enlarged and squared appearance of the frontal horns of the lateral ventricles. Five individuals (28%) presented with dysgenesis of the splenium of the corpus callosum. Cortical developmental abnormalities were noted in 8 individuals (44%), with dysgyria and hypoplastic temporal poles being the most frequent presentation. CONCLUSIONS Imaging phenotypes in germline H3F3-affected individuals are related to brain features, including a small posterior fossa as well as dysgenesis of the corpus callosum, cortical developmental abnormalities, and deformity of lateral ventricles.
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Affiliation(s)
| | - O Sherbini
- Department of Neurology (O.S., A.V.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - D Steel
- Neurology (D.S., M.A.K.), Great Ormond Street Hospital for Children, London, UK.,Molecular Neurosciences (D.S., M.A.K.), Zayed Centre for Research into Rare Diseases in Children, UCL GOS-Institute of Child Health, London, UK
| | - M A Kurian
- Neurology (D.S., M.A.K.), Great Ormond Street Hospital for Children, London, UK.,Molecular Neurosciences (D.S., M.A.K.), Zayed Centre for Research into Rare Diseases in Children, UCL GOS-Institute of Child Health, London, UK
| | - F C Radio
- Genetics and Rare Diseases Research Division (F.C.R., M.T.), Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - G B Ferrero
- Department of Public Health and Pediatrics (G.B.F., D.C.), University of Torino, Turin, Italy
| | - D Carli
- Department of Public Health and Pediatrics (G.B.F., D.C.), University of Torino, Turin, Italy
| | - M Tartaglia
- Genetics and Rare Diseases Research Division (F.C.R., M.T.), Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - T B Balci
- Medical Genetics Programof Southwestern Ontario (T.B.B.), London Health Sciences Centre, London, Ontario, Canada.,Department of Paediatrics (T.B.B.), Western University, London, Ontario, Canada
| | - N N Powell-Hamilton
- Division of Medical Genetics (N.N.P.-H.), Nemours Children's Hospital, Wilmington, Delaware
| | - S A Schrier Vergano
- Division of Medical Genetics and Metabolism (S.A.S.V.), Children's Hospital of The King's Daughters, Norfolk, Virginia.,Department of Pediatrics (S.A.S.V.), Eastern Virginia Medical School, Norfolk, Virginia
| | - H Reutter
- Division of Neonatology and Pediatric Intensive Care (H.R.), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Nürnberg-Erlangen, Erlangen, Germany
| | - J Hoefele
- Institute of Human Genetics (J.H., R.G.)
| | - R Günthner
- Institute of Human Genetics (J.H., R.G.).,Department of Nephrology (R.G.), Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - E R Roeder
- Department of Pediatrics and Molecular and Human Genetics (E.R.R., R.O.L.), Baylor College of Medicine, San Antonio, Texas
| | - R O Littlejohn
- Department of Pediatrics and Molecular and Human Genetics (E.R.R., R.O.L.), Baylor College of Medicine, San Antonio, Texas
| | - D Lessel
- Institute of Human Genetics (D.L., S.L.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Lüttgen
- Institute of Human Genetics (D.L., S.L.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Kentros
- Division of Clinical Genetics (C.K., K.A.-Y.), Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - K Anyane-Yeboa
- Division of Clinical Genetics (C.K., K.A.-Y.), Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - C B Catarino
- Friedrich-Baur-Institute (C.B.C., T.K.), Department of Neurology, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | - S Mercimek-Andrews
- Department of Medical Genetics (S.M.-A.), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Genetics (S.M.-A.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Denecke
- Department of Pediatrics (J.D.), University Medical Center Eppendorf, Hamburg, Germany
| | - M J Lyons
- Greenwood Genetic Center (M.J.L.), Greenwood, South Carolina
| | - T Klopstock
- Friedrich-Baur-Institute (C.B.C., T.K.), Department of Neurology, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (T.K.), Munich, Germany.,Munich Cluster for Systems Neurology (T.K.), Munich, Germany
| | - E J Bhoj
- Department of Radiology, Division of Human Genetics (E.J.B., L.B.)
| | - L Bryant
- Department of Radiology, Division of Human Genetics (E.J.B., L.B.)
| | - A Vanderver
- Department of Pediatrics, and Division of Neurology (A.V.), Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Neurology (O.S., A.V.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Roosendaal SD, van de Brug T, Alves CAPF, Blaser S, Vanderver A, Wolf NI, van der Knaap MS. Imaging Patterns Characterizing Mitochondrial Leukodystrophies. AJNR Am J Neuroradiol 2021; 42:1334-1340. [PMID: 34255734 DOI: 10.3174/ajnr.a7097] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Achieving a specific diagnosis in leukodystrophies is often difficult due to clinical and genetic heterogeneity. Mitochondrial defects cause 5%-10% of leukodystrophies. Our objective was to define MR imaging features commonly shared by mitochondrial leukodystrophies and to distinguish MR imaging patterns related to specific genetic defects. MATERIALS AND METHODS One hundred thirty-two patients with a mitochondrial leukodystrophy with known genetic defects were identified in the data base of the Amsterdam Leukodystrophy Center. Numerous anatomic structures were systematically assessed on brain MR imaging. Additionally, lesion characteristics were scored. Statistical group analysis was performed for 57 MR imaging features by hierarchic testing on clustered genetic subgroups. RESULTS MR imaging features indicative of mitochondrial disease that were frequently found included white matter rarefaction (n = 50 patients), well-delineated cysts (n = 20 patients), T2 hyperintensity of the middle blade of the corpus callosum (n = 85 patients), and symmetric abnormalities in deep gray matter structures (n = 42 patients). Several disorders or clusters of disorders had characteristic features. The combination of T2 hyperintensity in the brain stem, middle cerebellar peduncles, and thalami was associated with complex 2 deficiency. Predominantly periventricular localization of T2 hyperintensities and cystic lesions with a distinct border was associated with defects in complexes 3 and 4. T2-hyperintense signal of the cerebellar cortex was specifically associated with variants in the gene NUBPL. T2 hyperintensities predominantly affecting the directly subcortical cerebral white matter, globus pallidus, and substantia nigra were associated with Kearns-Sayre syndrome. CONCLUSIONS In a large group of patients with a mitochondrial leukodystrophy, general MR imaging features suggestive of mitochondrial disease were found. Additionally, we identified several MR imaging patterns correlating with specific genotypes. Recognition of these patterns facilitates the diagnosis in future patients.
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Affiliation(s)
| | - T van de Brug
- Epidemiology and Biostatistics (T.v.d.B.), Amsterdam UMC, Amsterdam, the Netherlands
| | | | - S Blaser
- Division of Neuroradiology (S.B.), Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - A Vanderver
- Department of Radiology and Division of Neurology (A.V.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N I Wolf
- Department of Pediatric Neurology (M.S.v.d.K, N.I.W.), Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - M S van der Knaap
- Department of Pediatric Neurology (M.S.v.d.K, N.I.W.), Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Functional Genomics (M.S.v.d.K.), Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, the Netherlands
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4
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Stutterd CA, Lake NJ, Peters H, Lockhart PJ, Taft RJ, van der Knaap MS, Vanderver A, Thorburn DR, Simons C, Leventer RJ. Severe Leukoencephalopathy with Clinical Recovery Caused by Recessive BOLA3 Mutations. JIMD Rep 2018; 43:63-70. [PMID: 29654549 DOI: 10.1007/8904_2018_100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 03/10/2023] Open
Abstract
AIM To identify the genetic aetiology of a distinct leukoencephalopathy causing acute neurological regression in infancy with apparently complete clinical recovery. METHODS We performed trio whole genome sequencing (WGS) to determine the genetic basis of the disorder. Mitochondrial function analysis in cultured patient fibroblasts was undertaken to confirm the pathogenicity of candidate variants. RESULTS The patient presented at 18 months with acute hemiplegia and cognitive regression without obvious trigger. This was followed by clinical recovery over 4 years. MRI at disease onset revealed bilateral T2 hyperintensity involving the periventricular and deep white matter and MR spectroscopy of frontal white matter demonstrated a lactate doublet. Lactate levels and mitochondrial respiratory chain enzyme activity in muscle, liver and fibroblasts were normal. Plasma glycine was elevated. The MRI abnormalities improved. WGS identified compound heterozygous variants in BOLA3: one previously reported (c.136C>T, p.Arg46*) and one novel variant (c.176G>A, p.Cys59Tyr). Analysis of cultured patient fibroblasts demonstrated deficient pyruvate dehydrogenase (PDH) activity and reduced quantity of protein subunits of mitochondrial complexes I and II, consistent with BOLA3 dysfunction. Previously reported cases of multiple mitochondrial dysfunctions syndrome 2 (MMDS2) with hyperglycinaemia caused by BOLA3 mutations have leukodystrophy with severe, progressive neurological and multisystem disease. CONCLUSIONS We report a novel phenotype for MMDS2 associated with apparently complete clinical recovery and partial resolution of MRI abnormalities. We have identified a novel disease-causing variant in BOLA3 validated by functional cellular studies. Our patient's clinical course broadens the phenotypic spectrum of MMDS2 and highlights the potential for some genetic leukoencephalopathies to spontaneously improve.
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Affiliation(s)
- C A Stutterd
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia.
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - N J Lake
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - H Peters
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Department of Metabolic Medicine, Royal Children's Hospital, Parkville, VIC, Australia
- Metabolic Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - P J Lockhart
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - R J Taft
- Illumina Inc, San Diego, CA, USA
| | - M S van der Knaap
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - A Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D R Thorburn
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - C Simons
- Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
- Translational Bioinformatics Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - R J Leventer
- Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Neuroscience Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
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5
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Perrier S, Gauquelin L, Tétreault M, Tran L, Webb N, Srour M, Mitchell J, Brunel-Guitton C, Majewski J, Long V, Keller S, Gambello M, Simons C, Vanderver A, Bernard G. Recessive mutations in NDUFA2
cause mitochondrial leukoencephalopathy. Clin Genet 2017; 93:396-400. [DOI: 10.1111/cge.13126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/07/2017] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. Perrier
- Department of Neurology and Neurosurgery; McGill University; Montreal Canada
| | - L. Gauquelin
- Department of Neurology and Neurosurgery; McGill University; Montreal Canada
- Department of Pediatrics; McGill University; Montreal Canada
| | - M. Tétreault
- Department of Human Genetics; McGill University; Montreal Canada
- McGill University and Genome Quebec Innovation Centre; Montreal Canada
| | - L.T. Tran
- Department of Neurology and Neurosurgery; McGill University; Montreal Canada
- Department of Pediatrics; McGill University; Montreal Canada
- Department of Medical Genetics, Montreal Children's Hospital; McGill University Health Center; Montreal Canada
- Child Health and Human Development Program; Research Institute of the McGill University Health Centre; Montreal Canada
| | - N. Webb
- Department of Human Genetics; McGill University; Montreal Canada
- Division of Medical Genetics, Department of Pediatrics; CHU Sainte-Justine and Université de Montréal; Montreal Canada
- Montreal Neurological Institute; McGill University; Montreal Canada
| | - M. Srour
- Department of Neurology and Neurosurgery; McGill University; Montreal Canada
- Department of Pediatrics; McGill University; Montreal Canada
- Child Health and Human Development Program; Research Institute of the McGill University Health Centre; Montreal Canada
| | - J.J. Mitchell
- Department of Pediatrics; McGill University; Montreal Canada
- Department of Medical Genetics, Montreal Children's Hospital; McGill University Health Center; Montreal Canada
| | - C. Brunel-Guitton
- Division of Medical Genetics, Department of Pediatrics; CHU Sainte-Justine and Université de Montréal; Montreal Canada
| | - J. Majewski
- Department of Human Genetics; McGill University; Montreal Canada
- McGill University and Genome Quebec Innovation Centre; Montreal Canada
| | - V. Long
- Department of Human Genetics, Division of Medical Genetics; Emory University School of Medicine; Atlanta Georgia
| | - S. Keller
- Department of Pediatrics, Division of Pediatric Neurology; Emory University School of Medicine; Atlanta Georgia
| | - M.J. Gambello
- Department of Human Genetics, Division of Medical Genetics; Emory University School of Medicine; Atlanta Georgia
| | - C. Simons
- Institute for Molecular Bioscience; The University of Queensland; St. Lucia Australia
| | - A. Vanderver
- Department of Neurology, Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
- Division of Neurology; Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - G. Bernard
- Department of Neurology and Neurosurgery; McGill University; Montreal Canada
- Department of Pediatrics; McGill University; Montreal Canada
- Department of Medical Genetics, Montreal Children's Hospital; McGill University Health Center; Montreal Canada
- Child Health and Human Development Program; Research Institute of the McGill University Health Centre; Montreal Canada
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Abstract
Aicardi-Goutières syndrome (AGS) is a genetically determined disorder, affecting most particularly the brain and the skin, characterized by the inappropriate induction of a type I interferon-mediated immune response. In most, but not all, cases the condition is severe, with a high associated morbidity and mortality. A number of important recent advances have helped to elucidate the biology of the AGS-related proteins, thus providing considerable insight into disease pathology. In this study, we outline the clinical phenotype of AGS, paying particular attention to factors relevant to therapeutic intervention. We then discuss the pathogenesis of AGS from a molecular and cell biology perspective. Finally, we suggest possible treatment strategies in light of these emerging insights.
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Affiliation(s)
- Y J Crow
- Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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7
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Abstract
Aicardi-Goutières syndrome (AGS) is a genetically determined disorder, affecting most particularly the brain and the skin, characterized by the inappropriate induction of a type I interferon-mediated immune response. In most, but not all, cases the condition is severe, with a high associated morbidity and mortality. A number of important recent advances have helped to elucidate the biology of the AGS-related proteins, thus providing considerable insight into disease pathology. In this study, we outline the clinical phenotype of AGS, paying particular attention to factors relevant to therapeutic intervention. We then discuss the pathogenesis of AGS from a molecular and cell biology perspective. Finally, we suggest possible treatment strategies in light of these emerging insights.
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Affiliation(s)
- Y J Crow
- Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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8
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Osterman B, Orcesi S, Sylvain M, Sebire G, Melancon S, Chouinard S, Vanderver A, Bernard G. Pol III-Related Leukodystrophies: Dystonia as a New Clinical Feature (IN10-1.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in10-1.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Tonduti D, Vanderver A, Olivieri I, Lowenstein J, Fazzi E, La Piana R, Orcesi S. Neopterin and Tetrahydrobiopterin Cerebrospinal Fluid Elevations in Aicardi Goutieres Syndrome: Confirmation of Findings in Mutation Confirmed Subjects (P05.134). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Tetreault M, Choquet K, Orcesi S, Tonduti D, Ballotin U, Teichmann M, Fribourg S, Schiffmann R, Brais B, Vanderver A, Bernard G. Recessive Mutations in POLR3B Encoding the Second Largest Subunit of Pol III Cause a Rare Hypomyelinating Leukodystrophy (P05.136). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vanderver A, Tonduti D, Lebon P, Blau N, Loewenstein J, Gahl W, Toro C, Hyland K. Neurotransmitter Abnormalities and Response to L-Dopa in SPG11 (P05.133). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Osterman B, Orcesi S, Sylvain M, Sebire G, Melancon S, Chouinard S, Vanderver A, Bernard G. Pol III-Related Leukodystrophies: Dystonia as a New Clinical Feature (P05.137). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sekul E, Strickland S, Flannery D, Figueroa R, Vanderver A. Episodic Leukoencephalopathy Due to Novel Mitochondrial Complex I NDUFV1 Gene Mutations (P02.172). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Prust M, Wang J, Morizono H, Messing A, Brenner M, Gordon E, Hartka T, Sokohl A, Schiffmann R, Gordish-Dressman H, Albin R, Amartino H, Brockman K, Dinopoulos A, Dotti MT, Fain D, Fernandez R, Ferreira J, Fleming J, Gill D, Griebel M, Heilstedt H, Kaplan P, Lewis D, Nakagawa M, Pedersen R, Reddy A, Sawaishi Y, Schneider M, Sherr E, Takiyama Y, Wakabayashi K, Gorospe JR, Vanderver A. GFAP mutations, age at onset, and clinical subtypes in Alexander disease. Neurology 2011; 77:1287-94. [PMID: 21917775 PMCID: PMC3179649 DOI: 10.1212/wnl.0b013e3182309f72] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 06/14/2011] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize Alexander disease (AxD) phenotypes and determine correlations with age at onset (AAO) and genetic mutation. AxD is an astrogliopathy usually characterized on MRI by leukodystrophy and caused by glial fibrillary acidic protein (GFAP) mutations. METHODS We present 30 new cases of AxD and reviewed 185 previously reported cases. We conducted Wilcoxon rank sum tests to identify variables scaling with AAO, survival analysis to identify predictors of mortality, and χ(2) tests to assess the effects of common GFAP mutations. Finally, we performed latent class analysis (LCA) to statistically define AxD subtypes. RESULTS LCA identified 2 classes of AxD. Type I is characterized by early onset, seizures, macrocephaly, motor delay, encephalopathy, failure to thrive, paroxysmal deterioration, and typical MRI features. Type II is characterized by later onset, autonomic dysfunction, ocular movement abnormalities, bulbar symptoms, and atypical MRI features. Survival analysis predicted a nearly 2-fold increase in mortality among patients with type I AxD relative to those with type II. R79 and R239 GFAP mutations were most common (16.6% and 20.3% of all cases, respectively). These common mutations predicted distinct clinical outcomes, with R239 predicting the most aggressive course. CONCLUSIONS AAO and the GFAP mutation site are important clinical predictors in AxD, with clear correlations to defined patterns of phenotypic expression. We propose revised AxD subtypes, type I and type II, based on analysis of statistically defined patient groups.
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Affiliation(s)
- M Prust
- Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA
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Mochel F, Engelke UFH, Barritault J, Yang B, McNeill NH, Thompson JN, Vanderver A, Wolf NI, Willemsen MA, Verheijen FW, Seguin F, Wevers RA, Schiffmann R. Elevated CSF N-acetylaspartylglutamate in patients with free sialic acid storage diseases. Neurology 2010; 74:302-5. [PMID: 20101035 DOI: 10.1212/wnl.0b013e3181cbcdc4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate body fluids of patients with undiagnosed leukodystrophies using in vitro (1)H-NMR spectroscopy (H-NMRS). METHODS We conducted a cross-sectional study using high-resolution in vitro H-NMRS on CSF and urine samples. RESULTS We found a significant increase of free sialic acid in CSF or urine in 6 of 41 patients presenting with hypomyelination of unknown etiology. Molecular genetic testing revealed pathogenic mutations in the SLC17A5 gene in all 6 patients. H-NMRS revealed an increase of N-acetylaspartylglutamate in the CSF of all patients with SLC17A5 mutation (range 13-114 micromol/L, reference <12 micromol/L). CONCLUSION In patients with undiagnosed leukodystrophies, increased free sialic acid in CSF or urine is a marker for free sialic acid storage disorder and facilitates the identification of the underlying genetic defect. Because increase of N-acetylaspartylglutamate in CSF has been observed in other hypomyelinating disorders, it can be viewed as a marker of a subgroup of hypomyelinating disorders.
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Affiliation(s)
- F Mochel
- INSERM UMR S975, Hôpital de La Salpêtrière, Paris, France.
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Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, Brown K, Berl MM, Stephens S, Zeitchick A, Gaillard WD. New-onset afebrile seizures in infants: role of neuroimaging. Neurology 2010; 74:150-6. [PMID: 20065250 DOI: 10.1212/wnl.0b013e3181c91847] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1-24 months) and the yield of neuroimaging. METHODS Prospective data were obtained from a standardized evaluation and management plan mandated by a critical care pathway. A total of 317 infants presented with new-onset afebrile seizures between 2001 and 2007. EEG was performed on 90.3%, head CT was obtained on 94%, and MRI was obtained on 57.4%. RESULTS We found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI-only 1 resulted in altered medical management. CONCLUSIONS Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
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Affiliation(s)
- D T Hsieh
- Center for Neuroscience, Children's National Medical Center, Washington, DC 20010, USA
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Mochel F, Sedel F, Vanderver A, Engelke UFH, Barritault J, Yang BZ, Kulkarni B, Adams DR, Clot F, Ding JH, Kaneski CR, Verheijen FW, Smits BW, Seguin F, Brice A, Vanier MT, Huizing M, Schiffmann R, Durr A, Wevers RA. Cerebellar ataxia with elevated cerebrospinal free sialic acid (CAFSA). ACTA ACUST UNITED AC 2009; 132:801-9. [PMID: 19153153 DOI: 10.1093/brain/awn355] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In order to identify new metabolic abnormalities in patients with complex neurodegenerative disorders of unknown aetiology, we performed high resolution in vitro proton nuclear magnetic resonance spectroscopy on patient cerebrospinal fluid (CSF) samples. We identified five adult patients, including two sisters, with significantly elevated free sialic acid in the CSF compared to both the cohort of patients with diseases of unknown aetiology (n = 144; P < 0.001) and a control group of patients with well-defined diseases (n = 91; P < 0.001). All five patients displayed cerebellar ataxia, with peripheral neuropathy and cognitive decline or noteworthy behavioural changes. Cerebral MRI showed mild to moderate cerebellar atrophy (5/5) as well as white matter abnormalities in the cerebellum including the peridentate region (4/5), and at the periventricular level (3/5). Two-dimensional gel analyses revealed significant hyposialylation of transferrin in CSF of all patients compared to age-matched controls (P < 0.001)--a finding not present in the CSF of patients with Salla disease, the most common free sialic acid storage disorder. Free sialic acid content was normal in patients' urine and cultured fibroblasts as were plasma glycosylation patterns of transferrin. Analysis of the ganglioside profile in peripheral nerve biopsies of two out of five patients was also normal. Sequencing of four candidate genes in the free sialic acid biosynthetic pathway did not reveal any mutation. We therefore identified a new free sialic acid syndrome in which cerebellar ataxia is the leading symptom. The term CAFSA is suggested (cerebellar ataxia with free sialic acid).
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Affiliation(s)
- F Mochel
- INSERM UMR S679, Hôpital de la Salpêtrière, 47 Bld de l'Hôpital, Bâtiment Nouvelle Pharmacie-4ème étage, 75013 Paris, France.
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Vanderver A, Hathout Y, Maletkovic J, Gordon ES, Mintz M, Timmons M, Hoffman EP, Horzinski L, Niel F, Fogli A, Boespflug-Tanguy O, Schiffmann R. Sensitivity and specificity of decreased CSF asialotransferrin for eIF2B-related disorder. Neurology 2008; 70:2226-32. [PMID: 18519871 DOI: 10.1212/01.wnl.0000313857.54398.0e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This is a study estimating diagnostic accuracy of CSF asialotransferrin to transferrin ratio measurement in eIF2B related disorders by using clinical evaluation and EIF2B mutation analysis as the reference standard. eIF2B-related disorder is a relatively common leukodystrophy with broad phenotypic variation that is caused by mutations in any of the five EIF2B genes. There is a need for a simple and clinically valid screening tool for physicians evaluating patients with an unclassified leukodystrophy. METHODS CSF two-dimensional gel (2DG) electrophoresis analyses to measure asialotransferrin to transferrin ratios were performed in 60 subjects including 6 patients with documented EIF2B gene mutations, patients with other types of leukodystrophy, and patients with no leukodystrophy. RESULTS All six patients with mutation proven eIF2B-related disease showed low to nearly undetectable amounts of asialotransferrin in their CSF when compared to 54 unaffected controls by CSF 2DG analyses in this study. eIF2B-like patients, with clinically similar presentations but no mutations in EIF2B1-5, were distinguished from patients with mutations in EIF2B1-5 by this biomarker. Patients with mutations in EIF2B1-5 had asialotransferrin/transferrin ratio levels significantly different from the group as a whole (p < 0.001). Using 8% asialotransferrin/transferrin ratio as a cutoff, this biomarker has a 100% sensitivity (95% CI = 52-100%) and 94% specificity (95% CI = 84-99%). CONCLUSION Decreased asialotransferrin/transferrin ratio in the CSF of patients with eIF2B-related disorder is highly sensitive and specific. This rapid (<48 hours) and inexpensive diagnostic tool for eIF2B-related disorders has the potential to identify patients with likely eIF2B-related disorder for mutation analysis.
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Affiliation(s)
- A Vanderver
- Children's National Medical Center, Children's Research Institute, Center for Genetic Medicine, Washington, DC 20010, USA.
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