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Yunisova G, Ceylaner S, Oflazer P, Deymeer F, Parman YG, Durmus H. Clinical and genetic characteristics of Emery-Dreifuss muscular dystrophy patients from Turkey: 30 years longitudinal follow-up study. Neuromuscul Disord 2022; 32:718-727. [DOI: 10.1016/j.nmd.2022.07.397] [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] [Received: 11/15/2021] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
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Gungor Tuncer O, Deymeer F. Clinical course and outcome of an outpatient clinic population with myasthenia gravis and COVID-19. Muscle Nerve 2022; 65:447-452. [PMID: 35040147 PMCID: PMC9015549 DOI: 10.1002/mus.27497] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 11/21/2022]
Abstract
Introduction/Aims Coronavirus disease‐2019 (COVID‐19) may have a more severe course in patients with myasthenia gravis (MG). We aimed to assess severity of the infection and factors contributing to its severity in a group of MG patients, most of whom were not hospitalized. Methods One hundred forty outpatients with MG followed between March 2020 and April 2021 were included in our study. Patients were asked to respond to a brief questionnaire in person, by telemedicine, or through electronic messages. Results Nineteen patients tested positive for COVID‐19 by polymerase chain reaction. Two were asymptomatic. Of the 17 symptomatic patients, 11 had mild symptoms. They either had no treatment or received antivirals, antibiotics, and anticoagulants. Their myasthenia was well‐controlled before infection and was unaffected by COVID‐19. Three patients with moderate COVID‐19 required hospitalization, but not intensive care, and had full recovery. Three other patients, the oldest in the cohort, had severe disease: One patient with a postsurgery myasthenic exacerbation before the infection needed intensive care without intubation, but recovered completely; two morbidly obese patients with comorbidities required intubation and died. Corticosteroids were increased in four of the six moderate/severely affected patients. Immunosuppressive (IS) agents were generally continued. Hydroxychloroquine (HCQ) for COVID‐19 was used in one patient. Discussion Most patients had mild COVID‐19 and all but two patients recovered. The design of the study made it possible to capture mild cases. Having well‐controlled MG before infection and absence of comorbidities likely affected the course of the infection favorably. IS did not influence the progression.
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Affiliation(s)
| | - Feza Deymeer
- Department of Neurology, Memorial Sisli Hospital, Istanbul, Turkey
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3
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Vural A, Şimşir G, Tekgül Ş, Koçoğlu C, Akçimen F, Kartal E, Şen NE, Lahut S, Ömür Ö, Saner N, Gül T, Bayraktar E, Palvadeau R, Tunca C, Pirkevi Çetinkaya C, Gündoğdu Eken A, Şahbaz I, Kovancılar Koç M, Öztop Çakmak Ö, Hanağası H, Bilgiç B, Eraksoy M, Gündüz A, Apaydın H, Kızıltan G, Özekmekçi S, Siva A, Altıntaş A, Kaya Güleç ZE, Parman Y, Oflazer P, Deymeer F, Durmuş H, Şahin E, Çakar A, Tüfekçioğlu Z, Tektürk P, Çorbalı MO, Tireli H, Akdal G, Yiş U, Hız S, Şengün İ, Bora E, Serdaroğlu G, Erer Özbek S, Ağan K, İnce Günal D, Us Ö, Kurt SG, Aksoy D, Bora Tokçaer A, Elmas M, Gültekin M, Kumandaş S, Acer H, Kaya Özçora GD, Yayla V, Soysal A, Genç G, Güllüoğlu H, Kotan D, Özözen Ayas Z, Şahin HA, Tan E, Topçu M, Topçuoğlu ES, Akbostancı C, Koç F, Ertan S, Elibol B, Başak AN. The Complex Genetic Landscape of Hereditary Ataxias in Turkey and Implications in Clinical Practice. Mov Disord 2021; 36:1676-1688. [PMID: 33624863 DOI: 10.1002/mds.28518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/13/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The genetic and epidemiological features of hereditary ataxias have been reported in several populations; however, Turkey is still unexplored. Due to high consanguinity, recessive ataxias are more common in Turkey than in Western European populations. OBJECTIVE To identify the prevalence and genetic structure of hereditary ataxias in the Turkish population. METHODS Our cohort consisted of 1296 index cases and 324 affected family members. Polymerase chain reaction followed by Sanger sequencing or fragment analysis were performed to screen for the trinucleotide repeat expansions in families with a dominant inheritance pattern, as well as in sporadic cases. The expansion in the frataxin (FXN) gene was tested in all autosomal recessive cases and in sporadic cases with a compatible phenotype. Whole-exome sequencing was applied to 251 probands, selected based on the family history, age of onset, and phenotype. RESULTS Mutations in known ataxia genes were identified in 30% of 1296 probands. Friedreich's ataxia was found to be the most common recessive ataxia in Turkey, followed by autosomal recessive spastic ataxia of Charlevoix-Saguenay. Spinocerebellar ataxia types 2 and 1 were the most common dominant ataxias. Whole-exome sequencing was performed in 251 probands with an approximate diagnostic yield of 50%. Forty-eight novel variants were found in a plethora of genes, suggesting a high heterogeneity. Variants of unknown significance were discussed in light of clinical data. CONCLUSION With the large sample size recruited across the country, we consider that our results provide an accurate picture of the frequency of hereditary ataxias in Turkey. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Atay Vural
- Department of Neurology, School of Medicine, Koç University, İstanbul, Turkey
| | - Gülşah Şimşir
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey
| | - Şeyma Tekgül
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey
| | - Cemile Koçoğlu
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Fulya Akçimen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Ece Kartal
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Nesli E Şen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Suna Lahut
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Özgür Ömür
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Nazan Saner
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Tuğçe Gül
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey
| | - Elif Bayraktar
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey
| | - Robin Palvadeau
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey
| | - Ceren Tunca
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Caroline Pirkevi Çetinkaya
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Aslı Gündoğdu Eken
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Irmak Şahbaz
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Müge Kovancılar Koç
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
| | - Özgür Öztop Çakmak
- Department of Neurology, School of Medicine, Koç University, İstanbul, Turkey
| | - Haşmet Hanağası
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hülya Apaydın
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Güneş Kızıltan
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Sibel Özekmekçi
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Altıntaş
- Department of Neurology, School of Medicine, Koç University, İstanbul, Turkey.,Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Zeynep E Kaya Güleç
- Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Yeşim Parman
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Piraye Oflazer
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Hacer Durmuş
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Arman Çakar
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Zeynep Tüfekçioğlu
- Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Pınar Tektürk
- Department of Pediatric Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - M Osman Çorbalı
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Hülya Tireli
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Gülden Akdal
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Uluç Yiş
- Division of Child Neurology, Department of Pediatrics, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Semra Hız
- Division of Child Neurology, Department of Pediatrics, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - İhsan Şengün
- Division of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Elçin Bora
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gül Serdaroğlu
- Division of Child Neurology, Department of Pediatrics, Ege University Medical School, İzmir, Turkey
| | - Sevda Erer Özbek
- Department of Neurology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Kadriye Ağan
- Department of Neurology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Dilek İnce Günal
- Department of Neurology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Önder Us
- Department of Neurology, Acıbadem Kozyatağı Hospital, İstanbul, Turkey
| | - Semiha G Kurt
- Department of Neurology, School of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Dürdane Aksoy
- Department of Neurology, School of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ayşe Bora Tokçaer
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Muhsin Elmas
- Department of Medical Genetics, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Murat Gültekin
- Department of Neurology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sefer Kumandaş
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hamit Acer
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gül D Kaya Özçora
- Department of Pediatric Neurology, Kayseri Training and Research City Hospital, Kayseri, Turkey
| | - Vildan Yayla
- Department of Neurology, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırköy Training and Research Hospital for Psychiatry, Neurology, Neurosurgery, İstanbul, Turkey
| | - Gençer Genç
- Department of Neurology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Halil Güllüoğlu
- Department of Neurology, Medical Park İzmir Hospital, İzmir, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | | | - Hüseyin A Şahin
- Department of Neurology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ersin Tan
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meral Topçu
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esen Saka Topçuoğlu
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cenk Akbostancı
- Department of Neurology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Filiz Koç
- Department of Neurology, Çukurova University, School of Medicine, Adana, Turkey
| | - Sibel Ertan
- Department of Neurology, School of Medicine, Koç University, İstanbul, Turkey.,Department of Neurology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Bülent Elibol
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - A Nazlı Başak
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, KUTTAM, School of Medicine, Koç University, İstanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory, Department of Molecular Biology and Genetics, Boğaziçi University, İstanbul, Turkey
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4
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Abstract
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction which affects all striated muscles, resulting in fluctuating weakness. Approaching MG as a disease with subgroups having different clinical, serological and genetic features is crucial in predicting the progression and planning treatment. Three relatively less frequently seen subtypes of MG are the subject of this review: MG with anti-MuSK antibodies (MuSK MG), non-thymomatous late-onset MG (LOMG), and ocular MG (OMG). In addition to reviewing the literature, mainly from a clinical point of view, our experience in each of the subgroups, based on close to 600 patients seen over a 10 year period, is related. MuSK MG is a severe disease with predominant bulbar involvement. It is more common in women and in early-onset patients. With the use of high dose corticosteroids, azathioprine and more recently rituximab, outcome is favorable, though the patients usually require higher maintenance doses of immunosuppressives. LOMG with onset ≥ 50 years of age is more common in men and ocular onset is common. Frequency of anti-AChR and anti-titin antibodies are high. Although it can be severe in some patients, response to treatment is usually very good. OMG is reported to be more frequent in men in whom the disease has a later onset. Anti-AChR antibodies are present in about half of the patients. Generalization is less likely when symptoms remain confined to ocular muscles for 2 years. Low dose corticosteroids are usually sufficient. Thyroid disease is the most common autoimmune disease accompanying all three subgroups.
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Affiliation(s)
- Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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5
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Yilmaz V, Tuzun E, Durmus H, Oflazer P, Aysal F, Parman Y, Gungor-Tuncer O, Deymeer F, Saruhan-Direskeneli G. The treatment effect on peripheral B cell markers in antibody positive myasthenia gravis patients. J Neuroimmunol 2020; 349:577402. [PMID: 32977248 DOI: 10.1016/j.jneuroim.2020.577402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/08/2020] [Revised: 09/01/2020] [Accepted: 09/19/2020] [Indexed: 12/13/2022]
Abstract
B cells play a major role in the pathophysiology of myasthenia gravis (MG) with their ability to produce disease specific, pathogenic antibodies. However, their status during disease development and follow-up stages of the disease in the peripheral blood may need further studies to determine useful markers. In this study, we aimed to detect B cell associated factors concerning immunosuppressive treatment in generalized non-thymomatous MG patients. Although CD19+ B cell distribution did not vary among disease subgroups, expressions of both CD38 and BAFFR were altered on B cells in MG patients under immunosuppressive therapy. Serum levels of BAFF were elevated in untreated MG patients as compared to treated MG patients and healthy controls. B cell activation factors may show profound alterations due to immunosuppression.
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Affiliation(s)
- V Yilmaz
- Department of Physiology, Istanbul University, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey..
| | - E Tuzun
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - H Durmus
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - P Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - F Aysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Y Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - O Gungor-Tuncer
- Department of Neurology, Sisli Florence Nightingale Hospital, Demiroglu Bilim University, Turkey
| | - F Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Turkey
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6
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Abstract
The first description of myasthenia gravis (MG) was given by Thomas Willis in 1672. MG was the focus of attention after mid-nineteenth century and a great amount of information has been accumulated in a span of 150 years. The aim of this review is to convey this information according to a particular systematic and to briefly relate the experience of Istanbul University. MG history was examined in four periods: 1868-1930, 1930-1960, 1960-1990, and 1990-2020. In the first period (1868-1930), all the clinical characteristics of MG were defined. Physiological/pharmacological studies on the transmission at the neuromuscular junction were initiated, and the concept of repetitive nerve stimulation emerged. A toxic agent was believed to be the cause of MG which appeared to resemble curare intoxication. Association of MG with thymus was noticed. No noteworthy progress was made in its treatment. In the second period (1930-1960), acetylcholine was discovered to be the transmitter at the neuromuscular junction. Repetitive nerve stimulation was used as a diagnostic test. The autoimmune nature of MG was suspected and experiments to this end started to give results. The hallmark of this period was the use of anticholinesterases and thymectomy in the treatment of MG. The third period (1960-1990) can probably be considered a revolutionary era for MG. Important immunological mechanisms (acetylcholine receptor isolation, discovery of anti-acetylcholine receptor antibodies) were clarified and the autoimmune nature of MG was demonstrated. Treatment modalities which completely changed the prognosis of MG, including positive pressure mechanic ventilation and corticosteroids as well as plasma exchange/IVIg and azathioprine, were put to use. In the fourth period (1990-2020), more immunological progress, including the discovery of anti-MuSK antibodies, was achieved. Videothoracoscopic thymectomy reduced the morbidity and mortality rate associated with surgery. New drugs emerged and clinical trials were performed. Valuable guidelines were published. In the last part of the review, the experience in MG of Istanbul University, a pioneer in Turkey, is related.
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Affiliation(s)
- Feza Deymeer
- İstanbul University Faculty of Medicine Retired Faculty Member, İstanbul, Turkey
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7
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Tunca C, Şeker T, Akçimen F, Coşkun C, Bayraktar E, Palvadeau R, Zor S, Koçoğlu C, Kartal E, Şen NE, Hamzeiy H, Özoğuz Erimiş A, Norman U, Karakahya O, Olgun G, Akgün T, Durmuş H, Şahin E, Çakar A, Başar Gürsoy E, Babacan Yıldız G, İşak B, Uluç K, Hanağası H, Bilgiç B, Turgut N, Aysal F, Ertaş M, Boz C, Kotan D, İdrisoğlu H, Soysal A, Uzun Adatepe N, Akalın MA, Koç F, Tan E, Oflazer P, Deymeer F, Taştan Ö, Çiçek AE, Kavak E, Parman Y, Başak AN. Cover, Volume 41, Issue 8. Hum Mutat 2020. [DOI: 10.1002/humu.24087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ceren Tunca
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM)Koç University School of MedicineIstanbul Turkey
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Tuncay Şeker
- Genomize Inc.Boğaziçi University Technology Development RegionIstanbul Turkey
| | - Fulya Akçimen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Cemre Coşkun
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Elif Bayraktar
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM)Koç University School of MedicineIstanbul Turkey
| | - Robin Palvadeau
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM)Koç University School of MedicineIstanbul Turkey
| | - Seyit Zor
- Genomize Inc.Boğaziçi University Technology Development RegionIstanbul Turkey
| | - Cemile Koçoğlu
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Ece Kartal
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Nesli Ece Şen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Hamid Hamzeiy
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Aslıhan Özoğuz Erimiş
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
| | - Utku Norman
- Department of Computer EngineeringBilkent UniversityAnkara Turkey
| | | | - Gülden Olgun
- Department of Computer EngineeringBilkent UniversityAnkara Turkey
| | - Tahsin Akgün
- Department of Anesthesiology and ReanimationAmerican HospitalIstanbul Turkey
| | - Hacer Durmuş
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Arman Çakar
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Esra Başar Gürsoy
- Department of Neurology, Faculty of MedicineBezmialem Vakıf UniversityIstanbul Turkey
| | - Gülsen Babacan Yıldız
- Department of Neurology, Faculty of MedicineBezmialem Vakıf UniversityIstanbul Turkey
| | - Barış İşak
- Department of NeurologyMarmara University School of MedicineIstanbul Turkey
| | - Kayıhan Uluç
- Department of NeurologyMarmara University School of MedicineIstanbul Turkey
| | - Haşmet Hanağası
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Başar Bilgiç
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Nilda Turgut
- Department of NeurologyNamık Kemal University School of MedicineTekirdağ Turkey
| | - Fikret Aysal
- Department of NeurologyMedipol University School of MedicineIstanbul Turkey
| | - Mustafa Ertaş
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Cavit Boz
- Department of NeurologyKaradeniz Technical University School of MedicineTrabzon Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of MedicineSakarya UniversitySakarya Turkey
| | - Halil İdrisoğlu
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Aysun Soysal
- Department of NeurologyBakırköy Research and Training Hospital for Neurologic and Psychiatric DiseasesIstanbul Turkey
| | - Nurten Uzun Adatepe
- Department of Neurology, Cerrahpaşa Medical SchoolIstanbul University‐CerrahpaşaIstanbul Turkey
| | - Mehmet Ali Akalın
- Department of Neurology, Cerrahpaşa Medical SchoolIstanbul University‐CerrahpaşaIstanbul Turkey
| | - Filiz Koç
- Department of NeurologyÇukurova University Medical SchoolAdana Turkey
| | - Ersin Tan
- Department of NeurologyHacettepe University Medical SchoolAnkara Turkey
| | - Piraye Oflazer
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - Öznur Taştan
- Department of Computer Science and EngineeringSabancı UniversityIstanbul Turkey
| | - A. Ercüment Çiçek
- Department of Computer EngineeringBilkent UniversityAnkara Turkey
- Department of Computational BiologyCarnegie Mellon UniversityPittsburgh Pennsylvania
| | - Erşen Kavak
- Genomize Inc.Boğaziçi University Technology Development RegionIstanbul Turkey
| | - Yeşim Parman
- Department of Neurology, Istanbul Medical SchoolIstanbul UniversityIstanbul Turkey
| | - A. Nazlı Başak
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM)Koç University School of MedicineIstanbul Turkey
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and GeneticsBoğaziçi UniversityIstanbul Turkey
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8
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Affiliation(s)
- Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University.
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9
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Tunca C, Şeker T, Akçimen F, Coşkun C, Bayraktar E, Palvadeau R, Zor S, Koçoğlu C, Kartal E, Şen NE, Hamzeiy H, Özoğuz Erimiş A, Norman U, Karakahya O, Olgun G, Akgün T, Durmuş H, Şahin E, Çakar A, Başar Gürsoy E, Babacan Yıldız G, İşak B, Uluç K, Hanağası H, Bilgiç B, Turgut N, Aysal F, Ertaş M, Boz C, Kotan D, İdrisoğlu H, Soysal A, Uzun Adatepe N, Akalın MA, Koç F, Tan E, Oflazer P, Deymeer F, Taştan Ö, Çiçek AE, Kavak E, Parman Y, Başak AN. Revisiting the complex architecture of ALS in Turkey: Expanding genotypes, shared phenotypes, molecular networks, and a public variant database. Hum Mutat 2020; 41:e7-e45. [PMID: 32579787 DOI: 10.1002/humu.24055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/12/2019] [Revised: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Abstract
The last decade has proven that amyotrophic lateral sclerosis (ALS) is clinically and genetically heterogeneous, and that the genetic component in sporadic cases might be stronger than expected. This study investigates 1,200 patients to revisit ALS in the ethnically heterogeneous yet inbred Turkish population. Familial ALS (fALS) accounts for 20% of our cases. The rates of consanguinity are 30% in fALS and 23% in sporadic ALS (sALS). Major ALS genes explained the disease cause in only 35% of fALS, as compared with ~70% in Europe and North America. Whole exome sequencing resulted in a discovery rate of 42% (53/127). Whole genome analyses in 623 sALS cases and 142 population controls, sequenced within Project MinE, revealed well-established fALS gene variants, solidifying the concept of incomplete penetrance in ALS. Genome-wide association studies (GWAS) with whole genome sequencing data did not indicate a new risk locus. Coupling GWAS with a coexpression network of disease-associated candidates, points to a significant enrichment for cell cycle- and division-related genes. Within this network, literature text-mining highlights DECR1, ATL1, HDAC2, GEMIN4, and HNRNPA3 as important genes. Finally, information on ALS-related gene variants in the Turkish cohort sequenced within Project MinE was compiled in the GeNDAL variant browser (www.gendal.org).
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Affiliation(s)
- Ceren Tunca
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Tuncay Şeker
- Genomize Inc., Boğaziçi University Technology Development Region, Istanbul, Turkey
| | - Fulya Akçimen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Cemre Coşkun
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Elif Bayraktar
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
| | - Robin Palvadeau
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
| | - Seyit Zor
- Genomize Inc., Boğaziçi University Technology Development Region, Istanbul, Turkey
| | - Cemile Koçoğlu
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Ece Kartal
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Nesli Ece Şen
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Hamid Hamzeiy
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Aslıhan Özoğuz Erimiş
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
| | - Utku Norman
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
| | - Oğuzhan Karakahya
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
| | - Gülden Olgun
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
| | - Tahsin Akgün
- Department of Anesthesiology and Reanimation, American Hospital, Istanbul, Turkey
| | - Hacer Durmuş
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Arman Çakar
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Esra Başar Gürsoy
- Department of Neurology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Gülsen Babacan Yıldız
- Department of Neurology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Barış İşak
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kayıhan Uluç
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haşmet Hanağası
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Nilda Turgut
- Department of Neurology, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Fikret Aysal
- Department of Neurology, Medipol University School of Medicine, Istanbul, Turkey
| | - Mustafa Ertaş
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Halil İdrisoğlu
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Nurten Uzun Adatepe
- Department of Neurology, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehmet Ali Akalın
- Department of Neurology, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Filiz Koç
- Department of Neurology, Çukurova University Medical School, Adana, Turkey
| | - Ersin Tan
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
| | - Piraye Oflazer
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Öznur Taştan
- Department of Computer Science and Engineering, Sabancı University, Istanbul, Turkey
| | - A Ercüment Çiçek
- Department of Computer Engineering, Bilkent University, Ankara, Turkey.,Department of Computational Biology, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Erşen Kavak
- Genomize Inc., Boğaziçi University Technology Development Region, Istanbul, Turkey
| | - Yeşim Parman
- Department of Neurology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - A Nazlı Başak
- Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey.,Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Department of Molecular Biology and Genetics, Boğaziçi University, Istanbul, Turkey
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10
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Yildiz Celik S, Durmus H, Yilmaz V, Saruhan Direskeneli G, Gulsen Parman Y, Serdaroglu Oflazer P, Deymeer F. Late-onset generalized myasthenia gravis: clinical features, treatment, and outcome. Acta Neurol Belg 2020; 120:133-140. [PMID: 31811563 DOI: 10.1007/s13760-019-01252-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023]
Abstract
Late-onset myasthenia gravis (LOMG) is a unique MG subgroup. More information is needed on its subgroups such as non-thymomatous generalized LOMG. We evaluated the effect of demographic, clinical, and serological factors as well as different immunosuppressive modalities on outcome in generalized non-thymomatous LOMG with onset ≥ 50 years. Myasthenia Gravis Foundation of America (MGFA) Clinical Classification, MGFA postintervention score (MGFA PIS) and MG Composite scores were obtained to define the severity of disease and clinical outcome. In 95 patients with generalized non-thymomatous LOMG, 60 (63%) were men, 45 (47%) had mild disease, 80 (84%) were anti-AChR, and 56 (61%) were anti-titin positive. In those who received immunosuppressives and provided the clinical scores (84 patients), 50 (60%) had favorable outcome (MGFA PIS categories of complete stable remission, pharmacological remission and minimal manifestations) at the end of 3 years. Use of prednisone + azathioprine had significantly positive effect on outcome. The presence of anti-titin antibodies had no significant effect on severity and outcome. Five anti-MuSK-positive patients had favorable outcome. In conclusion, the presence of neither anti-titin nor anti-MuSK antibodies points to unfavorable outcome. Prednisone and azathioprine combination has beneficial effects in non-thymomatous generalized LOMG.
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Affiliation(s)
- Senay Yildiz Celik
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Hacer Durmus
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vuslat Yilmaz
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Yesim Gulsen Parman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Feza Deymeer
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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11
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Toksoy G, Durmus H, Aghayev A, Bagirova G, Sevinc Rustemoglu B, Basaran S, Avci S, Karaman B, Parman Y, Altunoglu U, Yapici Z, Tekturk P, Deymeer F, Topaloglu H, Kayserili H, Oflazer-Serdaroglu P, Uyguner ZO. Mutation spectrum of 260 dystrophinopathy patients from Turkey and important highlights for genetic counseling. Neuromuscul Disord 2019; 29:601-613. [DOI: 10.1016/j.nmd.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
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12
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Çebi M, Durmuş H, Yılmaz V, Yentür SP, Aysal F, Oflazer P, Parman Y, Deymeer F, Saruhan-Direskeneli G. Relation of HLA-DRB1 to IgG4 autoantibody and cytokine production in muscle-specific tyrosine kinase myasthenia gravis (MuSK-MG). Clin Exp Immunol 2019; 197:214-221. [PMID: 30929252 DOI: 10.1111/cei.13302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
A small subset of myasthenia gravis (MG) patients develop autoantibodies against muscle-specific kinase (MuSK), which are predominantly of the immunoglobulin (Ig)G4 isotype. MuSK-MG is strongly associated with HLA-DRB1*14, HLA-DRB1*16 and HLA-DQB1*05. In this study, the possible effects of these HLA associations on MuSK IgG autoantibody or cytokine production were investigated. Samples from 80 MG patients with MuSK antibodies were studied. The disease-associated HLA types were screened in the DNA samples. The IgG1, IgG2, IgG3 and IgG4 titres of the MuSK antibodies and the levels of interleukin (IL)-4, IL-6, IL-17A and IL-10 were measured in the sera. Comparisons were made among the groups with or without HLA-DRB1*14, HLA-DRB1*16 or HLA-DQB1*05. The IgG4 titres of the MuSK antibodies were higher than those of the IgG1, IgG2 and IgG3 isotypes among the whole group of patients. DRB1*14 (+) DRB1*16 (-) patients had higher levels of IgG4 antibodies than those of DRB1*14 (-) DRB1*16 (+) patients. DRB1*14 (+) DRB1*16 (+) patients also had higher levels of IgG4 antibodies than those of DRB1*14 (-) DRB1*16 (+) and DRB1*14 (-) DRB1*16 (-) patients. Higher IL-10 and lower IL-17A levels were measured in DRB1*14 (+) DRB1*16 (-) patients than in DRB1*14 (-) DRB1*16 (-) patients. The higher IgG4 titres of MuSK autoantibodies in patients carrying HLA-DRB1*14 than those in the other patients suggest a role for HLA in the production of the antibodies. The differences in IL-10 and IL-17A support the role of DRB1 in the etiopathogenesis of this autoimmune response.
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Affiliation(s)
- M Çebi
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - H Durmuş
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - V Yılmaz
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S P Yentür
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Aysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.,Department of Neurology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - P Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Y Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - G Saruhan-Direskeneli
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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13
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Atmaca MM, Durmus Tekce H, Kocasoy Orhan E, Baslo MB, Deymeer F. Myasthenia gravis with clinical facilitation: a case series. NEUROL SCI NEUROPHYS 2018. [DOI: 10.5152/nsn.2018.11208] [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: 11/22/2022] Open
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14
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Sirin NG, Kocasoy Orhan E, Durmus H, Deymeer F, Baslo MB. Repetitive nerve stimulation and jitter measurement with disposable concentric needle electrode in newly diagnosed myasthenia gravis patients. Neurophysiol Clin 2018; 48:261-267. [DOI: 10.1016/j.neucli.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022] Open
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15
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Durmus H, Shen XM, Serdaroglu-Oflazer P, Kara B, Parman-Gulsen Y, Ozdemir C, Brengman J, Deymeer F, Engel AG. Corrigendum to "Congenital myasthenic syndromes in Turkey: Clinical clues and prognosis with long term follow-up" [Neuromuscular Disorders 28/4 (2018) 315-322]. Neuromuscul Disord 2018; 28:896. [PMID: 30290857 DOI: 10.1016/j.nmd.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hacer Durmus
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Xin-Ming Shen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Piraye Serdaroglu-Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Bulent Kara
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Yesim Parman-Gulsen
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Coskun Ozdemir
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Joan Brengman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Andrew G Engel
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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16
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Orhan EK, Kiraç LB, DİKmen PY, Matur Z, Ertaş M, Öge AE, Deymeer F, Yazici J, Baslo MB. Electromyography in Pediatric Population. Noro Psikiyatr Ars 2018; 55:36-39. [PMID: 30042639 DOI: 10.5152/npa.17023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022]
Abstract
Introduction Electrodiagnostic evaluation provides an important extension to the neurological examination for the evaluation of pediatric neuromuscular disease. Many pediatric neuromuscular diseases are analogous to those seen in the adult. However, the relative frequency of these illnesses varies greatly when different age populations are compared. The purpose of the present study is to provide a retrospective analysis of children referred to our electromyography (EMG) laboratory for electrophysiological examinations. Methods We retrospectively reviewed electrodiagnostic records of patients aged between 0-15 years, from January 2004 to June 2013. Patients were classified as having plexopathy, nerve root lesions, polyneuropathy, myopathy, mononeuropathy, anterior horn cell disease, neuromuscular transmission disorder, facial nerve palsy, and other rare disorders. Results We reviewed totally 5563 pediatric records, which was on the average 578 studies per year. It was about 14% of the all EMG examinations performed in our laboratory. When we looked at all the procedures, 3271 of the records included needle EMGs, 170 of them were single fiber EMGs, 100 of them were repetitive nerve stimulations, and 52 of them were evoked potentials. The results were normal in 55% of the cases. As a result of electrophysiological examinations, the common diagnoses were: plexopathy (28.6%), polyneuropathy (7.4%), and myopathy (6.6%) in patients aged 0-5 years (41.2% of all records); myopathy (9.4%), PNP (8.5%), mononeuropathy (6.4%), and plexopathy (5.9%) in 6-10 years (28.2% of all records); PNP (11.3%), myopathy (6.6%), and mononeuropathy (5.6%) in 11-15 years (30.6% of all records). Conclusion Infants and toddlers mostly suffered from brachial plexopathy which can be prevented by proper obstetrical management. Nerve conduction studies and EMG yielded diagnostic importance for demyelinating neuropathy and myopathy in patients older than 6 years of age.
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Affiliation(s)
- Elif Kocasoy Orhan
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Baysal Kiraç
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Pınar Yalinay DİKmen
- Department of Neurology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, Istanbul Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Mustafa Ertaş
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - A Emre Öge
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Jale Yazici
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - M Barş Baslo
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
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17
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Hocaoğlu M, Durmuş H, Özkan B, Yentür SP, Doğan Ö, Parman Y, Deymeer F, Saruhan-Direskeneli G. Increased costimulatory molecule expression of thymic and peripheral B cells and a sensitivity to IL-21 in myasthenia gravis. J Neuroimmunol 2018; 323:36-42. [PMID: 30196831 DOI: 10.1016/j.jneuroim.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/10/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 01/08/2023]
Abstract
B cells may contribute to the pathogenesis of myasthenia gravis with anti-acetylcholine antibodies (AChR+ MG) by co-stimulation or selection of T cells. In this study, we investigated costimulatory molecules on B cells in the blood and in the thymus as well as by TLR9 and IL-21 stimulations in AChR+ MG patients with or without immunosuppressive treatment and controls. CD80 and CD86 expression on B cells was increased in the peripheral blood and in the thymus of untreated patients. CD86 was further amplified by IL-21. A role for activated B cells, active thymic environment and IL-21 is implicated in MG.
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Affiliation(s)
- Mehmet Hocaoğlu
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hacer Durmuş
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sibel P Yentür
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Öner Doğan
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yeşim Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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18
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Durmus H, Shen XM, Serdaroglu-Oflazer P, Kara B, Parman-Gulsen Y, Ozdemir C, Brengman J, Deymeer F, Engel AG. Congenital myasthenic syndromes in Turkey: Clinical clues and prognosis with long term follow-up. Neuromuscul Disord 2018; 28:315-322. [PMID: 29395675 PMCID: PMC5924610 DOI: 10.1016/j.nmd.2017.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 11/28/2022]
Abstract
Congenital myasthenic syndromes (CMS) are a group of hereditary disorders affecting the neuromuscular junction. Here, we present clinical, electrophysiological and genetic findings of 69 patients from 51 unrelated kinships from Turkey. Genetic tests of 60 patients were performed at Mayo Clinic. Median follow-up time was 9.8 years (range 1-22 years). The most common CMS was primary acetylcholine receptor (AChR) deficiency (31/51) and the most common mutations in AChR were c.1219 + 2T > G (12/51) and c.1327delG (6/51) in CHRNE. Four of our 5 kinships with AChE deficiency carried p.W148X that truncates the collagen domain of COLQ, and was previously reported only in patients from Turkey. These were followed by GFPT1 deficiency (4/51), DOK7 deficiency (3/51), slow channel CMS (3/51), fast channel CMS (3/51), choline acetyltransferase deficiency (1/51) and a CMS associated with desmin deficiency (1/51). Distribution of muscle weakness was sometimes useful in giving a clue to the CMS subtype. Presence of repetitive compound muscle action potentials pointed to AChE deficiency or slow channel CMS. Our experience confirms that one needs to be cautious using pyridostigmine, since it can worsen some types of CMS. Ephedrine/salbutamol were very effective in AChE and DOK7 deficiencies and were useful as adjuncts in other types of CMS. Long follow-up gave us a chance to assess progression of the disease, and to witness 12 mainly uneventful pregnancies in 8 patients. In this study, we describe some new phenotypes and detail the clinical features of the well-known CMS.
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Affiliation(s)
- Hacer Durmus
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Xin-Ming Shen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Piraye Serdaroglu-Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Bulent Kara
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Yesim Parman-Gulsen
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Coskun Ozdemir
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Joan Brengman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Andrew G Engel
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Shen XM, Brengman JM, Shen S, Durmus H, Preethish-Kumar V, Yuceyar N, Vengalil S, Nalini A, Deymeer F, Sine SM, Engel AG. Mutations causing congenital myasthenia reveal principal coupling pathway in the acetylcholine receptor ε-subunit. JCI Insight 2018; 3:97826. [PMID: 29367459 DOI: 10.1172/jci.insight.97826] [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] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/12/2017] [Indexed: 11/17/2022] Open
Abstract
We identify 2 homozygous mutations in the ε-subunit of the muscle acetylcholine receptor (AChR) in 3 patients with severe congenital myasthenia: εR218W in the pre-M1 region in 2 patients and εE184K in the β8-β9 linker in 1 patient. Arg218 is conserved in all eukaryotic members of the Cys-loop receptor superfamily, while Glu184 is conserved in the α-, δ-, and ε-subunits of AChRs from all species. εR218W reduces channel gating efficiency 338-fold and AChR expression on the cell surface 5-fold, whereas εE184K reduces channel gating efficiency 11-fold but does not alter AChR cell surface expression. Determinations of the effective channel gating rate constants, combined with mutant cycle analyses, demonstrate strong energetic coupling between εR218 and εE184, and between εR218 and εE45 from the β1-β2 linker, as also observed for equivalent residues in the principal coupling pathway of the α-subunit. Thus, efficient and rapid gating of the AChR channel is achieved not only by coupling between conserved residues within the principal coupling pathway of the α-subunit, but also between corresponding residues in the ε-subunit.
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Affiliation(s)
- Xin-Ming Shen
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan M Brengman
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Shelley Shen
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Hacer Durmus
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Veeramani Preethish-Kumar
- Department of Neurology and.,Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nur Yuceyar
- Department of Neurology, Ege University, Izmir, Turkey
| | | | | | - Feza Deymeer
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Steven M Sine
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Departments of Physiology and Biomedical Engineering and of Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew G Engel
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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Durmus H, Scalco R, Gardiner A, Manole A, Schapira A, Morrow J, Houlden H, Holton J, Johnson K, Töpf A, Phillips L, Deymeer F, Parman Y, Straub V, Quinlivan R, Oflazer-Serdaoglu P. Anoctamin 5 muscular dystrophy mimicking metabolic myopathy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.188] [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: 11/16/2022]
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Çakar A, Durmuş Tekçe H, Deymeer F, Oflazer Serdaroğlu P, Parman YG. Transthyretin-Related Familial Amyloid Polyneuropathy: In the Light of New Developments. tnd 2017. [DOI: 10.4274/tnd.03206] [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: 12/01/2022] Open
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Kocasoy Orhan E, Baysal Kirac L, Yalinay Dikmen P, Matur Z, Ertas M, Oge AE, Deymeer F, Yazici J, Baslo MB. Electromyography in Pediatric Population. Noro Psikiyatr Ars 2017. [DOI: 10.5152/npa.2017.17023] [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: 11/22/2022] Open
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Gungor-Tuncer O, Yilmaz V, Toker A, Saruhan-Direskeneli G, Gulsen-Parman Y, Oflazer-Serdaroglu P, Deymeer F. Prompt Response to Prednisone Predicts Benign Course in MuSK-MG. Eur Neurol 2017; 78:137-142. [DOI: 10.1159/000479228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/04/2017] [Indexed: 11/19/2022]
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Alahgholi-Hajibehzad M, Durmuş H, Aysal F, Gülşen-Parman Y, Oflazer P, Deymeer F, Saruhan-Direskeneli G. The effect of interleukin (IL)-21 and CD4 + CD25 ++ T cells on cytokine production of CD4 + responder T cells in patients with myasthenia gravis. Clin Exp Immunol 2017; 190:201-207. [PMID: 28671717 DOI: 10.1111/cei.13006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 12/11/2022] Open
Abstract
Impairment of the suppressive function of regulatory T (Treg ) cells has been reported in myasthenia gravis (MG). In this study, cytokine-related mechanisms that may lead to the defect of Treg were investigated in patients with anti-acetylcholine receptor antibody-positive MG (AChR + MG). Proliferation and cytokine production of responder T (Tresp ) cells in response to polyclonal activation were measured in a suppression assay. The effect of interleukin (IL)-21 on suppression was evaluated in vitro in co-culture. IL-21 increased the proliferation of Tresp cells in Tresp /Treg co-cultures. Tresp cells from patients with MG secreted significantly lower levels of IL-2. In patients with MG, IL-2 levels did not change with the addition of Treg to cultures, whereas it decreased significantly in controls. In Tresp /Treg co-cultures, IL-4, IL-6 and IL-10 production increased in the presence of Treg in patients. Interferon (IFN)-γ was decreased, whereas IL-17A was increased in both patient and control groups. IL-21 inhibited the secretion of IL-4 in MG and healthy controls (HC), and IL-17A in HC only. The results demonstrated that IL-21 enhances the proliferation of Tresp cells in the presence of Treg . An effect of IL-21 mainly on Tresp cells through IL-2 is implicated.
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Affiliation(s)
- M Alahgholi-Hajibehzad
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.,Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - H Durmuş
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Aysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Y Gülşen-Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - P Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - G Saruhan-Direskeneli
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Durmus H, Yilmaz R, Gulsen-Parman Y, Oflazer-Serdaroglu P, Cuttini M, Dursun M, Deymeer F. Muscle magnetic resonance imaging in spinal muscular atrophy type 3: Selective and progressive involvement. Muscle Nerve 2017; 55:651-656. [PMID: 27543937 DOI: 10.1002/mus.25385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In this study we sought to identify magnetic resonance imaging (MRI) signs of selective muscle involvement and disease progression in patients with spinal muscular atrophy type 3b (SMA3b). METHODS Twenty-five patients with genetically confirmed SMA3b underwent MRI on a 1.5-Tesla MR scanner. RESULTS MRI showed significantly more severe involvement of the iliopsoas than of the gluteus maximus muscles, and more severe involvement of the triceps brachii than of the biceps brachii muscles. The quadriceps femoris muscles were severely involved. The deltoid, adductor longus, portions of the hamstrings, gracilis, sartorius, and rectus abdominis muscles were well preserved. We found a significant positive correlation between MRI changes and disease duration for gluteus maximus and triceps brachii. Follow-up MRIs of 4 patients showed disease progression. CONCLUSIONS This study confirms the pattern of selective muscle involvement suggested by previous studies and further refines muscle MRI changes in SMA3b. Progressive muscle involvement is implicated. Muscle Nerve 55: 651-656, 2017.
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Affiliation(s)
- Hacer Durmus
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yesim Gulsen-Parman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Piraye Oflazer-Serdaroglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Memduh Dursun
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
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Şirin NG, Kocasoy Orhan E, Durmuş H, Oflazer P, Parman Y, Öge AE, Deymeer F, Baslo MB. Jitter measurement with concentric needle in 133 patients with myasthenia gravis: a retrospective analysis. NEUROL SCI NEUROPHYS 2017. [DOI: 10.24165/jns.10168.17] [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: 11/18/2022] Open
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Akçakaya NH, Alpsan Gökmen MH, Parman YG, Deymeer F, Oflazer P. Differential Diagnosis Approach to Bilateral Peripheral Facial Paralysis: A Case Report. tnd 2016. [DOI: 10.4274/tnd.02212] [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: 12/01/2022] Open
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28
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Durmus H, Deymeer F, Parman Y, Oflazer-Serdaroğlu P. Distribution and severity of weakness in patients with polymyositis and dermatomyositis: Different pathophysiology, different affected muscle groups. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.218] [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: 10/21/2022]
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Durmuş H, Ayhan Ö, Çırak S, Deymeer F, Parman Y, Franke A, Eiber N, Chevessier F, Schlötzer-Schrehardt U, Clemen CS, Hashemolhosseini S, Schröder R, Hemmrich-Stanisak G, Tolun A, Serdaroğlu-Oflazer P. Neuromuscular endplate pathology in recessive desminopathies: Lessons from man and mice. Neurology 2016; 87:799-805. [PMID: 27440146 DOI: 10.1212/wnl.0000000000003004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 05/17/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the clinical, genetic, and myopathologic findings in 2 cousins with lack of desmin, the response to salbutamol in one patient, and the neuromuscular endplate pathology in a knock-in mouse model for recessive desminopathy. METHODS We performed clinical investigations in the patients, genetic studies for linkage mapping, exome sequencing, and qPCR for transcript quantification, assessment of efficacy of (3-month oral) salbutamol administration by muscle strength assessment, 6-minute walking test (6MWT), and forced vital capacity, analysis of neuromuscular endplate pathology in a homozygous R349P desmin knock-in mouse by immunofluorescence staining of the hind limb muscles, and quantitative 3D morphometry and expression studies of acetylcholine receptor genes by quantitative PCR. RESULTS Both patients had infantile-onset weakness and fatigability, facial weakness with bilateral ptosis and ophthalmoparesis, generalized muscle weakness, and a decremental response over 10% on repetitive nerve stimulation. Salbutamol improved 6MWT and subjective motor function in the treated patient. Genetic analysis revealed previously unreported novel homozygous truncating desmin mutation c.345dupC leading to protein truncation and consequent fast degradation of the mutant mRNA. In the recessive desminopathy mouse with low expression of the mutant desmin protein, we demonstrated fragmented motor endplates with increased surface areas, volumes, and fluorescence intensities in conjunction with increased α and γ acetylcholine receptor subunit expression in oxidative soleus muscle. CONCLUSIONS The patients were desmin-null and had myopathy, cardiomyopathy, and a congenital myasthenic syndrome. The data from man and mouse demonstrate that the complete lack as well as the markedly decreased expression of mutant R349P desmin impair the structural and functional integrity of neuromuscular endplates.
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Affiliation(s)
- Hacer Durmuş
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany.
| | - Özgecan Ayhan
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Sebahattin Çırak
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Feza Deymeer
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Yeşim Parman
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Andre Franke
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Nane Eiber
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Frederic Chevessier
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Ursula Schlötzer-Schrehardt
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Christoph S Clemen
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Said Hashemolhosseini
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Rolf Schröder
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Georg Hemmrich-Stanisak
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Aslıhan Tolun
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
| | - Piraye Serdaroğlu-Oflazer
- From the Department of Neurology (H.D., F.D., Y.P., P.S.-O.), Faculty of Medicine, Istanbul University; Department of Molecular Biology and Genetics (Ö.A., A.T.), Boğaziçi University, Istanbul, Turkey; Children's National Medical Center (S.Ç.), Research Center for Genetic Medicine, Washington, DC; Department of Pediatrics, Institute for Human Genetics, and Center for Molecular Medicine, University Hospital Cologne; Institute of Clinical Molecular Biology (A.F., G.H.-S.), Christian-Albrechts-University of Kiel; Institute of Biochemistry (N.E., S.H.), Institute of Neuropathology (F.C., R.S.), and Department of Ophthalmology (U.S.-S.), Friedrich-Alexander-University of Erlangen-Nuremberg; and Center for Biochemistry, Institute of Biochemistry I, Medical Faculty (C.S.C.), University of Cologne, Germany
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Saruhan-Direskeneli G, Hughes T, Yilmaz V, Durmus H, Adler A, Alahgholi-Hajibehzad M, Aysal F, Yentür SP, Akalin MA, Dogan O, Marx A, Gülsen-Parman Y, Oflazer P, Deymeer F, Sawalha AH. Genetic heterogeneity within the HLA region in three distinct clinical subgroups of myasthenia gravis. Clin Immunol 2016; 166-167:81-8. [PMID: 27181991 DOI: 10.1016/j.clim.2016.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/15/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 01/09/2023]
Abstract
This study aims to investigate genetic susceptibility to early-onset and late-onset anti-acetylcholine receptor antibody positive myasthenia gravis (EOMG and LOMG) and anti-muscle specific kinase antibody positive MG (MuSK-MG) at genome-wide level in a single population. Using a custom-designed array and imputing additional variants and the classical HLA alleles in 398 patients, we detected distinct associations. In EOMG, rs113519545 in the HLA class I region (OR=5.71 [3.77-8.66], P=2.24×10(-16)), HLA-B*08:01 (OR=7.04 [3.95-12.52], P=3.34×10(-11)) and HLA-C*07:01 (OR=2.74 [1.97-3.81], P=2.07(-9)), in LOMG, rs111256513 in the HLA class II region (OR=2.22 [1.59-3.09], P=2.48×10(-6)) and in MuSK-MG, an intronic variant within HLA-DQB1 (rs68081734, OR=5.86, P=2.25×10(-14)) and HLA-DQB1*05:02 (OR=8.56, P=6.88×10(-13)) revealed the most significant associations for genome-wide significance. Differential genetic susceptibility within the HLA to EOMG, LOMG and MuSK-MG has been established in a population from Turkey.
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Affiliation(s)
| | - Travis Hughes
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Health Science and Technology, Harvard Medical School, Boston, MA, USA
| | - Vuslat Yilmaz
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hacer Durmus
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Adam Adler
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Fikret Aysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Sibel P Yentür
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Ali Akalin
- Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Oner Dogan
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Yesim Gülsen-Parman
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Piraye Oflazer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Amr H Sawalha
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Durmuş-Tekçe H, Matur Z, Mert Atmaca M, Poda M, Çakar A, Hıdır Ulaş Ü, Oflazer-Serdaroğlu P, Deymeer F, Parman YG. Genotypic and phenotypic presentation of transthyretin-related familial amyloid polyneuropathy (TTR-FAP) in Turkey. Neuromuscul Disord 2016; 26:441-6. [PMID: 27238058 DOI: 10.1016/j.nmd.2016.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 09/13/2015] [Revised: 04/16/2016] [Accepted: 04/28/2016] [Indexed: 12/27/2022]
Abstract
Transthyretin-related familial amyloid polyneuropathy (TTR-FAP) is an autosomal dominant disorder caused by mutations of the transthyretin (TTR) gene. The mutant amyloidogenic transthyretin protein causes the systemic accumulation of amyloid fibrils that result in organ dysfunction. TTR-associated FAP is a progressive and fatal disease, if left untreated, and should be considered in the differential diagnosis of any person presenting with a progressive polyneuropathy, particularly with accompanying autonomic involvement. The clinical, electrophysiological, histopathological, and genetic characteristics of 17 patients from Turkey (5 female, 13 male) from nine families with polyneuropathy and mutations in TTR were evaluated. Sequence analysis of the TTR gene revealed five mutations (Val30Met, Glu89Gln, Gly53Glu, Glu54Gly and Gly47Glu). Mean age at disease onset was 40.4 ± 13.9 years (range 21-66 years). The most commonly reported initial complaint was paresthesia in the feet (asymmetric in three patients). Three patients (2 male) with the Glu89Gln mutation presented with carpal tunnel syndrome. Two patients with the Gly53Glu mutation showed episodes of dysarthria and hemiparesis, consistent with this genotype. Seven patients died during the period of follow-up as a result of systemic involvement. Our study suggests that a cohort of patients from Turkey with TTR-FAP exhibits clinical and genetic heterogeneity.
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Affiliation(s)
- Hacer Durmuş-Tekçe
- Neurology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zeliha Matur
- Neurology Department, Medical Faculty, Istanbul Bilim University, Istanbul, Turkey
| | - Murat Mert Atmaca
- Neurology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehves Poda
- Genetics Department, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Arman Çakar
- Neurology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ümit Hıdır Ulaş
- Neurology Department, Gulhane Military Medical Academy, Ankara, Turkey
| | | | - Feza Deymeer
- Neurology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yesim G Parman
- Neurology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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Görkem Şirin N, Kocasoy Orhan E, Durmuş H, Barış Baslo M, Deymeer F. ID 181 – Does high-pass filtering proposed for concentric needle electrode recording affect the calculated neuromuscular jitter in myasthenia gravis? Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.298] [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: 11/28/2022]
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Stergiou C, Lazaridis K, Zouvelou V, Tzartos J, Mantegazza R, Antozzi C, Andreetta F, Evoli A, Deymeer F, Saruhan-Direskeneli G, Durmus H, Brenner T, Vaknin A, Berrih-Aknin S, Behin A, Sharshar T, De Baets M, Losen M, Martinez-Martinez P, Kleopa KA, Zamba-Papanicolaou E, Kyriakides T, Kostera-Pruszczyk A, Szczudlik P, Szyluk B, Lavrnic D, Basta I, Peric S, Tallaksen C, Maniaol A, Gilhus NE, Casasnovas Pons C, Pitha J, Jakubíkova M, Hanisch F, Bogomolovas J, Labeit D, Labeit S, Tzartos SJ. Titin antibodies in "seronegative" myasthenia gravis--A new role for an old antigen. J Neuroimmunol 2016; 292:108-15. [PMID: 26943968 DOI: 10.1016/j.jneuroim.2016.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 12/18/2015] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease caused by antibodies targeting the neuromuscular junction of skeletal muscles. Triple-seronegative MG (tSN-MG, without detectable AChR, MuSK and LRP4 antibodies), which accounts for ~10% of MG patients, presents a serious gap in MG diagnosis and complicates differential diagnosis of similar disorders. Several AChR antibody positive patients (AChR-MG) also have antibodies against titin, usually detected by ELISA. We have developed a very sensitive radioimmunoprecipitation assay (RIPA) for titin antibodies, by which many previously negative samples were found positive, including several from tSN-MG patients. The validity of the RIPA results was confirmed by western blots. Using this RIPA we screened 667 MG sera from 13 countries; as expected, AChR-MG patients had the highest frequency of titin antibodies (40.9%), while MuSK-MG and LRP4-MG patients were positive in 14.6% and 16.4% respectively. Most importantly, 13.4% (50/372) of the tSN-MG patients were also titin antibody positive. None of the 121 healthy controls or the 90 myopathy patients, and only 3.6% (7/193) of other neurological disease patients were positive. We thus propose that the present titin antibody RIPA is a useful tool for serological MG diagnosis of tSN patients.
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Affiliation(s)
- C Stergiou
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece
| | | | - V Zouvelou
- Neurology Department, Aeginition Hospital, Athens, Greece
| | - J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece
| | - R Mantegazza
- Neurological Institute "C. Besta", Milano, Italy
| | - C Antozzi
- Neurological Institute "C. Besta", Milano, Italy
| | - F Andreetta
- Neurological Institute "C. Besta", Milano, Italy
| | - A Evoli
- Institute of Neurology, Catholic University, Rome, Italy
| | - F Deymeer
- Istanbul University, Istanbul, Turkey
| | | | - H Durmus
- Istanbul University, Istanbul, Turkey
| | - T Brenner
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Vaknin
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - A Behin
- UPMC and INSERM, Paris, France
| | - T Sharshar
- Raymond Poincaré Hospital, Garches, France
| | - M De Baets
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - M Losen
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - P Martinez-Martinez
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - K A Kleopa
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - T Kyriakides
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - P Szczudlik
- Department of Neurology, Medical University of Warsaw, Poland
| | - B Szyluk
- Department of Neurology, Medical University of Warsaw, Poland
| | - D Lavrnic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - C Tallaksen
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway; Faculty of Medicine, Olso University, Norway
| | - A Maniaol
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - N E Gilhus
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - J Pitha
- Department of Neurology and Clinical Neuroscience Center, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic
| | - M Jakubíkova
- Department of Neurology and Clinical Neuroscience Center, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic
| | - F Hanisch
- Universitätsklinikum Halle, Halle, Germany
| | - J Bogomolovas
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany
| | - D Labeit
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany; Myomedix GmbH, 69151 Neckargemuend, Germany
| | - S Labeit
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany
| | - S J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece.
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Durmus H, Matur Z, Atmaca MM, Poda M, Cakar A, Serdaroglu-Oflazer P, Deymeer F, Parman Y. Genotypic and phenotypic presentation of Glu89Gln mutation in Turkey. Orphanet J Rare Dis 2015. [PMCID: PMC4642122 DOI: 10.1186/1750-1172-10-s1-p33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gelisin O, Durmus H, Yakal S, Kasikcioglu E, Parman Y, Deymeer F, Oflazer-Serdaroğlu P. Evaluation of maximum oxygen utilization in McArdle patients before and after exercise training. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.130] [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: 11/26/2022]
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Inal Gültekin G, Toptaş Hekimoğlu B, Görmez Z, Durmuş H, Demirci H, Sağıroğlu M, Parman Y, Deymeer F, Yılmaz H, Pençe S, Kurt C, Tan E, Özdamar S, Giger U, Öztürk O, Serdaroğlu-Oflazer P. Myophosphorylase (PYGM) mutations in Turkish patients with McArdle disease: A next generation sequencing study. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.129] [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: 10/23/2022]
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Alahgholi-Hajibehzad M, Oflazer P, Aysal F, Durmuş H, Gülşen-Parman Y, Marx A, Deymeer F, Saruhan-Direskeneli G. Regulatory function of CD4+CD25++ T cells in patients with myasthenia gravis is associated with phenotypic changes and STAT5 signaling: 1,25-Dihydroxyvitamin D3 modulates the suppressor activity. J Neuroimmunol 2015; 281:51-60. [DOI: 10.1016/j.jneuroim.2015.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
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Yilmaz V, Oflazer P, Aysal F, Parman YG, Direskeneli H, Deymeer F, Saruhan-Direskeneli G. B cells produce less IL-10, IL-6 and TNF-α in myasthenia gravis. Autoimmunity 2014; 48:201-7. [PMID: 25518708 DOI: 10.3109/08916934.2014.992517] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
B cells from myasthenia gravis (MG) patients with autoantibodies (Aab) against acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or with no detectable Aab were investigated as cytokine producing cells in this study. B cells were evaluated for memory phenotypes and expressions of IL-10, IL-6 and IL-12A. Induced productions of IL-10, IL-6, IL-12p40, TNF-α and LT from isolated B cells in vitro were measured by immunoassays. MG patients receiving immunosuppressive treatment had higher proportions of memory B cells compared with healthy controls and untreated patients. With CD40 stimulation MG patients produced significantly lower levels of IL-10, IL-6. With CD40 and B cell receptor stimulation of B cells, TNF-α production also decreased in addition to these cytokines. The lower levels of these cytokine productions were not related to treatment. Our results confirm a disturbance of B cell subpopulations in MG subgroups on immunosuppressive treatment. B cell derived IL-10, IL-6 and TNF-α are down-regulated in MG, irrespective of different antibody productions. Ineffective cytokine production by B cells may be a susceptibility factor in dysregulation of autoimmune Aab production.
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Durmuş H, Dursun M, Sencer S, Deymeer F, Oflazer-serdaroğlu P. Facial and Skeletal Muscle Magnetic Resonance Imaging In Oculopharyngodistal Myopathy. tnd 2014. [DOI: 10.4274/tnd.52385] [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: 12/01/2022] Open
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41
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Ozcan O, Durmus H, Tarhan O, Polat Z, Deymeer F, Parman Y, Oflazer-Serdaroglu P. G.P.8. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.022] [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: 10/24/2022]
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42
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Kocasoy Orhan E, Baysal Kirac L, Yalınay Dikmen P, Matur Z, Baslo M, Ertaş M, Öge A, Deymeer F, Yazıcı J. P420: EMG in pediatric population: was it worth it? Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50529-9] [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: 10/25/2022]
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43
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Gungor-Tuncer O, Orhan EK, Yilmaz V, Parman Y, Oflazer P, Saruhan-Direskeneli G, Deymeer F. Prepubertal anti-Musk positive myasthenia gravis with long remission. Neuromuscul Disord 2014; 24:36-9. [DOI: 10.1016/j.nmd.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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Zisimopoulou P, Evangelakou P, Tzartos J, Lazaridis K, Zouvelou V, Mantegazza R, Antozzi C, Andreetta F, Evoli A, Deymeer F, Saruhan-Direskeneli G, Durmus H, Brenner T, Vaknin A, Berrih-Aknin S, Frenkian Cuvelier M, Stojkovic T, DeBaets M, Losen M, Martinez-Martinez P, Kleopa KA, Zamba-Papanicolaou E, Kyriakides T, Kostera-Pruszczyk A, Szczudlik P, Szyluk B, Lavrnic D, Basta I, Peric S, Tallaksen C, Maniaol A, Tzartos SJ. A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis. J Autoimmun 2013; 52:139-45. [PMID: 24373505 DOI: 10.1016/j.jaut.2013.12.004] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [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: 06/29/2013] [Accepted: 12/08/2013] [Indexed: 11/29/2022]
Abstract
Double-seronegative myasthenia gravis (dSN-MG, without detectable AChR and MuSK antibodies) presents a serious gap in MG diagnosis and understanding. Recently, autoantibodies against the low-density lipoprotein receptor-related protein 4 (LRP4) have been identified in several dSN-MG sera, but with dramatic frequency variation (∼2-50%). We have developed a cell based assay (CBA) based on human LRP4 expressing HEK293 cells, for the reliable and efficient detection of LRP4 antibodies. We have screened about 800 MG patient sera from 10 countries for LRP4 antibodies. The overall frequency of LRP4-MG in the dSN-MG group (635 patients) was 18.7% but with variations among different populations (range 7-32.7%). Interestingly, we also identified double positive sera: 8/107 anti-AChR positive and 10/67 anti-MuSK positive sera also had detectable LRP4 antibodies, predominantly originating from only two of the participating groups. No LRP4 antibodies were identified in sera from 56 healthy controls tested, while 4/110 from patients with other neuroimmune diseases were positive. The clinical data, when available, for the LRP4-MG patients were then studied. At disease onset symptoms were mild (81% had MGFA grade I or II), with some identified thymic changes (32% hyperplasia, none with thymoma). On the other hand, double positive patients (AChR/LRP4-MG and MuSK/LRP4-MG) had more severe symptoms at onset compared with any single positive MG subgroup. Contrary to MuSK-MG, 27% of ocular dSN-MG patients were LRP4 antibody positive. Similarly, contrary to MuSK antibodies, which are predominantly of the IgG4 subtype, LRP4 antibodies were predominantly of the IgG1 and IgG2 subtypes. The prevalence was higher in women than in men (female/male ratio 2.5/1), with an average disease onset at ages 33.4 for females and 41.9 for males. Overall, the response of LRP4-MG patients to treatment was similar to published responses of AChR-MG rather than to MuSK-MG patients.
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Affiliation(s)
| | - P Evangelakou
- Hellenic Pasteur Institute, Athens, Greece; University of Patras, Patras, Greece
| | - J Tzartos
- Hellenic Pasteur Institute, Athens, Greece
| | | | - V Zouvelou
- Neurology Department, Aeginition Hospital, Athens, Greece
| | - R Mantegazza
- Neurological Institute "C. Besta", Milano, Italy
| | - C Antozzi
- Neurological Institute "C. Besta", Milano, Italy
| | - F Andreetta
- Neurological Institute "C. Besta", Milano, Italy
| | - A Evoli
- Institute of Neurology, Catholic University, Rome, Italy
| | - F Deymeer
- Istanbul University, Istanbul, Turkey
| | | | - H Durmus
- Istanbul University, Istanbul, Turkey
| | - T Brenner
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Vaknin
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - M DeBaets
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - M Losen
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - P Martinez-Martinez
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - K A Kleopa
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - T Kyriakides
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - P Szczudlik
- Department of Neurology, Medical University of Warsaw, Poland
| | - B Szyluk
- Department of Neurology, Medical University of Warsaw, Poland
| | - D Lavrnic
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - I Basta
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - S Peric
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - C Tallaksen
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - A Maniaol
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - S J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; University of Patras, Patras, Greece.
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Orhan EK, Deymeer F, Oflazer P, Parman Y, Baslo MB. Jitter analysis with concentric needle electrode in the masseter muscle for the diagnosis of generalised myasthenia gravis. Clin Neurophysiol 2013; 124:2277-82. [DOI: 10.1016/j.clinph.2013.04.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 03/30/2013] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
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46
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Yıldız-Celik S, Durmus H, Yilmaz V, Serdaroglu-Oflazer P, Gulsen-Parman Y, Saruhan-Direskeneli G, Deymeer F. Late-onset non-thymomatous generalized myasthenia gravis. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1683] [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: 10/26/2022]
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Goksungur M, Okamoto Y, Pehlivan D, Matur Z, Akyüz K, Battaloglu E, Deymeer F, Serdaroglu P, Lupski J, Parman Y. An autosomal recessive CMT family with a new mutation in the NDRG1 gene. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1700] [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: 10/26/2022]
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Alahgholi-Hajibehzad M, Yilmaz V, Gülsen-Parman Y, Aysal F, Oflazer P, Deymeer F, Saruhan-Direskeneli G. Association of HLA-DRB1∗14, -DRB1∗16 and -DQB1∗05 with MuSK-myasthenia gravis in patients from Turkey. Hum Immunol 2013; 74:1633-5. [PMID: 23993985 DOI: 10.1016/j.humimm.2013.08.271] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/11/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
Abstract
Susceptibility to myasthenia gravis (MG) has been demonstrated with several HLA in different disease subgroups. HLA-DR14, -DR16 and -DQ5 were reported as predisposing factors in muscle-specific kinase antibody positive MG (MuSK-MG). These markers were evaluated in MG subgroups from Turkey. Among 164 generalized MG patients, 116 had antibodies against anti-acetylcholine receptor (AChR-MG) and 48 had MuSK-MG. Only HLA-DRB1 and DQB1 allele groups reported to be associated with MuSK-MG were compared with 250 healthy controls (HC). Highly significant associations of both DRB1(∗)16 and DRB1(∗)14 were found with MuSK-MG compared to HC (p = 1.9 × 10(-5), OR: 4.95 and p = 0.0028, OR: 3.1). On the contrary, HLA-DRB1(∗)03 was less frequent in MuSK-MG (p = 0.006, OR: 0.09). DQB1(∗)05 was also associated with MuSK-MG (p = 2.5 × 10(-6) OR: 4.8). This study provides a replication of the highly significant associations of both HLA-DRB1(∗)16,-DRB1(∗)14 and -DQB1(∗)05 with MuSK-MG. Moreover, HLA-DRB1(∗)03 appears to have a distinguishing role for this disease subgroup compared to early-onset and AChR-MG.
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Uyan Ö, Ömür Ö, Ağım ZS, Özoğuz A, Li H, Parman Y, Deymeer F, Oflazer P, Koç F, Tan E, Özçelik H, Başak AN. Genome-wide copy number variation in sporadic amyotrophic lateral sclerosis in the Turkish population: deletion of EPHA3 is a possible protective factor. PLoS One 2013; 8:e72381. [PMID: 23991104 PMCID: PMC3753249 DOI: 10.1371/journal.pone.0072381] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/08/2013] [Indexed: 01/06/2023] Open
Abstract
The genome-wide presence of copy number variations (CNVs), which was shown to affect the expression and function of genes, has been recently suggested to confer risk for various human disorders, including Amyotrophic Lateral Sclerosis (ALS). We have performed a genome-wide CNV analysis using PennCNV tool and 733K GWAS data of 117 Turkish ALS patients and 109 matched healthy controls. Case-control association analyses have implicated the presence of both common (>5%) and rare (<5%) CNVs in the Turkish population. In the framework of this study, we identified several common and rare loci that may have an impact on ALS pathogenesis. None of the CNVs associated has been implicated in ALS before, but some have been reported in different types of cancers and autism. The most significant associations were shown for 41 kb and 15 kb intergenic heterozygous deletions (Chr11: 50,545,009–50,586,426 and Chr19: 20,860,930–20,875,787) both contributing to increased risk for ALS. CNVs in coding regions of the MAP4K3, HLA-B, EPHA3 and DPYD genes were detected however, after validation by Log R Ratio (LRR) values and TaqMan CNV genotyping, only EPHA3 deletion remained as a potential protective factor for ALS (p = 0.0065024). Based on the knowledge that EPHA4 has been previously shown to rescue SOD1 transgenic mice from ALS phenotype and prolongs survival, EPHA3 may be a promising candidate for therepuetic interventions.
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Affiliation(s)
- Özgün Uyan
- Suna and İnan Kıraç Foundation Neurodegeneration Research Laboratory, Molecular Biology and Genetics Department, Bogazici University, Istanbul, Turkey
| | - Özgür Ömür
- Suna and İnan Kıraç Foundation Neurodegeneration Research Laboratory, Molecular Biology and Genetics Department, Bogazici University, Istanbul, Turkey
| | - Zeynep Sena Ağım
- Suna and İnan Kıraç Foundation Neurodegeneration Research Laboratory, Molecular Biology and Genetics Department, Bogazici University, Istanbul, Turkey
| | - Aslıhan Özoğuz
- Suna and İnan Kıraç Foundation Neurodegeneration Research Laboratory, Molecular Biology and Genetics Department, Bogazici University, Istanbul, Turkey
| | - Hong Li
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Yeşim Parman
- Neurology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Neurology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Piraye Oflazer
- Neurology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Filiz Koç
- Neurology Department, Medical School, Çukurova University, Adana, Turkey
| | - Ersin Tan
- Neurology Department, Hacettepe University, Ankara, Turkey
| | - Hilmi Özçelik
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - A. Nazlı Başak
- Suna and İnan Kıraç Foundation Neurodegeneration Research Laboratory, Molecular Biology and Genetics Department, Bogazici University, Istanbul, Turkey
- * E-mail:
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Selcen D, Shen XM, Milone M, Brengman J, Ohno K, Deymeer F, Finkel R, Rowin J, Engel AG. GFPT1-myasthenia: clinical, structural, and electrophysiologic heterogeneity. Neurology 2013; 81:370-8. [PMID: 23794683 DOI: 10.1212/wnl.0b013e31829c5e9c] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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 identify patients with GFPT1-related limb-girdle myasthenia and analyze phenotypic consequences of the mutations. METHODS We performed genetic analysis, histochemical, immunoblot, and ultrastructural studies and in vitro electrophysiologic analysis of neuromuscular transmission. RESULTS We identified 16 recessive mutations in GFPT1 in 11 patients, of which 12 are novel. Ten patients had slowly progressive limb-girdle weakness responsive to cholinergic agonists with onset between infancy and age 19 years. One patient (no. 6) harbored a nonsense mutation and a second mutation that disrupts the muscle-specific GFPT1 exon. This patient never moved in utero, was apneic and arthrogrypotic at birth, and was bedfast, tube-fed, and barely responded to therapy at age 6 years. Histochemical studies in 9 of 11 patients showed tubular aggregates in 6 and rimmed vacuoles in 3. Microelectrode studies of intercostal muscle endplates in 5 patients indicated reduced synaptic response to acetylcholine in 3 and severely reduced quantal release in patient 6. Endplate acetylcholine receptor content was moderately reduced in only one patient. The synaptic contacts were small and single or grape-like, and quantitative electron microscopy revealed hypoplastic endplate regions. Numerous muscle fibers of patient 6 contained myriad dilated and degenerate vesicular profiles, autophagic vacuoles, and bizarre apoptotic nuclei. Glycoprotein expression in muscle was absent in patient 6 and reduced in 5 others. CONCLUSIONS GFPT1-myasthenia is more heterogeneous than previously reported. Different parameters of neuromuscular transmission are variably affected. When disruption of muscle-specific isoform determines the phenotype, this has devastating clinical, pathologic, and biochemical consequences.
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Affiliation(s)
- Duygu Selcen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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