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Kempers MJ, Wessels M, Van Berendoncks A, van de Laar IM, de Leeuw N, Loeys B. Phenotype of COL3A1/COL5A2 deletion patients. Eur J Med Genet 2022; 65:104593. [PMID: 35964930 DOI: 10.1016/j.ejmg.2022.104593] [Citation(s) in RCA: 4] [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: 11/25/2021] [Revised: 06/23/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The diagnosis of Ehlers-Danlos syndrome is usually based on well-defined diagnostic criteria and the result of DNA investigation. Classical (cEDS) and vascular type (vEDS) are the most prevalent subtypes and are caused by heterozygous pathogenic variants in COL5A1, COL5A2, COL1A1 or, respectively, in COL3A1. We describe 3 cases with contiguous deletions resulting in haploinsufficiency of both genes with relative mild features of connective tissue disease. PATIENTS AND METHODS Information on medical history, physical information, genetic results (CNV-analysis) and imaging were obtained from the medical file. RESULTS The first patient was a 31 yr old female, diagnosed during pregnancy after the NIPT result showed an interstitial deletion of 2.3 Mb on chromosome 2q32.2, confirmed by XON array. She had normal aortic diameters. She had no signs of cEDS or vEDS except for a relatively thin skin with increased visibility of the veins. Her father died suddenly of a type A/B dissection at the age of 62 years. The second patient was diagnosed at the age of 10 years after she was referred because of her intellectual disability, autism and constipation. She was known with a thin and vulnerable skin and had a bleeding after tooth extraction. Array showed a 14,5 Mb deletion of 2q31.3q32.3 (de novo). Imaging (latest age 17 years) did not show any abnormalities. The third patient, aged 28 years, was diagnosed during pregnancy with an interstitial deletion of circa 6 Mb on chromosome 2q31.1q32.2 3, previously shown in the fetus with bilateral club feet and hydronephrosis. She had no vEDS facial features and the skin was relatively thin. She has thoracolumbar scoliosis and dural ectasia. Imaging did not reveal any vascular abnormalities. Her son, born at 37 weeks 3 days. had club feet but not other clinical signs suggestive of classical or vascular EDS. DISCUSSION Three patients are described with a contiguous deletion of varying size encompassing the COL3A1 and COL5A2 gene. Due to the mild phenotype a diagnosis of EDS was not suspected and was found coincidental. Since two of the patients were pregnant without major complications these patients may require a less defensive, approach to pregnancy/delivery.
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Affiliation(s)
- Marlies Je Kempers
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Marja Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital/University of Antwerp, Antwerp, Belgium
| | - Ingrid Mbh van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole de Leeuw
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart Loeys
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Center for Medical Genetics, Antwerp University Hospital/University of Antwerp, Antwerp, Belgium
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Shintaku J, Pernice WM, Eyaid W, Gc JB, Brown ZP, Juanola-Falgarona M, Torres-Torronteras J, Sommerville EW, Hellebrekers DM, Blakely EL, Donaldson A, van de Laar IM, Leu CS, Marti R, Frank J, Tanji K, Koolen DA, Rodenburg RJ, Chinnery PF, Smeets HJM, Gorman GS, Bonnen PE, Taylor RW, Hirano M. RRM1 variants cause a mitochondrial DNA maintenance disorder via impaired de novo nucleotide synthesis. J Clin Invest 2022; 132:145660. [PMID: 35617047 PMCID: PMC9246377 DOI: 10.1172/jci145660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/04/2020] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Mitochondrial DNA (mtDNA) depletion/deletions syndromes (MDDS) encompass a clinically and etiologically heterogenous group of mitochondrial disorders due to impaired mtDNA maintenance. Among the most frequent causes of MDDS are defects in nucleoside/nucleotide metabolism, which is critical for synthesis and homeostasis of the deoxynucleoside triphosphate (dNTP) substrates of mtDNA replication. A central enzyme for generating dNTPs is ribonucleotide reductase, a critical mediator of de novo nucleotide synthesis composed of catalytic RRM1 subunits in complex with RRM2 or p53R2. Here, we report five probands from four families who presented with ptosis and ophthalmoplegia, plus other manifestations and multiple mtDNA deletions in muscle. We identified three RRM1 loss-of-function variants, including a dominant catalytic site variant (NP_001024.1: p.N427K) and two homozygous recessive variants at p.R381, which has evolutionarily conserved interactions with the specificity site. Atomistic molecular dynamics simulations indicate mechanisms by which RRM1 variants affect protein structure. Cultured primary skin fibroblasts of probands manifested mtDNA depletion under cycling conditions, indicating impaired de novo nucleotide synthesis. Fibroblasts also exhibited aberrant nucleoside diphosphate and dNTP pools and mtDNA ribonucleotide incorporation. Our data reveal primary RRM1 deficiency and, by extension, impaired de novo nucleotide synthesis are causes of MDDS.
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Affiliation(s)
- Jonathan Shintaku
- Department of Neurology, Columbia University Irving Medical Center, New York, United States of America
| | - Wolfgang M Pernice
- Department of Neurology, Columbia University Irving Medical Center, New York, United States of America
| | - Wafaa Eyaid
- Department of Pediatrics, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Jeevan B Gc
- Department of Biochemistry and Molecular Biophysics, Columbia University Irving Medical Center, New York, United States of America
| | - Zuben P Brown
- Department of Biochemistry and Molecular Biophysics, Columbia University Irving Medical Center, New York, United States of America
| | - Marti Juanola-Falgarona
- Department of Neurology, Columbia University Irving Medical Center, New York, United States of America
| | | | - Ewen W Sommerville
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle, United Kingdom
| | - Debby Mei Hellebrekers
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emma L Blakely
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle, United Kingdom
| | - Alan Donaldson
- Clinical Genetics Department, University of Bristol, Bristol, United Kingdom
| | - Ingrid Mbh van de Laar
- Department of Clinical Genetics, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cheng-Shiun Leu
- Biostatistics, Columbia University, New York, United States of America
| | - Ramon Marti
- Laboratori de patologia neuromuscular i mitocondrial, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Joachim Frank
- Department of Biochemistry and Molecular Biophysics, Columbia University Irving Medical Center, New York, United States of America
| | - Kurenai Tanji
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
| | - David A Koolen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Richard J Rodenburg
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patrick F Chinnery
- Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - H J M Smeets
- University of Maastricht, Maastricht, Netherlands
| | - Gráinne S Gorman
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle, United Kingdom
| | - Penelope E Bonnen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States of America
| | | | - Michio Hirano
- Department of Neurology, Columbia University Irving Medical Center, New York, United States of America
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Srebniak MI, Boter M, Oudesluijs GO, Cohen-Overbeek T, Govaerts LC, Diderich KE, Oegema R, Knapen MF, van de Laar IM, Joosten M, Van Opstal D, Galjaard RJH. Genomic SNP array as a gold standard for prenatal diagnosis of foetal ultrasound abnormalities. Mol Cytogenet 2012; 5:14. [PMID: 22413963 PMCID: PMC3328283 DOI: 10.1186/1755-8166-5-14] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 03/13/2012] [Indexed: 01/10/2023] Open
Abstract
Background We have investigated whether replacing conventional karyotyping by SNP array analysis in cases of foetal ultrasound abnormalities would increase the diagnostic yield and speed of prenatal diagnosis in clinical practice. Findings/results From May 2009 till June 2011 we performed HumanCytoSNP-12 array (HCS) (http://www.Illumina.com) analysis in 207 cases of foetal structural abnormalities. HCS allows detecting unbalanced genomic abnormalities with a resolution of about 150/200 kb. All cases were selected by a clinical geneticist after excluding the most common aneuploidies by RAD (rapid aneuploidy detection). Pre-test genetic counselling was offered in all cases. In 24/207 (11,6%) foetuses a clinically relevant genetic abnormality was detected. Only 8/24 abnormalities would have been detected if only routine karyotyping was performed. Submicroscopic abnormalities were found in 16/207 (7,7%) cases. The array results were achieved within 1-2 weeks after amniocentesis. Conclusions Prenatal SNP array testing is faster than karyotyping and allows detecting much smaller aberrations (~0.15 Mb) in addition to the microscopic unbalanced chromosome abnormalities detectable with karyotyping (~ > 5 Mb). Since karyotyping would have missed 66% (16/24) of genomic abnormalities in our cohort, we propose to perform genomic high resolution array testing assisted by pre-test counselling as a primary prenatal diagnostic test in cases of foetal ultrasound abnormalities.
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