The psychiatric phenotype of 15q11.2-q13.3 duplications

Introduction

15q11.2-q13.3 region is prone to genomic rearrangements leading to both deletions and duplications. A wide spectrum of neuropsychiatric conditions, such as developmental delay/intellectual disability (DD/ID), autism, attention-deficit hyperactivity disorder, schizophrenia, epilepsy was reported in association with genomic imbalances of this region.

Objectives

In this paper we report on 9 children carrying 15q11.2-q13.3 duplications.

Methods

Seven boys and two girls, aged 15 months to 15 years, were included in the study. Genomic investigations were carried out by array-based comparative genomic hybridization (Agilent Technologies). In all patients the psychomotor development, dysmorphic features, neuroimaging and EEG anomalies were assessed. Psychologic and psychiatric evaluation was performed with specific tests.

Results

The size of the duplications ranged from 9.65 Mb to 0.38 Mb. All patients presented speech delay. Autistic behavior and muscular hypotonia were detected in 8 out of 9 patients, DD/ID in 6. Two children presented epileptic seizures, in addition 4 other children had EEG anomalies. Facial dysmorphic features were observed in 5 patients. Neuroimaging studies showed anomalies in 4 children. The smallest region of overlap in our patient group harbors CHRNA7 gene, a candidate for the behavioral abnormalities.

Conclusions

15q duplications encompassing CHRNA7 gene were associated with different neuropsychiatric features in our patients. Our results further support the association of 15q duplications with neuropsychiatric phenotypes, with clinical heterogeneity and variable severity, which is yet to be explained. Acknowledgment: The research leading to these results has received funding from the EEA RO NO Grant 2014-2021, the project contract No 6/2019.

Disclosure

No significant relationships.

Point of care HbA1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries

BACKGROUND

Diabetes mellitus (DM) is common among tuberculosis (TB) patients and often undiagnosed or poorly controlled. We compared point of care (POC) with laboratory glycated haemoglobin (HbA_1c) testing among newly diagnosed TB patients to assess POC test accuracy, safety and acceptability in settings in which immediate access to DM services may be difficult.

METHODS

We measured POC and accredited laboratory HbA_1c (using high-performance liquid chromatography) in 1942 TB patients aged 18 years recruited from Peru, Romania, Indonesia and South Africa. We calculated overall agreement and individual variation (mean ± 2 standard deviations) stratified by country, age, sex, body mass index (BMI), HbA_1c level and comorbidities (anaemia, human immunodeficiency virus [HIV]). We used an error grid approach to identify disagreement that could raise significant concerns.

RESULTS

Overall mean POC HbA_1c values were modestly higher than laboratory HbA_1c levels by 0.1% units (95%CI 0.1-0.2); however, there was a substantial discrepancy for those with severe anaemia (1.1% HbA_1c, 95%CI 0.7-1.5). For 89.6% of 1942 patients, both values indicated the same DM status (no DM, HbA_1c <6.5%) or had acceptable deviation (relative difference <6%). Individual agreement was variable, with POC values up to 1.8% units higher or 1.6% lower. For a minority, use of POC HbA_1c alone could result in error leading to potential overtreatment (n = 40, 2.1%) or undertreatment (n = 1, 0.1%). The remainder had moderate disagreement, which was less likely to influence clinical decisions.

CONCLUSION

POC HbA_1c is pragmatic and sufficiently accurate to screen for hyperglycaemia and DM risk among TB patients.

The mitogenome of a 35,000-year-old Homo sapiens from Europe supports a Palaeolithic back-migration to Africa

After the dispersal of modern humans (Homo sapiens) Out of Africa, hominins with a similar morphology to that of present-day humans initiated the gradual demographic expansion into Eurasia. The mitogenome (33-fold coverage) of the Peştera Muierii 1 individual (PM1) from Romania (35 ky cal BP) we present in this article corresponds fully to Homo sapiens, whilst exhibiting a mosaic of morphological features related to both modern humans and Neandertals. We have identified the PM1 mitogenome as a basal haplogroup U6*, not previously found in any ancient or present-day humans. The derived U6 haplotypes are predominantly found in present-day North-Western African populations. Concomitantly, those found in Europe have been attributed to recent gene-flow from North Africa. The presence of the basal haplogroup U6* in South East Europe (Romania) at 35 ky BP confirms a Eurasian origin of the U6 mitochondrial lineage. Consequently, we propose that the PM1 lineage is an offshoot to South East Europe that can be traced to the Early Upper Paleolithic back migration from Western Asia to North Africa, during which the U6 lineage diversified, until the emergence of the present-day U6 African lineages.

A rare occurrence of three consecutive autosomal trisomic pregnancies in a couple without offspring

BACKGROUND

Trisomies are the most common chromosomal abnormalities, being a major cause of pregnancy loss in the first trimester. Data from preimplantation embryos support the concept of recurrent aneuploidy in women with recurrent abortion.

CASE

The authors report a rare case with three different consecutive trisomic pregnancies: 47,XY,+21, 47,XX,+9, and 47,XX,+18. All pregnancies resulted from the same relationship and no consanguinity was present. Standard clinical cytogenetic analysis indicated that both members had normal peripheral blood karyotype, with no evidence of mosaicism in either patient or her partner.

CONCLUSION

The present report sup- ports the hypothesis that some women have a higher risk for nondisjunction than others of the same age. Counseling a couple with re- current trisomies is difficult and future research on genetics of cell division are required to assist them.

The association of the rs1049353 polymorphism of the CNR1 gene with hypoadiponectinemia

The endocannabinoid system (ECS) is an important physiological system that modulates appetite, food intake, energy homeostasis, substance addiction. It is comprised of the cannabinoid receptors (CB1 and CB2), the endogenous lipid ligands of these receptors and the enzymes that mediate the endogenous ligands' biosynthesis and degradation. CB1 receptor is expressed in the brain, adipose tissue, liver, skeletal muscle, gastrointestinal tract and pancreas. The CB1 receptor is encoded by CNR1 gene located at 6q14-q15 level. The aim of our study was to investigate the possible correlation between rs1049353 polymorphism of the CNR1 gene with levels of adiponectin in a group of subjects from Romania. The study included 305 subjects divided in two groups according to their fasting adiponectin levels. Fasting adiponectin levels were determined using ELISA technique. The genotyping of the rs1049353 polymorphism of the CNR1 gene was made using the Real-Time PCR technique. The statistical analysis was performed using De Finetti's program. The differences between the allelic frequencies indicated that the presence of G-wild allele seems to confer risk for expressing low levels of adiponectin (OR=1.917; 95%C.I.=1.353-2.715; p=0.00023) and A-mutant allele seems to be protective (OR=0.522; 95%C.I.=0.368-0.739; p=0.00023). At the test of allelic positivity, the presence of the G-allele conferred risk of hypoadiponectinemia (OR=2.113; 95%C.I.=1.324-3.373). In conclusion, this study indicates that the rs1049353 polymorphism of the CNR1 gene is associated with decreased levels of adiponectin. Further research is needed in order to elucidate the link between the polymorphisms of the CNR1 gene and adiponectin levels.

Clinical relevance of vascular endothelial growth factor-A in colorectal cancer

PURPOSE

To study the expression status and clinical relevance of vascular endothelial growth factor-A (VEGF-A) in colorectal cancer (CRC) tissues.

EXPERIMENTAL DESIGN

VEGF-A expression was investigated by immunohistochemistry in 89 cases with CRC. Some demographic and histopathological variables were compared with VEGF-A expression to determine the prognostic significance in CRC.

RESULTS

VEGF-A (-) was found in 24 cases; (+), (++) and (+++) stainings were detected in 24, 35 and six cases, respectively. VEGF-A (-) was found in 20 of 58 cases with left colon cancer, while only four of 31 cases with right colon cancer were VEGF-A (-) (p=0.024). There was a trend for lower tumor grade and lesser serosal invasion in cases with VEGF-A (-) samples (p=0.07 and p=0.079, respectively). Although the correlation was not statistically significant, there was a trend for lower death rate in cases with VEGF-A (-) tumor (p=0.087). The longest survival was found in cases with VEGF-A (-) tumor and the shortest survival was found in cases with VEGF-A (+++) tumor. Median survival for patients with VEGF-A (-), (+), (++) and (+++) tumors was 59, 47, 35 and 11 months, respectively (p=0.02). The Cox proportional hazards model identified stage IV disease and VEGF-A (+++) tumor as having the most important influences upon overall survival (odds ratio: 5.1, 95% confidence interval: 2.0-13.0 and odds ratio: 3.6, 95% confidence interval: 1.0-12.7, respectively), followed by serosal invasion (odds ratio: 2.4, 95% confidence interval: 1.0-5.9).

CONCLUSIONS

This study shows that VEGF-A is a poor prognostic factor in cases with CRC, but the relatively small size of the study group precluded the correlation with the entire known prognostic indicator.

Genetic patterns of metalloproteinases and their tissular inhibitors - clinicopathologic and prognostic significance in colorectal cancer

Colorectal cancer (CRC) is the third most common cancer in men and second in women. Progression and invasion of colorectal cancer is a multistep process involving multiple interactions between the tumor and the surrounding stroma mediated by many proteins, among them metalloproteinases (MMPs) and tissular inhibitors of metalloproteinases (TIMPs). We aimed to review the correlations between the expression of the MMPs and TIMPs genes and the clinicopathologic variables of the CRC. Levels of MMPs genes expression in colorectal cancer correlate with the depth of invasion, hematogenous and lymphatic metastasis, poor differentiation, Duke's stage and prognosis. Levels of TIMP's genes expression correlate with better prognosis and longer survival. There are also some controversial data explained by the fact that most of the studies addressed one or few MMPs and÷or TIMPs. The methods to assess the variance in gene expression were not always the same. The promoter regions of metalloproteinases present many polymorphisms and all have allele-specific effects on regulation of MMP gene transcription. Numerous studies on the association of these polymorphisms with cancer susceptibility have been carried out. Most of the studies addressed one or two polymorphisms and their implications. A meta-analysis is necessary to confirm significant correlations. The heterogenicity of the MMPs and TIMPs genetic patterns generated by different studies on colorectal cancer does not allow us to have an overall correlation with clinicopathologic variables and the prognosis of the disease. Studies that involve many MMPs, TIMPs polymorphisms and their tissular expression would be more valuable to better assess the role of those enzymes in the progression of the disease and may serve as a starting point for selective therapeutic approaches.

Pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disorder of connective tissue, characterized by elastic fibers mineralization and fragmentation, and affects the skin, eyes, cardiovascular system, and gastrointestinal system. PXE is caused by mutations in the ABCC6 gene, located on chromosome 16p13.1. We investigated clinical and laboratory three patients with pseudoxanthoma elasticum. All the patients present on dermatological examination yellowish papules, located especially on the neck and axillary area. In case no. 2 the patient presents "cutis laxa" in the axillary area. In case no. 3 the patient presents hyperpigmented spot on right forearm and another maculo-pigmented oval spot located at the base of the left posterior hemithorax. In two cases, the ophthalmologic examination shows angioid streaks. The modifications of elastic fibers (thickened or fragmented) are present in all cases.

Modified variant of the Rieske iron-sulfur protein in the hippocampus of kindled rats and human epileptic patients

Kindled seizures are widely used to model epileptogenesis, but the molecular mechanisms underlying the attainment of kindling status are largely unknown. Recently we showed that achievement of kindling status in the Sprague-Dawley rat is associated with a critical developmental interval of 25 +/- 1 days; the identification of this long, well-defined developmental interval for inducing kindling status makes possible a dissection of the cellular and genetic events underlying this phenomenon and its relationship to normal and pathological brain function. Now we report the identification, by proteomics, of a modified variant of the Rieske iron-sulfur protein, a component of the mitochondrial cytochrome bc1 complex, whose isoelectric point is shifted toward more alkaline values in the hippocampus of kindled rats. By immunohistochemistry the Rieske protein is well-expressed in the hippocampus except in the CA1 subfield, a region of selective vulnerability to seizures in humans and animal models. We also noted an asymmetric, selective expression of the Rieske protein in the subgranular neurons of the dorsal dentate gyrus, a region implicated in neurogenesis. Abnormal changes in Rieske protein immunoreactivity also were found in sections obtained from human epileptic patients. These results suggest that the Rieske protein may play a role in the response of neurons to seizure activity and could give important new insights into the molecular pathogenesis of epilepsy.