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Almannai M, Marafi D, Zaki MS, Maroofian R, Efthymiou S, Saadi NW, Filimban B, Dafsari HS, Rahman F, Maqbool S, Faqeih E, Al Mutairi F, Alsharhan H, Abdelaty O, Bin-Hasan S, Duan R, Noureldeen MM, Alqattan A, Houlden H, Hunter JV, Posey JE, Lupski JR, El-Hattab AW. Expanding the phenotype of PPP1R21-related neurodevelopmental disorder. Clin Genet 2024; 105:620-629. [PMID: 38356149 PMCID: PMC11065596 DOI: 10.1111/cge.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
PPP1R21 encodes for a conserved protein that is involved in endosomal maturation. Biallelic pathogenic variants in PPP1R21 have been associated with a syndromic neurodevelopmental disorder from studying 13 affected individuals. In this report, we present 11 additional individuals from nine unrelated families and their clinical, radiological, and molecular findings. We identified eight different variants in PPP1R21, of which six were novel variants. Global developmental delay and hypotonia are neurological features that were observed in all individuals. There is also a similar pattern of dysmorphic features with coarse faces as a gestalt observed in several individuals. Common findings in 75% of individuals with available brain imaging include delays in myelination, wavy outline of the bodies of the lateral ventricles, and slight prominence of the bodies of the lateral ventricles. PPP1R21-related neurodevelopmental disorder is associated with a consistent phenotype and should be considered in highly consanguineous individuals presenting with developmental delay/intellectual disability along with coarse facial features.
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Affiliation(s)
- Mohammed Almannai
- Genetics and Precision Medicine department (GPM), King
Abdullah Specialized Children’s Hospital (KASCH), King Abdulaziz Medical
City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- Medical Genomics Research Department, King Abdullah
International Medical Research Center, Ministry of National Guard Health Affairs,
King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard
Health Affairs, Riyadh, Saudi Arabia
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas, 77030, USA
- Department of Pediatrics, College of Medicine, Kuwait
University, P.O. Box 24923, 13110 Safat, Kuwait
| | - Maha S. Zaki
- Clinical Genetics Department, Human Genetics and Genome
Research Institute National Research Centre, Cairo, Egypt
- Genetics Department, Armed Forces College of Medicine
(AFCM), Cairo, Egypt
| | - Reza Maroofian
- Department of Neuromuscular disorders, UCL Queen Square
Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular disorders, UCL Queen Square
Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Nebal Waill Saadi
- College of Medicine, University of Baghdad, Pediatric
Neurology, Children Welfare Teaching Hospital, Baghdad, Iraq
| | - Bilal Filimban
- Section of Medical Genetics, Children’s Hospital,
King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hormos Salimi Dafsari
- Department of Pediatrics, Center for Rare Diseases,
Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne,
Germany
- Randall Centre for Cell and Molecular Biophysics,
Faculty of Life Sciences and Medicine (FoLSM), King’s College London, London,
United Kingdom
- Max-Planck-Institute for Biology of Ageing, Cologne,
Germany
- Cologne Excellence Cluster on Cellular Stress Responses
in Aging Associated Diseases (CECAD), Cologne, Germany
| | - Fatima Rahman
- Department of Developmental - Behavioral Pediatrics,
University of Child Health Sciences & The Children’s Hospital, Lahore,
Pakistan
| | - Shazia Maqbool
- Department of Developmental - Behavioral Pediatrics,
University of Child Health Sciences & The Children’s Hospital, Lahore,
Pakistan
| | - Eissa Faqeih
- Section of Medical Genetics, Children’s Hospital,
King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fuad Al Mutairi
- Genetics and Precision Medicine department (GPM), King
Abdullah Specialized Children’s Hospital (KASCH), King Abdulaziz Medical
City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- Medical Genomics Research Department, King Abdullah
International Medical Research Center, Ministry of National Guard Health Affairs,
King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard
Health Affairs, Riyadh, Saudi Arabia
| | - Hind Alsharhan
- Department of Pediatrics, College of Medicine, Kuwait
University, P.O. Box 24923, 13110 Safat, Kuwait
- Department of Pediatrics, Farwaniya Hospital, Ministry
of Health, Sabah Al-Nasser, 92426, Kuwait
- Kuwait Medical Genetics Center, Ministry of Health,
Sulaibikhat, 80901, Kuwait
- Department of Genetic Medicine, Johns Hopkins University
School of Medicine, Baltimore, MD, USA
| | - Omar Abdelaty
- Department of Pediatrics, Farwaniya Hospital, Ministry
of Health, Sabah Al-Nasser, 92426, Kuwait
| | - Saadoun Bin-Hasan
- Department of Pediatrics, Farwaniya Hospital, Ministry
of Health, Sabah Al-Nasser, 92426, Kuwait
| | - Ruizhi Duan
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas, 77030, USA
| | - Mahmoud M. Noureldeen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef
University, Beni-Suef, Egypt
| | - Alaa Alqattan
- Department of Pediatrics, Farwaniya Hospital, Ministry
of Health, Sabah Al-Nasser, 92426, Kuwait
| | - Henry Houlden
- Department of Neuromuscular disorders, UCL Queen Square
Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jill V Hunter
- Texas Children Hospital, Houston, Texas, 77030,
USA
- Department of Radiology, Baylor College of Medicine,
Houston, Texas, 77030
| | - Jennifer E. Posey
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas, 77030, USA
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas, 77030, USA
- Texas Children Hospital, Houston, Texas, 77030,
USA
- Human Genome Sequencing Center, Baylor College of
Medicine, Houston, Texas, 77030, USA
- Department of Pediatrics, Baylor College of Medicine,
Houston, Texas, 77030, USA
| | - Ayman W. El-Hattab
- Department of Clinical Sciences, College of Medicine,
University of Sharjah, Sharjah, United Arab Emirates
- Genetics Clinics, University Hospital Sharjah, Sharjah,
United Arab Emirates
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2
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Vong KI, Lee S, Au KS, Crowley TB, Capra V, Martino J, Haller M, Araújo C, Machado HR, George R, Gerding B, James KN, Stanley V, Jiang N, Alu K, Meave N, Nidhiry AS, Jiwani F, Tang I, Nisal A, Jhamb I, Patel A, Patel A, McEvoy-Venneri J, Barrows C, Shen C, Ha YJ, Howarth R, Strain M, Ashley-Koch AE, Azam M, Mumtaz S, Bot GM, Finnell RH, Kibar Z, Marwan AI, Melikishvili G, Meltzer HS, Mutchinick OM, Stevenson DA, Mroczkowski HJ, Ostrander B, Schindewolf E, Moldenhauer J, Zackai EH, Emanuel BS, Garcia-Minaur S, Nowakowska BA, Stevenson RE, Zaki MS, Northrup H, McNamara HK, Aldinger KA, Phelps IG, Deng M, Glass IA, Morrow B, McDonald-McGinn DM, Sanna-Cherchi S, Lamb DJ, Gleeson JG, Koch AEA, Meltzer HS, Le J, Au KS, Northrup H, Bot GM, Capra V, Finnell RH, Kibar Z, Lupo PJ, Machado HR, Araújo C, Magana T, Marwan AI, Melikishvili G, Mutchinick OM, Stevenson RE, Yurrita A, Zaki MS, Mumtaz S, Medina-Bereciartu JR, Kolvenbach CM, Shril S, Hildebrandt F, Noureldeen MM, Salem AM, Takahashi Y, Salimi-Dafsari H, Phillips HW, Hanak B, Kara B, Güneş AS, Gonda DD, Kirmani S, Tkemaladze T, Gleeson JG. Risk of meningomyelocele mediated by the common 22q11.2 deletion. Science 2024; 384:584-590. [PMID: 38696583 DOI: 10.1126/science.adl1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/27/2024] [Indexed: 05/04/2024]
Abstract
Meningomyelocele is one of the most severe forms of neural tube defects (NTDs) and the most frequent structural birth defect of the central nervous system. We assembled the Spina Bifida Sequencing Consortium to identify causes. Exome and genome sequencing of 715 parent-offspring trios identified six patients with chromosomal 22q11.2 deletions, suggesting a 23-fold increased risk compared with the general population. Furthermore, analysis of a separate 22q11.2 deletion cohort suggested a 12- to 15-fold increased NTD risk of meningomyelocele. The loss of Crkl, one of several neural tube-expressed genes within the minimal deletion interval, was sufficient to replicate NTDs in mice, where both penetrance and expressivity were exacerbated by maternal folate deficiency. Thus, the common 22q11.2 deletion confers substantial meningomyelocele risk, which is partially alleviated by folate supplementation.
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Affiliation(s)
- Keng Ioi Vong
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Sangmoon Lee
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Kit Sing Au
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX 77030, USA
| | - T Blaine Crowley
- 22q and You Center, Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Valeria Capra
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Jeremiah Martino
- Division of Nephrology, Department of Medicine, Columbia University, NY 10027, USA
| | - Meade Haller
- Center for Reproductive Medicine, Department of Molecular and Cellular Biology and Scott Department of Urology, Baylor College of Medicine, TX 77030, USA
| | - Camila Araújo
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Hélio R Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Renee George
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Bryn Gerding
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Kiely N James
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Valentina Stanley
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Nan Jiang
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Kameron Alu
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Naomi Meave
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Anna S Nidhiry
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Fiza Jiwani
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Isaac Tang
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Ashna Nisal
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Ishani Jhamb
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Arzoo Patel
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Aakash Patel
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Jennifer McEvoy-Venneri
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Chelsea Barrows
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Celina Shen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Yoo-Jin Ha
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Robyn Howarth
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Madison Strain
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Matloob Azam
- Pediatrics and Child Neurology, Wah Medical College, Wah Cantt, Punjab 47000, Pakistan
| | - Sara Mumtaz
- Department of Biological Sciences, National University of Medical Sciences (NUMS), Punjab 46000, Pakistan
| | - Gyang Markus Bot
- Neurosurgery Division, Department of Surgery, Jos University Teaching Hospital, Jos 930105, Nigeria
| | - Richard H Finnell
- Center for Precision Environmental Health, Departments of Molecular and Human Genetics, Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zoha Kibar
- Department of Neurosciences, University of Montreal and CHU Sainte Justine Research Center, Montreal, QC H3T 1C5, Canada
| | - Ahmed I Marwan
- Division of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital of Colorado, Colorado Fetal Care Center, Aurora, CO 80045, USA
| | - Gia Melikishvili
- Department of Pediatrics, MediClubGeorgia Medical Center, Tbilisi 0160, Georgia
| | - Hal S Meltzer
- Department of Neurosurgery, University of California San Diego, Rady Children's Hospital, San Diego, CA 92123, USA
| | - Osvaldo M Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico
| | - David A Stevenson
- Division of Medical Genetics, Stanford University, Palo Alto, CA 94305, USA
| | - Henry J Mroczkowski
- Division of Medical Genetics, University of Tennessee Health Science Campus, Memphis, TN 38163, USA
| | - Betsy Ostrander
- Division of Pediatric Neurology, Primary Children's Hospital, University of Utah, Salt Lake City, UT 84113, USA
| | - Erica Schindewolf
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Julie Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Elaine H Zackai
- 22q and You Center, Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beverly S Emanuel
- 22q and You Center, Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sixto Garcia-Minaur
- Clinical Genetics Section, Institute of Medical and Molecular Genetics, University Hospital La Paz, 28046 Madrid, Spain
| | - Beata A Nowakowska
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka, 01-211 Warsaw, Poland
| | - Roger E Stevenson
- JC Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC 29646, USA
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo 12311, Egypt
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX 77030, USA
| | - Hanna K McNamara
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Kimberly A Aldinger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
- Departments of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Department of Neurology, University of Washington, Seattle, WA 98105, USA
| | - Ian G Phelps
- Departments of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Mei Deng
- Departments of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Ian A Glass
- Departments of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Bernice Morrow
- Division of Translational Genetics, Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Donna M McDonald-McGinn
- 22q and You Center, Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Human Biology and Medical Genetics, Sapienza University, 00185-Rome RM, Italy
| | - Simone Sanna-Cherchi
- Division of Nephrology, Department of Medicine, Columbia University, NY 10027, USA
| | - Dolores J Lamb
- Center for Reproductive Medicine, Department of Molecular and Cellular Biology and Scott Department of Urology, Baylor College of Medicine, TX 77030, USA
- Department of Urology, Center for Reproductive Genomics, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Joseph G Gleeson
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA
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Lin SJ, Vona B, Lau T, Huang K, Zaki MS, Aldeen HS, Karimiani EG, Rocca C, Noureldeen MM, Saad AK, Petree C, Bartolomaeus T, Abou Jamra R, Zifarelli G, Gotkhindikar A, Wentzensen IM, Liao M, Cork EE, Varshney P, Hashemi N, Mohammadi MH, Rad A, Neira J, Toosi MB, Knopp C, Kurth I, Challman TD, Smith R, Abdalla A, Haaf T, Suri M, Joshi M, Chung WK, Moreno-De-Luca A, Houlden H, Maroofian R, Varshney GK. Evaluating the association of biallelic OGDHL variants with significant phenotypic heterogeneity. Genome Med 2023; 15:102. [PMID: 38031187 PMCID: PMC10688095 DOI: 10.1186/s13073-023-01258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Biallelic variants in OGDHL, encoding part of the α-ketoglutarate dehydrogenase complex, have been associated with highly heterogeneous neurological and neurodevelopmental disorders. However, the validity of this association remains to be confirmed. A second OGDHL patient cohort was recruited to carefully assess the gene-disease relationship. METHODS Using an unbiased genotype-first approach, we screened large, multiethnic aggregated sequencing datasets worldwide for biallelic OGDHL variants. We used CRISPR/Cas9 to generate zebrafish knockouts of ogdhl, ogdh paralogs, and dhtkd1 to investigate functional relationships and impact during development. Functional complementation with patient variant transcripts was conducted to systematically assess protein functionality as a readout for pathogenicity. RESULTS A cohort of 14 individuals from 12 unrelated families exhibited highly variable clinical phenotypes, with the majority of them presenting at least one additional variant, potentially accounting for a blended phenotype and complicating phenotypic understanding. We also uncovered extreme clinical heterogeneity and high allele frequencies, occasionally incompatible with a fully penetrant recessive disorder. Human cDNA of previously described and new variants were tested in an ogdhl zebrafish knockout model, adding functional evidence for variant reclassification. We disclosed evidence of hypomorphic alleles as well as a loss-of-function variant without deleterious effects in zebrafish variant testing also showing discordant familial segregation, challenging the relationship of OGDHL as a conventional Mendelian gene. Going further, we uncovered evidence for a complex compensatory relationship among OGDH, OGDHL, and DHTKD1 isoenzymes that are associated with neurodevelopmental disorders and exhibit complex transcriptional compensation patterns with partial functional redundancy. CONCLUSIONS Based on the results of genetic, clinical, and functional studies, we formed three hypotheses in which to frame observations: biallelic OGDHL variants lead to a highly variable monogenic disorder, variants in OGDHL are following a complex pattern of inheritance, or they may not be causative at all. Our study further highlights the continuing challenges of assessing the validity of reported disease-gene associations and effects of variants identified in these genes. This is particularly more complicated in making genetic diagnoses based on identification of variants in genes presenting a highly heterogenous phenotype such as "OGDHL-related disorders".
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Affiliation(s)
- Sheng-Jia Lin
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Barbara Vona
- Institute of Human Genetics, Julius Maximilians University Würzburg, Würzburg, Germany
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Department of Otolaryngology-Head and Neck Surgery, Tübingen Hearing Research Center, Eberhard Karls University, Tübingen, 72076, Germany
| | - Tracy Lau
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Kevin Huang
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Huda Shujaa Aldeen
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Ehsan Ghayoor Karimiani
- Molecular and Clinical Sciences Institute, St. George's, University of London, Cranmer Terrace London, London, UK
| | - Clarissa Rocca
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Mahmoud M Noureldeen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed K Saad
- Medical Molecular Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Cassidy Petree
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Tobias Bartolomaeus
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | | | | | | | - Emalyn Elise Cork
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pratishtha Varshney
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Narges Hashemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Aboulfazl Rad
- Department of Otolaryngology-Head and Neck Surgery, Tübingen Hearing Research Center, Eberhard Karls University, Tübingen, 72076, Germany
| | - Juanita Neira
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Cordula Knopp
- Institute for Human Genetics and Genomic Medicine, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Ingo Kurth
- Institute for Human Genetics and Genomic Medicine, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Thomas D Challman
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Rebecca Smith
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Asmahan Abdalla
- Department of Pediatric Endocrinology, Gaafar Ibn Auf Children's Tertiary Hospital, Khartoum, Sudan
| | - Thomas Haaf
- Institute of Human Genetics, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Mohnish Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Manali Joshi
- Bioinformatics Centre, S. P. Pune University, Pune, India
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospitaland, Harvard Medical School , Boston, MA, USA
| | - Andres Moreno-De-Luca
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Henry Houlden
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Reza Maroofian
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK.
| | - Gaurav K Varshney
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.
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Zaki MS, Sharaf-Eldin WE, Rafat K, Elbendary HM, Kamel M, Elkhateeb N, Noureldeen MM, Abdeltawab MA, Sadek AA, Essawi ML, Lau T, Murphy D, Abdel-Hamid MS, Holuden H, Issa MY, Gleeson JG. Clinical and molecular spectrum of a large Egyptian cohort with ALS2-related disorders of infantile-onset of clinical continuum IAHSP/JPLS. Clin Genet 2023. [PMID: 37055917 DOI: 10.1111/cge.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Abstract
This study presents 46 patients from 23 unrelated Egyptian families with ALS2-related disorders without evidence of lower motor neuron involvement. Age at onset ranged from 10 months to 2.5 years, featuring progressive upper motor neuron signs. Detailed clinical phenotypes demonstrated inter- and intrafamilial variability. We identified 16 homozygous disease-causing ALS2 variants; sorted as splice-site, missense, frameshift, nonsense and in-frame in eight, seven, four, three, and one families, respectively. Seven of these variants were novel, expanding the mutational spectrum of the ALS2 gene. As expected, clinical severity was positively correlated with disease onset (p = 0.004). This work provides clinical and molecular profiles of a large single ethnic cohort of patients with ALS2 mutations, and suggests that infantile ascending hereditary spastic paralysis (IAHSP) and juvenile primary lateral sclerosis (JPLS) are belonged to one entity with no phenotype-genotype correlation.
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Affiliation(s)
- Maha S Zaki
- Department of Clinical Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Wessam E Sharaf-Eldin
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Karima Rafat
- Department of Clinical Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Hasnaa M Elbendary
- Department of Clinical Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Mona Kamel
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nour Elkhateeb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Clinical Genetics, Cambridge University Hospitals, Cambridge, UK
| | - Mahmoud M Noureldeen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed A Abdeltawab
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Abdelrahim A Sadek
- Pediatric Neurology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mona L Essawi
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Tracy Lau
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David Murphy
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Mohamed S Abdel-Hamid
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Henry Holuden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Mahmoud Y Issa
- Department of Clinical Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Joseph G Gleeson
- Department of Neurosciences, University of California, San Diego, La Jolla, USA
- Rady Children's Hospital, Rady Children's Institute for Genomic Medicine, San Diego, La Jolla, USA
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5
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Klöckner C, Murray JPF, Tavasoli M, Sticht H, Stoltenburg-Didinger G, Scholle LM, Bakhtiari S, Kruer MC, Darvish H, Firouzabadi SG, Pagnozzi A, Shukla A, Girisha KM, Narayanan DL, Kaur P, Maroofian R, Zaki MS, Noureldeen MM, Merkenschlager A, Gburek-Augustat J, Cali E, Banu S, Nahar K, Efthymiou S, Houlden H, Jamra RA, Williams J, McMaster CR, Platzer K. Bi-allelic variants in CHKA cause a neurodevelopmental disorder with epilepsy and microcephaly. Brain 2022; 145:1916-1923. [PMID: 35202461 DOI: 10.1093/brain/awac074] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/15/2021] [Accepted: 02/06/2022] [Indexed: 11/14/2022] Open
Abstract
The Kennedy pathways catalyze the de novo synthesis of phosphatidylcholine and phosphatidylethanolamine, the most abundant components of eukaryotic cell membranes. In recent years, these pathways have moved into clinical focus since four out of ten genes involved have been associated with a range of autosomal recessive rare diseases such as a neurodevelopmental disorder with muscular dystrophy (CHKB), bone abnormalities and cone-rod dystrophy (PCYT1A), and spastic paraplegia (PCYT2, SELENOI). We identified six individuals from five families with bi-allelic variants in CHKA presenting with severe global developmental delay, epilepsy, movement disorders, and microcephaly. Using structural molecular modeling and functional testing of the variants in a in a cell-based S. cerevisiae model, we determined that these variants reduce the enzymatic activity of CHKA and confer a significant impairment of the first enzymatic step of the Kennedy pathway. In summary, we present CHKA as a novel autosomal recessive gene for a neurodevelopmental disorder with epilepsy and microcephaly.
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Affiliation(s)
- Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Mahtab Tavasoli
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3N 0A1, Canada
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Child Health, Neurology, Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Child Health, Neurology, Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Hossein Darvish
- Neuroscience Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Alex Pagnozzi
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, QLD 4029, Australia
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Katta Mohan Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Parneet Kaur
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Reza Maroofian
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mahmoud M Noureldeen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Andreas Merkenschlager
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Elisa Cali
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Selina Banu
- Department of Pediatric Neurology, Dr. M.R. Khan Shishu (Children) Hospital and ICH, Mirpur, Dhaka, Bangladesh
| | - Kamrun Nahar
- Department of Pediatric Neurology, Dr. M.R. Khan Shishu (Children) Hospital and ICH, Mirpur, Dhaka, Bangladesh
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Jason Williams
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3N 0A1, Canada
| | | | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
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