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Venkatakrishna SSB, Sharma P, Tierradentro-Garcia LO, Elsingergy M, Worede F, Curic J, Alves CAP, Andronikou S. Frequency of Cerebellar Abnormalities Associated With the Differing Magnetic Resonance Imaging Patterns of Term Hypoxic-Ischemic Injury in Children. Pediatr Neurol 2024; 152:73-78. [PMID: 38232653 DOI: 10.1016/j.pediatrneurol.2023.12.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 11/30/2023] [Accepted: 12/25/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND We aimed to determine the frequency of cerebellar injury using delayed magnetic resonance imaging (MRI) in children with cerebral palsy, diagnosed with term hypoxic-ischemic injury (HII), and to characterize this for the different MRI patterns of HII. METHODS We retrospectively reviewed delayed MRI scans in children with cerebral palsy, of whom 1175 had term HII. The pattern of HII was classified into basal ganglia-thalamus (BGT) pattern, watershed (WS) pattern, combined BGT/WS, and multicystic HII. Cerebellar location (hemisphere versus vermis) and the MRI characteristics were documented overall and for each of the different patterns of HII, as well as the association with thalamic injury. RESULTS Cerebellar injury was found in 252 of 1175 (21.4%) (median age 6 years [interquartile range: 3 to 9 years]). Of these, 49% (124 of 252) were associated with a BGT pattern, 13% (32 of 252) with a WS pattern, 28% (72 of 252) with a combined BGT/WS pattern, and 10% (24 of 252) with a multicystic pattern. The vermis was abnormal in 83% (209 of 252), and the hemispheres were abnormal in 34% (86 of 252) (with 17% [43 of 252] showing both vermis and hemispheric abnormality). CONCLUSIONS Over a fifth of patients with cerebral palsy due to HII had a cerebellar abnormality on delayed MRI, most commonly involving the vermis (83%), and as part of a BGT pattern of injury in just under half of these likely reflecting the association of cerebellar vermis injury with profound insults.
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Affiliation(s)
| | - Parth Sharma
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mohamed Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fikadu Worede
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jelena Curic
- Graduate MBA Program, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Cesar Augusto P Alves
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Iwata-Otsubo A, Skraban CM, Yoshimura A, Sakata T, Alves CAP, Fiordaliso SK, Kuroda Y, Vengoechea J, Grochowsky A, Ernste P, Lulis L, Nesbitt A, Tayoun AA, Gray C, Towne MC, Radtke K, Normand EA, Rhodes L, Seiler C, Shirahige K, Izumi K. Biallelic variants in GTF3C5, a regulator of RNA polymerase III-mediated transcription, cause a multisystem developmental disorder. Hum Genet 2024; 143:437-453. [PMID: 38520561 DOI: 10.1007/s00439-024-02656-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/25/2024]
Abstract
General transcription factor IIIC subunit 5 (GTF3C5) encodes transcription factor IIIC63 (TFIIIC63). It binds to DNA to recruit another transcription factor, TFIIIB, and RNA polymerase III (Pol III) to mediate the transcription of small noncoding RNAs, such as tRNAs. Here, we report four individuals from three families presenting with a multisystem developmental disorder phenotype with biallelic variants in GTF3C5. The overlapping features include growth retardation, developmental delay, intellectual disability, dental anomalies, cerebellar malformations, delayed bone age, skeletal anomalies, and facial dysmorphism. Using lymphoblastoid cell lines (LCLs) from two affected individuals, we observed a reduction in TFIIIC63 protein levels compared to control LCLs. Genome binding of TFIIIC63 protein is also reduced in LCL from one of the affected individuals. Additionally, approximately 40% of Pol III binding regions exhibited reduction in the level of Pol III occupancy in the mutant genome relative to the control, while approximately 54% of target regions showed comparable levels of Pol III occupancy between the two, indicating partial impairment of Pol III occupancy in the mutant genome. Yeasts with subject-specific variants showed temperature sensitivity and impaired growth, supporting the notion that the identified variants have deleterious effects. gtf3c5 mutant zebrafish showed developmental defects, including a smaller body, head, and eyes. Taken together, our data show that GTF3C5 plays an important role in embryonic development, and that biallelic variants in this gene cause a multisystem developmental disorder. Our study adds GTF3C5-related disorder to the growing list of genetic disorders associated with Pol III transcription machinery.
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Affiliation(s)
- Aiko Iwata-Otsubo
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Pathology, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| | - Cara M Skraban
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Atsunori Yoshimura
- Laboratory of Genome Structure and Function, Institute for Quantitative Biosciences, The University of Tokyo, Tokyo, 113-0032, Japan
| | - Toyonori Sakata
- Laboratory of Genome Structure and Function, Institute for Quantitative Biosciences, The University of Tokyo, Tokyo, 113-0032, Japan
| | - Cesar Augusto P Alves
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Sarah K Fiordaliso
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Yukiko Kuroda
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jaime Vengoechea
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Angela Grochowsky
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Paige Ernste
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Invitae, San Francisco, CA, 94103, USA
| | - Lauren Lulis
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Addie Nesbitt
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Veritas Genetics, Danvers, MA, 01923, USA
| | - Ahmad Abou Tayoun
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Center for Genomic Discovery, Mohammed Bin Rashid University, Dubai Health, UAE
| | - Christopher Gray
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | | | | | | | | | - Christoph Seiler
- Zebrafish Core, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Katsuhiko Shirahige
- Laboratory of Genome Structure and Function, Institute for Quantitative Biosciences, The University of Tokyo, Tokyo, 113-0032, Japan
| | - Kosuke Izumi
- Division of Human Genetics/Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Laboratory of Rare Disease Research, Institute for Quantitative Biosciences, The University of Tokyo, Tokyo, 113-0032, Japan.
- Division of Genetics and Metabolism, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8573, USA.
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3
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Nomakuchi TT, Alves CAP, Beslow LA, Zarnow D, Goyal N, Zackai EH, Reynoso Santos FJ. Subdural Hemorrhage as an Early Presentation in a Case of Sotos Syndrome. Neuropediatrics 2024; 55:71-74. [PMID: 36914163 DOI: 10.1055/a-2052-8750] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Subdural hemorrhages (SDHs) in the pediatric population are associated with a high mortality and morbidity and may present in the context of abusive head trauma. Diagnostic investigations for such cases often include evaluation for rare genetic and metabolic disorders that can have associated SDH. Sotos syndrome is an overgrowth syndrome associated with macrocephaly and increased subarachnoid spaces and rarely with neurovascular complications. Here, we report two cases of Sotos syndrome, one with SDH during infancy who underwent repeated evaluation for suspected child abuse prior to the Sotos syndrome diagnosis and the other with enlarged extra-axial cerebrospinal fluid spaces, demonstrating a possible mechanism for SDH development in this setting. These cases suggest that some individuals with Sotos syndrome may be at elevated risk of developing SDH in infancy and that Sotos syndrome should be on the differential diagnosis during a medical genetics evaluation in cases of unexplained SDH, especially in the setting of macrocephaly.
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Affiliation(s)
- Tomoki T Nomakuchi
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Cesar Augusto P Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Deborah Zarnow
- Division of Neuroradiology, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Radiology Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Neera Goyal
- Department of Pediatrics, Nemours Children's Health and Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Francis Jeshira Reynoso Santos
- Division of Human Genetics, Children's Hospital of Philadelphia, Pennsylvania, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
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Guo R, Rippert A, Cook EB, Alves CAP, Bird LM, Izumi K. Expansion of clinical and variant spectrum of EEF2-related neurodevelopmental disorder: Report of two additional cases. Am J Med Genet A 2023; 191:2602-2609. [PMID: 37159414 PMCID: PMC10527330 DOI: 10.1002/ajmg.a.63230] [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: 01/31/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
Eukaryotic translation elongation factor 2 (eEF2), encoded by the gene EEF2, is an essential factor involved in the elongation phase of protein translation. A specific heterozygous missense variant (p.P596H) in EEF2 was originally identified in association with autosomal dominant adult-onset spinocerebellar ataxia-26 (SCA26). More recently, additional heterozygous missense variants in this gene have been described to cause a novel, childhood-onset neurodevelopmental disorder with benign external hydrocephalus. Herein, we report two unrelated individuals with a similar gene-disease correlation to support this latter observation. Patient 1 is a 7-year-old male with a previously reported, de novo missense variant (p.V28M) who has motor and speech delay, autism spectrum disorder, failure to thrive with relative macrocephaly, unilateral microphthalmia with coloboma and eczema. Patient 2 is a 4-year-old female with a novel de novo nonsense variant (p.Q145X) with motor and speech delay, hypotonia, macrocephaly with benign ventricular enlargement, and keratosis pilaris. These additional cases help to further expand the genotypic and phenotypic spectrum of this newly described EEF2-related neurodevelopmental syndrome.
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Affiliation(s)
- Rose Guo
- Division of Human Genetics, Children’s Hospital of Philadelphia, Pennsylvania, Pennsylvania, USA
| | - Alyssa Rippert
- Division of Human Genetics, Children’s Hospital of Philadelphia, Pennsylvania, Pennsylvania, USA
| | - Edward B Cook
- Division of Human Genetics, Children’s Hospital of Philadelphia, Pennsylvania, Pennsylvania, USA
| | - Cesar Augusto P Alves
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California San Diego; Division of Dysmorphology/Genetics, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Kosuke Izumi
- Division of Human Genetics, Children’s Hospital of Philadelphia, Pennsylvania, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Current affiliation: Division of Genetics and Metabolism, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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5
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Wongkittichote P, Pantano C, Bogush E, Alves CAP, Hong X, He M, Demczko MM, Ganetzky RD, Goldstein A. Clinical, radiological, biochemical and molecular characterization of a new case with multiple mitochondrial dysfunction syndrome due to IBA57: Lysine and tryptophan metabolites as potential biomarkers. Mol Genet Metab 2023; 140:107710. [PMID: 37903659 DOI: 10.1016/j.ymgme.2023.107710] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
Iron‑sulfur clusters (FeS) are one of the most primitive and ubiquitous cofactors used by various enzymes in multiple pathways. Biosynthesis of FeS is a complex multi-step process that is tightly regulated and requires multiple machineries. IBA57, along with ISCA1 and ISCA2, play a role in maturation of [4Fe-4S] clusters which are required for multiple mitochondrial enzymes including mitochondrial Complex I, Complex II, lipoic acid synthase, and aconitase. Pathogenic variants in IBA57 have been associated with multiple mitochondrial dysfunctions syndrome 3 (MMDS3) characterized by infantile to early childhood-onset psychomotor regression, optic atrophy and nonspecific dysmorphism. Here we report a female proband who had prenatal involvement including IUGR and microcephaly and developed subacute psychomotor regression at the age of 5 weeks in the setting of preceding viral infection. Brain imaging revealed cortical malformation with polymicrogyria and abnormal signal alteration in brainstem and spinal cord. Biochemical analysis revealed increased plasma glycine and hyperexcretion of multiple organic acids in urine, raising the concern for lipoic acid biosynthesis defects and mitochondrial FeS assembly defects. Molecular analysis subsequently detected compound heterozygous variants in IBA57, confirming the diagnosis of MMDS3. Although the number of MMDS3 patients are limited, certain degree of genotype-phenotype correlation has been observed. Unusual brain imaging in the proband highlights the need to include mitochondrial disorders as differential diagnoses of structural brain abnormalities. Lastly, in addition to previously known biomarkers including high blood lactate and plasma glycine levels, the increase of 2-hydroxyadipic and 2-ketoadipic acids in urine organic acid analysis, in the appropriate clinical context, should prompt an evaluation for the lipoic acid biosynthesis defects and mitochondrial FeS assembly defects.
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Affiliation(s)
- Parith Wongkittichote
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cassandra Pantano
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emily Bogush
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cesar Augusto P Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xinying Hong
- Division of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miao He
- Division of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew M Demczko
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca D Ganetzky
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Amy Goldstein
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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