Identification of a novel splice-site WWOX variant with paternal uniparental isodisomy in a patient with infantile epileptic encephalopathy

WOREE syndrome is an early infantile epileptic encephalopathy characterized by drug-resistant seizures and severe psychomotor developmental delays. We report a case of a WWOX splice-site mutation with uniparental isodisomy. A 1-year and 7-month-old girl presented with nystagmus and epileptic seizures from early infancy, with no fixation or pursuit of vision. Physical examination revealed small deformities, such as swelling of both cheeks, folded fingers, rocking feet, and scoliosis. Brain imaging revealed slight hypoplasia of the cerebrum. Electroencephalogram showed focal paroxysmal discharges during the interictal phase of seizures. Vitamin B6 and zonisamide were administered for early infantile epileptic encephalopathy; however, the seizures were not relieved. Despite altering the type and dosage of antiepileptic drugs and ACTH therapy, the seizures were intractable. Whole-exome analysis revealed the homozygosity of WWOX(NM_016373.4):c.516+1G>A. The WWOX mRNA sequencing using peripheral blood RNA confirmed that exon 5 was homozygously deleted. Based on these results, the patient was diagnosed with WOREE syndrome at 5 months. The WWOX variant found in this study is novel and has never been reported before. WOREE syndrome being extremely rare, further case series and analyses of its pathophysiology are warranted.

Immunological characteristics of severe acute hepatitis of unknown origin in a child post SARS-CoV-2 infection

Recent studies have reported that pediatric acute liver failure of unknown origin is immune-mediated, with CD8⁺ T cells playing a key role. Moreover, investigation of superantigen-mediated T-cell activation by the SARS-CoV-2 spike protein in pediatric severe acute hepatitis is needed in the context of the proposed mechanism of multisystem inflammatory syndrome in children (MIS-C). We investigated the immunological characteristics of a Japanese pediatric patient with severe acute hepatitis post SARS-CoV-2 infection. The patient demonstrated autoimmune hepatitis-like liver histology with CD8⁺ lymphocyte-predominant infiltration. There was Th1-type immune skewing, including remarkable peripheral CD8⁺ T-cell activation and a skewed T cell receptor repertoire. We also found elevated plasma levels of the anti-SARS-CoV-2 spike-specific IgG antibody, and the titer peaked after treatment, as seen with MIS-C. These findings support that immunological activation involving SARS-CoV-2 spike protein plays a crucial role in a pediatric patient with acute severe hepatitis post SARS-CoV-2 infection.

Development of pressure cell for specific heat measurement at low temperature and high Magnetic field

We report the performance of Ag-Pd-Cu alloy as the material of a pressure cell to carry out specific heat measurements at low temperatures and high magnetic fields. The Ag-Pd-Cu alloy is advantageous to reduce the background due to the nuclear specific heat in the pressure cell growing at low temperatures and high magnetic fields. We prepared 70-20-10 alloy composed of 70 mass % of Ag, 20 mass % of Pd, and 10 mass % of Cu. The maximum hardness over 100 HRB (Rockwell-B scale) is achieved by the heat treatment. The magnetization and susceptibility results show that the alloy includes a small amount of magnetic ions, whose concentration is smaller than that in the Be-Cu alloy. We confirm that the specific heat of a piston cylinder cell made of the 70-20-10 alloy increases smoothly from 0.2 to 9 K and the nuclear specific heat decreases drastically in magnetic field compared to that expected in the Be-Cu alloy. The pressure value in the cell at low temperature increases almost linearly up to P=0.4 GPa, which is nearly the limit of the inner piston made of the 70-20-10 alloy, with increasing of the load applied at room temperature.