Novel homozygous pathogenic mitochondrial DNAJC19 variant in a patient with dilated cardiomyopathy and global developmental delay

BACKGROUND

Dilated cardiomyopathy with ataxia syndrome (DCMA) or 3-methylglutaconic aciduria type V is a rare global autosomal recessive mitochondrial syndrome that is clinically and genetically heterogeneous. It is characterized by early-onset dilated cardiomyopathy and increased urinary excretion of 3-methylglutaconic acid. As a result, some patients die due to cardiac failure, while others manifest with growth retardation, microcytic anemia, mild ataxia, and mild muscle weakness. DCMA is caused by variants in the DnaJ heat shock protein family (Hsp40) member C19 gene (DNAJC19), which plays an important role in mitochondrial protein import machinery in the inner mitochondrial membrane.

METHODS

We describe a single affected family member who presented with cardiomyopathy, global developmental delay, chest infection, seizures, elevated excretion of 3-methylglutaconic acid, and 3-methylglutaric acid in the urine.

RESULTS

Whole-exome sequencing followed by Sanger sequencing revealed a homozygous frameshift variant in the reading frame starting at codon 54 in exon 4 in the DNAJC19 gene (c.159del [Phe54Leufs*5]), which results in a stop codon four positions downstream. Quantitative gene expression analysis revealed that DNAJC19 mRNA expression in this patient was substantially reduced compared to the control.

CONCLUSIONS

We present a novel variant in the DNAJC19 gene that causes rare autosomal recessive mitochondrial 3-methylglutaconic aciduria type V. By comparing the current case with previously reported ones, we conclude that the disease is extremely heterogeneous for reasons that are still unknown.

De novo truncating NOVA2 variants affect alternative splicing and lead to heterogeneous neurodevelopmental phenotypes

Alternative splicing (AS) is crucial for cell-type specific gene transcription and plays a critical role in neuronal differentiation and synaptic plasticity. De novo frameshift variants in NOVA2, encoding a neuron-specific key splicing factor, have been recently associated with a new neurodevelopmental disorder (NDD) with hypotonia, neurological features, and brain abnormalities. We investigated eight unrelated individuals by exome sequencing (ES) and identified seven novel pathogenic NOVA2 variants, including two with a novel localization at the KH1 and KH3 domains. In addition to a severe NDD phenotype, novel clinical features included psychomotor regression, attention deficit-hyperactivity disorder (ADHD), dyspraxia, and urogenital and endocrinological manifestations. To test the effect of the variants on splicing regulation, we transfected HeLa cells with wildtype and mutant NOVA2 cDNA. The novel variants NM_002516.4: c.754_756delCTGinsTT p.(Leu252Phefs*144) and c.1329dup p.(Lys444Glnfs*82) all negatively affected AS events. The distal p.(Lys444Glnfs*82) variant, causing a partial removal of the KH3 domain, had a milder functional effect leading to an intermediate phenotype. Our findings expand the molecular and phenotypic spectrum of NOVA2-related NDD, supporting the pathogenic role of AS disruption by truncating variants and suggesting that this is a heterogeneous condition with variable clinical course. This article is protected by copyright. All rights reserved.

A Comparative Study of Milk Fat Extracted from the Milk of Different Goat Breeds in China: Fatty Acids, Triacylglycerols and Thermal and Spectroscopic Characterization

Goat milk (GM) is an excellent alternative to cow milk and has recently been used in commercial infant formula preparation due to its superior fat composition. Here, the fatty acid (FA) composition, triacylglycerol (TAG) molecular species, thermal behavior and infrared spectra of extracted milk fat from the milk of the two main breeds of dairy goat bred in China (Guanzhong GM (GZG) and Xinong Saanen GM (XSG)) are investigated. Gas chromatography, Fourier-transform infrared spectroscopy, differential scanning calorimetry and ultra-performance convergence chromatography with quadrupole time-of-flight mass spectrometry are applied. The obtained results evidence significant fat compositional differences based on the breed that produced the considered GM. The major FAs in both GM fats were capric (C10:0), myristic (C14:0), palmitic (C16:0), stearic (C18:0) and oleic (C18:1 n-9c). GZG presented a higher content of medium-chain saturated FAs, while XSG had higher unsaturated FAs with higher ratios of L/Ln and n-6/n-3. A total of 339 and 359 TAGs were detected and quantified in GZG and XSG, and the major TAGs were those of m/z 740.6712 (14.10 ± 0.27%) and m/z 684.6094 (10.94 ± 0.02%), respectively. Milk TAGs of GZG and XSG showed 24–54 and 26–54 total acyl carbon numbers with a 0–4 and 0–5 double bond number at 68 and 72 various retention times, respectively. Thermal analysis showed that all GM fat samples melted below normal body temperature. Infrared spectra revealed higher absorption values of GZG milk fat. This study provides valuable information to the dairy industry sector about GM fat produced in China, assessing the appropriateness of Chinese GM fat to be applied in Chinese infant formula.

Case Report: Biallelic Variant in the tRNA Methyltransferase Domain of the AlkB Homolog 8 Causes Syndromic Intellectual Disability

Intellectual disability (ID) has become very common and is an extremely heterogeneous disorder, where the patients face many challenges with deficits in intellectual functioning and adaptive behaviors. A single affected family revealed severe disease phenotypes such as ID, developmental delay, dysmorphic facial features, postaxial polydactyly type B, and speech impairment. DNA of a single affected individual was directly subjected to whole exome sequencing (WES), followed by Sanger sequencing. Data analysis revealed a novel biallelic missense variant (c.1511G>C; p.(Trp504Ser)) in the ALKBH8 gene, which plays a significant role in tRNA modifications. Our finding adds another variant to the growing list of ALKBH8-associated tRNA modifications causing ID and additional phenotypic manifestations. The present study depicts the key role of the genes associated with tRNA modifications, such as ALKBH8, in the development and pathophysiology of the human brain.

HMG-CoA Lyase Deficiency: A Retrospective Study of 62 Saudi Patients

3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency (HMG-CoA lyase) is a rare inborn error of leucine degradation and ketone body synthesis, caused by homozygous or compound heterozygous disease-causing variants in HMGCL. To understand the natural history of this disease, we reviewed the biochemical, clinical, and molecular data of 62 patients from 54 different families with confirmed HMG-CoA lyase deficiency (HMGCLD) diagnosis from Saudi Arabia. The majority of the affected individuals were symptomatic. At initial diagnosis, 38 patients (61.29%) presented with hypoglycemia and 49 patients (79.03%) developed metabolic acidosis. In 27 patients (43.54%), the disorder manifested in the neonatal period, mostly within the first days of life, while 35 (56.45%) patients were diagnosed within the first year of life or beyond. All the patients were alive and developed long-term neurological complications during data collection, which may significantly influence their quality of life. Common neurological findings include seizures 17/62 (27.41%), hypotonic 3/62 (4.83%), speech delay 7/62 (11.29%), hyperactivity 4/62 (4.83%), developmental delay 6/62 (9.677%), learning disability 15/62 (24.14%), and ataxic gate 1/62 (1.612%). An MRI of the brain exhibited nonspecific periventricular and deep white matter hyperintense signal changes in 16 patients (25.80%) and cerebral atrophy was found in one (1/62; 1.612%) patient. We identified a founder variant [c.122G>A; p.(Arg41Gln)] in 48 affected individuals (77.41%) in the HMGCL gene. This is the largest cohort of HMGCLD patients reported from Saudi Arabia, signifying this disorder as a likely life-threatening disease, with a high prevalence in the region. Our findings suggest that diagnosis at an early stage with careful dietary management may avoid metabolic crises.

Thermal treatment alternatives for enzymes inactivation in fruit juices: Recent breakthroughs and advancements

Fruit juices (FJs) are frequently taken owing to their nutritious benefits, appealing flavour, and vibrant colour. The colours of the FJs are critical indicators of the qualitative features that influence the consumer's attention. Although FJs' intrinsic acidity serves as a barrier to bacterial growth, their enzymatic stability remains an issue for their shelf life. Inactivation of enzymes is critical during FJ processing, and selective inactivation is the primary focus of enzyme inactivation. The merchants, on the other hand, want the FJs to stay stable. The most prevalent technique of processing FJ is by conventional heat treatment, which degrades its nutritive value and appearance. The FJ processing industry has undergone a dramatic transformation from thermal treatments to nonthermal treatments (NTTs) during the past two decades to meet the requirements for microbiological and enzymatic stability. The manufacturers want safe and stable FJs, while buyers want high-quality FJs. According to the past investigation, NTTs have the potential to manufacture microbiologically safe and enzymatically stable FJs with low loss of bioactive components. Furthermore, it has been demonstrated that different NTTs combined with or without other NTTs or mild heating as a hurdle technology increase the synergistic effect for microbiological safety and stability of FJs. Concise information about the variables that affect NTTs' action mode has also been addressed. Primary inactivates enzymes by modifying the protein structure and active site conformation. NTTs may increase enzyme activity depending on the nature of the enzyme contained in FJs, the applied pressure, pH, temperature, and treatment period. This is due to the release of membrane-bound enzymes as well as changes in protein structure and active sites that allow substrate interaction. Additionally, the combination of several NTTs as a hurdle technology, as well as temperature and treatment periods, resulted in increased enzyme inactivation in FJs. Therefore, a combination of thermal and non-thermal technologies is suggested to increase the effectiveness of the process as well as preserve the juice quality.

The Handover and Performance Analysis of LTE Network with Traditional and SDN Approaches

The mobility of user equipment (UE) in cellular network is a challenging issue in terms of its management. Current traditional handover in Long-Term Evolution (LTE) network is managed by evolved Node B or eNodeB (eNB) which is a decentralized solution. In contrast to existing technology, software defined network (SDN) has the capability of serving the packets of the switching equipment without involving the SDN controller except for the first one. We have proposed an SDN-based centralized solution for handover management in LTE network. Based on our solution, the handover is being managed by SDN controller which keeps track of the overall network management and dictates the flow entries to the OpenFlow switches in the network. In our testbed, two UEs are connected to two eNBs, and one of the UE performs a handover from one eNB to other eNB. It enhances the performance of the network in terms of reducing the delay while performing the handover and increasing the data rate of the running application. The initial delay will be bit higher due to the initial flow entry absence in the flow tables of the switches; later, the delay will be reduced. It is evident from the results that our approach keeps track of the overall network at centralized controller with improved performance.

Primary chondroblastic osteosarcoma of the mitral valve without metastasis

Primary osteosarcomas of the heart are extremely rare entities, with common subtypes including osteoblastic, chondroblastic and fibroblastic subtypes. We describe a case of a 53-year-old female with history of treated breast cancer who presented with progressive dyspnea on exertion. A pulmonary artery protocol CTA demonstrated an anterior mitral leaflet lobulated mass without an osteoid or chondroid matrix. Additional cross-sectional imaging demonstrated no evidence of distant metastasis. The mass was surgically excised with pathology demonstrating a malignant neoplasm with spindle cells, bone, cartilage and rare osteoid, most consistent with a high grade chondroblastic osteosarcoma. After the expected postsurgical recovery, the patient was initiated on adjuvant therapy consisting of ifosfamide and etoposide and is currently disease free for 9 years now. Review of literature demonstrates that cardiac primary osteosarcomas typically involve the left atrium. Imaging usually shows a lobulated or irregular mass with heterogenous attenuation/enhancement and, counterintuitively, a lack of a calcified matrix. Complete surgical excision is challenging leading to poor prognosis, even in cases undergoing post-surgical chemotherapy. Median survival has been reported as about 20 months.

Bilateral Facial Palsy Without Ocular Muscle Involvement in Myasthenia Gravis: Case Report

Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder that is more common among women than men. It has two major subtypes, namely, ocular and generalized MG, and while facial weakness is common in generalized MG, facial weakness without the involvement of ocular muscle is exceedingly rare. Here, we describe the case of a middle-aged man who presented with bilateral facial palsy but without diplopia or proximal muscle weakness. The patient tested positive for acetylcholine receptor antibodies and exhibited amplitude decrement on repetitive nerve stimulation, which are diagnostic for MG. This report emphasizes the importance of neurodiagnostic and physiological testing in patients presenting with bilateral facial weakness alone.

LC-ESI-QTOF/MS characterization of antimicrobial compounds with their action mode extracted from vine tea (Ampelopsis grossedentata) leaves

Vine tea (Ampelopsis grossedentata) is a tea plant cultivated south of the Chinese Yangtze River. It has anti-inflammatory properties and is used to normalize blood circulation and detoxification. The leaves of vine tea are the most abundant source of flavonoids, such as dihydromyricetin and myricetin. However, as the main bioactive flavonoid in vine tea, dihydromyricetin was the main focus of previous research. This study aimed to explore the antibacterial activities of vine tea against selected foodborne pathogens. The antimicrobial activity of vine tea extract was evaluated by the agar well diffusion method. Cell membrane integrity and bactericidal kinetics, along with physical damage to the cell membrane, were also observed. The extract was analyzed using a high-performance liquid chromatography-diode array detector (HPLC-DAD), and the results were confirmed using a modified version of a previously published method that combined liquid chromatography and electrospray-ionized quadrupole time-of-flight mass spectrometry (LC-ESI-QTOF/MS). Cell membrane integrity and bactericidal kinetics were determined by releasing intracellular material in suspension and monitoring it at 260 nm using an ultraviolet (UV) spectrophotometer. A scanning electron microscope (SEM) was used to detect morphological alterations and physical damage to the cell membrane. Six compounds were isolated successfully: (1) myricetin (C15H10O8), (2) myricetin 3-O-rhamnoside (C21H20O12), (3) 5,7,8,3,4-pentahydroxyisoflavone (C15H10O7), (4) dihydroquercetin (C15H12O7), (5) 6,8-dihydroxykaempferol (C15H10O8), and (6) ellagic acid glucoside (C20H16O13). Among these bioactive compounds, C15H10O7 was found to have vigorous antimicrobial activity against Bacillus cereus (AS11846) and Staphylococcus aureus (CMCCB26003). A dose-dependent bactericidal kinetics with a higher degree of absorbance at optical density 260 (OD260) was observed when the bacterial suspension was incubated with C15H10O7 for 8 h. Furthermore, a scanning electron microscope study revealed physical damage to the cell membrane. In addition, the action mode of C15H10O7 was on the cell wall of the target microorganism. Together, these results suggest that C15H10O7 has vigorous antimicrobial activity and can be used as a potent antimicrobial agent in the food processing industry.

Content-Aware SLIC Super-Pixels for Semi-Dark Images (SLIC++)

Super-pixels represent perceptually similar visual feature vectors of the image. Super-pixels are the meaningful group of pixels of the image, bunched together based on the color and proximity of singular pixel. Computation of super-pixels is highly affected in terms of accuracy if the image has high pixel intensities, i.e., a semi-dark image is observed. For computation of super-pixels, a widely used method is SLIC (Simple Linear Iterative Clustering), due to its simplistic approach. The SLIC is considerably faster than other state-of-the-art methods. However, it lacks in functionality to retain the content-aware information of the image due to constrained underlying clustering technique. Moreover, the efficiency of SLIC on semi-dark images is lower than bright images. We extend the functionality of SLIC to several computational distance measures to identify potential substitutes resulting in regular and accurate image segments. We propose a novel SLIC extension, namely, SLIC++ based on hybrid distance measure to retain content-aware information (lacking in SLIC). This makes SLIC++ more efficient than SLIC. The proposed SLIC++ does not only hold efficiency for normal images but also for semi-dark images. The hybrid content-aware distance measure effectively integrates the Euclidean super-pixel calculation features with Geodesic distance calculations to retain the angular movements of the components present in the visual image exclusively targeting semi-dark images. The proposed method is quantitively and qualitatively analyzed using the Berkeley dataset. We not only visually illustrate the benchmarking results, but also report on the associated accuracies against the ground-truth image segments in terms of boundary precision. SLIC++ attains high accuracy and creates content-aware super-pixels even if the images are semi-dark in nature. Our findings show that SLIC++ achieves precision of 39.7%, outperforming the precision of SLIC by a substantial margin of up to 8.1%.

Homozygous missense variant in POPDC3 causes recessive limb girdle muscular dystrophy type 26

BACKGROUND

Limb-girdle muscular dystrophy (LGMD) is a heterogeneous group of diseases, which affects different muscles, predominantly skeletal muscles and cardiac muscles of the body. LGMD is classified into two main sub-types A and B, which are further sub-classified into eight dominant and thirty recessive sub-types. Three genes, mainly POPDC1, POPDC2 and POPDC3, encodes popeye domain-containing protein (POPDC), and the variants of POPDC1 and POPDC3 genes have been associated with LGMD.

METHODS

In this study, we performed whole-exome sequencing (WES) analysis on a single-family to investigate the hallmark features of LGMD. The results of WES were further confirmed by Sanger sequencing and 3D protein modeling was also performed.

RESULTS

WES data analysis and sanger sequencing revealed a homozygous missense variant (c.460A>G; p.Lys154Glu) at a highly conserved amino acid position in the POPDC3. Mutations in the POPDC3 gene have been previously associated with recessive limb-girdle muscular dystrophy type 26. 3D protein modeling further suggested that the identified variant might affect the POPDC3 structure and proper function.

DISCUSSION/CONCLUSIONS

This study confirms the role of POPDC3 in LGMD, and will facilitate in genetic counseling of the family to mitigate the risks of the carrier or affected in future pregnancies.

Prostatic adenocarcinoma in a patient with persistent Müllerian duct syndrome

The embryonal male sexual differentiation is driven by testosterone, and Anti-Müllerian hormone (AMH). AMH is responsible for regression of Müllerian ducts in a genetically male fetus. Mutations inactivating AMH or its receptors are responsible for persistent Müllerian duct syndrome (PMDS) in virilized 46, XY males. PMDS is a rare genetic disorder affecting males, with less than 300 cases described in literature. The syndrome is usually recognized early in life with patients present with bilateral undescended testicles, and often decreased testosterone production by Leydig cells later in life. The role of testosterone in the development and progression of prostate cancer is well established, and men with low circulating free testosterone are expected to have a lower risk of developing prostate cancer. Indeed, 2 cases of prostate cancer in patients with PMDS have previously been described. Herein, we are reporting the third of prostate cancer in patient with PMDS.

The current status of lean manufacturing in small, medium and large scale manufacturing companies of Karachi, Pakistan

The major purpose of this study was to examine the current status of lean manufacturing in small, medium and large scale manufacturing companies situated in Karachi, Pakistan.The status of lean awareness, implementation, barriers and benefits in manufacturing companies were investigated through the questionnaire survey. The questionnaire was sent to 320 manufacturing companies and a response rate of 40.6% was received. SPSS 22.0 software was used to determine the average mean score for each factor and certain statistical analyses were performed to evaluate the results. It was observed that large organizations and SMEs both are fairly aware of the basic lean concepts but there is a sufficient difference in understanding of lean tools and techniques. Large organizations have a greater understanding and implementation of lean tools and techniques than SMEs. Some tools like 5S, Poka-yoke and TPM were found to have a similar status of implementation in various manufacturing companies irrespective of their size. The results of this study are applicable in Pakistani context, but could vary for other regions of the world, considering the awareness and challenges manufacturing enterprises are facing. To date there has been no research carried out in the context of large, small and medium manufacturing enterprises together in Pakistan, specifically in the Karachi region which investigate the status of lean awareness, implementation, benefits and barriers. Therefore, this study would serve as a foundation for conducting further in depth studies on lean manufacturing in Pakistani manufacturing companies.

MRA of the Supraaortic Vasculature: Comparison of Gadobutrol and Gadoterate Meglumine at 1.5 T

BACKGROUND

Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM.

PURPOSE

To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV.

STUDY TYPE

Prospective, crossover.

POPULATION

Twenty-eight subjects (54 ± 13 years; 17 female).

FIELD STRENGTH/SEQUENCE

1.5 T; three-dimensional (3D) gradient recalled echo.

ASSESSMENT

Quantitative image quality was measured by normalized signal intensity (SI_n ) [SI_n  = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence).

STATISTICAL TESTS

SI_n and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test.

RESULTS

No significant difference in SI_n was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SI_n s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery.

DATA CONCLUSION

At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 2.

FIG4-Associated Yunis-Varon Syndrome: Identification of a Novel Missense Variant

Yunis-Varon syndrome (YVS; OMIM 216340) is a rare heterogeneous autosomal recessive disorder with easy recognition of characteristic severe neurological and skeletal abnormalities involving skeletal muscles and cartilages. This cleidocranial dysplasia is characterized by bone and tooth disorders; it also affects the cardiovascular system and tissues from ectoderm with very poor outcomes. Rarely, mutations of the FIG4 gene, encoding a 50-phosphoinositide phosphatase have been identified as the cause for YVS. We report a neonate born to a consanguineous couple with typical clinical manifestations of YVS. Using whole-exome sequencing, we identified a novel homozygous missense variant (c.968A>G; p.Gln323Arg) in the FIG4 gene. Thus, our study expands the molecular and genetic spectrum of FIG4-associated mutations. To our knowledge, this is the first reported case of YVS from the Saudi population.

Variants in the PNPLA1 Gene in Families with Autosomal Recessive Congenital Ichthyosis Reveal Clinical Significance

The term autosomal recessive congenital ichthyosis (ARCI) is the subgroup of ichthyosis, which describes a highly heterogeneous group of genetic disorders of the skin characterized by cornification and defective keratinocytes differentiation associated with mutations in at least 14 genes including PNPLA1. To study the molecular basis of the Pakistani kindreds (A and B) affected by ARCI, whole-exome sequencing (WES) in the DNA samples of affected members was performed followed by Sanger sequencing of the candidate gene to hunt down the disease-causing sequence variant/s. WES data analysis led to the identification of a novel nonsense sequence variant (c.892C>T; p.Arg298*, family A) and a recurrent missense variant (c.102C>A; p.Asp34Glu, family B) in PNPLA1 mapped to the ARCI locus in chromosome 6p21.31. Validation and cosegregation analysis of the variants in the remaining family members of the respective families were confirmed by Sanger sequencing. The current investigation expands the spectrum of PNPLA1 mutations and helps establish the proper clinico-genetic diagnosis and correct genotype-phenotype correlation.

Diagnosis and Management of Diffuse Large B-Cell Lymphoma: Society of Medical Oncology, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology Joint Clinical Practice Guideline

Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the low- and middle-income countries across the globe. Modified Delphi methodology was used to develop consensus guidelines. Guidelines questions were drafted, and meetings were convened by a steering committee to develop initial recommendations on the basis of local challenges and review of the literature. A consensus panel reviewed the initial draft recommendations and rated the guidelines on a five-point Likert scale; recommendations achieving more than 75% consensus were accepted. Resource grouping initially suggested by Breast Health Global Initiative was applied for resource stratification into basic, limited, and enhanced resource settings. The panel generated consensus ratings for 35 questions of interest and concluded that diagnosis and treatment recommendations in resource-constrained settings need to be based on available resources and management expertise.

A Homozygous Missense Variant in PPP1R1B/DARPP-32 Is Associated With Generalized Complex Dystonia

BACKGROUND

The dystonias are a heterogeneous group of hyperkinetic disorders characterized by sustained or intermittent muscle contractions that cause abnormal movements and/or postures. Although more than 200 causal genes are known, many cases of primary dystonia have no clear genetic cause.

OBJECTIVES

To identify the causal gene in a consanguineous family with three siblings affected by a complex persistent generalized dystonia, generalized epilepsy, and mild intellectual disability.

METHODS

We performed exome sequencing in the parents and two affected siblings and characterized the expression of the identified gene by immunohistochemistry in control human and zebrafish brains.

RESULTS

We identified a novel missense variant (c.142G>A (NM_032192); p.Glu48Lys) in the protein phosphatase 1 regulatory inhibitor subunit 1B gene (PPP1R1B) that was homozygous in all three siblings and heterozygous in the parents. This gene is also known as dopamine and cAMP-regulated neuronal phosphoprotein 32 (DARPP-32) and has been involved in the pathophysiology of abnormal movements. The uncovered variant is absent in public databases and modifies the conserved glutamate 48 localized close to the serine 45 phosphorylation site. The PPP1R1B protein was shown to be expressed in cells and regions involved in movement control, including projection neurons of the caudate-putamen, substantia nigra neuropil, and cerebellar Purkinje cells. The latter cells were also confirmed to be positive for PPP1R1B expression in the zebrafish brain.

CONCLUSIONS

We report the association of a PPP1R1B/DARPP-32 variant with generalized dystonia in man. It might be relevant to include the sequencing of this new gene in the diagnosis of patients with otherwise unexplained movement disorders. © 2021 International Parkinson and Movement Disorder Society.

Ultrasound-Assisted Extraction of Carotenoids from Carrot Pomace and Their Optimization through Response Surface Methodology

Ultrasound-assisted extraction (UAE) was used to extract carotenoids from the carrot pomace. To investigate the effect of independent variables on the UAE, the response surface methodology (RSM) with central-composite design (CCD) was employed. The study was conducted with three independent variables including extraction time (min), temperature (°C), and ethanol concentration (%). The results showed that the optimal conditions for UAE were achieved with an extraction time of 17 min, temperature of 32 °C, and ethanol concentration of 51% of total carotenoids (31.82 ± 0.55); extraction time of 16 min, temperature of 29 °C, and ethanol concentration of 59% for a combination of β-carotene (14.89 ± 0.40), lutein (5.77 ± 0.19), and lycopene (2.65 ± 0.12). The non-significant (p > 0.05) correlation under optimal extraction conditions between predicted and experimental values suggested that UAE is the more productive process than conventional techniques for the extraction of carotenoids from the carrot pomace.

A Novel Homozygous Missense Mutation in the Zinc Finger DNA Binding Domain of GLI1 Causes Recessive Post-Axial Polydactyly

Background: Polydactyly is a prevalent digit abnormality characterized by having extra digits/toes. Mutations in eleven known genes have been associated to cause nonsyndromic polydactyly: GLI3, GLI1, ZRS regulating LMBR1, IQCE, ZNF141, PITX1, MIPOL1, FAM92A, STKLD1, KIAA0825, and DACH1. Method: A single affected family member (IV-4) was subjected to whole-exome sequencing (WES) to identify the causal gene. Bi-directional Sanger sequencing was performed to segregate the identified variant within the family. In silico analysis was performed to investigate the effect of the variant on DNA binding properties. Results: whole-exome sequencing identified a bi-allelic missense variant (c.1010C > T; p. Ser337Leu) in exon nine of GLI1 gene located on chromosome 12q13.3. With the use of Sanger sequencing, the identified variant segregated perfectly with the disease phenotype. Furthermore, in silico analysis of this DNA binding protein revealed that the variant weakened the DNA binding interaction, resulting in indecorous GLI1 function. Conclusion: Herein, we report a novel variant in GLI1 gene, causing autosomal recessive post-axial polydactyly type A (PAPA) type 8. This confirms the critical role of GLI1 in digit development and might help in genotype-phenotype correlation in the future.