51
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Englert M, Aurbach K, Becker IC, Gerber A, Heib T, Wackerbarth LM, Kusch C, Mott K, Araujo GHM, Baig AA, Dütting S, Knaus UG, Stigloher C, Schulze H, Nieswandt B, Pleines I, Nagy Z. Impaired microtubule dynamics contribute to microthrombocytopenia in RhoB-deficient mice. Blood Adv 2022; 6:5184-5197. [PMID: 35819450 PMCID: PMC9631634 DOI: 10.1182/bloodadvances.2021006545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Megakaryocytes are large cells in the bone marrow that give rise to blood platelets. Platelet biogenesis involves megakaryocyte maturation, the localization of the mature cells in close proximity to bone marrow sinusoids, and the formation of protrusions, which are elongated and shed within the circulation. Rho GTPases play important roles in platelet biogenesis and function. RhoA-deficient mice display macrothrombocytopenia and a striking mislocalization of megakaryocytes into bone marrow sinusoids and a specific defect in G-protein signaling in platelets. However, the role of the closely related protein RhoB in megakaryocytes or platelets remains unknown. In this study, we show that, in contrast to RhoA deficiency, genetic ablation of RhoB in mice results in microthrombocytopenia (decreased platelet count and size). RhoB-deficient platelets displayed mild functional defects predominantly upon induction of the collagen/glycoprotein VI pathway. Megakaryocyte maturation and localization within the bone marrow, as well as actin dynamics, were not affected in the absence of RhoB. However, in vitro-generated proplatelets revealed pronouncedly impaired microtubule organization. Furthermore, RhoB-deficient platelets and megakaryocytes displayed selective defects in microtubule dynamics/stability, correlating with reduced levels of acetylated α-tubulin. Our findings imply that the reduction of this tubulin posttranslational modification results in impaired microtubule dynamics, which might contribute to microthrombocytopenia in RhoB-deficient mice. Importantly, we demonstrate that RhoA and RhoB are localized differently and have selective, nonredundant functions in the megakaryocyte lineage.
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Affiliation(s)
- Maximilian Englert
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Katja Aurbach
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Isabelle C. Becker
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Annika Gerber
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Tobias Heib
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Lou M. Wackerbarth
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Charly Kusch
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Kristina Mott
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Gabriel H. M. Araujo
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Ayesha A. Baig
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Sebastian Dütting
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Ulla G. Knaus
- Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland; and
| | | | - Harald Schulze
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Irina Pleines
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Zoltan Nagy
- Institute of Experimental Biomedicine, University Hospital, University of Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
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52
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Dzinovic I, Winkelmann J, Zech M. Genetic intersection between dystonia and neurodevelopmental disorders: Insights from genomic sequencing. Parkinsonism Relat Disord 2022; 102:131-140. [DOI: 10.1016/j.parkreldis.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
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53
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Martinez-Lozano E, Beeram I, Yeritsyan D, Grinstaff MW, Snyder BD, Nazarian A, Rodriguez EK. Management of arthrofibrosis in neuromuscular disorders: a review. BMC Musculoskelet Disord 2022; 23:725. [PMID: 35906570 PMCID: PMC9336011 DOI: 10.1186/s12891-022-05677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
Arthrofibrosis, or rigid contracture of major articular joints, is a significant morbidity of many neurodegenerative disorders. The pathogenesis depends on the mechanism and severity of the precipitating neuromuscular disorder. Most neuromuscular disorders, whether spastic or hypotonic, culminate in decreased joint range of motion. Limited range of motion precipitates a cascade of pathophysiological changes in the muscle-tendon unit, the joint capsule, and the articular cartilage. Resulting joint contractures limit functional mobility, posing both physical and psychosocial burdens to patients, economic burdens on the healthcare system, and lost productivity to society. This article reviews the pathophysiology of arthrofibrosis in the setting of neuromuscular disorders. We describe current non-surgical and surgical interventions for treating arthrofibrosis of commonly affected joints. In addition, we preview several promising modalities under development to ameliorate arthrofibrosis non-surgically and discuss limitations in the field of arthrofibrosis secondary to neuromuscular disorders.
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Affiliation(s)
- Edith Martinez-Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Indeevar Beeram
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, 0025, Armenia
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.
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54
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Haldipur P, Millen KJ, Aldinger KA. Human Cerebellar Development and Transcriptomics: Implications for Neurodevelopmental Disorders. Annu Rev Neurosci 2022; 45:515-531. [PMID: 35440142 PMCID: PMC9271632 DOI: 10.1146/annurev-neuro-111020-091953] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Developmental abnormalities of the cerebellum are among the most recognized structural brain malformations in human prenatal imaging. Yet reliable information regarding their cause in humans is sparse, and few outcome studies are available to inform prognosis. We know very little about human cerebellar development, in stark contrast to the wealth of knowledge from decades of research on cerebellar developmental biology of model organisms, especially mice. Recent studies show that multiple aspects of human cerebellar development significantly differ from mice and even rhesus macaques, a nonhuman primate. These discoveries challenge many current mouse-centric models of normal human cerebellar development and models regarding the pathogenesis of several neurodevelopmental phenotypes affecting the cerebellum, including Dandy-Walker malformation and medulloblastoma. Since we cannot model what we do not know, additional normative and pathological human developmental data are essential, and new models are needed.
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Affiliation(s)
- Parthiv Haldipur
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA;
| | - Kathleen J Millen
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA; .,Department of Pediatrics, Division of Medical Genetics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kimberly A Aldinger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA;
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55
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Scher MS. Gene-Environment Interactions During the First Thousand Days Influence Childhood Neurological Diagnosis. Semin Pediatr Neurol 2022; 42:100970. [PMID: 35868730 DOI: 10.1016/j.spen.2022.100970] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
Gene-environment (G x E) interactions significantly influence neurologic outcomes. The maternal-placental-fetal (MPF) triad, neonate, or child less than 2 years may first exhibit significant brain disorders. Neuroplasticity during the first 1000 days will more likely result in life-long effects given critical periods of development. Developmental origins and life-course principles help recognize changing neurologic phenotypes across ages. Dual diagnostic approaches are discussed using representative case scenarios to highlight time-dependent G x E interactions that contribute to neurologic sequelae. Horizontal analyses identify clinically relevant phenotypic form and function at different ages. Vertical analyses integrate the approach using systems-biology from genetic through multi-organ system interactions during each developmental age to understand etiopathogenesis. The process of ontogenetic adaptation results in immediate or delayed positive and negative outcomes specific to the developmental niche, expressed either as a healthy child or one with neurologic sequelae. Maternal immune activation, ischemic placental disease, and fetal inflammatory response represent prenatal disease pathways that contribute to fetal brain injuries. These processes involve G x E interactions within the MPF triad, phenotypically expressed as fetal brain malformations or destructive injuries within the MPF triad. A neonatal minority express encephalopathy, seizures, stroke, and encephalopathy of prematurity as a continuum of trimester-specific G x E interactions. This group may later present with childhood sequelae. A healthy neonatal majority present at older ages with sequelae such as developmental disorders, epilepsy, mental health diseases, tumors, and neurodegenerative disease, often during the first 1000 days. Effective preventive, rescue, and reparative neuroprotective strategies require consideration of G x E interactions interplay over time. Addressing maternal and pediatric health disparities will maximize medical equity with positive global outcomes that reduce the burden of neurologic diseases across the lifespan.
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Affiliation(s)
- Mark S Scher
- Department of Pediatrics, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
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56
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Hu H, Xu K. Reply: Is it time to rename hereditary cases of cerebral palsy? Brain 2022; 145:e84-e85. [PMID: 35776105 PMCID: PMC9586535 DOI: 10.1093/brain/awac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hao Hu
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China.,Third Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
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57
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Coates J, Mulpuri K, Farr J, Miller SD. Cerebral palsy diagnosis and the impact on hip surveillance enrollment. Dev Med Child Neurol 2022; 64:890-896. [PMID: 35213730 DOI: 10.1111/dmcn.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
AIM To investigate the diagnosis at enrollment in the Child Health British Columbia Hip Surveillance Program for Children with Cerebral Palsy (CP) and review the etiologies of children enrolled without a CP diagnosis. METHOD Data from 959 children (543 males, 416 females; mean [SD] age at enrollment 6 years 8 months [4 years 2 months]) enrolled in the program between September 2015 and December 2019 were retrospectively reviewed. Enrollment diagnosis, Gross Motor Function Classification System level, migration percentage, and age at enrollment were included. Chart reviews were completed to confirm diagnoses for all children. Etiologies were compared to a list of conditions that are included and excluded from CP registries. RESULTS Diagnosis at enrollment was CP for 612 (64%), possible CP for 120 (13%), and 'other' for 220 (23%). No diagnosis was provided for seven (<1%). CP was confirmed for 700 (73%), including 106 (11.1%) enrolled as 'possible CP' or 'other'; 56 (5.8%) did not have CP due to progressive conditions. Migration percentage was similar across all groups at enrollment. INTERPRETATION One in four children were enrolled in hip surveillance without a diagnosis of CP or possible CP. Encouraging participation in hip surveillance when children meet the clinical criteria for CP but do not have a confirmed CP diagnosis can improve access to care.
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Affiliation(s)
- Jaimy Coates
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Farr
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Stacey D Miller
- Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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58
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Guo H, Hou L, Shi Y, Jin SC, Zeng X, Li B, Lifton RP, Brueckner M, Zhao H, Lu Q. Quantifying concordant genetic effects of de novo mutations on multiple disorders. eLife 2022; 11:75551. [PMID: 35666111 PMCID: PMC9217133 DOI: 10.7554/elife.75551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Exome sequencing on tens of thousands of parent-proband trios has identified numerous deleterious de novo mutations (DNMs) and implicated risk genes for many disorders. Recent studies have suggested shared genes and pathways are enriched for DNMs across multiple disorders. However, existing analytic strategies only focus on genes that reach statistical significance for multiple disorders and require large trio samples in each study. As a result, these methods are not able to characterize the full landscape of genetic sharing due to polygenicity and incomplete penetrance. In this work, we introduce EncoreDNM, a novel statistical framework to quantify shared genetic effects between two disorders characterized by concordant enrichment of DNMs in the exome. EncoreDNM makes use of exome-wide, summary-level DNM data, including genes that do not reach statistical significance in single-disorder analysis, to evaluate the overall and annotation-partitioned genetic sharing between two disorders. Applying EncoreDNM to DNM data of nine disorders, we identified abundant pairwise enrichment correlations, especially in genes intolerant to pathogenic mutations and genes highly expressed in fetal tissues. These results suggest that EncoreDNM improves current analytic approaches and may have broad applications in DNM studies.
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Affiliation(s)
- Hanmin Guo
- Center for Statistical Science, Tsinghua UniversityBeijingChina
- Department of Industrial Engineering, Tsinghua UniversityBeijingChina
| | - Lin Hou
- Center for Statistical Science, Tsinghua UniversityBeijingChina
- Department of Industrial Engineering, Tsinghua UniversityBeijingChina
- MOE Key Laboratory of Bioinformatics, School of Life Sciences, Tsinghua UniversityBeijingChina
| | - Yu Shi
- Yale School of Management, Yale UniversityNew HavenUnited States
| | - Sheng Chih Jin
- Department of Genetics, Washington University in St. LouisSt. LouisUnited States
| | - Xue Zeng
- Department of Genetics, Yale UniversityNew HavenUnited States
- Laboratory of Human Genetics and Genomics, Rockefeller UniversityNew YorkUnited States
| | - Boyang Li
- Department of Biostatistics, Yale School of Public HealthNew HavenUnited States
| | - Richard P Lifton
- Department of Genetics, Yale UniversityNew HavenUnited States
- Laboratory of Human Genetics and Genomics, Rockefeller UniversityNew YorkUnited States
| | - Martina Brueckner
- Department of Genetics, Yale UniversityNew HavenUnited States
- Department of Pediatrics, Yale UniversityNew HavenUnited States
| | - Hongyu Zhao
- Department of Genetics, Yale UniversityNew HavenUnited States
- Department of Biostatistics, Yale School of Public HealthNew HavenUnited States
- Program of Computational Biology and Bioinformatics, Yale UniversityNew HavenUnited States
| | - Qiongshi Lu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-MadisonMadisonUnited States
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59
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Abstract
Immunity could be viewed as the common factor in neurodevelopmental disorders and cancer. The immune and nervous systems coevolve as the embryo develops. Immunity can release cytokines that activate MAPK signaling in neural cells. In specific embryonic brain cell types, dysregulated signaling that results from germline or embryonic mutations can promote changes in chromatin organization and gene accessibility, and thus expression levels of essential genes in neurodevelopment. In cancer, dysregulated signaling can emerge from sporadic somatic mutations during human life. Neurodevelopmental disorders and cancer share similarities. In neurodevelopmental disorders, immunity, and cancer, there appears an almost invariable involvement of small GTPases (e.g., Ras, RhoA, and Rac) and their pathways. TLRs, IL-1, GIT1, and FGFR signaling pathways, all can be dysregulated in neurodevelopmental disorders and cancer. Although there are signaling similarities, decisive differentiating factors are timing windows, and cell type specific perturbation levels, pointing to chromatin reorganization. Finally, we discuss drug discovery.
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Affiliation(s)
- Ruth Nussinov
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Cancer Innovation Laboratory, National Cancer Institute, Frederick, MD 21702, USA
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Corresponding author
| | - Chung-Jung Tsai
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Cancer Innovation Laboratory, National Cancer Institute, Frederick, MD 21702, USA
| | - Hyunbum Jang
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Cancer Innovation Laboratory, National Cancer Institute, Frederick, MD 21702, USA
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60
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Duy PQ, Weise SC, Marini C, Li XJ, Liang D, Dahl PJ, Ma S, Spajic A, Dong W, Juusola J, Kiziltug E, Kundishora AJ, Koundal S, Pedram MZ, Torres-Fernández LA, Händler K, De Domenico E, Becker M, Ulas T, Juranek SA, Cuevas E, Hao LT, Jux B, Sousa AMM, Liu F, Kim SK, Li M, Yang Y, Takeo Y, Duque A, Nelson-Williams C, Ha Y, Selvaganesan K, Robert SM, Singh AK, Allington G, Furey CG, Timberlake AT, Reeves BC, Smith H, Dunbar A, DeSpenza T, Goto J, Marlier A, Moreno-De-Luca A, Yu X, Butler WE, Carter BS, Lake EMR, Constable RT, Rakic P, Lin H, Deniz E, Benveniste H, Malvankar NS, Estrada-Veras JI, Walsh CA, Alper SL, Schultze JL, Paeschke K, Doetzlhofer A, Wulczyn FG, Jin SC, Lifton RP, Sestan N, Kolanus W, Kahle KT. Impaired neurogenesis alters brain biomechanics in a neuroprogenitor-based genetic subtype of congenital hydrocephalus. Nat Neurosci 2022; 25:458-473. [PMID: 35379995 PMCID: PMC9664907 DOI: 10.1038/s41593-022-01043-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/28/2022] [Indexed: 01/16/2023]
Abstract
Hydrocephalus, characterized by cerebral ventricular dilatation, is routinely attributed to primary defects in cerebrospinal fluid (CSF) homeostasis. This fosters CSF shunting as the leading reason for brain surgery in children despite considerable disease heterogeneity. In this study, by integrating human brain transcriptomics with whole-exome sequencing of 483 patients with congenital hydrocephalus (CH), we found convergence of CH risk genes in embryonic neuroepithelial stem cells. Of all CH risk genes, TRIM71/lin-41 harbors the most de novo mutations and is most specifically expressed in neuroepithelial cells. Mice harboring neuroepithelial cell-specific Trim71 deletion or CH-specific Trim71 mutation exhibit prenatal hydrocephalus. CH mutations disrupt TRIM71 binding to its RNA targets, causing premature neuroepithelial cell differentiation and reduced neurogenesis. Cortical hypoplasia leads to a hypercompliant cortex and secondary ventricular enlargement without primary defects in CSF circulation. These data highlight the importance of precisely regulated neuroepithelial cell fate for normal brain-CSF biomechanics and support a clinically relevant neuroprogenitor-based paradigm of CH.
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Affiliation(s)
- Phan Q Duy
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.,Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT, USA
| | - Stefan C Weise
- Molecular Immunology and Cell Biology, Life & Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Claudia Marini
- Institute for Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Xiao-Jun Li
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Hearing and Balance, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan Liang
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Peter J Dahl
- Microbial Sciences Institute, Yale University, West Haven, CT, USA.,Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Shaojie Ma
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Ana Spajic
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Weilai Dong
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | | | - Emre Kiziltug
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sunil Koundal
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Maysam Z Pedram
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Lucia A Torres-Fernández
- Molecular Immunology and Cell Biology, Life & Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Kristian Händler
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.,Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE). PRECISE Platform for Genomics and Epigenomics at DZNE and University of Bonn, Bonn, Germany
| | - Elena De Domenico
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.,Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE). PRECISE Platform for Genomics and Epigenomics at DZNE and University of Bonn, Bonn, Germany
| | - Matthias Becker
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.,Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE). PRECISE Platform for Genomics and Epigenomics at DZNE and University of Bonn, Bonn, Germany
| | - Thomas Ulas
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.,Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE). PRECISE Platform for Genomics and Epigenomics at DZNE and University of Bonn, Bonn, Germany
| | - Stefan A Juranek
- Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Elisa Cuevas
- Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Le Thi Hao
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Bettina Jux
- Molecular Immunology and Cell Biology, Life & Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - André M M Sousa
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Fuchen Liu
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Suel-Kee Kim
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Mingfeng Li
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Yiying Yang
- Yale Stem Cell Center, Yale University School of Medicine, New Haven, CT, USA
| | - Yutaka Takeo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Alvaro Duque
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | | | - Yonghyun Ha
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Kartiga Selvaganesan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie M Robert
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Amrita K Singh
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Garrett Allington
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Charuta G Furey
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew T Timberlake
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Smith
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ashley Dunbar
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tyrone DeSpenza
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - June Goto
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Arnaud Marlier
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andres Moreno-De-Luca
- Department of Radiology, Autism & Developmental Medicine Institute, Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Xin Yu
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evelyn M R Lake
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Pasko Rakic
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Haifan Lin
- Yale Stem Cell Center, Yale University School of Medicine, New Haven, CT, USA
| | - Engin Deniz
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Helene Benveniste
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Nikhil S Malvankar
- Microbial Sciences Institute, Yale University, West Haven, CT, USA.,Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Juvianee I Estrada-Veras
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Pediatric Subspecialty Genetics Walter Reed National Military Medical Center, Bethesda, MD, USA.,Murtha Cancer Center/Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher A Walsh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Seth L Alper
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joachim L Schultze
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany.,Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE). PRECISE Platform for Genomics and Epigenomics at DZNE and University of Bonn, Bonn, Germany
| | - Katrin Paeschke
- Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Angelika Doetzlhofer
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Hearing and Balance, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - F Gregory Wulczyn
- Institute for Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard P Lifton
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Nenad Sestan
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Waldemar Kolanus
- Molecular Immunology and Cell Biology, Life & Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA. .,Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, MA, USA.
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Davis KW, Bilancia CG, Martin M, Vanzo R, Rimmasch M, Hom Y, Uddin M, Serrano MA. NeuroSCORE is a genome-wide omics-based model that identifies candidate disease genes of the central nervous system. Sci Rep 2022; 12:5427. [PMID: 35361823 PMCID: PMC8971396 DOI: 10.1038/s41598-022-08938-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
To identify candidate disease genes of central nervous system (CNS) phenotypes, we created the Neurogenetic Systematic Correlation of Omics-Related Evidence (NeuroSCORE). We identified five genome-wide metrics highly associated with CNS phenotypes to score 19,601 protein-coding genes. Genes scored one point per metric (range: 0-5), identifying 8298 scored genes (scores ≥ 1) and 1601 "high scoring" genes (scores ≥ 3). Using logistic regression, we determined the odds ratio that genes with a NeuroSCORE from 1 to 5 would be associated with known CNS-related phenotypes compared to genes that scored zero. We tested NeuroSCORE using microarray copy number variants (CNVs) in case-control cohorts and aggregate mouse model data. High scoring genes are associated with CNS phenotypes (OR = 5.5, p < 2E-16), enriched in case CNVs, and mouse ortholog genes that cause behavioral and nervous system abnormalities. We identified 1058 high scoring genes with no disease association in OMIM. Transforming the logistic regression results indicates high scoring genes have an 84-92% chance of being associated with a CNS phenotype. Top scoring genes include GRIA1, MAP4K4, SF1, TNPO2, and ZSWIM8. Finally, we interrogated CNVs in the Clinical Genome Resource, finding the majority of clinically significant CNVs contain high scoring genes. These findings can direct future research and improve molecular diagnostics.
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Affiliation(s)
- Kyle W Davis
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Colleen G Bilancia
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Megan Martin
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Rena Vanzo
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Megan Rimmasch
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Yolanda Hom
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA
| | - Mohammed Uddin
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Cellular Intelligence (Ci) Lab, GenomeArc Inc., Toronto, ON, Canada
| | - Moises A Serrano
- Bionano Genomics, Lineagen Division, Inc., 9540 Towne Center, Dr. #100, San Diego, CA, 92121, USA.
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62
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Michelson M, Lidzbarsky G, Nishri D, Israel-Elgali I, Berger R, Gafner M, Shomron N, Lev D, Goldberg Y. Microdeletion of 16q24.1-q24.2-A unique etiology of Lymphedema-Distichiasis syndrome and neurodevelopmental disorder. Am J Med Genet A 2022; 188:1990-1996. [PMID: 35312147 PMCID: PMC9314700 DOI: 10.1002/ajmg.a.62730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/09/2021] [Accepted: 01/28/2022] [Indexed: 01/15/2023]
Abstract
Interstitial deletions of 16q24.1–q24.2 are associated with alveolar capillary dysplasia, congenital renal malformations, neurodevelopmental disorders, and congenital abnormalities. Lymphedema–Distichiasis syndrome (LDS; OMIM # 153400) is a dominant condition caused by heterozygous pathogenic variants in FOXC2. Usually, lymphedema and distichiasis occur in puberty or later on, and affected individuals typically achieve normal developmental milestones. Here, we describe a boy with congenital lymphedema, distichiasis, bilateral hydronephrosis, and global developmental delay, with a de novo microdeletion of 894 kb at 16q24.1–q24.2. This report extends the phenotype of both 16q24.1–q24.2 microdeletion syndrome and of LDS. Interestingly, the deletion involves only the 3′‐UTR part of FOXC2.
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Affiliation(s)
- Marina Michelson
- Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel.,The Genetic Institute of Maccabi Health Medicinal Organization, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Lidzbarsky
- Raphael Recanati Genetic Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Daniella Nishri
- Child Developmental Center of Maccabi Health Medicinal Organization, Tel-Aviv, Israel
| | - Ifat Israel-Elgali
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachel Berger
- The Genetic Institute of Maccabi Health Medicinal Organization, Tel-Aviv, Israel
| | - Michal Gafner
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Shomron
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit Lev
- Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel.,The Genetic Institute of Maccabi Health Medicinal Organization, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Goldberg
- The Genetic Institute of Maccabi Health Medicinal Organization, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Raphael Recanati Genetic Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
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63
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Upadhyay J, Ansari MN, Samad A, Sayana A. Dysregulation of multiple signaling pathways: A possible cause of cerebral palsy. Exp Biol Med (Maywood) 2022; 247:779-787. [PMID: 35253451 DOI: 10.1177/15353702221081022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cerebral palsy (CP) is a lifelong disability characterized by the impairment of brain functions that result in improper posture and abnormal motor patterns. Understanding this brain abnormality and the role of genetic, epigenetic, and non-genetic factors such as signaling pathway dysregulation and cytokine dysregulation in the pathogenesis of CP is a complex process. Hypoxic-ischemic injury and prematurity are two well-known contributors of CP. Like in the case of other neurodevelopmental disorders such as intellectual disability and autism, the genomic constituents in CP are highly complex. The neuroinflammation that is triggered by maternal cytokine response plays a critical role in the pathogenesis of fetal inflammation response, which is one of the contributing factors of CP, and it continues even after the birth of children suffering from CP. Canonical Wnt signaling pathway is important for the development of mammalian fetal brain and it regulates distinct processes including neurogenesis. The glycogen synthase kinase-3 (GSK-3) antagonistic activity in the Wnt signaling pathway plays a crucial role in neurogenesis and neural development. In this review, we investigated several genetic and non-genetic pathways that are involved in the pathogenesis of CP and their regulation, impairment, and implications for causing CP during embryonic growth and developmental period. Investigating the role of these pathways help to develop novel therapeutic interventions and biomarkers for early diagnosis and treatment. This review also helps us to comprehend the mechanical approach of various signaling pathways, as well as their consequences and relevance in the understanding of CP.
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Affiliation(s)
- Jyoti Upadhyay
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun 248007, India
| | - Mohd Nazam Ansari
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdul Samad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Tishk International University, Erbil 44001, Iraq
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64
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Bastos PAD, Barbosa R. A Newly Identified Int22h1/Int22h2‐Mediated Xq28 Duplication Syndrome Case Misdiagnosed as Cerebral Palsy. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1743435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractCerebral palsy (CP) is a nonprogressive, early-onset neurodevelopmental disorder affecting ∼2 to 3/1,000 children worldwide. It is characterized by movement/postural disabilities accompanied by sensitive, perceptual, cognitive, communicational, behavioral, and musculoskeletal perturbations. Many CP patients are thought to have genetic etiologies overlapping those of other neurodevelopmental conditions. Herein, we reported a newly discovered case (the 36th case to date) of a female patient (misdiagnosed with CP until age 19) with the rare X-linked intellectual disability syndrome resulting from an int22h1/int22h2-mediated Xq28 duplication. A microarray analysis revealed a ∼0.4 Mb duplication within the 154.1 to 154.6 Mb subregion of Xq28 (hg19, CRCh37), confirming a diagnosis of the rare int22h1/int22h2-mediated Xq28 duplication intellectual disability syndrome. Atypical T2 hyperintensities were also observed. This case report builds upon the limited cohort of X-linked intellectual disability syndrome patients and reiterates the growing observations pertaining to the phenotypic overlap between genetic CP cases and other neurodevelopmental disorders.
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Affiliation(s)
- Paulo André Dias Bastos
- Chronic Diseases Research Centre, NOVA Medical School, Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Barbosa
- Chronic Diseases Research Centre, NOVA Medical School, Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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65
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Wilson JL, Kim YM, O'Malley JA, Gelineau-Morel R, Gilbert L, Bain JM, Aravamuthan BR. Cerebral Palsy in Child Neurology and Neurodevelopmental Disabilities Training: An Unmet Need. J Child Neurol 2022; 37:194-201. [PMID: 35037781 PMCID: PMC10392704 DOI: 10.1177/08830738211072711] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of childhood motor disability. However, there is limited guidance on training of child neurologists and neurodevelopmental disability specialists in the care of individuals with cerebral palsy. We sought to determine training program directors' impressions of the importance and adequacy of training in the diagnosis and management of cerebral palsy. METHODS In this cross-sectional study, all 82 child neurology and neurodevelopmental disability program directors were asked to complete a survey querying program characteristics, aspects of training in cerebral palsy, importance of cerebral palsy training, and perceived competence at graduation in cerebral palsy care. RESULTS There were 35 responses (43% response rate). Nearly all program directors (91%) reported "learning to diagnose cerebral palsy" as very important, and most (71%) felt that "learning to manage cerebral palsy" was very important. Although most program directors reported trainees to be very or extremely competent in cerebral palsy diagnosis (77%), only 43% of program directors felt that trainees were very or extremely competent in cerebral palsy management. Time spent with cerebral palsy faculty was associated with higher reported competence in cerebral palsy diagnosis (P = .03) and management (P < .01). The presence of a cerebral palsy clinic was associated with higher reported competence in cerebral palsy management (P = .03). CONCLUSIONS Child neurology and neurodevelopmental disability program directors reported that training in cerebral palsy is important for residents; however, a significant proportion felt that residents were not very well prepared to manage cerebral palsy. The development of cerebral palsy curricula and exposure to cerebral palsy clinics may improve training, translating to better care of individuals with cerebral palsy.
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Affiliation(s)
- Jenny L Wilson
- Division of Pediatric Neurology, 6684Oregon Health & Science University, Portland, OR, USA
| | - Young-Min Kim
- Division of Pediatric Neurology, Department of Pediatrics, 12221Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jennifer A O'Malley
- Division of Child Neurology, Department of Neurology, 6429Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rose Gelineau-Morel
- Division of Neurology, Department of Pediatrics, 12273University of Missouri Kansas City, Kansas City, MO, USA
| | - Laura Gilbert
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, 7548Washington University in St Louis and St Louis Children's Hospital, St Louis, MO, USA
| | - Jennifer M Bain
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, 7548Washington University in St Louis and St Louis Children's Hospital, St Louis, MO, USA
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66
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Zech M, Kopajtich R, Steinbrücker K, Bris C, Gueguen N, Feichtinger RG, Achleitner MT, Duzkale N, Périvier M, Koch J, Engelhardt H, Freisinger P, Wagner M, Brunet T, Berutti R, Smirnov D, Navaratnarajah T, Rodenburg RJ, Pais LS, Austin-Tse C, O’Leary M, Boesch S, Jech R, Bakhtiari S, Jin SC, Wilbert F, Kruer MC, Wortmann SB, Eckenweiler M, Mayr JA, Distelmaier F, Steinfeld R, Winkelmann J, Prokisch H. Variants in Mitochondrial ATP Synthase Cause Variable Neurologic Phenotypes. Ann Neurol 2022; 91:225-237. [PMID: 34954817 PMCID: PMC9939050 DOI: 10.1002/ana.26293] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE ATP synthase (ATPase) is responsible for the majority of ATP production. Nevertheless, disease phenotypes associated with mutations in ATPase subunits are extremely rare. We aimed at expanding the spectrum of ATPase-related diseases. METHODS Whole-exome sequencing in cohorts with 2,962 patients diagnosed with mitochondrial disease and/or dystonia and international collaboration were used to identify deleterious variants in ATPase-encoding genes. Findings were complemented by transcriptional and proteomic profiling of patient fibroblasts. ATPase integrity and activity were assayed using cells and tissues from 5 patients. RESULTS We present 10 total individuals with biallelic or de novo monoallelic variants in nuclear ATPase subunit genes. Three unrelated patients showed the same homozygous missense ATP5F1E mutation (including one published case). An intronic splice-disrupting alteration in compound heterozygosity with a nonsense variant in ATP5PO was found in one patient. Three patients had de novo heterozygous missense variants in ATP5F1A, whereas another 3 were heterozygous for ATP5MC3 de novo missense changes. Bioinformatics methods and populational data supported the variants' pathogenicity. Immunohistochemistry, proteomics, and/or immunoblotting revealed significantly reduced ATPase amounts in association to ATP5F1E and ATP5PO mutations. Diminished activity and/or defective assembly of ATPase was demonstrated by enzymatic assays and/or immunoblotting in patient samples bearing ATP5F1A-p.Arg207His, ATP5MC3-p.Gly79Val, and ATP5MC3-p.Asn106Lys. The associated clinical profiles were heterogeneous, ranging from hypotonia with spontaneous resolution (1/10) to epilepsy with early death (1/10) or variable persistent abnormalities, including movement disorders, developmental delay, intellectual disability, hyperlactatemia, and other neurologic and systemic features. Although potentially reflecting an ascertainment bias, dystonia was common (7/10). INTERPRETATION Our results establish evidence for a previously unrecognized role of ATPase nuclear-gene defects in phenotypes characterized by neurodevelopmental and neurodegenerative features. ANN NEUROL 2022;91:225-237.
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Affiliation(s)
- Michael Zech
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Robert Kopajtich
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Katja Steinbrücker
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Céline Bris
- Unité Mixte de Recherche MITOVASC, CNRS 6015/INSERM 1083, Université d'Angers, Angers, France,Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Naig Gueguen
- Unité Mixte de Recherche MITOVASC, CNRS 6015/INSERM 1083, Université d'Angers, Angers, France,Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - René G. Feichtinger
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Melanie T. Achleitner
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Neslihan Duzkale
- Department of Medical Genetic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | | - Johannes Koch
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Harald Engelhardt
- Kinderkrankenhaus St. Marien gGmbH, Zentrum für Kinder- und Jugendmedizin, Landshut, Germany
| | | | - Matias Wagner
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Theresa Brunet
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Riccardo Berutti
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Dmitrii Smirnov
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Tharsini Navaratnarajah
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Richard J.T. Rodenburg
- Radboud Centre for Mitochondrial Medicine, Department of Paediatrics Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands
| | - Lynn S Pais
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Christina Austin-Tse
- Harvard Medical School & Center for Genomic Medicine, Massachusetts General Hospital, Boston & Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA
| | - Melanie O’Leary
- Broad Center for Mendelian Genomics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - 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, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA,Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Friederike Wilbert
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - 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, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Saskia B. Wortmann
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria,Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes A. Mayr
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Robert Steinfeld
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Juliane Winkelmann
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany,Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Holger Prokisch
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
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Chopra M, Gable DL, Love‐Nichols J, Tsao A, Rockowitz S, Sliz P, Barkoudah E, Bastianelli L, Coulter D, Davidson E, DeGusmao C, Fogelman D, Huth K, Marshall P, Nimec D, Sanders JS, Shore BJ, Snyder B, Stone SSD, Ubeda A, Watkins C, Berde C, Bolton J, Brownstein C, Costigan M, Ebrahimi‐Fakhari D, Lai A, O'Donnell‐Luria A, Paciorkowski AR, Pinto A, Pugh J, Rodan L, Roe E, Swanson L, Zhang B, Kruer MC, Sahin M, Poduri A, Srivastava S. Mendelian etiologies identified with whole exome sequencing in cerebral palsy. Ann Clin Transl Neurol 2022; 9:193-205. [PMID: 35076175 PMCID: PMC8862420 DOI: 10.1002/acn3.51506] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 01/24/2023] Open
Abstract
Objectives Cerebral palsy (CP) is the most common childhood motor disability, yet its link to single‐gene disorders is under‐characterized. To explore the genetic landscape of CP, we conducted whole exome sequencing (WES) in a cohort of patients with CP. Methods We performed comprehensive phenotyping and WES on a prospective cohort of individuals with cryptogenic CP (who meet criteria for CP; have no risk factors), non‐cryptogenic CP (who meet criteria for CP; have at least one risk factor), and CP masqueraders (who could be diagnosed with CP, but have regression/progressive symptoms). We characterized motor phenotypes, ascertained medical comorbidities, and classified brain MRIs. We analyzed WES data using an institutional pipeline. Results We included 50 probands in this analysis (20 females, 30 males). Twenty‐four had cryptogenic CP, 20 had non‐cryptogenic CP, five had CP masquerader classification, and one had unknown classification. Hypotonic‐ataxic subtype showed a difference in prevalence across the classification groups (p = 0.01). Twenty‐six percent of participants (13/50) had a pathogenic/likely pathogenic variant in 13 unique genes (ECHS1, SATB2, ZMYM2, ADAT3, COL4A1, THOC2, SLC16A2, SPAST, POLR2A, GNAO1, PDHX, ACADM, ATL1), including one patient with two genetic disorders (ACADM, PDHX) and two patients with a SPAST‐related disorder. The CP masquerader category had the highest diagnostic yield (n = 3/5, 60%), followed by the cryptogenic CP category (n = 7/24, 29%). Fifteen percent of patients with non‐cryptogenic CP (n = 3/20) had a Mendelian disorder on WES. Interpretation WES demonstrated a significant prevalence of Mendelian disorders in individuals clinically diagnosed with CP, including in individuals with known CP risk factors.
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Nussinov R, Tsai CJ, Jang H. How can same-gene mutations promote both cancer and developmental disorders? SCIENCE ADVANCES 2022; 8:eabm2059. [PMID: 35030014 PMCID: PMC8759737 DOI: 10.1126/sciadv.abm2059] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/22/2021] [Indexed: 05/05/2023]
Abstract
The question of how same-gene mutations can drive both cancer and neurodevelopmental disorders has been puzzling. It has also been puzzling why those with neurodevelopmental disorders have a high risk of cancer. Ras, MEK, PI3K, PTEN, and SHP2 are among the oncogenic proteins that can harbor mutations that encode diseases other than cancer. Understanding why some of their mutations can promote cancer, whereas others promote neurodevelopmental diseases, and why even the same mutations may promote both phenotypes, has important clinical ramifications. Here, we review the literature and address these tantalizing questions. We propose that cell type–specific expression of the mutant protein, and of other proteins in the respective pathway, timing of activation (during embryonic development or sporadic emergence), and the absolute number of molecules that the mutations activate, alone or in combination, are pivotal in determining the pathological phenotypes—cancer and (or) developmental disorders.
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Affiliation(s)
- Ruth Nussinov
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Laboratory of Cancer Immunometabolism, National Cancer Institute, Frederick, MD 21702, USA
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Chung-Jung Tsai
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Laboratory of Cancer Immunometabolism, National Cancer Institute, Frederick, MD 21702, USA
| | - Hyunbum Jang
- Computational Structural Biology Section, Frederick National Laboratory for Cancer Research in the Laboratory of Cancer Immunometabolism, National Cancer Institute, Frederick, MD 21702, USA
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The phenotypic spectrum of PCDH12 associated disorders - Five new cases and review of the literature. Eur J Paediatr Neurol 2022; 36:7-13. [PMID: 34773825 PMCID: PMC9939053 DOI: 10.1016/j.ejpn.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/15/2021] [Accepted: 10/26/2021] [Indexed: 01/15/2023]
Abstract
PCDH12 is a member of the non-clustered protocadherin family of calcium-dependent cell adhesion proteins, which are involved in the regulation of brain development and endothelial adhesion. To date, only 15 families have been reported with PCDH12 associated disease. The main features previously associated with PCDH12 deficiency are developmental delay, movement disorder, epilepsy, microcephaly, visual impairment, midbrain malformations, and intracranial calcifications. Here, we report novel clinical features such as onset of epilepsy after infancy, episodes of transient developmental regression, and dysplasia of the medulla oblongata associated with three different novel truncating PCDH12 mutations in five cases (three children, two adults) from three unrelated families. Interestingly, our data suggests a clinical overlap with interferonopathies, and we show an elevated interferon score in two pediatric patients. This case series expands the genetic and phenotypic spectrum of PCDH12 associated diseases and highlights the broad clinical variability.
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Maclennan AH. All cases of cerebral palsy warrant genomic screening. Dev Med Child Neurol 2021; 63:1369. [PMID: 34114233 DOI: 10.1111/dmcn.14951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alastair H Maclennan
- The Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
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May HJ, Fasheun JA, Bain JM, Baugh EH, Bier LE, Revah-Politi A, Roye DP, Goldstein DB, Carmel JB. Genetic testing in individuals with cerebral palsy. Dev Med Child Neurol 2021; 63:1448-1455. [PMID: 34114234 PMCID: PMC9277698 DOI: 10.1111/dmcn.14948] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/28/2022]
Abstract
AIM To determine which patients with cerebral palsy (CP) should undergo genetic testing, we compared the rate of likely causative genetic variants from whole-exome sequencing in individuals with and without environmental risk factors. METHOD Patients were part of a convenience and physician-referred cohort recruited from a single medical center, and research whole-exome sequencing was completed. Participants were evaluated for the following risk factors: extreme preterm birth, brain bleed or stroke, birth asphyxia, brain malformations, and intrauterine infection. RESULTS A total of 151 unrelated individuals with CP (81 females, 70 males; mean age 25y 7mo [SD 17y 5mo], range 3wks-72y) participated. Causative genetic variants were identified in 14 participants (9.3%). There was no significant difference in diagnostic rate between individuals with risk factors (10 out of 123; 8.1%) and those without (4 out of 28; 14.3%) (Fisher's exact p=0.3). INTERPRETATION While the rate of genetic diagnoses among individuals without risk factors was higher than those with risk factors, the difference was not statistically significant at this sample size. The identification of genetic diagnoses in over 8% of cases with risk factors suggests that these might confer susceptibility to environmental factors, and that further research should include individuals with risk factors. What this paper adds There is no significant difference in diagnostic rate between individuals with and without risk factors. Genetic variants may confer susceptibility to environmental risk factors. Six causative variants were identified in genes not previously associated with cerebral palsy. Global developmental delay/intellectual disability is positively associated with a genetic etiology. Extreme preterm birth, stroke/brain hemorrhage, and older age are negatively associated with a genetic etiology.
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Affiliation(s)
- Halie J. May
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jennifer A. Fasheun
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
| | - Jennifer M. Bain
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Evan H. Baugh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Louise E. Bier
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - David P. Roye
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
| | - David B. Goldstein
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jason B. Carmel
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - NYP/CUIMC Genomics Team
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
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Suchowersky O, Ashtiani S, Au PYB, McLeod S, Estiar MA, Gan-Or Z, Rouleau GA. Hereditary spastic paraplegia initially diagnosed as cerebral palsy. Clin Park Relat Disord 2021; 5:100114. [PMID: 34816117 PMCID: PMC8592889 DOI: 10.1016/j.prdoa.2021.100114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Spastic diplegia presenting in infancy is common to both cerebral palsy (CP) and hereditary spastic paraplegia (HSP). We report the clinical and genetic features of a cohort of Alberta patients with a diagnosis of HSP, who were initially diagnosed with CP. Methods Fourteen patients with an initial diagnosis of CP were identified from an Alberta registry of HSP patients via chart review. Whole exome sequencing (WES) was performed to identify genetic causes. Results From 90 families in the database, individuals in 29 families had a pediatric presentation of spasticity, with 20 presenting under 3 years of age. Individuals from 14 families had received an initial diagnosis of CP and correct diagnosis was made after neurogenetic assessment due to symptom progression. All had early onset (<3 years) of symptoms. WES identified pathogenic or likely pathogenic mutations in nine cases involving six genes: ATL1, PLP1, PNPLA6, SACS, SPAST, and SYNE1. In five families, WES did not reveal a genetic etiology but progression of symptoms and positive family history suggests HSP is the most likely diagnosis. Conclusion In our cohort, 70% of HSP children presenting with spasticity under 3 years had been misdiagnosed with CP. In a young child presenting with spastic diplegia without clear history of prematurity, intrauterine growth restriction, infection or vascular insult, it is important to consider HSP. Accurate diagnosis has implications for prognosis, management, and recurrence risk.
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Affiliation(s)
- Oksana Suchowersky
- University of Alberta, Departments of Medicine (Neurology) and Medical Genetics, Edmonton, Canada
- Corresponding author at: Departments of Medicine (Neurology) and Medical Genetics, University of Alberta, 7-112Q Clinical Sciences Building, 11350 83 Ave, Edmonton, Alberta T6G 2G3, Canada.
| | | | | | - Scott McLeod
- Alberta Children's Hospital, Developmental Pediatrics, Calgary, Canada
| | | | - Ziv Gan-Or
- McGill University, Department of Human Genetics, Montreal, Canada
- McGill University, Department of Neurology and Neurosurgery, Montreal, Canada
| | - Guy A. Rouleau
- McGill University, Department of Human Genetics, Montreal, Canada
- McGill University, Department of Neurology and Neurosurgery, Montreal, Canada
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An Emerging Role for Epigenetics in Cerebral Palsy. J Pers Med 2021; 11:jpm11111187. [PMID: 34834539 PMCID: PMC8625874 DOI: 10.3390/jpm11111187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Cerebral palsy is a set of common, severe, motor disabilities categorized by a static, nondegenerative encephalopathy arising in the developing brain and associated with deficits in movement, posture, and activity. Spastic CP, which is the most common type, involves high muscle tone and is associated with altered muscle function including poor muscle growth and contracture, increased extracellular matrix deposition, microanatomic disruption, musculoskeletal deformities, weakness, and difficult movement control. These muscle-related manifestations of CP are major causes of progressive debilitation and frequently require intensive surgical and therapeutic intervention to control. Current clinical approaches involve sophisticated consideration of biomechanics, radiologic assessments, and movement analyses, but outcomes remain difficult to predict. There is a need for more precise and personalized approaches involving omics technologies, data science, and advanced analytics. An improved understanding of muscle involvement in spastic CP is needed. Unfortunately, the fundamental mechanisms and molecular pathways contributing to altered muscle function in spastic CP are only partially understood. In this review, we outline evidence supporting the emerging hypothesis that epigenetic phenomena play significant roles in musculoskeletal manifestations of CP.
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Ebrahimi-Fakhari D, Alecu JE, Ziegler M, Geisel G, Jordan C, D'Amore A, Yeh RC, Akula SK, Saffari A, Prabhu SP, Sahin M, Yang E. Systematic Analysis of Brain MRI Findings in Adaptor Protein Complex 4-Associated Hereditary Spastic Paraplegia. Neurology 2021; 97:e1942-e1954. [PMID: 34544818 DOI: 10.1212/wnl.0000000000012836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES AP-4-associated hereditary spastic paraplegia (AP-4-HSP: SPG47, SPG50, SPG51, SPG52) is an emerging cause of childhood-onset hereditary spastic paraplegia and mimic of cerebral palsy. This study aims to define the spectrum of brain MRI findings in AP-4-HSP and to investigate radioclinical correlations. METHODS We performed a systematic qualitative and quantitative analysis of 107 brain MRI studies from 76 individuals with genetically confirmed AP-4-HSP and correlation with clinical findings including surrogates of disease severity. RESULTS We define AP-4-HSP as a disorder of gray and white matter and demonstrate that abnormal myelination is common and that metrics of reduced white matter volume correlate with severity of motor symptoms. We identify a common diagnostic imaging signature consisting of (1) a thin splenium of the corpus callosum, (2) an absent or thin anterior commissure, (3) characteristic signal abnormalities of the forceps minor ("ears of the grizzly sign"), and (4) periventricular white matter abnormalities. The presence of 2 or more of these findings has a sensitivity of ∼99% for detecting AP-4-HSP; the combination of all 4 is found in ∼45% of cases. Compared to other HSPs with a thin corpus callosum, the absent anterior commissure appears to be specific to AP-4-HSP. Our analysis identified a subset of patients with polymicrogyria, underscoring the role of AP-4 in early brain development. These patients displayed a higher prevalence of seizures and status epilepticus, many at a young age. DISCUSSION Our findings define the MRI spectrum of AP-4-HSP, providing opportunities for early diagnosis, identification of individuals at risk for complications, and a window into the role of the AP-4 complex in brain development and neurodegeneration.
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Affiliation(s)
- Darius Ebrahimi-Fakhari
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA.
| | - Julian E Alecu
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Marvin Ziegler
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Gregory Geisel
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Catherine Jordan
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Angelica D'Amore
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Rebecca C Yeh
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Shyam K Akula
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Afshin Saffari
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Sanjay P Prabhu
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Mustafa Sahin
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Edward Yang
- From the Department of Neurology (D.E.-F., J.E.A., M.Z., G.G., C.J., A.D., A.S., M.S.), and Division of Neuroradiology, Department of Radiology (S.P.P., E.Y.), The Manton Center for Orphan Disease Research (D.E.-F., R.C.Y., S.K.A.), Rosamund Stone Zander Translational Neuroscience Center (M.S.), and Division of Genetics and Genomics (D.E.-F., R.C.Y., S.K.A.), Boston Children's Hospital, Harvard Medical School, MA
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Redline RW. Placental pathology: Pathways leading to or associated with perinatal brain injury in experimental neurology, special issue: Placental mediated mechanisms of perinatal brain injury. Exp Neurol 2021; 347:113917. [PMID: 34748755 DOI: 10.1016/j.expneurol.2021.113917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
Perinatal brain injury is a multifactorial process. In utero placental physiology plays a major role in neuroprotection and the normal development of the fetal central nervous system. Advances in placental pathology have clarified several specific mechanisms of injury and the histologic lesions most strongly associated with them. This review provides an updated summary of the relevant placental anatomy and physiology, the specific placental pathways leading to brain injury, the revised Amsterdam classification system for placental pathology, and the known associations of specific placental lesions with subtypes of adverse neurologic outcomes.
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Affiliation(s)
- Raymond W Redline
- Case Western Reserve University School of Medicine, Departments of Pathology and Reproductive Biology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
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Wang Y, Qiao Y, Cheng Y, Su Y, Song L, Xu Y, Li H, Zhang L, Song J, Zhang X, Wang J, Zhu D, Tang T, Shang Q, Gao C, Wang X, Zhu C, Xing Q. TEP1 is a risk gene for sporadic cerebral palsy. J Genet Genomics 2021; 48:1134-1138. [PMID: 34543729 DOI: 10.1016/j.jgg.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Yangong Wang
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Yimeng Qiao
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Ye Cheng
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Yu Su
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Lili Song
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China; Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, 450052, China
| | - Hongwei Li
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Lingling Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Juan Song
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Jun Wang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Dengna Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China
| | - Tianxiang Tang
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Qing Shang
- Department of Pediatrics, Children's Hospital of Zhengzhou University and Henan Children's Hospital, Zhengzhou, 450053, China
| | - Chao Gao
- Department of Pediatrics, Children's Hospital of Zhengzhou University and Henan Children's Hospital, Zhengzhou, 450053, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China; Centre of Perinatal Medicine and Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Department of Pediatrics, The 3rd Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, 450052, China; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 17177, Sweden; Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden.
| | - Qinghe Xing
- Institutes of Biomedical Sciences and Children's Hospital, Fudan University, Shanghai, 201102, China; Shanghai Center for Women and Children's Health, Shanghai, 200062, China.
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Yield of clinically reportable genetic variants in unselected cerebral palsy by whole genome sequencing. NPJ Genom Med 2021; 6:74. [PMID: 34531397 PMCID: PMC8445947 DOI: 10.1038/s41525-021-00238-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of childhood physical disability, with incidence between 1/500 and 1/700 births in the developed world. Despite increasing evidence for a major contribution of genetics to CP aetiology, genetic testing is currently not performed systematically. We assessed the diagnostic rate of genome sequencing (GS) in a clinically unselected cohort of 150 singleton CP patients, with CP confirmed at >4 years of age. Clinical grade GS was performed on the proband and variants were filtered, and classified according to American College of Medical Genetics and Genomics–Association for Molecular Pathology (ACMG-AMP) guidelines. Variants classified as pathogenic or likely pathogenic (P/LP) were further assessed for their contribution to CP. In total, 24.7% of individuals carried a P/LP variant(s) causing or increasing risk of CP, with 4.7% resolved by copy number variant analysis and 20% carrying single nucleotide or indel variants. A further 34.7% carried one or more rare, high impact variants of uncertain significance (VUS) in variation intolerant genes. Variants were identified in a heterogeneous group of genes, including genes associated with hereditary spastic paraplegia, clotting and thrombophilic disorders, small vessel disease, and other neurodevelopmental disorders. Approximately 1/2 of individuals were classified as likely to benefit from changed clinical management as a result of genetic findings. In addition, no significant association between genetic findings and clinical factors was detectable in this cohort, suggesting that systematic sequencing of CP will be required to avoid missed diagnoses.
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Papavasiliou A, Ben-Pazi H, Mastroyianni S, Ortibus E. Editorial: Cerebral Palsy: New Developments. Front Neurol 2021; 12:738921. [PMID: 34456856 PMCID: PMC8386682 DOI: 10.3389/fneur.2021.738921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hilla Ben-Pazi
- Department of Pediatric Orthopedics, Assuta Ashdod Hospital, Ashdod, Israel
| | - Sotiria Mastroyianni
- Department of Pediatric Neurology, Pan and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
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Hale AT, Akinnusotu O, He J, Wang J, Hibshman N, Shannon CN, Naftel RP. Genome-Wide Association Study Identifies Genetic Risk Factors for Spastic Cerebral Palsy. Neurosurgery 2021; 89:435-442. [PMID: 34098570 PMCID: PMC8364821 DOI: 10.1093/neuros/nyab184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many clinical risk factors of spastic cerebral palsy (CP) have been identified, the genetic basis of spastic CP is largely unknown. Here, using whole-genome genetic information linked to a deidentified electronic health record (BioVU) with replication in the UK Biobank and FinnGen, we perform the first genome-wide association study (GWAS) for spastic CP. OBJECTIVE To define the genetic basis of spastic CP. METHODS Whole-genome data were obtained using the multi-ethnic genotyping array (MEGA) genotyping array capturing single-nucleotide polymorphisms (SNPs), minor allele frequency (MAF) > 0.01, and imputation quality score (r2) > 0.3, imputed based on the 1000 genomes phase 3 reference panel. Threshold for genome-wide significance was defined after Bonferroni correction for the total number of SNPs tested (P < 5.0 × 10-8). Replication analysis (defined as P < .05) was performed in the UK Biobank and FinnGen. RESULTS We identify 1 SNP (rs78686911) reaching genome-wide significance with spastic CP. Expression quantitative trait loci (eQTL) analysis suggests that rs78686911 decreases expression of GRIK4, a gene that encodes a high-affinity kainate glutamatergic receptor of largely unknown function. Replication analysis in the UK Biobank and FinnGen reveals additional SNPs in the GRIK4 loci associated with CP. CONCLUSION To our knowledge, we perform the first GWAS of spastic CP. Our study indicates that genetic variation contributes to CP risk.
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Affiliation(s)
- Andrew T Hale
- Vanderbilt University School of Medicine, Medical Scientist Training Program, Nashville, Tennessee, USA
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Oluwatoyin Akinnusotu
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Jing He
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Janey Wang
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie Hibshman
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Robert P Naftel
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
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Biallelic loss-of-function variants in the splicing regulator NSRP1 cause a severe neurodevelopmental disorder with spastic cerebral palsy and epilepsy. Genet Med 2021; 23:2455-2460. [PMID: 34385670 DOI: 10.1038/s41436-021-01291-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Alternative splicing plays a critical role in mouse neurodevelopment, regulating neurogenesis, cortical lamination, and synaptogenesis, yet few human neurodevelopmental disorders are known to result from pathogenic variation in splicing regulator genes. Nuclear Speckle Splicing Regulator Protein 1 (NSRP1) is a ubiquitously expressed splicing regulator not known to underlie a Mendelian disorder. METHODS Exome sequencing and rare variant family-based genomics was performed as a part of the Baylor-Hopkins Center for Mendelian Genomics Initiative. Additional families were identified via GeneMatcher. RESULTS We identified six patients from three unrelated families with homozygous loss-of-function variants in NSRP1. Clinical features include developmental delay, epilepsy, variable microcephaly (Z-scores -0.95 to -5.60), hypotonia, and spastic cerebral palsy. Brain abnormalities included simplified gyral pattern, underopercularization, and/or vermian hypoplasia. Molecular analysis identified three pathogenic NSRP1 predicted loss-of-function variant alleles: c.1359_1362delAAAG (p.Glu455AlafsTer20), c.1272dupG (p.Lys425GlufsTer5), and c.52C>T (p.Gln18Ter). The two frameshift variants result in a premature termination codon in the last exon, and the mutant transcripts are predicted to escape nonsense mediated decay and cause loss of a C-terminal nuclear localization signal required for NSRP1 function. CONCLUSION We establish NSRP1 as a gene for a severe autosomal recessive neurodevelopmental disease trait characterized by developmental delay, epilepsy, microcephaly, and spastic cerebral palsy.
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Lee S, Robinson K, Lodge M, Theroux M, Miller F, Akins R. Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy. J Pers Med 2021; 11:jpm11080765. [PMID: 34442409 PMCID: PMC8400439 DOI: 10.3390/jpm11080765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals with spastic cerebral palsy (CP) often exhibit altered sensitivities to neuromuscular blocking agents (NMBAs) used for surgical intubation. We assessed usage of the NMBA rocuronium in patients with spastic CP and evaluated potential modifiers of dosing including gross motor function classification system (GMFCS) level, birthweight, gestational age, and the use of anticonvulsant therapy. In a case-control study, surgical patients with spastic CP (n = 64) or with idiopathic or non-neuromuscular conditions (n = 73) were enrolled after informed consent/assent. Patient data, GMFCS level, anticonvulsant use, and rocuronium dosing for intubation and post-intubation neuromuscular blockade were obtained from medical records. Findings reveal participants with CP required more rocuronium per body weight for intubation than controls (1.00 ± 0.08 versus 0.64 ± 0.03 mg/kg; p < 0.0001). Dosing increased with GMFCS level (Spearman's rho = 0.323; p = 0.005), and participants with moderate to severe disability (GMFCS III-V) had elevated rocuronium with (1.21 ± 0.13 mg/kg) or without (0.86 ± 0.09 mg/kg) concurrent anticonvulsant therapy. Children born full-term or with birthweight >2.5 kg in the CP cohort required more rocuronium than preterm and low birthweight counterparts. Individuals with CP exhibited highly varied and significant resistance to neuromuscular blockade with rocuronium that was related to GMFCS and gestational age and weight at birth.
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Affiliation(s)
- Stephanie Lee
- Nemours Biomedical Research, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (S.L.); (K.R.); (M.L.)
| | - Karyn Robinson
- Nemours Biomedical Research, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (S.L.); (K.R.); (M.L.)
| | - Madison Lodge
- Nemours Biomedical Research, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (S.L.); (K.R.); (M.L.)
| | - Mary Theroux
- Department of Anesthesiology, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Freeman Miller
- Department of Orthopedics, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Robert Akins
- Nemours Biomedical Research, Nemours-Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (S.L.); (K.R.); (M.L.)
- Correspondence: ; Tel.: +1-302-651-6779
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Kundishora AJ, Peters ST, Pinard A, Duran D, Panchagnula S, Barak T, Miyagishima DF, Dong W, Smith H, Ocken J, Dunbar A, Nelson-Williams C, Haider S, Walker RL, Li B, Zhao H, Thumkeo D, Marlier A, Duy PQ, Diab NS, Reeves BC, Robert SM, Sujijantarat N, Stratman AN, Chen YH, Zhao S, Roszko I, Lu Q, Zhang B, Mane S, Castaldi C, López-Giráldez F, Knight JR, Bamshad MJ, Nickerson DA, Geschwind DH, Chen SSL, Storm PB, Diluna ML, Matouk CC, Orbach DB, Alper SL, Smith ER, Lifton RP, Gunel M, Milewicz DM, Jin SC, Kahle KT. DIAPH1 Variants in Non-East Asian Patients With Sporadic Moyamoya Disease. JAMA Neurol 2021; 78:993-1003. [PMID: 34125151 PMCID: PMC8204259 DOI: 10.1001/jamaneurol.2021.1681] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Importance Moyamoya disease (MMD), a progressive vasculopathy leading to narrowing and ultimate occlusion of the intracranial internal carotid arteries, is a cause of childhood stroke. The cause of MMD is poorly understood, but genetic factors play a role. Several familial forms of MMD have been identified, but the cause of most cases remains elusive, especially among non-East Asian individuals. Objective To assess whether ultrarare de novo and rare, damaging transmitted variants with large effect sizes are associated with MMD risk. Design, Setting, and Participants A genetic association study was conducted using whole-exome sequencing case-parent MMD trios in a small discovery cohort collected over 3.5 years (2016-2019); data were analyzed in 2020. Medical records from US hospitals spanning a range of 1 month to 1.5 years were reviewed for phenotyping. Exomes from a larger validation cohort were analyzed to identify additional rare, large-effect variants in the top candidate gene. Participants included patients with MMD and, when available, their parents. All participants who met criteria and were presented with the option to join the study agreed to do so; none were excluded. Twenty-four probands (22 trios and 2 singletons) composed the discovery cohort, and 84 probands (29 trios and 55 singletons) composed the validation cohort. Main Outcomes and Measures Gene variants were identified and filtered using stringent criteria. Enrichment and case-control tests assessed gene-level variant burden. In silico modeling estimated the probability of variant association with protein structure. Integrative genomics assessed expression patterns of MMD risk genes derived from single-cell RNA sequencing data of human and mouse brain tissue. Results Of the 24 patients in the discovery cohort, 14 (58.3%) were men and 18 (75.0%) were of European ancestry. Three of 24 discovery cohort probands contained 2 do novo (1-tailed Poisson P = 1.1 × 10-6) and 1 rare, transmitted damaging variant (12.5% of cases) in DIAPH1 (mammalian diaphanous-1), a key regulator of actin remodeling in vascular cells and platelets. Four additional ultrarare damaging heterozygous DIAPH1 variants (3 unphased) were identified in 3 other patients in an 84-proband validation cohort (73.8% female, 77.4% European). All 6 patients were non-East Asian. Compound heterozygous variants were identified in ena/vasodilator-stimulated phosphoproteinlike protein EVL, a mammalian diaphanous-1 interactor that regulates actin polymerization. DIAPH1 and EVL mutant probands had severe, bilateral MMD associated with transfusion-dependent thrombocytopenia. DIAPH1 and other MMD risk genes are enriched in mural cells of midgestational human brain. The DIAPH1 coexpression network converges in vascular cell actin cytoskeleton regulatory pathways. Conclusions and Relevance These findings provide the largest collection to date of non-East Asian individuals with sporadic MMD harboring pathogenic variants in the same gene. The results suggest that DIAPH1 is a novel MMD risk gene and impaired vascular cell actin remodeling in MMD pathogenesis, with diagnostic and therapeutic ramifications.
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Affiliation(s)
- Adam J. Kundishora
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Samuel T. Peters
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson
| | - Amélie Pinard
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Daniel Duran
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson
| | | | - Tanyeri Barak
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
- Yale Program on Neurogenetics, Yale School of Medicine, New Haven, Connecticut
| | - Danielle F. Miyagishima
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
- Yale Program on Neurogenetics, Yale School of Medicine, New Haven, Connecticut
| | - Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | - Hannah Smith
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Jack Ocken
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Ashley Dunbar
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Shozeb Haider
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, London, United Kingdom
| | - Rebecca L. Walker
- Department of Neurology, Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Boyang Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Dean Thumkeo
- Department of Drug Discovery Medicine, Kyoto University, Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Arnaud Marlier
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Phan Q. Duy
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Nicholas S. Diab
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin C. Reeves
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | | | | | - Amber N. Stratman
- Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, Missouri
| | - Yi-Hsien Chen
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Shujuan Zhao
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Isabelle Roszko
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Qiongshi Lu
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison
| | - Bo Zhang
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Shrikant Mane
- Yale Center for Genome Analysis, West Haven, Connecticut
| | | | | | | | | | | | - Daniel H. Geschwind
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles
| | - Shih-Shan Lang Chen
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Phillip B. Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael L. Diluna
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Charles C. Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Darren B. Orbach
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seth L. Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Edward R. Smith
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard P. Lifton
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | - Murat Gunel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Dianna M. Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Kristopher T. Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut
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Lewis SA, Bakhtiari S, Heim J, Cornejo P, Liu J, Huang A, Musmacker A, Jin SC, Bilguvar K, Padilla-Lopez SR, Kruer MC. Mutation in ZDHHC15 Leads to Hypotonic Cerebral Palsy, Autism, Epilepsy, and Intellectual Disability. NEUROLOGY-GENETICS 2021; 7:e602. [PMID: 34345675 PMCID: PMC8323736 DOI: 10.1212/nxg.0000000000000602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022]
Abstract
Objective To determine whether mutations reported for ZDHHC15 can cause mixed neurodevelopmental disorders, we performed both functional studies on variant pathogenicity and ZDHHC15 function in animal models. Methods We examined protein function of 4 identified variants in ZDHHC15 in a yeast complementation assay and locomotor defects of loss-of-function genotypes in a Drosophila model. Results Although we assessed multiple patient variants, only 1 (p.H158R) affected protein function. We report a patient with a diagnosis of hypotonic cerebral palsy, autism, epilepsy, and intellectual disability associated with this bona fide damaging X-linked variant. Features include tall forehead with mild brachycephaly, down-slanting palpebral fissures, large ears, long face, facial muscle hypotonia, high-arched palate with dental crowding, and arachnodactyly. The patient had mild diminished cerebral volume, with left-sided T2/FLAIR hyperintense periatrial ovoid lesion. We found that loss-of-function mutations in orthologs of this gene cause flight and coordinated movement defects in Drosophila. Conclusions Our findings support a functional expansion of this gene to a role in motor dysfunction. Although ZDHHC15 mutations represent a rare cause of neurodevelopmental disability, candidate variants need to be carefully assessed before pathogenicity can be determined.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Jennifer Heim
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Patricia Cornejo
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - James Liu
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Aris Huang
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Andrew Musmacker
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Sheng Chih Jin
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Kaya Bilguvar
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Sergio R Padilla-Lopez
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
| | - Michael C Kruer
- Pediatric Movement Disorders Program (S.A.L., S.B., J.H., J.L., S.R.P.-L., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Neurology, Genetics and Cellular & Molecular Medicine (S.A.L., S.B., J.L., S.R.P.-L., M.C.K.), University of Arizona College of Medicine; Division of Neuroradiology (P.C.), Department of Radiology, Phoenix Children's Hospital, AZ; Programs in Neuroscience and Molecular & Cellular Biology (A.H., A.M.), Arizona State University, Tempe; and Department of Genetics (S.C.J.), Washington University, St. Louis, MO; Department of Genetics (K.B.), Yale University, New Haven, CT
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84
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Yechieli M, Gulsuner S, Ben-Pazi H, Fattal A, Aran A, Kuzminsky A, Sagi L, Guttman D, Schneebaum Sender N, Gross-Tsur V, Klopstock T, Walsh T, Renbaum P, Zeligson S, Shemer Meiri L, Lev D, Shmueli D, Blumkin L, Lahad A, King MC, Levy EL, Segel R. Diagnostic yield of chromosomal microarray and trio whole exome sequencing in cryptogenic cerebral palsy. J Med Genet 2021; 59:759-767. [PMID: 34321325 DOI: 10.1136/jmedgenet-2021-107884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the yield of genetic diagnoses using chromosomal microarray (CMA) and trio whole exome sequencing (WES), separately and combined, among patients with cryptogenic cerebral palsy (CP). METHODS Trio WES of patients with prior CMA analysis for cryptogenic CP, defined as disabling, non-progressive motor symptoms beginning before the age of 3 years without known cause. RESULTS Given both CMA analysis and trio WES, clinically significant genetic findings were identified for 58% of patients (26 of 45). Diagnoses were eight large CNVs detected by CMA and 18 point mutations detected by trio WES. None had more than one severe mutation. Approximately half of events (14 of 26) were de novo. Yield was significantly higher in patients with CP with comorbidities (69%, 22 of 32) than in those with pure motor CP (31%, 4 of 13; p=0.02). Among patients with genetic diagnoses, CNVs were more frequent than point mutations among patients with congenital anomalies (OR 7.8, 95% CI 1.2 to 52.4) or major dysmorphic features (OR 10.5, 95% CI 1.4 to 73.7). Clinically significant mutations were identified in 18 different genes: 14 with known involvement in CP-related disorders and 4 responsible for other neurodevelopmental conditions. Three possible new candidate genes for CP were ARGEF10, RTF1 and TAOK3. CONCLUSIONS Cryptogenic CP is genetically highly heterogeneous. Genomic analysis has a high yield and is warranted in all these patients. Trio WES has higher yield than CMA, except in patients with congenital anomalies or major dysmorphic features, but these methods are complementary. Patients with negative results with one approach should also be tested by the other.
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Affiliation(s)
- Michal Yechieli
- Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Suleyman Gulsuner
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Hilla Ben-Pazi
- Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviva Fattal
- Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Aran
- Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alla Kuzminsky
- Pediatric Neurology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Liora Sagi
- Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Guttman
- Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Nira Schneebaum Sender
- Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Varda Gross-Tsur
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Neurology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tehila Klopstock
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tom Walsh
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Paul Renbaum
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sharon Zeligson
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Dorit Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Medical Genetics, Edith Wolfson Medical Center, Holon, Israel
| | - Dorit Shmueli
- Child Development Services, Clalit Health Services, Tel Aviv, Israel
| | - Luba Blumkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology, Edith Wolfson Hospital, Holon, Israel
| | - Amnon Lahad
- Braun School of Public Health, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Family Medicine, Clalit Health Services, Jerusalem, Israel
| | - Mary-Claire King
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Ephrat Lahad Levy
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reeval Segel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel .,Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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85
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Genetic Variants Account for About 14% of Cerebral Palsy Cases. Am J Med Genet A 2021; 185:9-10. [PMID: 33331116 DOI: 10.1002/ajmg.a.61646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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86
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Kumar KK, Grant GA. Commentary: Genome-Wide Association Study Identifies Genetic Risk Factors for Spastic Cerebral Palsy. Neurosurgery 2021; 89:E145-E146. [PMID: 34133737 DOI: 10.1093/neuros/nyab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/02/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kevin K Kumar
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
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87
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Li N, Zhou P, Tang H, He L, Fang X, Zhao J, Wang X, Qi Y, Sun C, Lin Y, Qin F, Yang M, Zhang Z, Liao C, Zheng S, Peng X, Xue T, Zhu Q, Li H, Li Y, Liu L, Huang J, Liu L, Peng C, Kaindl AM, Gecz J, Han D, Liu D, Xu K, Hu H. In-depth analysis reveals complex molecular aetiology in a cohort of idiopathic cerebral palsy. Brain 2021; 145:119-141. [PMID: 34077496 PMCID: PMC8967106 DOI: 10.1093/brain/awab209] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Cerebral palsy is the most prevalent physical disability in children; however, its inherent molecular mechanisms remain unclear. In the present study, we performed in-depth clinical and molecular analysis on 120 idiopathic cerebral palsy families, and identified underlying detrimental genetic variants in 45% of these patients. In addition to germline variants, we found disease-related postzygotic mutations in ∼6.7% of cerebral palsy patients. We found that patients with more severe motor impairments or a comorbidity of intellectual disability had a significantly higher chance of harbouring disease-related variants. By a compilation of 114 known cerebral-palsy-related genes, we identified characteristic features in terms of inheritance and function, from which we proposed a dichotomous classification system according to the expression patterns of these genes and associated cognitive impairments. In two patients with both cerebral palsy and intellectual disability, we revealed that the defective TYW1, a tRNA hypermodification enzyme, caused primary microcephaly and problems in motion and cognition by hindering neuronal proliferation and migration. Furthermore, we developed an algorithm and demonstrated in mouse brains that this malfunctioning hypermodification specifically perturbed the translation of a subset of proteins involved in cell cycling. This finding provided a novel and interesting mechanism for congenital microcephaly. In another cerebral palsy patient with normal intelligence, we identified a mitochondrial enzyme GPAM, the hypomorphic form of which led to hypomyelination of the corticospinal tract in both human and mouse models. In addition, we confirmed that the aberrant Gpam in mice perturbed the lipid metabolism in astrocytes, resulting in suppressed astrocytic proliferation and a shortage of lipid contents supplied for oligodendrocytic myelination. Taken together, our findings elucidate novel aspects of the aetiology of cerebral palsy and provide insights for future therapeutic strategies.
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Affiliation(s)
- Na Li
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Pei Zhou
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
| | - Xiang Fang
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Jinxiang Zhao
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, China
| | - Xin Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, China
| | - Yifei Qi
- Division of Uterine Vascular Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Chuanbo Sun
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Yunting Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Fengying Qin
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Miaomiao Yang
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Zhan Zhang
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Caihua Liao
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Shuxin Zheng
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Xiaofang Peng
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Ting Xue
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Qianying Zhu
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Hong Li
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Yan Li
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
| | - Jingyu Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Changgeng Peng
- The First Rehabilitation Hospital of Shanghai, Tongji University School of Medicine, 200029, Shanghai, China
| | - Angela M Kaindl
- Institute of Cell Biology and Neurobiology, Charité-Universitätsmedizin, 13353, Berlin, Germany.,Department of Pediatric Neurology, Charité-Universitätsmedizin, 13353, Berlin, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin, 13353, Berlin, Germany
| | - Jozef Gecz
- Adelaide Medical School, University of Adelaide, SA5005, Adelaide, Australia
| | - Dingding Han
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China
| | - Dong Liu
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510120, Guangzhou, China
| | - Hao Hu
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, China.,Third Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
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88
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Bakhtiari S, Tafakhori A, Jin SC, Guida BS, Alehabib E, Firouzbadi S, Bilguvar K, Fahey MC, Darvish H, Kruer MC. Recessive COL4A2 Mutation Leads to Intellectual Disability, Epilepsy, and Spastic Cerebral Palsy. NEUROLOGY-GENETICS 2021; 7:e583. [PMID: 33912663 PMCID: PMC8077768 DOI: 10.1212/nxg.0000000000000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Somayeh Bakhtiari
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Abbas Tafakhori
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Sheng Chih Jin
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Brandon S Guida
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Elham Alehabib
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Saghar Firouzbadi
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Kaya Bilguvar
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Michael C Fahey
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Hossein Darvish
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
| | - Michael C Kruer
- Pediatric Movement Disorders Program (S.B., B.S.G., M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, AZ; Departments of Child Health (S.B., B.S.G., M.C.K.), Neurology, Genetics, and Cellular & Molecular Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Iranian Center of Neurological Research (A.T., H.D.), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Genetics (S.C.J.), Washington University School of Medicine, St. Louis, MO; Student Research Committee (E.A.), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Genetics Research Center (S.F.), University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Genetics (K.B.), Yale University, New Haven, CT; and Department of Paediatrics (M.C.F.), Monash University, Melbourne, Victoria, Australia
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89
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Dzinovic I, Škorvánek M, Pavelekova P, Zhao C, Keren B, Whalen S, Bakhtiari S, Chih Jin S, Kruer MC, Jech R, Winkelmann J, Zech M. Variant recurrence confirms the existence of a FBXO31-related spastic-dystonic cerebral palsy syndrome. Ann Clin Transl Neurol 2021; 8:951-955. [PMID: 33675180 PMCID: PMC8045898 DOI: 10.1002/acn3.51335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
The role of genetics in the causation of cerebral palsy has become the focus of many studies aiming to unravel the heterogeneous etiology behind this frequent neurodevelopmental disorder. A recent paper reported two unrelated children with a clinical diagnosis of cerebral palsy, who carried the same de novo c.1000G > A (p.Asp334Asn) variant in FBXO31, encoding a widely studied tumor suppressor not previously implicated in monogenic disease. We now identified a third individual with the recurrent FBXO31 de novo missense variant, featuring a spastic-dystonic phenotype. Our data confirm a link between variant FBXO31 and an autosomal dominant neurodevelopmental disorder characterized by prominent motor dysfunction.
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Affiliation(s)
- Ivana Dzinovic
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Matej Škorvánek
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Petra Pavelekova
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Chen Zhao
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Boris Keren
- Department of Genetics, Pitié-Salpêtrière Hospital, APHP.Sorbonne Université, Paris, France
| | - Sandra Whalen
- UF de Génétique Clinique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, APHP.Sorbonne Université, Hôpital Armand Trousseau, Paris, France
| | - 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, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, 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, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Michael Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
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90
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Affiliation(s)
- Jozef Gecz
- The Robinson Research Institute & Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Jesia G Berry
- The Robinson Research Institute & Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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91
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Smith SE, Gannotti M, Hurvitz EA, Jensen FE, Krach LE, Kruer MC, Msall ME, Noritz G, Rajan DS, Aravamuthan BR. Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review. Ann Neurol 2021; 89:860-871. [PMID: 33550625 DOI: 10.1002/ana.26040] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022]
Abstract
Cerebral palsy (CP) neurologic care and research efforts typically focus on children. However, most people with CP are adults. Adults with CP are at increased risk of new neurologic conditions, such as stroke and myelopathy, that require ongoing neurologic surveillance to distinguish them from baseline motor impairments. Neurologic factors could also contribute to the motor function decline, chronic pain, and chronic fatigue that are commonly experienced by adults with CP. Based on a systematic literature review, we suggest (1) guidelines for neurologic surveillance and neurologist referral and (2) clinical research questions regarding the evolving neurologic risks for adults with CP. ANN NEUROL 2021;89:860-871.
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Affiliation(s)
- Sarah E Smith
- Washington University School of Medicine, St Louis, MO, USA
| | - Mary Gannotti
- Shriners Hospitals for Children, Cerebral Palsy Network, University of Hartford, West Hartford, CT, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine/University of Michigan, Ann Arbor, MI, USA
| | - Frances E Jensen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda E Krach
- Gillette Children's Specialty Healthcare, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael C Kruer
- Cerebral Palsy & Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine-Phoenix Children's Hospital, Tucson, AZ, USA
| | - Michael E Msall
- University of Chicago Kennedy Research Center on Neurodevelopmental Disabilities, Chicago, IL, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
| | - Deepa S Rajan
- Department of Pediatrics, Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhooma R Aravamuthan
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, St Louis, MO, USA
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92
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Abstract
Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.
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Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
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93
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Moreno-De-Luca A, Millan F, Pesacreta DR, Elloumi HZ, Oetjens MT, Teigen C, Wain KE, Scuffins J, Myers SM, Torene RI, Gainullin VG, Arvai K, Kirchner HL, Ledbetter DH, Retterer K, Martin CL. Molecular Diagnostic Yield of Exome Sequencing in Patients With Cerebral Palsy. JAMA 2021; 325:467-475. [PMID: 33528536 PMCID: PMC7856544 DOI: 10.1001/jama.2020.26148] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Cerebral palsy is a common neurodevelopmental disorder affecting movement and posture that often co-occurs with other neurodevelopmental disorders. Individual cases of cerebral palsy are often attributed to birth asphyxia; however, recent studies indicate that asphyxia accounts for less than 10% of cerebral palsy cases. OBJECTIVE To determine the molecular diagnostic yield of exome sequencing (prevalence of pathogenic and likely pathogenic variants) in individuals with cerebral palsy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of patients with cerebral palsy that included a clinical laboratory referral cohort with data accrued between 2012 and 2018 and a health care-based cohort with data accrued between 2007 and 2017. EXPOSURES Exome sequencing with copy number variant detection. MAIN OUTCOMES AND MEASURES The primary outcome was the molecular diagnostic yield of exome sequencing. RESULTS Among 1345 patients from the clinical laboratory referral cohort, the median age was 8.8 years (interquartile range, 4.4-14.7 years; range, 0.1-66 years) and 601 (45%) were female. Among 181 patients in the health care-based cohort, the median age was 41.9 years (interquartile range, 28.0-59.6 years; range, 4.8-89 years) and 96 (53%) were female. The molecular diagnostic yield of exome sequencing was 32.7% (95% CI, 30.2%-35.2%) in the clinical laboratory referral cohort and 10.5% (95% CI, 6.0%-15.0%) in the health care-based cohort. The molecular diagnostic yield ranged from 11.2% (95% CI, 6.4%-16.2%) for patients without intellectual disability, epilepsy, or autism spectrum disorder to 32.9% (95% CI, 25.7%-40.1%) for patients with all 3 comorbidities. Pathogenic and likely pathogenic variants were identified in 229 genes (29.5% of 1526 patients); 86 genes were mutated in 2 or more patients (20.1% of 1526 patients) and 10 genes with mutations were independently identified in both cohorts (2.9% of 1526 patients). CONCLUSIONS AND RELEVANCE Among 2 cohorts of patients with cerebral palsy who underwent exome sequencing, the prevalence of pathogenic and likely pathogenic variants was 32.7% in a cohort that predominantly consisted of pediatric patients and 10.5% in a cohort that predominantly consisted of adult patients. Further research is needed to understand the clinical implications of these findings.
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Affiliation(s)
- Andrés Moreno-De-Luca
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Department of Radiology, Geisinger, Danville, Pennsylvania
- Diagnostic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Denis R. Pesacreta
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Matthew T. Oetjens
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Karen E. Wain
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Scott M. Myers
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | - H. Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - David H. Ledbetter
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Christa L. Martin
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
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94
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Aravamuthan BR, Fehlings D, Shetty S, Fahey M, Gilbert L, Tilton A, Kruer MC. Variability in Cerebral Palsy Diagnosis. Pediatrics 2021; 147:e2020010066. [PMID: 33402528 PMCID: PMC7906070 DOI: 10.1542/peds.2020-010066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common childhood motor disability. The emergence of genetic CP etiologies, variable inclusion of hypotonic CP in international registries, and involvement of different medical disciplines in CP diagnosis can promote diagnostic variability. This variability could adversely affect patients' understanding of their symptoms and access to care. Therefore, we sought to determine the presence and extent of practice variability in CP diagnosis. METHODS We surveyed physicians in the United States and Canada interested in CP on the basis of membership in the American Academy of Cerebral Palsy and Developmental Medicine or the Child Neurology Society Neonatal Neurology, Movement Disorders, or Neurodevelopmental Disabilities Special Interest Groups. The survey included the 2007 consensus definition of CP and 4 hypothetical case scenarios. RESULTS Of 695 contacted physicians, 330 (47%) completed the survey. Two scenarios yielded consensus: (1) nonprogressive spastic diplegia after premature birth with periventricular leukomalacia on brain MRI (96% would diagnose CP) and (2) progressive spastic diplegia (92% would not diagnose CP). Scenarios featuring genetic etiologies or hypotonia as the cause of nonprogressive motor disability yielded variability: only 46% to 67% of practitioners would diagnose CP in these settings. CONCLUSIONS There is practice variability in whether a child with a nonprogressive motor disability due to a genetic etiology or generalized hypotonia will be diagnosed with CP. This variability occurred despite anchoring questions with the 2007 consensus definition of CP. On the basis of these results, we have suggested ways to reduce diagnostic variability, including clarification of the consensus definition.
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Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri;
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto and Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sheetal Shetty
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Michael Fahey
- Department of Paediatrics, Monash University, Melbourne, Australia; and
| | - Laura Gilbert
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri
| | - Ann Tilton
- Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Michael C Kruer
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
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95
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Lewis SA, Shetty S, Wilson BA, Huang AJ, Jin SC, Smithers-Sheedy H, Fahey MC, Kruer MC. Insights From Genetic Studies of Cerebral Palsy. Front Neurol 2021; 11:625428. [PMID: 33551980 PMCID: PMC7859255 DOI: 10.3389/fneur.2020.625428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Cohort-based whole exome and whole genome sequencing and copy number variant (CNV) studies have identified genetic etiologies for a sizable proportion of patients with cerebral palsy (CP). These findings indicate that genetic mutations collectively comprise an important cause of CP. We review findings in CP genomics and propose criteria for CP-associated genes at the level of gene discovery, research study, and clinical application. We review the published literature and report 18 genes and 5 CNVs from genomics studies with strong evidence of for the pathophysiology of CP. CP-associated genes often disrupt early brain developmental programming or predispose individuals to known environmental risk factors. We discuss the overlap of CP-associated genes with other neurodevelopmental disorders and related movement disorders. We revisit diagnostic criteria for CP and discuss how identification of genetic etiologies does not preclude CP as an appropriate diagnosis. The identification of genetic etiologies improves our understanding of the neurobiology of CP, providing opportunities to study CP pathogenesis and develop mechanism-based interventions.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Sheetal Shetty
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Bryce A Wilson
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Aris J Huang
- Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States.,Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States
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