1
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Morison LD, Kennis MGP, Rots D, Bouman A, Kummeling J, Palmer E, Vogel AP, Liegeois F, Brignell A, Srivastava S, Frazier Z, Milnes D, Goel H, Amor DJ, Scheffer IE, Kleefstra T, Morgan AT. Expanding the phenotype of Kleefstra syndrome: speech, language and cognition in 103 individuals. J Med Genet 2024; 61:578-585. [PMID: 38290825 PMCID: PMC11148766 DOI: 10.1136/jmg-2023-109702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Speech and language impairments are core features of the neurodevelopmental genetic condition Kleefstra syndrome. Communication has not been systematically examined to guide intervention recommendations. We define the speech, language and cognitive phenotypic spectrum in a large cohort of individuals with Kleefstra syndrome. METHOD 103 individuals with Kleefstra syndrome (40 males, median age 9.5 years, range 1-43 years) with pathogenic variants (52 9q34.3 deletions, 50 intragenic variants, 1 balanced translocation) were included. Speech, language and non-verbal communication were assessed. Cognitive, health and neurodevelopmental data were obtained. RESULTS The cognitive spectrum ranged from average intelligence (12/79, 15%) to severe intellectual disability (12/79, 15%). Language ability also ranged from average intelligence (10/90, 11%) to severe intellectual disability (53/90, 59%). Speech disorders occurred in 48/49 (98%) verbal individuals and even occurred alongside average language and cognition. Developmental regression occurred in 11/80 (14%) individuals across motor, language and psychosocial domains. Communication aids, such as sign and speech-generating devices, were crucial for 61/103 (59%) individuals including those who were minimally verbal, had a speech disorder or following regression. CONCLUSIONS The speech, language and cognitive profile of Kleefstra syndrome is broad, ranging from severe impairment to average ability. Genotype and age do not explain the phenotypic variability. Early access to communication aids may improve communication and quality of life.
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Affiliation(s)
- Lottie D Morison
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Milou G P Kennis
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Dmitrijs Rots
- Department of Clinical Genetics, Erasmus MC, Rotterdam, Netherlands
| | - Arianne Bouman
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Joost Kummeling
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Elizabeth Palmer
- Sydney Children's Hospital Network, Randwick, New South Wales, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam P Vogel
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
| | - Frederique Liegeois
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amanda Brignell
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | | | - Zoe Frazier
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Di Milnes
- Genetic Health Queensland, Herston, Queensland, Australia
| | - Himanshu Goel
- Hunter Genetics, Waratah, New South Wales, Australia
| | - David J Amor
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ingrid E Scheffer
- Melbourne Brain Centre, Austin Health, Heidelberg, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Tjitske Kleefstra
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
- Department of Clinical Genetics, Erasmus MC, Rotterdam, Netherlands
| | - Angela T Morgan
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
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2
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Singh R. A Gene-Based Algorithm for Identifying Factors That May Affect a Speaker's Voice. ENTROPY (BASEL, SWITZERLAND) 2023; 25:897. [PMID: 37372241 DOI: 10.3390/e25060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Over the past decades, many machine-learning- and artificial-intelligence-based technologies have been created to deduce biometric or bio-relevant parameters of speakers from their voice. These voice profiling technologies have targeted a wide range of parameters, from diseases to environmental factors, based largely on the fact that they are known to influence voice. Recently, some have also explored the prediction of parameters whose influence on voice is not easily observable through data-opportunistic biomarker discovery techniques. However, given the enormous range of factors that can possibly influence voice, more informed methods for selecting those that may be potentially deducible from voice are needed. To this end, this paper proposes a simple path-finding algorithm that attempts to find links between vocal characteristics and perturbing factors using cytogenetic and genomic data. The links represent reasonable selection criteria for use by computational by profiling technologies only, and are not intended to establish any unknown biological facts. The proposed algorithm is validated using a simple example from medical literature-that of the clinically observed effects of specific chromosomal microdeletion syndromes on the vocal characteristics of affected people. In this example, the algorithm attempts to link the genes involved in these syndromes to a single example gene (FOXP2) that is known to play a broad role in voice production. We show that in cases where strong links are exposed, vocal characteristics of the patients are indeed reported to be correspondingly affected. Validation experiments and subsequent analyses confirm that the methodology could be potentially useful in predicting the existence of vocal signatures in naïve cases where their existence has not been otherwise observed.
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Affiliation(s)
- Rita Singh
- Center for Voice Intelligence and Security, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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3
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Samango-Sprouse CA, Hamzik MP, Rosenbaum K, Khaksari K, Mitchell F, Kommareddi R, Brooks MR, Tipton E, Sadeghin T, Gropman AL. Case Report: A Case Study on the Neurodevelopmental Profile of a Child With Pallister-Killian Syndrome and His Unaffected Twin. Front Pediatr 2022; 10:817133. [PMID: 35372156 PMCID: PMC8965074 DOI: 10.3389/fped.2022.817133] [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: 12/14/2021] [Accepted: 01/21/2022] [Indexed: 11/21/2022] Open
Abstract
Pallister-Killian syndrome is an uncommon genetic disorder that has broad developmental and multisystemic effects. While medical complications are widely reported throughout the literature, research on the neurodevelopmental profile has been limited. Case reports make up the majority of the few existing studies regarding the neurodevelopmental phenotype associated with this disorder. The current case report describes a 3-year-old male with Pallister-Killian syndrome (AF), reports the neurodevelopmental evaluation of his unaffected twin brother (MF), and outlines the results of an optical imaging study on both boys. AF presents with severe developmental delays, however, he ambulates with support and engages in conversation using his communication device. Most severely impaired was AF's speech and expressive language, with childhood apraxia of speech (CAS) as a possible explanation for these severe deficits. MF, the sibling, demonstrated neurotypical abilities and often advanced scores for his age. Both subjects completed a functional near-infrared spectroscopy (fNIRS) study, revealing decreased temporal and frontal lobe function in AF and typical functioning in MF. This case report expands on the existing literature on PKS by describing variances in fraternal twin presentation and novel reporting on fNIRS findings in both boys.
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Affiliation(s)
- Carole A Samango-Sprouse
- Department of Pediatrics, George Washington University, Washington, DC, United States.,Department of Human and Molecular Genetics, Florida International University, Miami, FL, United States.,Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Mary P Hamzik
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Kenneth Rosenbaum
- Division of Genetics and Metabolism, Children's National Health System, Washington, DC, United States
| | - Kosar Khaksari
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Francie Mitchell
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Ritika Kommareddi
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Michaela R Brooks
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Elizabeth Tipton
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Teresa Sadeghin
- Department of Research, The Focus Foundation, Davidsonville, MD, United States
| | - Andrea L Gropman
- Division of Neurogenetics and Developments Pediatrics, Children's National Health System, Washington, DC, United States.,Department of Neurology, George Washington University, Washington, DC, United States
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4
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Higuchi S, Takagi M, Takeda R, Yoshihashi H, Narumi S, Hasegawa T. An association with hypopituitarism and 9q subtelomere deletion syndrome. Clin Case Rep 2018; 6:2371-2375. [PMID: 30564331 PMCID: PMC6293262 DOI: 10.1002/ccr3.1591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022] Open
Abstract
Hypopituitarism could have been overlooked so far in the patients with 9q subtelomere deletion syndrome (9qSTDS); thus, further investigations or reevaluation of clinical information, especially hormonal evaluations, are warranted to determine whether hypopituitarism is a rare or relatively common presentation in patients with 9qSTDS.
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Affiliation(s)
- Shinji Higuchi
- Department of Pediatric Endocrinology and MetabolismChildren’s Medical CenterOsaka City General HospitalOsakaJapan
| | - Masaki Takagi
- Department of PediatricsKeio University School of MedicineTokyoJapan
- Kojiya Child ClinicTokyoJapan
| | - Ryojun Takeda
- Department of Medical GeneticsTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Hiroshi Yoshihashi
- Department of Medical GeneticsTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Satoshi Narumi
- Department of PediatricsKeio University School of MedicineTokyoJapan
- Department of Molecular EndocrinologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Tomonobu Hasegawa
- Department of PediatricsKeio University School of MedicineTokyoJapan
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5
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Vermeulen K, de Boer A, Janzing JGE, Koolen DA, Ockeloen CW, Willemsen MH, Verhoef FM, van Deurzen PAM, van Dongen L, van Bokhoven H, Egger JIM, Staal WG, Kleefstra T. Adaptive and maladaptive functioning in Kleefstra syndrome compared to other rare genetic disorders with intellectual disabilities. Am J Med Genet A 2017; 173:1821-1830. [PMID: 28498556 DOI: 10.1002/ajmg.a.38280] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/10/2017] [Indexed: 11/11/2022]
Abstract
Detailed neurobehavioural profiles are of major value for specific clinical management, but have remained underexposed in the population with intellectual disabilities (ID). This was traditionally classified based on IQ level only. Rapid advances in genetics enable etiology based stratification in the majority of patients, which reduces clinical heterogeneity. This paper illustrates that specific profiles can be obtained for rare syndromes with ID. Our main aim was to study (mal)adaptive functioning in Kleefstra Syndrome (KS) by comparing and contrasting our findings to three other subgroups: Koolen-de Vries Syndrome, GATAD2B-related syndrome, and a mixed control group of individuals with ID. In total, we studied 58 individuals (28 males, 30 females) with ID; 24 were diagnosed with KS, 13 with Koolen-de Vries Syndrome, 6 with the GATAD2B-related syndrome, and 15 individuals with undefined neurodevelopmental disorders. All individuals were examined with a Vineland Adaptive Behavior Scale, mini PAS-ADD interview, and an Autism Diagnostic Observation Schedule to obtain measures of adaptive and maladaptive functioning. Each of the three distinctive genetic disorders showed its own specific profile of adaptive and maladaptive functioning, while being contrasted mutually. However, when data of the subgroups altogether are contrasted to the data of KS, such differences could not be demonstrated. Based on our findings, specific management recommendations were discussed for each of the three syndromes. It is strongly suggested to consider the genetic origin in individuals with congenital neurodevelopmental disorders for individual based psychiatric and behavioral management.
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Affiliation(s)
- Karlijn Vermeulen
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke de Boer
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost G E Janzing
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David A Koolen
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Marjolein H Willemsen
- Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Floor M Verhoef
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands
| | - Patricia A M van Deurzen
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands
| | - Linde van Dongen
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Hans van Bokhoven
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Jos I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjitske Kleefstra
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
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6
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Blackburn PR, Tischer A, Zimmermann MT, Kemppainen JL, Sastry S, Knight Johnson AE, Cousin MA, Boczek NJ, Oliver G, Misra VK, Gavrilova RH, Lomberk G, Auton M, Urrutia R, Klee EW. A Novel Kleefstra Syndrome-associated Variant That Affects the Conserved TPL X Motif within the Ankyrin Repeat of EHMT1 Leads to Abnormal Protein Folding. J Biol Chem 2017; 292:3866-3876. [PMID: 28057753 PMCID: PMC5339767 DOI: 10.1074/jbc.m116.770545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/05/2017] [Indexed: 12/26/2022] Open
Abstract
Kleefstra syndrome (KS) (Mendelian Inheritance in Man (MIM) no. 610253), also known as 9q34 deletion syndrome, is an autosomal dominant disorder caused by haploinsufficiency of euchromatic histone methyltransferase-1 (EHMT1). The clinical phenotype of KS includes moderate to severe intellectual disability with absent speech, hypotonia, brachycephaly, congenital heart defects, and dysmorphic facial features with hypertelorism, synophrys, macroglossia, protruding tongue, and prognathism. Only a few cases of de novo missense mutations in EHMT1 giving rise to KS have been described. However, some EHMT1 variants have been described in individuals presenting with autism spectrum disorder or mild intellectual disability, suggesting that the phenotypic spectrum resulting from EHMT1 alterations may be quite broad. In this report, we describe two unrelated patients with complex medical histories consistent with KS in whom next generation sequencing identified the same novel c.2426C>T (p.P809L) missense variant in EHMT1. To examine the functional significance of this novel variant, we performed molecular dynamics simulations of the wild type and p.P809L variant, which predicted that the latter would have a propensity to misfold, leading to abnormal histone mark binding. Recombinant EHMT1 p.P809L was also studied using far UV circular dichroism spectroscopy and intrinsic protein fluorescence. These functional studies confirmed the model-based hypotheses and provided evidence for protein misfolding and aberrant target recognition as the underlying pathogenic mechanism for this novel KS-associated variant. This is the first report to suggest that missense variants in EHMT1 that lead to protein misfolding and disrupted histone mark binding can lead to KS.
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Affiliation(s)
- Patrick R Blackburn
- From the Center for Individualized Medicine and.,the Department of Health Science Research, Mayo Clinic, Jacksonville, Florida 32224
| | - Alexander Tischer
- the Division of Hematology, Departments of Internal Medicine and Biochemistry and Molecular Biology
| | - Michael T Zimmermann
- the Department of Health Science Research, Division of Biomedical Statistics and Informatics
| | | | - Sujatha Sastry
- the Department of Pediatrics, Division of Genetics and Metabolic Disorders, Wayne State University School of Medicine, Detroit, Michigan 48201, and
| | - Amy E Knight Johnson
- the Department of Human Genetics, University of Chicago, Chicago, Illinois 60637
| | - Margot A Cousin
- the Center for Individualized Medicine.,the Department of Health Science Research
| | - Nicole J Boczek
- the Center for Individualized Medicine.,the Department of Health Science Research
| | | | - Vinod K Misra
- the Department of Pediatrics, Division of Genetics and Metabolic Disorders, Wayne State University School of Medicine, Detroit, Michigan 48201, and
| | | | - Gwen Lomberk
- the Laboratory of Epigenetics and Chromatin Dynamics, Epigenomics Translational Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Matthew Auton
- the Division of Hematology, Departments of Internal Medicine and Biochemistry and Molecular Biology
| | - Raul Urrutia
- the Laboratory of Epigenetics and Chromatin Dynamics, Epigenomics Translational Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota 55905,
| | - Eric W Klee
- the Department of Clinical Genomics, .,the Center for Individualized Medicine.,the Department of Health Science Research
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7
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Targeted next generation sequencing of a panel of autism-related genes identifies an EHMT1 mutation in a Kleefstra syndrome patient with autism and normal intellectual performance. Gene 2016; 595:131-141. [PMID: 27651234 DOI: 10.1016/j.gene.2016.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with unknown genetic and environmental causation in most of the affected individuals. On the other hand, there are a growing number of ASD-associated syndromes, where the exact genetic origin can be revealed. Here we report a method, which included the targeted next generation sequencing (NGS) and filtering of 101 ASD associated genes, followed by database search. Next, RNA sequencing was used to study the region of interest at the transcriptional level. Using this workflow, we identified a de novo mutation in the euchromatic histone-lysine N-methyltransferase 1 gene (EHMT1) of an autistic patient with dysmorphisms. Sequencing of EHMT1 transcripts showed that the premature termination codon (Trp1138Ter) created by a single nucleotide change elicited nonsense-mediated mRNA decay, which led to haploinsufficiency already at the transcriptional level. Database and literature search provided evidence that this mutation caused Kleefstra syndrome (KS), which was confirmed by the presence of the disorder-specific phenotype in the patient. We provide a proof of principle that the implemented method is capable to elucidate the genetic etiology of individuals with syndromic autism. The novel mutation detected in the EHMT1 gene is responsible for KS's symptoms. In addition, further genetic factors might be involved in the ASD pathogenesis of the patient including a missense DPP6 mutation (Arg322Cys), which segregated with the autistic phenotype within the family.
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