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Kowkabi S, Yavarian M, Kaboodkhani R, Mohammadi M, Shervin Badv R. PCDH19-clustering epilepsy, pathophysiology and clinical significance. Epilepsy Behav 2024; 154:109730. [PMID: 38521028 DOI: 10.1016/j.yebeh.2024.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
PCDH19 clustering epilepsy (PCDH19-CE) is an X-linked epilepsy disorder associated with intellectual disability (ID) and behavioral disturbances, which is caused by PCDH19 gene variants. PCDH19 pathogenic variant leads to epilepsy in heterozygous females, not in hemizygous males and the inheritance pattern is unusual. The hypothesis of cellular interference was described as a key pathogenic mechanism. According to that, males do not develop the disease because of the uniform expression of PCDH19 (variant or wild type) unless they have a somatic variation. We conducted a literature review on PCDH19-CE pathophysiology and concluded that other significant mechanisms could contribute to pathogenesis including: asymmetric cell division and heterochrony, female-related allopregnanolone deficiency, altered steroid gene expression, decreased Gamma-aminobutyric acid receptor A (GABAA) function, and blood-brain barrier (BBB) dysfunction. Being aware of these mechanisms helps us when we should decide which therapeutic option is more suitable for which patient.
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Affiliation(s)
- Safoura Kowkabi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran; Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Majid Yavarian
- Hematology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mahmood Mohammadi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
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2
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Bernardo P, Cuccurullo C, Rubino M, De Vita G, Terrone G, Bilo L, Coppola A. X-Linked Epilepsies: A Narrative Review. Int J Mol Sci 2024; 25:4110. [PMID: 38612920 PMCID: PMC11012983 DOI: 10.3390/ijms25074110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024] Open
Abstract
X-linked epilepsies are a heterogeneous group of epileptic conditions, which often overlap with X-linked intellectual disability. To date, various X-linked genes responsible for epilepsy syndromes and/or developmental and epileptic encephalopathies have been recognized. The electro-clinical phenotype is well described for some genes in which epilepsy represents the core symptom, while less phenotypic details have been reported for other recently identified genes. In this review, we comprehensively describe the main features of both X-linked epileptic syndromes thoroughly characterized to date (PCDH19-related DEE, CDKL5-related DEE, MECP2-related disorders), forms of epilepsy related to X-linked neuronal migration disorders (e.g., ARX, DCX, FLNA) and DEEs associated with recently recognized genes (e.g., SLC9A6, SLC35A2, SYN1, ARHGEF9, ATP6AP2, IQSEC2, NEXMIF, PIGA, ALG13, FGF13, GRIA3, SMC1A). It is often difficult to suspect an X-linked mode of transmission in an epilepsy syndrome. Indeed, different models of X-linked inheritance and modifying factors, including epigenetic regulation and X-chromosome inactivation in females, may further complicate genotype-phenotype correlations. The purpose of this work is to provide an extensive and updated narrative review of X-linked epilepsies. This review could support clinicians in the genetic diagnosis and treatment of patients with epilepsy featuring X-linked inheritance.
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Affiliation(s)
- Pia Bernardo
- Pediatric Psychiatry and Neurology Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Claudia Cuccurullo
- Neurology and Stroke Unit, Ospedale del Mare Hospital, ASL Napoli 1 Centro, 80147 Naples, Italy;
| | - Marica Rubino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80131 Naples, Italy (L.B.)
| | - Gabriella De Vita
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy;
| | - Gaetano Terrone
- Child Neuropsychiatry Units, Department of Translational Medical Sciences, University Federico II of Naples, 80131 Naples, Italy;
| | - Leonilda Bilo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80131 Naples, Italy (L.B.)
| | - Antonietta Coppola
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80131 Naples, Italy (L.B.)
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Giansante G, Mazzoleni S, Zippo AG, Ponzoni L, Ghilardi A, Maiellano G, Lewerissa E, van Hugte E, Nadif Kasri N, Francolini M, Sala M, Murru L, Bassani S, Passafaro M. Neuronal network activity and connectivity are impaired in a conditional knockout mouse model with PCDH19 mosaic expression. Mol Psychiatry 2023:10.1038/s41380-023-02022-1. [PMID: 36997609 DOI: 10.1038/s41380-023-02022-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
Mutations in PCDH19 gene, which encodes protocadherin-19 (PCDH19), cause Developmental and Epileptic Encephalopathy 9 (DEE9). Heterogeneous loss of PCDH19 expression in neurons is considered a key determinant of the disorder; however, how PCDH19 mosaic expression affects neuronal network activity and circuits is largely unclear. Here, we show that the hippocampus of Pcdh19 mosaic mice is characterized by structural and functional synaptic defects and by the presence of PCDH19-negative hyperexcitable neurons. Furthermore, global reduction of network firing rate and increased neuronal synchronization have been observed in different limbic system areas. Finally, network activity analysis in freely behaving mice revealed a decrease in excitatory/inhibitory ratio and functional hyperconnectivity within the limbic system of Pcdh19 mosaic mice. Altogether, these results indicate that altered PCDH19 expression profoundly affects circuit wiring and functioning, and provide new key to interpret DEE9 pathogenesis.
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Affiliation(s)
| | - Sara Mazzoleni
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Antonio G Zippo
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy
| | - Luisa Ponzoni
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
| | - Anna Ghilardi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Greta Maiellano
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Elly Lewerissa
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Eline van Hugte
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Nael Nadif Kasri
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Maura Francolini
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | | | - Luca Murru
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy
| | - Silvia Bassani
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy.
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy.
| | - Maria Passafaro
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy.
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy.
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Chen Y, Yang X, Chen J, Yang X, Yang Y, Liu A, Zhang X, Wu W, Sun D, Yang Z, Jiang Y, Zhang Y. PCDH19-related epilepsy in mosaic males: The phenotypic implication of genotype and variant allele frequency. Front Neurol 2022; 13:1041509. [PMID: 36408521 PMCID: PMC9669318 DOI: 10.3389/fneur.2022.1041509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/06/2022] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To analyze the genotypes and phenotypes of mosaic male patients with PCDH19-related epilepsy (PCDH19-RE) and explore the correlation between genotype, variant allele frequency (VAF), and phenotypic severity. METHODS Clinical data and peripheral blood samples of 11 male mosaic patients were collected and analyzed in our study. The VAF of the PCDH19 gene from peripheral blood was quantified using amplicon-based deep sequencing. Additional 20 mosaic male patients with PCDH19-RE were collected from the published literature, with 10 patients whose VAFs of the PCDH19 gene were available for analytic purposes. RESULTS In our cohort of 11 patients, 10 variants were identified, and four were novel. The VAF of the PCDH19 gene from peripheral blood ranged from 27 to 90%. The median seizure onset age was 6 months (range: 4-9 months). Clinical manifestations included cluster seizures (100%), fever sensitivity (73%), focal seizures (91%), developmental delay/intellectual disability (DD/ID, 82%), and autistic features (45%). Thirty-one mosaic male patients collected from our cohort and the literature developed seizures mostly (87%) within one year of age. Variant types included missense variants (42%), truncating variants (52%), splice variants (3%), and whole PCDH19 deletion (3%). Among 21 patients with a definite VAF from our cohort and the literature, nine had a low VAF ( ≤ 50%) and 12 had a high VAF (> 50%). Seventy-five percent of variants from the high VAF group were missense, whereas 89% of those from the low VAF group were truncations. The median seizure onset age was 6 months in the low VAF group and 9 months in the high VAF group (p = 0.018). Forty-four percent (4/9) of patients from the low VAF group achieved seizure-free for ≥1 year, whereas none of the 12 patients from the high VAF group did (p = 0.021). DD/ID was present in 83% (10/12) of the high VAF group and 56% (5/9) of the low VAF group (p = 0.331). CONCLUSION The predominant variant types were truncating and missense variants. Missense variants tended to have higher VAFs. Patients with a high VAF were more likely to have a more severe epileptic phenotype. Our findings shed light on the phenotypic implications of VAF in mosaic males with PCDH19-RE.
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Affiliation(s)
- Yi Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoxu Yang
- Center for Bioinformatics, State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences, Peking University, Beijing, China
| | - Jiaoyang Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Aijie Liu
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoli Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Wenjuan Wu
- Department of Neurology, Hebei Children's Hospital, Shijiazhuang, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Wuhan, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Pancho A, Mitsogiannis MD, Aerts T, Dalla Vecchia M, Ebert LK, Geenen L, Noterdaeme L, Vanlaer R, Stulens A, Hulpiau P, Staes K, Van Roy F, Dedecker P, Schermer B, Seuntjens E. Modifying PCDH19 levels affects cortical interneuron migration. Front Neurosci 2022; 16:887478. [PMID: 36389226 PMCID: PMC9642031 DOI: 10.3389/fnins.2022.887478] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2023] Open
Abstract
PCDH19 is a transmembrane protein and member of the protocadherin family. It is encoded by the X-chromosome and more than 200 mutations have been linked to the neurodevelopmental PCDH-clustering epilepsy (PCDH19-CE) syndrome. A disturbed cell-cell contact that arises when random X-inactivation creates mosaic absence of PCDH19 has been proposed to cause the syndrome. Several studies have shown roles for PCDH19 in neuronal proliferation, migration, and synapse function, yet most of them have focused on cortical and hippocampal neurons. As epilepsy can also be caused by impaired interneuron migration, we studied the role of PCDH19 in cortical interneurons during embryogenesis. We show that cortical interneuron migration is affected by altering PCDH19 dosage by means of overexpression in brain slices and medial ganglionic eminence (MGE) explants. We also detect subtle defects when PCDH19 expression was reduced in MGE explants, suggesting that the dosage of PCDH19 is important for proper interneuron migration. We confirm this finding in vivo by showing a mild reduction in interneuron migration in heterozygote, but not in homozygote PCDH19 knockout animals. In addition, we provide evidence that subdomains of PCDH19 have a different impact on cell survival and interneuron migration. Intriguingly, we also observed domain-dependent differences in migration of the non-targeted cell population in explants, demonstrating a non-cell-autonomous effect of PCDH19 dosage changes. Overall, our findings suggest new roles for the extracellular and cytoplasmic domains of PCDH19 and support that cortical interneuron migration is dependent on balanced PCDH19 dosage.
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Affiliation(s)
- Anna Pancho
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Manuela D. Mitsogiannis
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Tania Aerts
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Marco Dalla Vecchia
- Laboratory for NanoBiology, Department of Chemistry, KU Leuven, Leuven, Belgium
- Molecular Signaling and Cell Death Unit, Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Lena K. Ebert
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Lieve Geenen
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
- Laboratory of Neuroplasticity and Neuroproteomics, Animal Physiology and Neurobiology Division, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lut Noterdaeme
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Ria Vanlaer
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Anne Stulens
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
| | - Paco Hulpiau
- Department of Biomedical Molecular Biology, Ghent University, Inflammation Research Center, VIB, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- BioInformatics Knowledge Center (BiKC), Howest University of Applied Sciences, Bruges, Belgium
| | - Katrien Staes
- Department of Biomedical Molecular Biology, Ghent University, Inflammation Research Center, VIB, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Frans Van Roy
- Department of Biomedical Molecular Biology, Ghent University, Inflammation Research Center, VIB, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Peter Dedecker
- Laboratory for NanoBiology, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - Bernhard Schermer
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Eve Seuntjens
- Developmental Neurobiology Group, Animal Physiology and Neurobiology Division, Department of Biology, KU Leuven, Leuven, Belgium
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6
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Lamers D, Landi S, Mezzena R, Baroncelli L, Pillai V, Cruciani F, Migliarini S, Mazzoleni S, Pasqualetti M, Passafaro M, Bassani S, Ratto GM. Perturbation of Cortical Excitability in a Conditional Model of PCDH19 Disorder. Cells 2022; 11:cells11121939. [PMID: 35741068 PMCID: PMC9222106 DOI: 10.3390/cells11121939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
PCDH19 epilepsy (DEE9) is an X-linked syndrome associated with cognitive and behavioral disturbances. Since heterozygous females are affected, while mutant males are spared, it is likely that DEE9 pathogenesis is related to disturbed cell-to-cell communication associated with mosaicism. However, the effects of mosaic PCDH19 expression on cortical networks are unknown. We mimicked the pathology of DEE9 by introducing a patch of mosaic protein expression in one hemisphere of the cortex of conditional PCDH19 knockout mice one day after birth. In the contralateral area, PCDH19 expression was unaffected, thus providing an internal control. In this model, we characterized the physiology of the disrupted network using local field recordings and two photon Ca2+ imaging in urethane anesthetized mice. We found transient episodes of hyperexcitability in the form of brief hypersynchronous spikes or bursts of field potential oscillations in the 9–25 Hz range. Furthermore, we observed a strong disruption of slow wave activity, a crucial component of NREM sleep. This phenotype was present also when PCDH19 loss occurred in adult mice, demonstrating that PCDH19 exerts a function on cortical circuitry outside of early development. Our results indicate that a focal mosaic mutation of PCDH19 disrupts cortical networks and broaden our understanding of DEE9.
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Affiliation(s)
- Didi Lamers
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Silvia Landi
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy;
| | - Roberta Mezzena
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Laura Baroncelli
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy;
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Vinoshene Pillai
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Federica Cruciani
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Sara Migliarini
- Unit of Cellular and Developmental Biology, Department of Biology, University of Pisa, 56127 Pisa, Italy; (S.M.); (M.P.)
| | - Sara Mazzoleni
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Massimo Pasqualetti
- Unit of Cellular and Developmental Biology, Department of Biology, University of Pisa, 56127 Pisa, Italy; (S.M.); (M.P.)
| | - Maria Passafaro
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Silvia Bassani
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gian Michele Ratto
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
- Correspondence:
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7
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Borghi R, Magliocca V, Trivisano M, Specchio N, Tartaglia M, Bertini E, Compagnucci C. Modeling PCDH19-CE: From 2D Stem Cell Model to 3D Brain Organoids. Int J Mol Sci 2022; 23:ijms23073506. [PMID: 35408865 PMCID: PMC8998847 DOI: 10.3390/ijms23073506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
PCDH19 clustering epilepsy (PCDH19-CE) is a genetic disease characterized by a heterogeneous phenotypic spectrum ranging from focal epilepsy with rare seizures and normal cognitive development to severe drug-resistant epilepsy associated with intellectual disability and autism. Unfortunately, little is known about the pathogenic mechanism underlying this disease and an effective treatment is lacking. Studies with zebrafish and murine models have provided insights on the function of PCDH19 during brain development and how its altered function causes the disease, but these models fail to reproduce the human phenotype. Induced pluripotent stem cell (iPSC) technology has provided a complementary experimental approach for investigating the pathogenic mechanisms implicated in PCDH19-CE during neurogenesis and studying the pathology in a more physiological three-dimensional (3D) environment through the development of brain organoids. We report on recent progress in the development of human brain organoids with a particular focus on how this 3D model may shed light on the pathomechanisms implicated in PCDH19-CE.
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Affiliation(s)
- Rossella Borghi
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Valentina Magliocca
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Marina Trivisano
- Department of Neurosciences, Rare and Complex Epilepsy Unit, Division of Neurology, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (M.T.); (N.S.)
| | - Nicola Specchio
- Department of Neurosciences, Rare and Complex Epilepsy Unit, Division of Neurology, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (M.T.); (N.S.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Enrico Bertini
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Claudia Compagnucci
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
- Correspondence:
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8
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Mazzurco M, Pulvirenti G, Caccamo M, Presti S, Soma R, Salafia S, Praticò ER, Filosco F, Falsaperla R, Praticò AD. PCDH19-Related Epilepsies. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1728641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractProtocadherin-19 (PCDH19) is considered one of the most relevant genes related to epilepsy. To date, more than 150 mutations have been identified as causative for PCDH19-female epilepsy (also known as early infantile epileptic encephalopathy-9, EIEE9), which is characterized by early onset epilepsy, intellectual disabilities, and behavioral disturbances. More recently, mosaic-males (i.e., exhibiting the variants in less than 25% of their cells) have been described as affected by infant-onset epilepsy associated with intellectual disability, as well as compulsive or aggressive behavior and autistic features. Although little is known about the physiological role of PCDH19 protein and the pathogenic mechanisms that lead to EIEE9, many reports and clinical observation seem to suggest a relevant role of this protein in the development of cellular hyperexcitability. However, a genotype–phenotype correlation is difficult to establish. The main feature of EIEE9 consists in early onset of seizures, which generally occur in clusters lasting 1 to 5 minutes and repeating up to 10 times a day for several days. Seizures tend to present during febrile episodes, similarly to the first phases of Dravet syndrome and PCDH19 variants have been found in ∼25% of females who present with features of Dravet syndrome and testing negative for SCN1A variants. There is no “standardized” treatment for PCDH19-related epilepsy and most of the patients receiving a combination of several drugs. In this review, we focus on the latest researches on these aspects, with regard to protein expression, its known functions, and the mechanisms by which the protein acts. The clinical phenotypes related to PCDH19 mutations are also discussed.
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Affiliation(s)
| | - Giulio Pulvirenti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Martina Caccamo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Santiago Presti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rachele Soma
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | | | | | - Federica Filosco
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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9
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Right Place at the Right Time: How Changes in Protocadherins Affect Synaptic Connections Contributing to the Etiology of Neurodevelopmental Disorders. Cells 2020; 9:cells9122711. [PMID: 33352832 PMCID: PMC7766791 DOI: 10.3390/cells9122711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
During brain development, neurons need to form the correct connections with one another in order to give rise to a functional neuronal circuitry. Mistakes during this process, leading to the formation of improper neuronal connectivity, can result in a number of brain abnormalities and impairments collectively referred to as neurodevelopmental disorders. Cell adhesion molecules (CAMs), present on the cell surface, take part in the neurodevelopmental process regulating migration and recognition of specific cells to form functional neuronal assemblies. Among CAMs, the members of the protocadherin (PCDH) group stand out because they are involved in cell adhesion, neurite initiation and outgrowth, axon pathfinding and fasciculation, and synapse formation and stabilization. Given the critical role of these macromolecules in the major neurodevelopmental processes, it is not surprising that clinical and basic research in the past two decades has identified several PCDH genes as responsible for a large fraction of neurodevelopmental disorders. In the present article, we review these findings with a focus on the non-clustered PCDH sub-group, discussing the proteins implicated in the main neurodevelopmental disorders.
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10
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Hirose S, Tanaka Y, Shibata M, Kimura Y, Ishikawa M, Higurashi N, Yamamoto T, Ichise E, Chiyonobu T, Ishii A. Application of induced pluripotent stem cells in epilepsy. Mol Cell Neurosci 2020; 108:103535. [DOI: 10.1016/j.mcn.2020.103535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023] Open
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11
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Jourdon A, Fasching L, Scuderi S, Abyzov A, Vaccarino FM. The role of somatic mosaicism in brain disease. Curr Opin Genet Dev 2020; 65:84-90. [PMID: 32622340 DOI: 10.1016/j.gde.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 12/25/2022]
Abstract
In this review we discuss the importance of genetic somatic mosaicism and its impact on brain diseases. We start from introducing the different types of somatic mutations, their frequencies and abundances across development and lifespan. We then describe how weakness in DNA repair mechanisms influences their prevalence. Finally, we address their functional consequences in the brain and review recent research showing their unsuspected importance in several neurodevelopmental, psychiatric, and neurodegenerative diseases.
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Affiliation(s)
| | - Liana Fasching
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Soraya Scuderi
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Alexej Abyzov
- Department of Health Sciences Research, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Flora M Vaccarino
- Child Study Center, Yale University, New Haven, CT 06520, USA; Department of Neuroscience, Yale University, New Haven, CT 06520, USA.
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12
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Yang X, Chen J, Zheng B, Liu X, Cao Z, Wang X. PCDH19-Related Epilepsy in Early Onset of Chinese Male Patient: Case Report and Literature Review. Front Neurol 2020; 11:311. [PMID: 32425876 PMCID: PMC7203462 DOI: 10.3389/fneur.2020.00311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/31/2020] [Indexed: 11/29/2022] Open
Abstract
Mutations in PCDH19 are associated with epilepsy, intellectual disability and behavioral disturbances, mostly related to females. The unique X-linked pattern of inheritance affects females predominantly, while usually is transmitted through asymptomatic males. Recently, new research has demonstrated that males with a mosaic pattern of inheritance could also be affected. As yet, PCDH19 mutations have been reported in hundreds of females; however, only 15 mosaic males were reported to exhibit epileptic seizures with the onset ranges between 6 and 31 months. These patients were usually reported to carry various mutations in the PCDH19. Here we describe a non-sense variant at the PCDH19 (c.498C>G; p.Y166*) in the Chinese male that exhibited early developmental delay and frequent seizures starting from the age of 5 months. We aim that this case report, focusing on studying clinical seizures, therapeutic approaches, and the patient's prognosis, will contribute to the cumulative knowledge of this rare and complex genetic disorder.
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Affiliation(s)
- Xiao Yang
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Chen
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - BiXia Zheng
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xianyu Liu
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zixuan Cao
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyu Wang
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
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13
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PCDH19-Related Epilepsy Syndrome: A Comprehensive Clinical Review. Pediatr Neurol 2020; 105:3-9. [PMID: 32057594 DOI: 10.1016/j.pediatrneurol.2019.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
Abstract
PCDH19-related epilepsy is a distinct childhood-onset epilepsy syndrome characterized by brief clusters of febrile and afebrile seizures with onset primarily before the age of three years, cognitive impairment, autistic traits, and behavioral abnormalities. PCDH19 gene is located in Xq22 and produces nonclustered delta protocadherin. This disorder primarily manifests in heterozygote females due to random X chromosome inactivation leading to somatic mosaicism and abnormal cellular interference between cells with and without delta-protocadherin. This article reviews the clinical features based on a comprehensive literature review (MEDLINE using PubMed and OvidSP vendors with appropriate keywords to incorporate recent evidence), personal practice, and experience. Significant progress has been made in the past 10 years, including identification of the gene responsible for the condition, characterization of clinical phenotypes, and development of animal models. More rigorous studies involving quality-of-life measures as well as standardized neuropsychiatric testing are necessary to understand the full spectrum of the disease. The recent discovery of allopregnanolone deficiency in patients with PCDH19-related epilepsy leads to opportunities in precision therapy. A phase 3 clinical study is currently active to evaluate the efficacy, safety, and tolerability of adjunctive ganaxolone (an allopregnanolone analog) therapy.
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14
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Dadali EL, Mishina IA, Borovikov AO, Sharkov AA, Kanivets IV. [Clinical and genetic characteristics of epilepsy caused by mutations in the PCDH19 gene (OMIM: 300088)]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:55-61. [PMID: 32105270 DOI: 10.17116/jnevro202012001155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM To analyze clinical and genetic characteristics of PCDH19-associated epilepsy in a sample of patients from the Russian population. MATERIAL AND METHODS The sample of patients with early epileptic encephalopathies included 16 people aged 10 month to 30 years. All patients underwent neurological examination according to standard methods, exome sequencing and EEG monitoring. RESULTS Most of the identified mutations led to a shift in the reading frame or the formation of a termination codon. Six of them were duplications, four were deletions of one nucleotide, and three were nonsense mutations. Consistent with earlier studies, the authors identified the polymorphism of clinical manifestations of seizures that did not depend on the type of mutation and its localization. CONCLUSION Based on the study of the clinical and genetic characteristics of the patients, the authors conclude that the so-called 'hot spots' are present in the PCDH19 gene, which are more common in the group of patients with mutations in this gene, and that the clinical picture of early infantile epileptic encephalopathy type 9 is variable.
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Affiliation(s)
- E L Dadali
- Federal State Budgetary Institution 'Research Centre for Medical Genetics', Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Mishina
- Federal State Budgetary Institution 'Research Centre for Medical Genetics', Moscow, Russia
| | - A O Borovikov
- Federal State Budgetary Institution 'Research Centre for Medical Genetics', Moscow, Russia
| | - A A Sharkov
- Pirogov Russian National Research Medical University, Moscow, Russia
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15
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Abstract
PURPOSE OF REVIEW There has been rapid progress in defining novel causative gene variants responsible for a large spectrum of human epilepsy syndromes and subtypes. Of particular interest is the discovery that somatic mutations, for example, noninherited mutations occurring in neuroglial progenitor cells during embryonic brain development, are highly linked to malformations of cortical development (MCD) such as focal cortical dysplasia (FCD) type II and hemimegalencephaly. RECENT FINDINGS Somatic gene variants have been identified in genes encoding regulatory proteins within the mechanistic target of rapamycin (mTOR) signaling cascade and have thus comprised the group classified as mTORopathies. FCD II and hemimegalencephaly often result from mutations in identical genes suggesting that these are spectrum disorders. An exciting recent development has been the identification of somatic mutations causing both FCD Ia and nonlesional neocortical epilepsy. SUMMARY Defining somatic gene mutations in brain tissue specimens has shed new light on how MCD form and the mechanisms of epileptogenesis associated with MCD. Trials of mTOR inhibitors in tuberous sclerosis complex have demonstrated that inhibition of mTOR activation in mTORopathies can reduce seizure frequency. New somatic mutations found for a variety of epilepsy syndromes may provide new targets for clinical therapeutics.
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16
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Kolc KL, Møller RS, Sadleir LG, Scheffer IE, Kumar R, Gecz J. PCDH19 Pathogenic Variants in Males: Expanding the Phenotypic Spectrum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1298:177-187. [PMID: 32852734 DOI: 10.1007/5584_2020_574] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Protocadherin-19 (PCDH19) pathogenic variants cause an infantile onset epilepsy syndrome called Girls Clustering Epilepsy due to the vast majority of affected individuals being female. This syndromic name was developed to foster early recognition and diagnosis in infancy. It has, however, sparked debate, as, there are rare males with postzygotic somatic, and therefore, mosaic, PCDH19 pathogenic variants with similar clinical features to females. Conversely, "transmitting" males with germline inherited PCDH19 variants are considered asymptomatic. To date, there has been no standardized neuropsychiatric assessment of males with PCDH19 pathogenic variants. Here, we studied 15 males with PCDH19 pathogenic variants (nine mosaic and six transmitting) aged 2 to 70 years. Our families completed a survey including standardized clinical assessments: Social Responsiveness Scale, Strengths and Difficulties Questionnaire, Behavior Rating Inventory of Executive Function, and Dimensional Obsessive-Compulsive Scale. We identified neuropsychiatric abnormalities in two males with germline PCDH19 possibly pathogenic variants. One had a prior history of a severe encephalopathic illness, which may have been unrelated. We also describe a non-penetrant somatic mosaic male with mosaicism confirmed in blood, but not identified in skin fibroblasts. Our data suggest that transmitting hemizygous males are generally unaffected, in contrast to males with postzygotic somatic mosaic variants who show a similar neuropsychiatric profile to females who are naturally mosaic, due to X-chromosome inactivation. The penetrance of PCDH19 pathogenic variants has been estimated to be 80%. Like females, not all mosaic males are affected. From our small sample, we estimate that males with mosaic PCHD19 pathogenic variants have a penetrance of 85%. With these insights into the male phenotypic spectrum of PCDH19 epilepsy, we propose the new term Clustering Epilepsy (CE). Both affected females and males typically present with infantile onset of clusters of seizures.
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Affiliation(s)
- Kristy L Kolc
- Adelaide Medical School, the University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, the University of Adelaide, Adelaide, SA, Australia
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, The Danish Epilepsy Centre, Dianalund, Denmark.,Department for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lynette G Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Ingrid E Scheffer
- Department of Medicine, Epilepsy Research Centre, The University of Melbourne, Austin Health, Melbourne, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, VIC, Australia.,The Florey and Murdoch Institutes, Melbourne, VIC, Australia
| | - Raman Kumar
- Adelaide Medical School, the University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, the University of Adelaide, Adelaide, SA, Australia
| | - Jozef Gecz
- Adelaide Medical School, the University of Adelaide, Adelaide, SA, Australia. .,Robinson Research Institute, the University of Adelaide, Adelaide, SA, Australia. .,Healthy Mothers and Babies, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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17
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Trivisano M, Specchio N. The role of PCDH19 in refractory status epilepticus. Epilepsy Behav 2019; 101:106539. [PMID: 31678000 DOI: 10.1016/j.yebeh.2019.106539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 01/20/2023]
Abstract
PCDH19-Girls Clustering Epilepsy (GCE) is an epileptic syndrome with infantile onset, characterized by clustered and fever-induced seizures, often associated with intellectual disability (ID) and autistic features. Seizures clusters could progress into status epilepticus (SE) with different semiology, both convulsive and nonconvulsive SE (NCSE), and often refractory to conventional antiepileptic drugs. We reviewed literature on PCDH19-GCE, in order to define prevalence, semiology, treatments, and outcome of SE. We conducted a comprehensive review of the PCDH19-GCE literature on the public databases PubMed and EMBASE from January 2008 to July 2019. An overall number of 59 full-text articles were selected, retrieved, and assessed for eligibility. We collected 269 cases with PCDH19-GCE, in 85 of them, a history of SE was reported. Prevalence of SE in all selected series of PCDH19-GCE series is 31.5%. Data on SE were fully exhaustive in 21 cases. There was no gender difference in SE occurrence. Median age at first SE occurrence was 12 months (6 months-11 years). Semiology of SE was reported in 17 cases: it was convulsive in 15 and nonconvulsive in 2. Status epilepticus was refractory in 15 out of 21 cases (71.4%). Benzodiazepine was the most commonly used drug for SE. Alternative treatments with steroids and ketogenic diet were reported as well. We found a high prevalence of ID and autism (19 out of 21 patients, 90%). Despite the relatively high frequency of SE in those patients, there are few specific descriptions of the semiology, EEG pattern, and treatment approach. We strongly believe that a multicenter study looking specifically at SE characteristics might improve the knowledge and consequently the overall outcome. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Marina Trivisano
- Rare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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18
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Yang L, Liu J, Su Q, Li Y, Yang X, Xu L, Tong L, Li B. Novel and de novo mutation of PCDH19 in Girls Clustering Epilepsy. Brain Behav 2019; 9:e01455. [PMID: 31714027 PMCID: PMC6908879 DOI: 10.1002/brb3.1455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND PCDH19 has become the second most relevant gene in epilepsy after SCN1A. Seizures often provoked by fever. METHODS We screened 152 children with fever-sensitive epilepsy for gene detection. Their clinical information was followed up. RESULTS We found eight PCDH19 point mutations (four novel and four reported) and one whole gene deletion in 10 female probands (seven sporadic cases and three family cases) who also had cluster seizures. The common clinical features of 16 patients in 10 families included fever-sensitive and cluster seizures, mainly focal or tonic-clonic seizures, and absence of status epilepticus, normal intelligence, or mild-to-moderate cognitive impairment, the onset age ranges from 5 months to 20 years. Only four patients had multiple or focal transient discharges in interictal EEG. Focal seizures originating in the frontal region were recorded in four patients, two from the parietal region, and one from the occipital region. CONCLUSION PCDH19 mutation can be inherited or de novo. The clinical spectrum of PCDH19 mutation includes PCDH19 Girls Clustering Epilepsy with or without mental retardation, psychosis, and asymptomatic male. The onset age of PCDH19 Girls Clustering Epilepsy can range from infancy to adulthood. Sisters in the same family may be sensitive to the same antiepileptic drugs. And our report expands the mutation spectrum of PCDH19 Girls Clustering Epilepsy.
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Affiliation(s)
- Li Yang
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China.,Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Jing Liu
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Quanping Su
- Central Laboratory, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Yufen Li
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Xiaofan Yang
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Liyun Xu
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Lili Tong
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
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19
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Vlaskamp DRM, Bassett AS, Sullivan JE, Robblee J, Sadleir LG, Scheffer IE, Andrade DM. Schizophrenia is a later-onset feature of PCDH19
Girls Clustering Epilepsy. Epilepsia 2019; 60:429-440. [DOI: 10.1111/epi.14678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Danique R. M. Vlaskamp
- Department of Medicine; Epilepsy Research Centre; The University of Melbourne; Austin Health; Melbourne Victoria Australia
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Genetics; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Anne S. Bassett
- Clinical Genetics Research Program; Campbell Family Mental Health Research Institute; Centre for Addiction and Mental Health; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Toronto Ontario Canada
- Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome; Toronto General Research Institute; University Health Network; Toronto Ontario Canada
| | - Joseph E. Sullivan
- Pediatric Epilepsy Center; Benioff Children's Hospital; University of California San Francisco; San Francisco California
| | - Jennifer Robblee
- Division of Neurology; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Lynette G. Sadleir
- Department of Paediatrics and Child Health; University of Otago; Wellington New Zealand
| | - Ingrid E. Scheffer
- Department of Medicine; Epilepsy Research Centre; The University of Melbourne; Austin Health; Melbourne Victoria Australia
- Department of Paediatrics; Royal Children's Hospital; The University of Melbourne; Victoria Australia
- The Florey Institute of Neurosciences and Mental Health; Melbourne Victoria Australia
| | - Danielle M. Andrade
- Division of Neurology; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
- Epilepsy Genetics Research Program; Krembil Neuroscience Centre; University of Toronto; Toronto Ontario Canada
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20
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Niazi R, Fanning EA, Depienne C, Sarmady M, Abou Tayoun AN. A mutation update for the PCDH19 gene causing early-onset epilepsy in females with an unusual expression pattern. Hum Mutat 2019; 40:243-257. [PMID: 30582250 DOI: 10.1002/humu.23701] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/26/2018] [Accepted: 12/18/2018] [Indexed: 11/08/2022]
Abstract
The PCDH19 gene consists of six exons encoding a 1,148 amino acid transmembrane protein, Protocadherin 19, which is involved in brain development. Heterozygous pathogenic variants in this gene are inherited in an unusual X-linked dominant pattern in which heterozygous females are affected, while hemizygous males are typically unaffected, although they pass on the pathogenic variant to each affected daughter. PCDH19-related disorder is known to cause early-onset epilepsy in females characterized by seizure clusters exacerbated by fever and in most cases, onset is within the first year of life. This condition was initially described in 1971 and in 2008 PCDH19 was identified as the underlying genetic etiology. This condition is the result of pathogenic loss-of-function variants that may be de novo or inherited from an affected mother or unaffected father and cellular interference has been hypothesized to be the culprit. Heterozygous females are symptomatic because of the presence of both wild-type and mutant cells that interfere with one another due to the production of different surface proteins, whereas nonmosaic hemizygous males produce a homogenous population of cells. Here, we review novel pathogenic variants in the PCDH19 gene since 2012 to date, and summarize any genotype-phenotype correlations.
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Affiliation(s)
- Rojeen Niazi
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth A Fanning
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris, 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, Paris, France.,IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France
| | - Mahdi Sarmady
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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21
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A systematic review and meta-analysis of 271 PCDH19-variant individuals identifies psychiatric comorbidities, and association of seizure onset and disease severity. Mol Psychiatry 2019; 24:241-251. [PMID: 29892053 PMCID: PMC6344372 DOI: 10.1038/s41380-018-0066-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/22/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022]
Abstract
Epilepsy and Mental Retardation Limited to Females (EFMR) is an infantile onset disorder characterized by clusters of seizures. EFMR is due to mutations in the X-chromosome gene PCDH19, and is underpinned by cellular mosaicism due to X-chromosome inactivation in females or somatic mutation in males. This review characterizes the neuropsychiatric profile of this disorder and examines the association of clinical and molecular factors with neuropsychiatric outcomes. Data were extracted from 38 peer-reviewed original articles including 271 individual cases. We found that seizure onset ≤12 months was significantly associated (p = 4.127 × 10-7) with more severe intellectual disability, compared with onset >12 months. We identified two recurrent variants p.Asn340Ser and p.Tyr366Leufs*10 occurring in 25 (20 unrelated) and 30 (11 unrelated) cases, respectively. PCDH19 mutations were associated with psychiatric comorbidities in approximately 60% of females, 80% of affected mosaic males, and reported in nine hemizygous males. Hyperactive, autistic, and obsessive-compulsive features were most frequently reported. There were no genotype-phenotype associations in the individuals with recurrent variants or the group overall. Age at seizure onset can be used to provide more informative prognostic counseling.
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22
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Nishioka M, Bundo M, Iwamoto K, Kato T. Somatic mutations in the human brain: implications for psychiatric research. Mol Psychiatry 2019; 24:839-856. [PMID: 30087451 PMCID: PMC6756205 DOI: 10.1038/s41380-018-0129-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/27/2018] [Accepted: 05/25/2018] [Indexed: 01/18/2023]
Abstract
Psychiatric disorders such as schizophrenia and bipolar disorder are caused by complex gene-environment interactions. While recent advances in genomic technologies have enabled the identification of several risk variants for psychiatric conditions, including single-nucleotide variants and copy-number variations, these factors can explain only a portion of the liability to these disorders. Although non-inherited factors had previously been attributed to environmental causes, recent genomic analyses have demonstrated that de novo mutations are among the main non-inherited risk factors for several psychiatric conditions. Somatic mutations in the brain may also explain how stochastic developmental events and environmental insults confer risk for a psychiatric disorder following fertilization. Here, we review evidence regarding somatic mutations in the brains of individuals with and without neuropsychiatric diseases. We further discuss the potential biological mechanisms underlying somatic mutations in the brain as well as the technical issues associated with the detection of somatic mutations in psychiatric research.
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Affiliation(s)
- Masaki Nishioka
- 0000 0001 2151 536Xgrid.26999.3dDivision for Counseling and Support, The University of Tokyo, Tokyo, Japan
| | - Miki Bundo
- 0000 0001 0660 6749grid.274841.cDepartment of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan ,0000 0004 1754 9200grid.419082.6PRESTO, Japan Science and Technology Agency, Saitama, Japan
| | - Kazuya Iwamoto
- Department of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan.
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23
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Trivisano M, Pietrafusa N, Terracciano A, Marini C, Mei D, Darra F, Accorsi P, Battaglia D, Caffi L, Canevini MP, Cappelletti S, Cesaroni E, de Palma L, Costa P, Cusmai R, Giordano L, Ferrari A, Freri E, Fusco L, Granata T, Martino T, Mastrangelo M, Bova SM, Parmeggiani L, Ragona F, Sicca F, Striano P, Specchio LM, Tondo I, Zambrelli E, Zamponi N, Zanus C, Boniver C, Vecchi M, Avolio C, Dalla Bernardina B, Bertini E, Guerrini R, Vigevano F, Specchio N. Defining the electroclinical phenotype and outcome of PCDH19-related epilepsy: A multicenter study. Epilepsia 2018; 59:2260-2271. [PMID: 30451291 DOI: 10.1111/epi.14600] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Marina Trivisano
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
- Clinic of Nervous System Diseases; University of Foggia; Foggia Italy
| | - Nicola Pietrafusa
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | | | - Carla Marini
- Pediatric Neurology Unit and Laboratories; Children’s Hospital Meyer-University of Florence; Florence Italy
| | - Davide Mei
- Pediatric Neurology Unit and Laboratories; Children’s Hospital Meyer-University of Florence; Florence Italy
| | - Francesca Darra
- Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | | | | | - Lorella Caffi
- Neuropsychiatric Unit; University of Bergamo; Bergamo Italy
| | - Maria P. Canevini
- Epilepsy Center; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Simona Cappelletti
- Unit of Clinical Psychology; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | | | - Luca de Palma
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Paola Costa
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo; Trieste Italy
| | - Raffaella Cusmai
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Lucio Giordano
- Child Neuropsychiatric Unit; Civilian Hospital; Brescia Italy
| | - Annarita Ferrari
- Department of Developmental Neuroscience; Clinical Neurophysiology Laboratory; IRCCS Stella Maris Foundation; Pisa Italy
| | - Elena Freri
- Department of Pediatric Neuroscience; IRCCS Foundation, Carlo Besta Neurological Institute; Milan Italy
| | - Lucia Fusco
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience; IRCCS Foundation, Carlo Besta Neurological Institute; Milan Italy
| | - Tommaso Martino
- Clinic of Nervous System Diseases; University of Foggia; Foggia Italy
| | - Massimo Mastrangelo
- Pediatric Neurology Unit; Vittore Buzzi Hospital; ASST Fatebenefratelli Sacco; Milan Italy
| | - Stefania M. Bova
- Pediatric Neurology Unit; Vittore Buzzi Hospital; ASST Fatebenefratelli Sacco; Milan Italy
| | - Lucio Parmeggiani
- Department of Neuropediatrics; Regional Hospital of Bolzano; Bolzano Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience; IRCCS Foundation, Carlo Besta Neurological Institute; Milan Italy
| | - Federico Sicca
- Department of Developmental Neuroscience; Clinical Neurophysiology Laboratory; IRCCS Stella Maris Foundation; Pisa Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences; Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, G. Gaslini Institute, University of Genoa; Genoa Italy
| | - Luigi M. Specchio
- Clinic of Nervous System Diseases; University of Foggia; Foggia Italy
| | - Ilaria Tondo
- Unit of Clinical Psychology; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Elena Zambrelli
- Epilepsy Center; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit; University of Ancona; Ancona Italy
| | - Caterina Zanus
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo; Trieste Italy
| | - Clementina Boniver
- Child Neurology and Clinical Neurophysiology Unit; Department of Women’s and Children’s Health; University Hospital of Padua; Padua Italy
| | - Marilena Vecchi
- Child Neurology and Clinical Neurophysiology Unit; Department of Women’s and Children’s Health; University Hospital of Padua; Padua Italy
| | - Carlo Avolio
- Clinic of Nervous System Diseases; University of Foggia; Foggia Italy
| | | | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders; Department of Neurosciences; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit and Laboratories; Children’s Hospital Meyer-University of Florence; Florence Italy
| | - Federico Vigevano
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
| | - Nicola Specchio
- Neurology Unit; Department of Neuroscience; Bambino Gesù Children’s Hospital; IRCCS; Rome Italy
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24
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Liu A, Yang X, Yang X, Wu Q, Zhang J, Sun D, Yang Z, Jiang Y, Wu X, Wei L, Zhang Y. Mosaicism and incomplete penetrance of PCDH19 mutations. J Med Genet 2018; 56:81-88. [PMID: 30287595 PMCID: PMC6581080 DOI: 10.1136/jmedgenet-2017-105235] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 08/25/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mutations in the PCDH19 gene have mainly been reported in female patients with epilepsy. To date, PCDH19 mutations have been reported in hundreds of females and only in 10 mosaic male epileptic patients with mosaicism. OBJECTIVE We aimed to investigate the occurrence of mosaic PCDH19 mutations in 42 families comprising at least one patient with PCDH19-related epilepsy. METHODS Two male patients with mosaic PCDH19 variants were identified using targeted next-generation sequencing. Forty female patients with PCDH19 variants were identified by Sanger sequencing and Multiple Ligation Probe Amplification (MLPA). Microdroplet digital PCR was used to quantify the mutant allelic fractions (MAFs) in 20 families with PCDH19 variants. RESULTS Five mosaic individuals, four males and one female, were identified in total. Mosaic variant was confirmed in multiple somatic tissues from one male patient and in blood from the other male patient. Among 22 female patients harbouring a newly occurred PCDH19 variant identified by Sanger sequencing and MLPA, Sanger sequencing revealed two mosaic fathers (9%, 2/22), one with two affected daughters and the other with an affected child. Two asymptomatic mosaic fathers were confirmed as gonosomal mosaicism, with MAFs ranging from 4.16% to 37.38% and from 1.27% to 19.13%, respectively. In 11 families with apparent de novo variants, 1 female patient was identified as a mosaic with a blood MAF of 26.72%. CONCLUSION Our study provides new insights into phenotype-genotype correlations in PCDH19 related epilepsy and the finding of high-frequency mosaicism has important implications for genetic counselling.
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Affiliation(s)
- Aijie Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoxu Yang
- Center for Bioinformatics, State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences, Peking University, Beijing, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qixi Wu
- School of Life Sciences, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Wuhan, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiru Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Liping Wei
- Center for Bioinformatics, State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences, Peking University, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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25
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Tan Y, Hou M, Ma S, Liu P, Xia S, Wang Y, Chen L, Chen Z. Chinese cases of early infantile epileptic encephalopathy: a novel mutation in the PCDH19 gene was proved in a mosaic male- case report. BMC MEDICAL GENETICS 2018; 19:92. [PMID: 29866057 PMCID: PMC5987650 DOI: 10.1186/s12881-018-0621-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022]
Abstract
Background The link between the protocadherin-19 (PCDH19) gene and epilepsy suggests that an unusual form of X-linked inheritance affects females but is transmitted through asymptomatic males. Individuals with epilepsy associated with mutations in the PCDH19 gene display generalized or focal seizures with or without fever sensitivity. The clinical manifestation of the condition ranges from mild to severe, resulting in intellectual disability and behavioural disturbance. In the present study, we assessed mutations in the PCDH19 gene and the clinical features of a group of Chinese patients with early infantile epileptic encephalopathy and aimed to provide further insight into the understanding of epilepsy and mental retardation limited to females (EFMR; MIM 300088). Case Presentation We described three variations in the PCDH19 gene in Chinese patients with epilepsy who developed generalized seizures occurring in clusters with or without triggering by fever. Candidate genes were screened for mutations that cause epilepsy and related paroxysmal or nervous system diseases in the coding exons and intron–exon boundaries using polymerase chain reaction (PCR) of genomic deoxyribonucleic acid (DNA) followed by sequencing. The variations were sequenced using next-generation sequencing technology and verified with first-generation sequencing. Exome sequencing of a multigene epilepsy panel revealed three mutations in the PCDH19 gene in a mosaic male and two unrelated females. These included a frameshift mutation c.1508_1509insT (p.Thr504HisfsTer19), a missense mutation c.1681C > T (p.Pro561Ser) and a nonsense mutation c.918C > G (p.Tyr306Ter). Of the three mutations in the PCDH19 gene associated with early infantile epileptic encephalopathy, the frameshift variation in a mosaic male is novel and de novo, the missense variation is de novo and is the second ever reported in females, and the nonsense variation was inherited from the paternal line and is the first example discovered in a female. Conclusions The results from our current study provide new insight into and perspectives for the molecular genetic link between epilepsy and PCDH19 alterations. Moreover, our new findings of the male mosaic variant broaden the spectrum of PCDH19-related epilepsy and provide a new understanding of this complex genetic disorder. Electronic supplementary material The online version of this article (10.1186/s12881-018-0621-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuxia Tan
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.,Department of Pediatrics, Zibo City Maternal and Child Health Hospital, Zibo City, 255029, Shandong Province, China
| | - Mei Hou
- Department of Pediatric Rehabilitation, The Affiliated Qingdao Women & Children's Hospital of Qingdao University, Qingdao, 266034, China
| | - Shaochun Ma
- Department of Pediatric Neurology, The Affiliated Qingdao Women & Children's Hospital of Qingdao University, Qingdao, 266034, China
| | - Peipei Liu
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Shungang Xia
- Department of Pediatrics, Zibo City Maternal and Child Health Hospital, Zibo City, 255029, Shandong Province, China
| | - Yu Wang
- Department of Pediatrics, Zibo City Maternal and Child Health Hospital, Zibo City, 255029, Shandong Province, China
| | - Liping Chen
- Department of Pediatrics, Zibo City Maternal and Child Health Hospital, Zibo City, 255029, Shandong Province, China
| | - Zongbo Chen
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
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26
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Homan CC, Pederson S, To TH, Tan C, Piltz S, Corbett MA, Wolvetang E, Thomas PQ, Jolly LA, Gecz J. PCDH19 regulation of neural progenitor cell differentiation suggests asynchrony of neurogenesis as a mechanism contributing to PCDH19 Girls Clustering Epilepsy. Neurobiol Dis 2018; 116:106-119. [PMID: 29763708 DOI: 10.1016/j.nbd.2018.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/25/2018] [Accepted: 05/09/2018] [Indexed: 01/12/2023] Open
Abstract
PCDH19-Girls Clustering Epilepsy (PCDH19-GCE) is a childhood epileptic encephalopathy characterised by a spectrum of neurodevelopmental problems. PCDH19-GCE is caused by heterozygous loss-of-function mutations in the X-chromosome gene, Protocadherin 19 (PCDH19) encoding a cell-cell adhesion molecule. Intriguingly, hemizygous males are generally unaffected. As PCDH19 is subjected to random X-inactivation, heterozygous females are comprised of a mosaic of cells expressing either the normal or mutant allele, which is thought to drive pathology. Despite being the second most prevalent monogeneic cause of epilepsy, little is known about the role of PCDH19 in brain development. In this study we show that PCDH19 is highly expressed in human neural stem and progenitor cells (NSPCs) and investigate its function in vitro in these cells of both mouse and human origin. Transcriptomic analysis of mouse NSPCs lacking Pcdh19 revealed changes to genes involved in regulation of neuronal differentiation, and we subsequently show that loss of Pcdh19 causes increased NSPC neurogenesis. We reprogramed human fibroblast cells harbouring a pathogenic PCDH19 mutation into human induced pluripotent stem cells (hiPSC) and employed neural differentiation of these to extend our studies into human NSPCs. As in mouse, loss of PCDH19 function caused increased neurogenesis, and furthermore, we show this is associated with a loss of human NSPC polarity. Overall our data suggests a conserved role for PCDH19 in regulating mammalian cortical neurogenesis and has implications for the pathogenesis of PCDH19-GCE. We propose that the difference in timing or "heterochrony" of neuronal cell production originating from PCDH19 wildtype and mutant NSPCs within the same individual may lead to downstream asynchronies and abnormalities in neuronal network formation, which in-part predispose the individual to network dysfunction and epileptic activity.
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Affiliation(s)
- Claire C Homan
- School of Medicine, The University of Adelaide, Adelaide 5005, Australia; Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia; School of Biological Sciences, The University of Adelaide, Adelaide 5005, Australia
| | - Stephen Pederson
- Bioinformatics Hub, School of Biological Sciences, The University of Adelaide, Adelaide, 5005, Australia
| | - Thu-Hien To
- Bioinformatics Hub, School of Biological Sciences, The University of Adelaide, Adelaide, 5005, Australia
| | - Chuan Tan
- School of Medicine, The University of Adelaide, Adelaide 5005, Australia; Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia
| | - Sandra Piltz
- Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia; School of Biological Sciences, The University of Adelaide, Adelaide 5005, Australia; South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Mark A Corbett
- School of Medicine, The University of Adelaide, Adelaide 5005, Australia; Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia; School of Biological Sciences, The University of Adelaide, Adelaide 5005, Australia
| | - Ernst Wolvetang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Queensland 4072, Australia
| | - Paul Q Thomas
- Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia; School of Biological Sciences, The University of Adelaide, Adelaide 5005, Australia; South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Lachlan A Jolly
- School of Medicine, The University of Adelaide, Adelaide 5005, Australia; Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia.
| | - Jozef Gecz
- School of Medicine, The University of Adelaide, Adelaide 5005, Australia; Robinson Research Institute, The University of Adelaide, Adelaide 5006, Australia; School of Biological Sciences, The University of Adelaide, Adelaide 5005, Australia; South Australian Health and Medical Research Institute, Adelaide 5000, Australia.
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27
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Smith L, Singhal N, El Achkar CM, Truglio G, Rosen Sheidley B, Sullivan J, Poduri A. PCDH19-related epilepsy is associated with a broad neurodevelopmental spectrum. Epilepsia 2018; 59:679-689. [PMID: 29377098 DOI: 10.1111/epi.14003] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterize the features associated with PCDH19-related epilepsy, also known as "female-limited epilepsy." METHODS We analyzed data from participants enrolled in the PCDH19 Registry, focusing on the seizure-related, developmental, neurobehavioral, and sleep-related features. We evaluated variants for pathogenicity based on previous reports, population databases, and in silico predictions, and included individuals with pathogenic or potentially pathogenic variants. We performed a retrospective analysis of medical records and administered a targeted questionnaire to characterize current or past features in probands and genotype-positive family members. RESULTS We included 38 individuals with pathogenic or potentially pathogenic variants in PCDH19: 21 de novo, 5 maternally inherited, 7 paternally inherited, and 5 unknown. All 38 had epilepsy; seizure burden varied, but typical features of clustering of seizures and association with fever were present. Thirty individuals had intellectual disability (ID), with a wide range of severity reported; notably, 8/38 (22%) had average intellect. Behavioral and sleep dysregulation were prominent, in 29/38 (76%) and 20/38 (53%), respectively. Autistic features were present in 22/38 (58%), of whom 12 had a formal diagnosis of autism spectrum disorder. We had additional data from 5 genotype-positive mothers, all with average intellect and 3 with epilepsy, and from 1 genotype-positive father. SIGNIFICANCE Our series represents a robust cohort with carefully curated PCDH19 variants. We observed seizures as a core feature with a range of seizure types and severity. Whereas the majority of individuals had ID, we highlight the possibility of average intellect in the setting of PCDH19-related epilepsy. We also note the high prevalence and severity of neurobehavioral phenotypes associated with likely pathogenic variants in PCDH19. Sleep dysregulation was also a major area of concern. Our data emphasize the importance of appropriate referrals for formal neuropsychological evaluations as well as the need for formal prospective studies to characterize the PCDH19-related neurodevelopmental syndrome in children and their genotype-positive parents.
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Affiliation(s)
- Lacey Smith
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Neurogenetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Nilika Singhal
- Department of Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, CA, USA
| | - Christelle M El Achkar
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Neurogenetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Gessica Truglio
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Beth Rosen Sheidley
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Neurogenetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Joseph Sullivan
- Department of Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, CA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Neurogenetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.,F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
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28
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Genomic mosaicism in paternal sperm and multiple parental tissues in a Dravet syndrome cohort. Sci Rep 2017; 7:15677. [PMID: 29142202 PMCID: PMC5688122 DOI: 10.1038/s41598-017-15814-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/02/2017] [Indexed: 12/21/2022] Open
Abstract
Genomic mosaicism in parental gametes and peripheral tissues is an important consideration for genetic counseling. We studied a Chinese cohort affected by a severe epileptic disorder, Dravet syndrome (DS). There were 56 fathers who donated semen and 15 parents who donated multiple peripheral tissue samples. We used an ultra-sensitive quantification method, micro-droplet digital PCR (mDDPCR), to detect parental mosaicism of the proband’s pathogenic mutation in SCN1A, the causal gene of DS in 112 families. Ten of the 56 paternal sperm samples were found to exhibit mosaicism of the proband’s mutations, with mutant allelic fractions (MAFs) ranging from 0.03% to 39.04%. MAFs in the mosaic fathers’ sperm were significantly higher than those in their blood (p = 0.00098), even after conditional probability correction (p’ = 0.033). In three mosaic fathers, ultra-low fractions of mosaicism (MAF < 1%) were detected in the sperm samples. In 44 of 45 cases, mosaicism was also observed in other parental peripheral tissues. Hierarchical clustering showed that MAFs measured in the paternal sperm, hair follicles and urine samples were clustered closest together. Milder epileptic phenotypes were more likely to be observed in mosaic parents (p = 3.006e-06). Our study provides new insights for genetic counseling.
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29
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High frequency of mosaic pathogenic variants in genes causing epilepsy-related neurodevelopmental disorders. Genet Med 2017; 20:403-410. [PMID: 28837158 PMCID: PMC5895461 DOI: 10.1038/gim.2017.114] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022] Open
Abstract
Purpose Mosaicism probably represents an underreported cause of genetic disorders due to detection challenges during routine molecular diagnostics. The purpose of this study was to evaluate the frequency of mosaicism detected by next-generation sequencing in genes associated with epilepsy-related neurodevelopmental disorders. Methods We conducted a retrospective analysis of 893 probands with epilepsy who had a multigene epilepsy panel or whole-exome sequencing performed in a clinical diagnostic laboratory and were positive for a pathogenic or likely pathogenic variant in one of nine genes (CDKL5, GABRA1, GABRG2, GRIN2B, KCNQ2, MECP2, PCDH19, SCN1A, or SCN2A). Parental results were available for 395 of these probands. Results Mosaicism was most common in the CDKL5, PCDH19, SCN2A, and SCN1A genes. Mosaicism was observed in GABRA1, GABRG2, and GRIN2B, which previously have not been reported to have mosaicism, and also in KCNQ2 and MECP2. Parental mosaicism was observed for pathogenic variants in multiple genes including KCNQ2, MECP2, SCN1A, and SCN2A. Conclusion Mosaic pathogenic variants were identified frequently in nine genes associated with various neurological conditions. Given the potential clinical ramifications, our findings suggest that next-generation sequencing diagnostic methods may be utilized when testing these genes in a diagnostic laboratory.
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30
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Hayashi S, Inoue Y, Hattori S, Kaneko M, Shioi G, Miyakawa T, Takeichi M. Loss of X-linked Protocadherin-19 differentially affects the behavior of heterozygous female and hemizygous male mice. Sci Rep 2017; 7:5801. [PMID: 28724954 PMCID: PMC5517645 DOI: 10.1038/s41598-017-06374-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/12/2017] [Indexed: 11/09/2022] Open
Abstract
Mutations in the X-linked gene Protocadherin-19 (Pcdh19) cause female-limited epilepsy and mental retardation in humans. Although Pcdh19 is known to be a homophilic cell-cell adhesion molecule, how its mutations bring about female-specific disorders remains elusive. Here, we report the effects of Pcdh19 knockout in mice on their development and behavior. Pcdh19 was expressed in various brain regions including the cerebral cortex and hippocampus. Although Pcdh19-positive cells were evenly distributed in layer V of wild-type cortices, their distribution became a mosaic in Pcdh19 heterozygous female cortices. In cortical and hippocampal neurons, Pcdh19 was localized along their dendrites, showing occasional accumulation on synapses. Pcdh19 mutants, however, displayed no detectable abnormalities in dendrite and spine morphology of layer V neurons. Nevertheless, Pcdh19 hemizygous males and heterozygous females showed impaired behaviors including activity defects under stress conditions. Notably, only heterozygous females exhibited decreased fear responses. In addition, Pcdh19 overexpression in wild-type cortices led to ectopic clustering of Pcdh19-positive neurons. These results suggest that Pcdh19 is required for behavioral control in mice, but its genetic loss differentially affects the male and female behavior, as seen in human, and they also support the hypothesis that the mosaic expression of Pcdh19 in brains perturbs neuronal interactions.
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Affiliation(s)
- Shuichi Hayashi
- Laboratory for Cell Adhesion and Tissue Patterning, RIKEN Center for Developmental Biology, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan. .,Department of Physiology, Anatomy and Genetics, Le Gros Clark Building, University of Oxford, South Parks Road, Oxford, OX1 3QX, UK.
| | - Yoko Inoue
- Laboratory for Cell Adhesion and Tissue Patterning, RIKEN Center for Developmental Biology, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoko Hattori
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Mari Kaneko
- Animal Resource Development Unit, RIKEN Center for Life Science Technologies, Kobe, 650-0047, Japan.,Genetic Engineering Team, RIKEN Center for Life Science Technologies, Kobe, 650-0047, Japan
| | - Go Shioi
- Genetic Engineering Team, RIKEN Center for Life Science Technologies, Kobe, 650-0047, Japan
| | - Tsuyoshi Miyakawa
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.,Section of Behavior Patterns, Center for Genetic Analysis of Behavior, National Institute for Physiological Sciences, 38 Nishigonaka, Okazaki, Aichi, 444-8787, Japan
| | - Masatoshi Takeichi
- Laboratory for Cell Adhesion and Tissue Patterning, RIKEN Center for Developmental Biology, 2-2-3 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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31
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Male patients affected by mosaic PCDH19 mutations: five new cases. Neurogenetics 2017; 18:147-153. [PMID: 28669061 PMCID: PMC5522515 DOI: 10.1007/s10048-017-0517-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/16/2017] [Indexed: 11/04/2022]
Abstract
Pathogenic variants in the PCDH19 gene are associated with epilepsy, intellectual disability (ID) and behavioural disturbances. Only heterozygous females and mosaic males are affected, likely due to a disease mechanism named cellular interference. Until now, only four affected mosaic male patients have been described in literature. Here, we report five additional male patients, of which four are older than the oldest patient reported so far. All reported patients were selected for genetic testing because of developmental delay and/or epilepsy. Custom-targeted next generation sequencing gene panels for epilepsy genes were used. Clinical data were collected from medical records. All patients were mosaic in blood for likely pathogenic variants in the PCDH19 gene. In most, clinical features were very similar to the female phenotype, with normal development before seizure onset, which occurred between 5 and 10 months of age, clustering of seizures and sensitivity to fever. Four out of five patients had mild to severe ID and behavioural problems. We reaffirm the similarity between male and female PCDH19-related phenotypes, now also in a later phase of the disorder (ages 10–14 years).
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32
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Perez D, Hsieh DT, Rohena L. Somatic Mosaicism of PCDH19
in a male with early infantile epileptic encephalopathy and review of the literature. Am J Med Genet A 2017; 173:1625-1630. [DOI: 10.1002/ajmg.a.38233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/05/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Dorian Perez
- Department of Pediatrics; San Antonio Military Medical Center; San Antonio Texas
| | | | - Luis Rohena
- Division of Medical Genetics, Department of Pediatrics; San Antonio Military Medical Center; San Antonio Texas
- Department of Pediatrics; University of Texas Health Science Center at San Antonio; San Antonio Texas
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Mei D, Parrini E, Marini C, Guerrini R. The Impact of Next-Generation Sequencing on the Diagnosis and Treatment of Epilepsy in Paediatric Patients. Mol Diagn Ther 2017; 21:357-373. [DOI: 10.1007/s40291-017-0257-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Cooper SR, Jontes JD, Sotomayor M. Structural determinants of adhesion by Protocadherin-19 and implications for its role in epilepsy. eLife 2016; 5. [PMID: 27787195 PMCID: PMC5115871 DOI: 10.7554/elife.18529] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/25/2016] [Indexed: 01/27/2023] Open
Abstract
Non-clustered δ-protocadherins are homophilic cell adhesion molecules essential for the development of the vertebrate nervous system, as several are closely linked to neurodevelopmental disorders. Mutations in protocadherin-19 (PCDH19) result in a female-limited, infant-onset form of epilepsy (PCDH19-FE). Over 100 mutations in PCDH19 have been identified in patients with PCDH19-FE, about half of which are missense mutations in the adhesive extracellular domain. Neither the mechanism of homophilic adhesion by PCDH19, nor the biochemical effects of missense mutations are understood. Here we present a crystallographic structure of the minimal adhesive fragment of the zebrafish Pcdh19 extracellular domain. This structure reveals the adhesive interface for Pcdh19, which is broadly relevant to both non-clustered δ and clustered protocadherin subfamilies. In addition, we show that several PCDH19-FE missense mutations localize to the adhesive interface and abolish Pcdh19 adhesion in in vitro assays, thus revealing the biochemical basis of their pathogenic effects during brain development. DOI:http://dx.doi.org/10.7554/eLife.18529.001 As the brain develops, its basic building blocks – cells called neurons – need to form the correct connections with one another in order to give rise to neural circuits. A mistake that leads to the formation of incorrect connections can result in a number of disorders or brain abnormalities. Proteins called cadherins that are present on the surface of neurons enable them to stick to their correct partners like Velcro. One of these proteins is called Protocadherin-19. However, it was not fully understood how this protein forms an adhesive bond with other Protocadherin-19 molecules, or how some of the proteins within the cadherin family are able to distinguish between one another. Cooper et al. used X-ray crystallography to visualize the molecular structure of Protocadherin-19 taken from zebrafish in order to better understand the adhesive bond that these proteins form with each other. In addition, the new structure showed the sites of the mutations that cause a form of epilepsy in infant females. From this, Cooper et al. could predict how the mutations would disrupt Protocadherin-19’s shape and function. The structures revealed that Protocadherin-19 molecules from adjacent cells engage in a “forearm handshake” to form the bond that connects neurons. Some of the mutations that cause epilepsy occur in the region responsible for this Protocadherin-19 forearm handshake. Laboratory experiments confirmed that these mutations impair the formation of the adhesive bond, revealing the molecular basis for some of the mutations that underlie Protocadherin-19-female-limited epilepsy. Other cadherin molecules may interact via a similar forearm handshake; this could be investigated in future experiments. It also remains to be discovered how brain wiring depends on Protocadherin-19 adhesion in animal development, and how altering these proteins can rewire developing brain circuits. DOI:http://dx.doi.org/10.7554/eLife.18529.002
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Affiliation(s)
- Sharon R Cooper
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, United States.,Department of Neuroscience, The Ohio State University, Columbus, United States
| | - James D Jontes
- Department of Neuroscience, The Ohio State University, Columbus, United States
| | - Marcos Sotomayor
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, United States
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