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Ozarkar S, Patel R, Vulli T, Smith A, Styner M, Hazlett H, Shen M, Burette A, Philpot B. Comparative profiling of white matter development in the human and mouse brain reveals volumetric deficits and delayed myelination in Angelman syndrome. RESEARCH SQUARE 2024:rs.3.rs-4681861. [PMID: 39149488 PMCID: PMC11326408 DOI: 10.21203/rs.3.rs-4681861/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background Angelman syndrome (AS), a severe neurodevelopmental disorder resulting from the loss of the maternal UBE3A gene, is marked by changes in the brain's white matter (WM). The extent of WM abnormalities seems to correlate with the severity of clinical symptoms, but these deficits are still not well characterized or understood. This study provides the first large-scale measurement of WM volume reduction in children with AS. Furthermore, we probed the underlying neuropathology by examining the progression of myelination in an AS mouse model. Methods We conducted magnetic resonance imaging (MRI) on children with AS (n=32) and neurotypical controls (n=99) aged 0.5-12 years. In parallel, we examined myelination in postnatal Ube3a maternal-null mice ( Ube3a m-/p+ ; AS model), Ube3a paternal-null mice ( Ube3a m+/p- ), and wildtype controls ( Ube3a m+/p+ ) using immunohistochemistry, Western blotting, and electron microscopy. Results Our data revealed that AS individuals exhibit significant reductions in brain volume by ~1 year of age, with WM reduced by 26% and gray matter by 21% by 6-12 years of age-approximately twice the reductions observed in the adult AS mouse model. In our AS mouse model, we saw a global delay in the onset of myelination, which normalized within days (likely corresponding to months or years in human development). This myelination delay is caused by the loss of UBE3A in neurons rather than UBE3A haploinsufficiency in oligodendrocytes. Interestingly, ultrastructural analyses did not reveal any abnormalities in myelinated or unmyelinated axons. Limitations: It is difficult to extrapolate the timing and duration of the myelination delay observed in AS model mice to individuals with AS. Conclusions This study reveals WM deficits as a hallmark in children with AS, demonstrating for the first time that these deficits are already apparent at 1 year of age. Parallel studies in a mouse model of AS show that these deficits may be associated with delayed onset of myelination due to the loss of neuronal (but not glial) UBE3A. These findings emphasize the potential of WM as both a therapeutic target for interventions and a valuable biomarker for tracking the progression of AS and the effectiveness of potential treatments.
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Valencia ML, Sofela FA, Jongens TA, Sehgal A. Do metabolic deficits contribute to sleep disruption in monogenic intellectual disability syndromes? Trends Neurosci 2024; 47:583-592. [PMID: 39054162 DOI: 10.1016/j.tins.2024.06.006] [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: 03/13/2024] [Revised: 05/28/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Abstract
Intellectual disability is defined as limitations in cognitive and adaptive behavior that often arise during development. Disordered sleep is common in intellectual disability and, given the importance of sleep for cognitive function, it may contribute to other behavioral phenotypes. Animal models of intellectual disability, in particular of monogenic intellectual disability syndromes (MIDS), recapitulate many disease phenotypes and have been invaluable for linking some of these phenotypes to specific molecular pathways. An emerging feature of MIDS, in both animal models and humans, is the prevalence of metabolic abnormalities, which could be relevant for behavior. Focusing on specific MIDS that have been molecularly characterized, we review sleep, circadian, and metabolic phenotypes in animal models and humans and propose that altered metabolic state contributes to the abnormal sleep/circadian phenotypes in MIDS.
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Affiliation(s)
- Mariela Lopez Valencia
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA
| | - Folasade A Sofela
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A Jongens
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA; Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Autism Spectrum Program of Excellence, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amita Sehgal
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA; Howard Hughes Medical Institute, Philadelphia, PA, USA.
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Dwivedi R, Kaushik M, Tripathi M, Dada R, Tiwari P. Unraveling the genetic basis of epilepsy: Recent advances and implications for diagnosis and treatment. Brain Res 2024; 1843:149120. [PMID: 39032529 DOI: 10.1016/j.brainres.2024.149120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
Epilepsy, affecting approximately 1% of the global population, manifests as recurring seizures and is heavily influenced by genetic factors. Recent advancements in genetic technologies have revolutionized our understanding of epilepsy's genetic landscape. Key studies, such as the discovery of mutations in ion channels (e.g., SCN1A and SCN2A), neurotransmitter receptors (e.g., GABRA1), and synaptic proteins (e.g., SYNGAP1, KCNQ2), have illuminated critical pathways underlying epilepsy susceptibility and pathogenesis. Genome-wide association studies (GWAS) have identified specific genetic variations linked to epilepsy risk, such as variants near SCN1A and PCDH7, enhancing diagnostic accuracy and enabling personalized treatment strategies. Moreover, epigenetic mechanisms, including DNA methylation (e.g., MBD5), histone modifications (e.g., HDACs), and non-coding RNAs (e.g., miR-134), play pivotal roles in altering gene expression and synaptic plasticity, contributing to epileptogenesis. These discoveries offer promising avenues for therapeutic interventions aimed at improving outcomes for epilepsy patients. Genetic testing has become essential in clinical practice, facilitating precise diagnosis and tailored management approaches based on individual genetic profiles. Furthermore, insights into epigenetic regulation suggest novel therapeutic targets for developing more effective epilepsy treatments. In summary, this review highlights significant progress in understanding the genetic and epigenetic foundations of epilepsy. By integrating findings from key studies and specifying genes involved in epigenetic modifications, we underscore the potential for advanced therapeutic strategies in this complex neurological disorder, emphasizing the importance of personalized medicine approaches in epilepsy management.
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Affiliation(s)
- Rekha Dwivedi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Meenakshi Kaushik
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Rima Dada
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Prabhakar Tiwari
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Summers J, Baribeau D, Perlman P, Hoang N, Cui S, Krakowski A, Ambrozewicz P, Ho A, Selvanayagam T, Sándor-Bajusz KA, Palad K, Patel N, McGaughey S, Gallagher L, Scherer SW, Szatmari P, Vorstman J. An integrated clinical approach to children at genetic risk for neurodevelopmental and psychiatric conditions: interdisciplinary collaboration and research infrastructure. J Neurodev Disord 2024; 16:37. [PMID: 38970057 PMCID: PMC11229023 DOI: 10.1186/s11689-024-09552-x] [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: 09/28/2023] [Accepted: 06/04/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND A sizeable proportion of pathogenic genetic variants identified in young children tested for congenital differences are associated with neurodevelopmental psychiatric disorders (NPD). In this growing group, a genetic diagnosis often precedes the emergence of diagnosable developmental concerns. Here, we describe DAGSY (Developmental Assessment of Genetically Susceptible Youth), a novel interdisciplinary 'genetic-diagnosis-first' clinic integrating psychiatric, psychological and genetic expertise, and report our first observations and feedback from families and referring clinicians. METHODS We retrieved data on referral sources and indications, genetic and NPD diagnoses and recommendations for children seen at DAGSY between 2018 and 2022. Through a survey, we obtained feedback from twenty families and eleven referring clinicians. RESULTS 159 children (mean age 10.2 years, 57.2% males) completed an interdisciplinary (psychiatry, psychology, genetic counselling) DAGSY assessment during this period. Of these, 69.8% had a pathogenic microdeletion or microduplication, 21.5% a sequence-level variant, 4.4% a chromosomal disorder, and 4.4% a variant of unknown significance with emerging evidence of pathogenicity. One in four children did not have a prior NPD diagnosis, and referral to DAGSY was motivated by their genetic vulnerability alone. Following assessment, 76.7% received at least one new NPD diagnosis, most frequently intellectual disability (24.5%), anxiety (20.7%), autism spectrum (18.9%) and specific learning (16.4%) disorder. Both families and clinicians responding to our survey expressed satisfaction, but also highlighted some areas for potential improvement. CONCLUSIONS DAGSY addresses an unmet clinical need for children identified with genetic variants that confer increased vulnerability for NPD and provides a crucial platform for research in this area. DAGSY can serve as a model for interdisciplinary clinics integrating child psychiatry, psychology and genetics, addressing both clinical and research needs for this emerging population.
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Affiliation(s)
- Jane Summers
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Danielle Baribeau
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Polina Perlman
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ny Hoang
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sunny Cui
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aneta Krakowski
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Patricia Ambrozewicz
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ariel Ho
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Thanuja Selvanayagam
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kinga A Sándor-Bajusz
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katrina Palad
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nishi Patel
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah McGaughey
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Louise Gallagher
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- McLaughlin Centre and Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada.
- Autism Research Unit, The Hospital for Sick Children, Toronto, ON, Canada.
- Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street Room 12.9702, Toronto, ON, M5G 0A4, Canada.
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Carriero PL, Zangari R, Sfreddo E, Ghirardi A, Schieppati A, Barbui T, Biroli F. Exploring the Clinical and Genetic Landscape of Angelman Syndrome: Patient-Reported Insights from an Italian Registry. J Clin Med 2024; 13:3520. [PMID: 38930051 PMCID: PMC11204522 DOI: 10.3390/jcm13123520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/01/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The Angelman Syndrome Registry (RISA) was developed as a retrospective study with the following objectives: to evaluate the clinical history of individuals with Angelman Syndrome (AS) in Italy and compare it with the existing literature; to investigate the feasibility of gathering data by directly involving participants in the data collection process; and to explore the relationship between different symptoms and genotypes. Methods: Established in 2018, RISA enrolled a total of 82 participants, with 62 (75.6%) providing complete data. Demographic, clinical, and genetic information was collected using electronic case report forms. Descriptive statistics characterized the sample, while associations between genotype and clinical characteristics were examined. Results: Descriptive analysis revealed a median participant age of 8.0 years, with males comprising 48.8% of the sample. Deletion (58.1%) was the most common genotype. The majority (82.2%) experienced epilepsy, with seizures typically onset before 3 years of age. Most patients (86.2%) required multiple anti-epileptic drugs for control, with generalized tonic-clonic seizures and atypical absence seizures being most prevalent. The deletion group exhibited more severe developmental delays and a trend towards higher seizure severity. Sleep problems affected 69.4% of participants, characterized by difficulties in sleep onset and maintenance. Conclusions: This study offers valuable insights into the clinical history and genetic characteristics of AS in Italy, consistent with the prior literature. Additionally, it underscores the efficacy of patient registries in capturing comprehensive data on rare diseases such as AS, highlighting their potential to advance research and enhance patient care.
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Affiliation(s)
- Pier Luigi Carriero
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
| | - Rosalia Zangari
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
| | - Eleonora Sfreddo
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
| | - Arianna Ghirardi
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
| | - Arrigo Schieppati
- Clinical Research Centre for Rare Diseases “Aldo and Cele Daccò”, Mario Negri Institute for Pharmacological Research, 24020 Ranica, Italy;
| | - Tiziano Barbui
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
| | - Francesco Biroli
- FROM Research Foundation ETS, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.L.C.); (R.Z.); (E.S.); (A.G.); (T.B.)
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Sadhwani A, Powers S, Wheeler A, Miller H, Potter SN, Peters SU, Bacino CA, Skinner SA, Wink LK, Erickson CA, Bird LM, Tan WH. Developmental milestones and daily living skills in individuals with Angelman syndrome. J Neurodev Disord 2024; 16:32. [PMID: 38879552 PMCID: PMC11179294 DOI: 10.1186/s11689-024-09548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/29/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a neurodevelopmental disorder associated with severe global developmental delay. However, the ages at which different developmental skills are achieved in these individuals remain unclear. We seek to determine the probability and the age of acquisition of specific developmental milestones and daily living skills in individuals with AS across the different molecular subtypes, viz. class I deletion, class II deletion, uniparental disomy, imprinting defect, and UBE3A variants. METHODS Caregivers participating in a longitudinal multicenter Angelman Syndrome Natural History Study completed a questionnaire regarding the age at which their children achieved specific developmental milestones and daily living skills. The Cox Proportional Hazard model was applied to analyze differences in the probability of achievement of skills at various ages among five molecular subtypes of AS. RESULTS Almost all individuals, regardless of molecular subtype, were able to walk with support by five years of age. By age 15, those with a deletion had at least a 50% probability of acquiring 17 out of 30 skills compared to 25 out of 30 skills among those without a deletion. Overall, fine and gross motor skills such as holding and reaching for small objects, sitting, and walking with support were achieved within a fairly narrow range of ages, while toileting, feeding, and hygiene skills tend to have greater variability in the ages at which these skills were achieved. Those without a deletion had a higher probability (25-92%) of achieving daily living skills such as independently toileting and dressing compared to those with a deletion (0-13%). Across all molecular subtypes, there was a low probability of achieving independence in bathing and brushing teeth. CONCLUSION Individuals with AS without a deletion are more likely to achieve developmental milestones and daily living skills at an earlier age than those with a deletion. Many individuals with AS are unable to achieve daily living skills necessary for independent self-care.
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Affiliation(s)
- Anjali Sadhwani
- Department of Psychiatry and Behavioral Services, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry and Behavioral Services, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Sonya Powers
- RTI International, Research Triangle Park, NC, USA
- Edmentum, Minneapolis, MN, USA
| | - Anne Wheeler
- RTI International, Research Triangle Park, NC, USA
| | - Hillary Miller
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Aetna, Hartford, CT, USA
| | | | - Sarika U Peters
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Carlos A Bacino
- Kleberg Genetics Clinic, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | | | - Logan K Wink
- Division of Child Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Talkiatry Management Services, LLC, New York, USA
| | - Craig A Erickson
- Division of Child Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Lynne M Bird
- University of California San Diego and Rady Children's Hospital, San Diego, CA, USA
| | - Wen-Hann Tan
- Department of Psychiatry and Behavioral Services, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, United States
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Andrews SM, Panjwani AA, Potter SN, Hamrick LR, Wheeler AC, Kelleher BL. Specificity of Early Childhood Hyperphagia Profiles in Neurogenetic Conditions. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:175-190. [PMID: 38657964 DOI: 10.1352/1944-7558-129.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/10/2023] [Indexed: 04/26/2024]
Abstract
Hyperphagia is highly penetrant in Prader-Willi syndrome (PWS) and has increasingly been reported in other neurogenetic conditions (NGC). The Hyperphagia Questionnaire (HQ) was completed by caregivers of 4-8-year-olds with PWS (n = 17), Angelman syndrome (AS; n = 22), Williams syndrome (WS; n = 25), or low-risk controls (LRC; n = 35). All NGC groups were significantly elevated in HQ Total and Behavior scores compared to LRC. Only AS and WS were significantly elevated in the Drive domain, and only PWS in the Severity domain. After controlling for externalizing behavior, HQ Total scores were higher for PWS relative to other groups. Hyperphagic symptoms may not differentiate PWS from other NGCs in early childhood. However, hyperphagic phenotypes may be most severe in PWS. Further investigation of these profiles may inform etiology and syndrome-specific treatments.
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O'Sullivan R, Bissell S, Agar G, Spiller J, Surtees A, Heald M, Clarkson E, Khan A, Oliver C, Bagshaw AP, Richards C. Exploring an objective measure of overactivity in children with rare genetic syndromes. J Neurodev Disord 2024; 16:18. [PMID: 38637764 PMCID: PMC11025271 DOI: 10.1186/s11689-024-09535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates. METHODS A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes. RESULTS M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex. DISCUSSION These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.
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Affiliation(s)
- Rory O'Sullivan
- School of Psychology, University of Birmingham, Birmingham, UK.
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Georgie Agar
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Jayne Spiller
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Andrew Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Mary Heald
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK
| | | | - Aamina Khan
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | | | - Andrew P Bagshaw
- School of Psychology, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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Hagenaar DA, Bindels-de Heus KGCB, van Gils MM, van den Berg L, Ten Hoopen LW, Affourtit P, Pel JJM, Joosten KFM, Hillegers MHJ, Moll HA, de Wit MCY, Dieleman GC, Mous SE. Outcome measures in Angelman syndrome. J Neurodev Disord 2024; 16:6. [PMID: 38429713 PMCID: PMC10905876 DOI: 10.1186/s11689-024-09516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by severe intellectual disability, little to no expressive speech, visual and motor problems, emotional/behavioral challenges, and a tendency towards hyperphagia and weight gain. The characteristics of AS make it difficult to measure these children's functioning with standard clinical tests. Feasible outcome measures are needed to measure current functioning and change over time, in clinical practice and clinical trials. AIM Our first aim is to assess the feasibility of several functional tests. We target domains of neurocognitive functioning and physical growth using the following measurement methods: eye-tracking, functional Near-Infrared Spectroscopy (fNIRS), indirect calorimetry, bio-impedance analysis (BIA), and BOD POD (air-displacement plethysmography). Our second aim is to explore the results of the above measures, in order to better understand the AS phenotype. METHODS The study sample consisted of 28 children with AS aged 2-18 years. We defined an outcome measure as feasible when (1) at least 70% of participants successfully finished the measurement and (2) at least 60% of those participants had acceptable data quality. Adaptations to the test procedure and reasons for early termination were noted. Parents rated acceptability and importance and were invited to make recommendations to increase feasibility. The results of the measures were explored. RESULTS Outcome measures obtained with eye-tracking and BOD POD met the definition of feasibility, while fNIRS, indirect calorimetry, and BIA did not. The most important reasons for early termination of measurements were showing signs of protest, inability to sit still and poor/no calibration (eye-tracking specific). Post-calibration was often applied to obtain valid eye-tracking results. Parents rated the BOD POD als most acceptable and fNIRS as least acceptable for their child. All outcome measures were rated to be important. Exploratory results indicated longer reaction times to high salient visual stimuli (eye-tracking) as well as high body fat percentage (BOD POD). CONCLUSIONS Eye-tracking and BOD POD are feasible measurement methods for children with AS. Eye-tracking was successfully used to assess visual orienting functions in the current study and (with some practical adaptations) can potentially be used to assess other outcomes as well. BOD POD was successfully used to examine body composition. TRIAL REGISTRATION Registered d.d. 23-04-2020 under number 'NL8550' in the Dutch Trial Register: https://onderzoekmetmensen.nl/en/trial/23075.
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Affiliation(s)
- Doesjka A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands.
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands.
| | - Karen G C B Bindels-de Heus
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Maud M van Gils
- Vestibular and Oculomotor Research Group, Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Louise van den Berg
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Philine Affourtit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands
| | - Johan J M Pel
- Vestibular and Oculomotor Research Group, Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Division of Pediatric ICU, Department of Neonatal and Pediatric ICU, Erasmus MC, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology and Paediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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10
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Hagenaar DA, Bindels-de Heus KGCB, Lubbers K, Ten Hoopen LW, Rietman AB, de Nijs PFA, Hillegers MHJ, Moll HA, de Wit MCY, Dieleman GC, Mous SE. Child characteristics associated with child quality of life and parenting stress in Angelman syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:248-263. [PMID: 38009976 DOI: 10.1111/jir.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterised by severe intellectual disability, movement disorder, epilepsy, sleeping problems, and behavioural issues. Little is known on child health-related quality of life (HRQoL) in AS. AS family studies have reported elevated parenting stress and a high impact of the child's syndrome on the parent. It is unclear which factors influence child HRQoL and parenting stress/impact in AS. METHODS We collected data prospectively through standardised clinical assessments of children with AS at the ENCORE Expertise centre for Angelman Syndrome at the Erasmus MC Sophia Children's Hospital. A linear regression analysis was conducted for the following outcome variables: (1) child HRQoL (Infant and Toddler Quality of Life Questionnaire); (2) the impact of the child's syndrome on the parent (Infant and Toddler Quality of Life Questionnaire); and (3) parenting stress (Parenting Stress Index). Predictor variables were child genotype, epilepsy, sleeping problems (Sleep Disturbance Scale for Children), cognitive developmental level (Bayley Cognition Scale), autistic features (Autism Diagnostic Observation Schedule) and emotional/behavioural problems (Child Behaviour Checklist). Covariates were sex, age and socio-economic status. RESULTS The study sample consisted of 73 children with AS, mean age = 9.1 years, range = 2-18 years. Emotional/behavioural problems were the strongest significant predictor of lowered child HRQoL. Internalising problems were driving this effect. In addition, having the deletion genotype and higher age was related to lower child HRQoL. Sleeping problems were related to a higher impact of the child's syndrome on the parent. Finally, emotional/behavioural problems were associated with higher parenting stress. Cognitive developmental level, autistic features and epilepsy were not a significant predictor of child HRQoL and parenting stress/impact. CONCLUSIONS These results suggest that interventions aimed at increasing child HRQoL and decreasing parenting stress/impact in AS should focus on child emotional/behavioural problems and sleeping problems, using a family-centred approach.
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Affiliation(s)
- D A Hagenaar
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K G C B Bindels-de Heus
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - K Lubbers
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - L W Ten Hoopen
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - P F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - M H J Hillegers
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - H A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - M C Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology and Paediatric Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - G C Dieleman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - S E Mous
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Department of Child- and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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11
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Bindels-de Heus KGCB, Hagenaar DA, Mous SE, Dekker I, van der Kaay DCM, Kerkhof GF, Elgersma Y, Moll HA, de Wit MCY. Bone health in children with Angelman syndrome at the ENCORE Expertise Center. Eur J Pediatr 2024; 183:103-111. [PMID: 37831301 PMCID: PMC10857954 DOI: 10.1007/s00431-023-05231-6] [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: 07/17/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Angelman syndrome (AS) is a rare genetic disorder due to lack of UBE3A function on chromosome 15q11.2q13 caused by a deletion, uniparental paternal disomy (UPD), imprinting center disorder (ICD), or pathological variant of the UBE3A gene. AS is characterized by developmental delay, epilepsy, and lack of speech. Although fractures are observed frequently in our clinical practice, there are few studies on bone health in AS. The aim of this study is to investigate bone health in children with AS. In this prospective cohort study, we describe bone health in 91 children with AS visiting the ENCORE Expertise Center for AS between April 2010 and December 2021. Bone health was assessed with the bone health index (BHI) in standard deviation score (SDS) measured by digital radiogrammetry of the left hand using BoneXpert software. Risk factors analyzed were age, sex, genetic subtype, epilepsy, anti-seizure medication use, mobility, body mass index (BMI), and onset of puberty. Children with AS had a mean BHI of -1.77 SDS (SD 1.4). A significantly lower BHI was found in children with a deletion (-2.24 SDS) versus non-deletion (-1.02 SDS). Other factors associated with reduced BHI-SDS were inability to walk and late onset of puberty. Children with a history of one or more fractures (22%) had a significantly lower BHI than children without fractures (-2.60 vs -1.56 SDS). Longitudinal analysis showed a significant decrease in BHI-SDS with age in all genetic subtypes. Conclusions: Children with AS have a reduced bone health. Risk factors are deletion genotype, no independent walking, and late onset of puberty. Bone health decreased significantly with age. What is Known: • Children with neurological disorders often have a low bone health and higher risk of fractures. • Little is known about bone health in children with Angelman syndrome (AS). What is New: • Children with AS showed a reduced bone health and this was significantly associated with having a deletion, not being able to walk independently, and late onset of puberty. • Longitudinal analysis showed a significant decrease in bone health as children got older.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
| | - Doesjka A Hagenaar
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilonka Dekker
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Gerthe F Kerkhof
- Dept. of Pediatric Endocrinology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A Moll
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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12
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Potter SN, Reynolds E, Okoniewski KC, Edwards A, Gable J, Hill C, Bakalov V, Zentz S, Whiting C, Cheves E, Garbarini K, Jalazo E, Howell C, Moore A, Wheeler A. Linking Angelman and dup15q data for expanded research (LADDER) database: a model for advancing research, clinical guidance, and therapeutic development for rare conditions. THERAPEUTIC ADVANCES IN RARE DISEASE 2024; 5:26330040241254122. [PMID: 38808315 PMCID: PMC11131393 DOI: 10.1177/26330040241254122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
Angelman syndrome (AS) and duplication 15q (dup15q) syndrome are rare neurogenetic conditions arising from a common locus on the long arm of chromosome 15. Individuals with both conditions share some clinical features (e.g. intellectual disability, epilepsy) and often require lifelong care. Disease-modifying therapies for both conditions are emerging, resulting in a significant need for a better understanding of the natural history of both AS and dup15q. Patient advocacy groups for both conditions recognized a need for a data repository that would link data on individuals from multiple sources to expand research, increase understanding of natural history, and accelerate the development of treatments, resulting in the Linking Angelman and Dup15q Data for Expanded Research (LADDER) Database. This paper describes the development and functionality of the LADDER Database - including challenges, lessons learned, and preliminary feasibility - and how it can be used as a model for other rare conditions.
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Affiliation(s)
- Sarah Nelson Potter
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | | | | | - Anne Edwards
- RTI International, Research Triangle Park, NC, USA
| | - Julia Gable
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | | | - Emily Cheves
- RTI International, Research Triangle Park, NC, USA
| | - Katie Garbarini
- Angelman Syndrome Foundation, Aurora, IL, USA
- Dup15q Alliance, Matthews, NC, USA
| | - Elizabeth Jalazo
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Anne Wheeler
- RTI International, Research Triangle Park, NC, USA
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13
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Keary C, Bird LM, de Wit MC, Hatti S, Heimer G, Heussler H, Kolevzon A, Mathews A, Ochoa-Lubinoff C, Tan WH, Yan Y, Adams M. Gaboxadol in angelman syndrome: A double-blind, parallel-group, randomized placebo-controlled phase 3 study. Eur J Paediatr Neurol 2023; 47:6-12. [PMID: 37639777 DOI: 10.1016/j.ejpn.2023.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To evaluate efficacy and safety of gaboxadol for treatment of children with Angelman syndrome (AS). METHOD In this international, double-blind, phase 3 trial, we randomized children 4-12 years old with a molecular diagnosis of AS and a Clinical Global Impression (CGI)-severity score ≥3 to either daily administration of weight-based gaboxadol or matching placebo for 12 weeks. The primary endpoint was the CGI-Improvement-AS (CGI-I-AS) score at week 12. Secondary endpoints included the proportion of participants with CGI-I-AS response of ≤3 (i.e., at least "minimal improvement") and ≤2 (i.e., at least "much improvement") at week 12. Safety and tolerability were monitored throughout the study. Weight based dosing of study drug ranged from 0.125 mg/kg to 0.24 mg/kg depending on weight range. RESULTS Between August 2019 and November 2020, 104 participants were enrolled: participants 4-12 years old were randomly (1:1) assigned to gaboxadol (n = 47) or placebo (n = 50), and 7 other participants 2─3 years old who received gaboxadol and were assessed for safety only. All gaboxadol-treated participants and 48 of 50 placebo-treated participants completed treatment. There was no significant difference in CGI-I-AS between groups: at week 12, mean CGI-I-AS score was 3.3 (SD, 1.00) and 3.2 (SD, 1.05) in the gaboxadol and placebo groups, respectively, yielding a least squares mean difference of zero (p = 0.83). There were no between-group significant differences with respect to CGI-I-AS responses. Gaboxadol was well tolerated in all age groups of this study. CONCLUSIONS There was no significant difference in CGI-I-AS between gaboxadol and placebo after 12 weeks of study treatment in pediatric AS participants. CLINICALTRIALS GOV: NCT04106557.
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Affiliation(s)
| | - Lynne M Bird
- University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Marie-Claire de Wit
- Department of Pediatric Neurology, ENCORE Expertise Center, ERN-Ithaca Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Gali Heimer
- Sheba Medical Center, The Tel Aviv University, Ramat Gan, Israel
| | - Helen Heussler
- Centre for Children's Health Research, University of Queensland, Brisbane, Australia; Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Queensland Children's Hospital, Brisbane, Australia
| | | | | | | | - Wen-Hann Tan
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ying Yan
- Ovid Therapeutics, Cambridge, MA, USA
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14
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Gruber N, Daka A, Lapidot N, Modan-Moses D, Pinhas-Hamiel O, Ben Zeev B, Heimer G. Short Stature and Distinct Growth Characteristics in Angelman Syndrome. Horm Res Paediatr 2023; 97:334-342. [PMID: 37844556 PMCID: PMC11251660 DOI: 10.1159/000534612] [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: 09/05/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Angelman syndrome (AS) is a rare, genetic, neurodevelopmental disorder characterized by severe impairments in speech, cognition, and motor skills accompanied by unique behaviors, distinct facial features, and high prevalence of epilepsy and sleep problems. Despite some reports of short stature among AS patients, this feature is not included in the clinical criteria defined in 2005. We investigated growth patterns among AS patients with respect to mutation type, growth periods, family history, and endocrine abnormalities. METHODS Data were collected from patients' medical files in AS National Clinic. Mutation subtypes were divided to deletion and non-deletion. Four growth periods were defined: preschool, childhood, peak height velocity, and final height. RESULTS The cohort included 88 individuals (46 males), with 54 (61.4%) carrying deletion subtype. A median of 3 observations per individual produced 280 data points. Final height SDS was significantly lower compared to general population (-1.23 ± 1.26, p < 0.001), and in deletion group versus non-deletion (-1.67 ± 1.3 vs. -0.65 ± 0.96, p = 0.03). Final height SDS was significantly lower compared to height SDS in preschool period (-1.32 vs. -0.47, p = 0.007). Patient's final height SDS was significantly lower than the parents' (∆final-height SDS = 0.94 ± 0.99, p = 0.002). IGF1-SDS was significantly decreased compared to general population (-0.55 ± 1.61, p = 0.04), with lower values among deletion group (-0.70 ± 1.44, p = 0.01). CONCLUSIONS AS patients demonstrate specific growth pattern with deceleration during childhood and adolescence, resulting in significantly decreased final height compared to normal population, and even lower among deletion subgroup, which could be attributed to reduced IGF1 levels. We propose adding short stature to the clinical criteria and developing adjusted growth curves for AS population.
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Affiliation(s)
- Noah Gruber
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Ayman Daka
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Pediatrics, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Noy Lapidot
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Pediatrics, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Dalit Modan-Moses
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Bruria Ben Zeev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Gali Heimer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
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15
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Bindels-de Heus KGCB, Hagenaar DA, Dekker I, van der Kaay DCM, Kerkhof GF, Elgersma Y, de Wit MCY, Mous SE, Moll HA. Hyperphagia, Growth, and Puberty in Children with Angelman Syndrome. J Clin Med 2023; 12:5981. [PMID: 37762921 PMCID: PMC10532359 DOI: 10.3390/jcm12185981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Angelman Syndrome (AS) is a rare genetic disorder caused by lack of maternal UBE3A protein due to a deletion of the chromosome 15q11.2-q13 region, uniparental paternal disomy, imprinting center defect, or pathogenic variant in the UBE3A gene. Characteristics are developmental delay, epilepsy, behavioral, and sleep problems. There is some evidence for hyperphagia, shorter stature, and higher BMI compared to neurotypical children, but longitudinal studies on growth are lacking. In this study, we analyzed prospectively collected data of 145 children with AS, who visited the ENCORE Expertise Center between 2010 and 2021, with a total of 853 visits. Children showed an elevated mean score of 25 on the Dykens Hyperphagia questionnaire (range 11-55) without genotype association. Higher scores were significantly associated with higher body mass index (BMI) standard deviation scores (SDS) (p = 0.004). Mean height was -1.2 SDS (SD 1.3), mean BMI-SDS was 0.6 (SD 1.7); 43% had a BMI-SDS > 1 and 20% had a BMI-SDS > 2. Higher BMI-SDS was significantly associated with non-deletion genotype (p = 0.037) and walking independently (p = 0.023). Height SDS decreased significantly with age (p < 0.001) and BMI-SDS increased significantly with age (p < 0.001. Onset of puberty was normal. In conclusion, children with AS showed moderate hyperphagia, lower height SDS, and higher BMI-SDS compared to norm data, with increasing deviation from the norm with age. It is uncertain how loss of maternal UBE3A function may influence growth. Attention to diet, exercise, and hyperphagia from an early age is recommended to prevent obesity and associated health problems.
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Affiliation(s)
- Karen G. C. B. Bindels-de Heus
- Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.A.H.); (I.D.); (H.A.M.)
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
| | - Doesjka A Hagenaar
- Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.A.H.); (I.D.); (H.A.M.)
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
- Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Ilonka Dekker
- Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.A.H.); (I.D.); (H.A.M.)
| | - Danielle C. M. van der Kaay
- Department of Pediatric Endocrinology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.C.M.v.d.K.); (G.F.K.)
| | - Gerthe F. Kerkhof
- Department of Pediatric Endocrinology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.C.M.v.d.K.); (G.F.K.)
| | - ENCORE Expertise Center for AS
- ENCORE Expertise Center for Neurodevelopmental Disorders, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Marie-Claire Y. de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
- Department of Neurology and Pediatric Neurology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Sabine E. Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
- Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.A.H.); (I.D.); (H.A.M.)
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands (M.-C.Y.d.W.); (S.E.M.)
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16
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Tjeertes J, Bacino CA, Bichell TJ, Bird LM, Bustamante M, Crean R, Jeste S, Komorowski RW, Krishnan ML, Miller MT, Nobbs D, Ochoa-Lubinoff C, Parkerson KA, Rotenberg A, Sadhwani A, Shen MD, Squassante L, Tan WH, Vincenzi B, Wheeler AC, Hipp JF, Berry-Kravis E. Enabling endpoint development for interventional clinical trials in individuals with Angelman syndrome: a prospective, longitudinal, observational clinical study (FREESIAS). J Neurodev Disord 2023; 15:22. [PMID: 37495977 PMCID: PMC10373389 DOI: 10.1186/s11689-023-09494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by the absence of a functional UBE3A gene, which causes developmental, behavioral, and medical challenges. While currently untreatable, comprehensive data could help identify appropriate endpoints assessing meaningful improvements in clinical trials. Herein are reported the results from the FREESIAS study assessing the feasibility and utility of in-clinic and at-home measures of key AS symptoms. METHODS Fifty-five individuals with AS (aged < 5 years: n = 16, 5-12 years: n = 27, ≥ 18 years: n = 12; deletion genotype: n = 40, nondeletion genotype: n = 15) and 20 typically developing children (aged 1-12 years) were enrolled across six USA sites. Several clinical outcome assessments and digital health technologies were tested, together with overnight 19-lead electroencephalography (EEG) and additional polysomnography (PSG) sensors. Participants were assessed at baseline (Clinic Visit 1), 12 months later (Clinic Visit 2), and during intermittent home visits. RESULTS The participants achieved high completion rates for the clinical outcome assessments (adherence: 89-100% [Clinic Visit 1]; 76-91% [Clinic Visit 2]) and varied feasibility of and adherence to digital health technologies. The coronavirus disease 2019 (COVID-19) pandemic impacted participants' uptake of and/or adherence to some measures. It also potentially impacted the at-home PSG/EEG recordings, which were otherwise feasible. Participants achieved Bayley-III results comparable to the available natural history data, showing similar scores between individuals aged ≥ 18 and 5-12 years. Also, participants without a deletion generally scored higher on most clinical outcome assessments than participants with a deletion. Furthermore, the observed AS EEG phenotype of excess delta-band power was consistent with prior reports. CONCLUSIONS Although feasible clinical outcome assessments and digital health technologies are reported herein, further improved assessments of meaningful AS change are needed. Despite the COVID-19 pandemic, remote assessments facilitated high adherence levels and the results suggested that at-home PSG/EEG might be a feasible alternative to the in-clinic EEG assessments. Taken altogether, the combination of in-clinic/at-home clinical outcome assessments, digital health technologies, and PSG/EEG may improve protocol adherence, reduce patient burden, and optimize study outcomes in AS and other rare disease populations.
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Affiliation(s)
- Jorrit Tjeertes
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Carlos A Bacino
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | | | - Lynne M Bird
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
- Division of Dysmorphology/Genetics, Rady Children's Hospital, San Diego, CA, USA
| | - Mariana Bustamante
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | | | - Shafali Jeste
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - Meghan T Miller
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - David Nobbs
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Cesar Ochoa-Lubinoff
- Departments of Pediatrics, Division of Developmental-Behavioral Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | | | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anjali Sadhwani
- Department of Psychiatry and Behavioral Services, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark D Shen
- Carolina Institute for Developmental Disabilities & UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa Squassante
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brenda Vincenzi
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Anne C Wheeler
- Carolina Institute for Developmental Disabilities, Carrboro, NC, USA
- RTI International, Durham, NC, USA
| | - Joerg F Hipp
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Anatomy and Cell Biology, Rush University Medical Center, 1725 W Harrison St, Suite 718, Chicago, IL, 60612, USA.
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17
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Geier B, Neely L, Coronado E, Reiter LT. Drosophila UBE3A regulates satiety signaling through the Piezo mechanosensitive ion channel. RESEARCH SQUARE 2023:rs.3.rs-3101314. [PMID: 37461494 PMCID: PMC10350227 DOI: 10.21203/rs.3.rs-3101314/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Angelman syndrome (AS) is a rare neurogenetic disorder characterized by developmental delays, speech impairments, ataxic movements, and in some cases, hyperphagic feeding behavior. Loss of function mutations, loss of expression from the maternal allele or absence of maternal UBE3A result in AS. Recent studies have established a connection between UBE3A and the mechanosensitive ion channel PIEZO2, suggesting the potential role of UBE3A in the regulation of PIEZO channels. In this study, we investigated the role of Drosophila UBE3A (Dube3a) in Piezo associated hyperphagic feeding behavior. We developed a novel assay using green fluorescent protein (GFP) expressing yeast to quantify gut distention in flies with Piezo and Dube3a mutations. We confirmed that Dube3a15b loss of function flies displayed gut distention to almost identical levels as PiezoKO flies. Further analysis using deficiency (Df) lines encompassing the Dube3a locus provided proof for a role of Dube3a in satiety signaling. We also investigated endogenous Piezo expression across the fly midgut and tracheal system. Piezo protein could be detected in both neurons and trachea of the midgut. Overexpression of Dube3a driven by the Piezo promoter resulted in distinct tracheal remodeling within the midgut. These findings suggest that Dube3a plays a key role in the regulation of Piezo and that subsequent dysregulation of these ion channels may explain the hyperphagic behavior observed in 32% of cases of AS. Further investigation will be needed to identify the intermediate protein(s) interacting between the Dube3a ubiquitin ligase and Piezo channels, as Piezo does not appear to be a direct ubiquitin substrate for UBE3A in mice and humans.
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Affiliation(s)
| | - Logan Neely
- University of Tennessee Health Science Center
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18
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Eggermann T, Monk D, de Nanclares GP, Kagami M, Giabicani E, Riccio A, Tümer Z, Kalish JM, Tauber M, Duis J, Weksberg R, Maher ER, Begemann M, Elbracht M. Imprinting disorders. Nat Rev Dis Primers 2023; 9:33. [PMID: 37386011 DOI: 10.1038/s41572-023-00443-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
Imprinting disorders (ImpDis) are congenital conditions that are characterized by disturbances of genomic imprinting. The most common individual ImpDis are Prader-Willi syndrome, Angelman syndrome and Beckwith-Wiedemann syndrome. Individual ImpDis have similar clinical features, such as growth disturbances and developmental delay, but the disorders are heterogeneous and the key clinical manifestations are often non-specific, rendering diagnosis difficult. Four types of genomic and imprinting defect (ImpDef) affecting differentially methylated regions (DMRs) can cause ImpDis. These defects affect the monoallelic and parent-of-origin-specific expression of imprinted genes. The regulation within DMRs as well as their functional consequences are mainly unknown, but functional cross-talk between imprinted genes and functional pathways has been identified, giving insight into the pathophysiology of ImpDefs. Treatment of ImpDis is symptomatic. Targeted therapies are lacking owing to the rarity of these disorders; however, personalized treatments are in development. Understanding the underlying mechanisms of ImpDis, and improving diagnosis and treatment of these disorders, requires a multidisciplinary approach with input from patient representatives.
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Affiliation(s)
- Thomas Eggermann
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - David Monk
- School of Biological Sciences, University of East Anglia, Norwich, UK
| | - Guiomar Perez de Nanclares
- Rare Diseases Research Group, Molecular (Epi)Genetics Laboratory, Bioaraba Research Health Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | - Masayo Kagami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Eloïse Giabicani
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, APHP, Hôpital Armand Trousseau, Endocrinologie Moléculaire et Pathologies d'Empreinte, Paris, France
| | - Andrea Riccio
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, Università della Campania Luigi Vanvitelli, Caserta, Italy
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer M Kalish
- Division of Human Genetics and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Departments of Pediatrics and Genetics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maithé Tauber
- Centre de Référence Maladies Rares PRADORT (syndrome de PRADer-Willi et autres Obésités Rares avec Troubles du comportement alimentaire), Hôpital des Enfants, CHU Toulouse, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse, France
| | - Jessica Duis
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rosanna Weksberg
- Division of Clinical and Metabolic Genetics, Department of Paediatrics and Genetics and Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Sciences and Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Matthias Begemann
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Miriam Elbracht
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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19
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Khan N, Cabo R, Burdine RD, Tan WH, Keary CJ, Ochoa-Lubinoff C, Bird LM. Health-related quality of life and medication use among individuals with Angelman syndrome. Qual Life Res 2023:10.1007/s11136-023-03375-4. [PMID: 37039911 DOI: 10.1007/s11136-023-03375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 04/12/2023]
Abstract
PURPOSE The primary goal of this analysis is to describe the health-related quality of life (HRQoL), medical history, and medication use among adolescents and adults individuals with Angelman syndrome (AS). METHODS The analysis uses baseline data collected during the STARS study, a double-blind placebo controlled trial of gaboxadol (OV101) in adolescents and adults with AS. The HRQoL was estimated using EuroQoL 5-Dimension 5-Level (EQ-5D) health questionnaire proxy 1 version, which was completed by the caregivers. EQ-5D consists of two parts, a 5-dimension descriptive and a visual analogue scale (VAS) component. The utility score derived from EQ-5D ranges from 0 to 1 (perfect health) and VAS ranges from 0 to 100 (perfect health). RESULTS 87 individuals with AS were included in the present analysis. The mean utility score was 0.44 ± 0.20 and VAS score was 84 ± 1.5. The EQ-5D data indicated that the self-care, mobility and daily activities were most impacted. All adolescents (100%) and most adults (93%) had at least moderate problems with self-care activities, such as washing or dressing themselves. More than half (55%) of the adolescents and adults had at least moderate issues with mobility and usual activities. Approximately, 30% of adolescents and adults had moderate to extreme problems with anxiety/depression. High baseline concomitant use of medications was observed across both age groups with an average of 5 medications being used per person. CONCLUSION This study highlights the impact of AS on HRQoL and medication utilization among adolescents and adults individuals with AS.
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Affiliation(s)
- Nasreen Khan
- RWEC, LLC, 73 Walsingham Road, Mendham, NJ, USA.
| | - Raquel Cabo
- Ovid Therapeutics Inc, 441 Ninth Avenue, New York, NY, 10001, USA
| | - Rebecca D Burdine
- Department of Molecular Biology, Princeton University, 159 Moffett Laboratory, Washington Road, Princeton, NJ, 08544-1014, USA
| | - Wen-Hann Tan
- Division of Genetics and Genomics: Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Christopher J Keary
- Angelman Syndrome Program, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, One Maguire Road, Lexington, MA, 02421, USA
| | - Cesar Ochoa-Lubinoff
- Division of Developmental-Behavioral Pediatrics, Rush University Medical Center, 1725 West Harrison Street, Suite 710, Chicago, IL, 60612, USA
| | - Lynne M Bird
- University of California, San Diego, Department of Pediatrics and Rady Children's Hospital San Diego, Division of Dysmorphology/Genetics, 3020 Children's Way #5031, San Diego, CA, 92123, USA
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20
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Bindels-de Heus KGCB, Hooven-Radstaake MT, Legerstee JS, Hoopen LWT, Dieleman GC, Moll HA, Mous SE, de Wit MCY. Sleep problems in children with Angelman Syndrome: The effect of a behavioral intervention program. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104444. [PMID: 36753818 DOI: 10.1016/j.ridd.2023.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to investigate the effect of a behavioral intervention on sleep problems, which are significant and an unmet clinical need in children with Angelman Syndrome (AS). METHODS & PROCEDURES Children (2-18 years) with AS and sleep problems were randomized to a behavioral intervention program or a control group. Intervention consisted of a standardized program including home visits, psycho-education, feedback based on direct observation of bedtime routine and video footage of the night and behavioral treatment techniques by a behavioral therapist. Change in sleep duration (primary) and parental sleep, nighttime visits, sleep hygiene, daytime behavior, parental stress and quality of life (secondary) were assessed post-intervention and at follow-up using questionnaires, diary, actigraphy and videosomnography. OUTCOMES & RESULTS The groups, 9 children in each, did not differ at baseline. We found a significant effect of intervention on wake after sleep onset with classical statistical analysis (videosomnography). With single case analysis we found a positive effect on total sleep time (diary and actigraphy) and wake after sleep onset (diary) with a persistent effect on total sleep time (actigraphy) and wake after sleep onset (diary). On secondary outcome there was a significant and persistent effect on sleep hygiene and several quality of life domains. CONCLUSIONS & IMPLICATIONS Behavioral intervention has a positive and persistent effect on sleep problems in children with AS. We advise psycho-education for all parents and use of videosomnography for both evaluation of and feedback on sleep behavior patterns, individual behavioral advice and specific behavioral techniques for children with sleep problems.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands.
| | - Maartje Ten Hooven-Radstaake
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Radboud University, Dept. of Social Sciences, Nijmegen, the Netherlands
| | - Jeroen S Legerstee
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Gwen C Dieleman
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Henriette A Moll
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Neurology and Pediatric Neurology, the Netherlands
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21
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Rotaru DC, Wallaard I, de Vries M, van der Bie J, Elgersma Y. UBE3A expression during early postnatal brain development is required for proper dorsomedial striatal maturation. JCI Insight 2023; 8:e166073. [PMID: 36810252 PMCID: PMC9977510 DOI: 10.1172/jci.insight.166073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023] Open
Abstract
Angelman syndrome (AS) is a severe neurodevelopmental disorder (NDD) caused by loss of functional ubiquitin protein ligase E3A (UBE3A). Previous studies showed that UBE3A plays an important role in the first postnatal weeks of mouse brain development, but its precise role is unknown. Since impaired striatal maturation has been implicated in several mouse models for NDDs, we studied the importance of UBE3A in striatal maturation. We used inducible Ube3a mouse models to investigate the maturation of medium spiny neurons (MSNs) from dorsomedial striatum. MSNs of mutant mice matured properly till postnatal day 15 (P15) but remained hyperexcitable with fewer excitatory synaptic events at later ages, indicative of stalled striatal maturation in Ube3a mice. Reinstatement of UBE3A expression at P21 fully restored MSN excitability but only partially restored synaptic transmission and the operant conditioning behavioral phenotype. Gene reinstatement at P70 failed to rescue both electrophysiological and behavioral phenotypes. In contrast, deletion of Ube3a after normal brain development did not result in these electrophysiological and behavioral phenotypes. This study emphasizes the role of UBE3A in striatal maturation and the importance of early postnatal reinstatement of UBE3A expression to obtain a full rescue of behavioral phenotypes associated with striatal function in AS.
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Affiliation(s)
- Diana C. Rotaru
- Department of Clinical Genetics and
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, Netherlands
| | - Ilse Wallaard
- Department of Clinical Genetics and
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, Netherlands
| | - Maud de Vries
- Department of Clinical Genetics and
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, Netherlands
| | - Julia van der Bie
- Department of Clinical Genetics and
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, Netherlands
| | - Ype Elgersma
- Department of Clinical Genetics and
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, Netherlands
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22
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Sadhwani A, Wheeler A, Gwaltney A, Peters SU, Barbieri-Welge RL, Horowitz LT, Noll LM, Hundley RJ, Bird LM, Tan WH. Developmental Skills of Individuals with Angelman Syndrome Assessed Using the Bayley-III. J Autism Dev Disord 2023; 53:720-737. [PMID: 33517526 PMCID: PMC8322148 DOI: 10.1007/s10803-020-04861-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 12/27/2022]
Abstract
We describe the development of 236 children with Angelman syndrome (AS) using the Bayley Scales of Infant and Toddler Development, Third Edition. Multilevel linear mixed modeling approaches were used to explore differences between molecular subtypes and over time. Individuals with AS continue to make slow gains in development through at least age 12 years of age at about 1-2 months/year based on age equivalent score and 1-16 growth score points/year depending on molecular subtype and domain. Children with a deletion have lower scores at baseline and slower rate of gaining skills while children with UBE3A variant subtype demonstrated higher scores as well as greater rates of skill attainment in all domains. The developmental profiles of UPD and ImpD were similar.
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Affiliation(s)
- Anjali Sadhwani
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Anne Wheeler
- RTI International, Research Triangle Park, NC, USA
| | | | - Sarika U. Peters
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rene L. Barbieri-Welge
- Developmental Evaluation Clinic, Rady Children’s Hospital - San Diego, San Diego, CA, USA
| | | | - Lisa M. Noll
- Psychology Service, Texas Children’s Hospital, Houston, TX, USA,Baylor College of Medicine, Houston, TX, USA
| | - Rachel J. Hundley
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lynne M. Bird
- Division of Dysmorphology/Genetics, Rady Children’s Hospital - San Diego, San Diego, CA, USA,Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Wen-Hann Tan
- Harvard Medical School, Boston, MA, USA,Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
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23
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Status Epilepticus in Chromosomal Disorders Associated with Epilepsy: A Systematic Review. Genes (Basel) 2023; 14:genes14020299. [PMID: 36833226 PMCID: PMC9956098 DOI: 10.3390/genes14020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Status Epilepticus (SE) is a neurological emergency resulting from the failure of mechanisms of seizure termination or from the initiation of mechanisms that lead to prolonged seizures. The International League Against Epilepsy (ILAE) identified 13 chromosomal disorders associated with epilepsy (CDAE); data regarding SE occurrence in these patients is lacking. A systematic scoping review was conducted to outline current literature evidence about clinical features, treatments, and outcomes of SE in pediatric and adult patients with CDAE. A total of 373 studies were identified with the initial search; 65 of these were selected and regarded as SE in Angelman Syndrome (AS, n = 20), Ring 20 Syndrome (R20, n = 24), and other syndromes (n = 21). Non-convulsive status epilepticus (NCSE) is frequently observed in AS and R20. No specific, targeted therapies for SE in CDAE are available to date; anecdotal reports about SE treatment are described in the text, as well as various brief- and long-term outcomes. Further evidence is needed to precisely portray the clinical features, treatment options, and outcomes of SE in these patients.
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24
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Leader G, Whelan S, Chonaill NN, Coyne R, Tones M, Heussler H, Bellgard M, Mannion A. Association between early and current gastro-intestinal symptoms and co-morbidities in children and adolescents with Angelman syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:865-879. [PMID: 36052644 PMCID: PMC9826167 DOI: 10.1111/jir.12975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a neurogenetic disorder that causes severe intellectual disability, expressive language deficits, motor impairment, ataxia, sleep problems, epileptic seizures and a happy disposition. People with AS frequently experience gastrointestinal (GI) symptoms. METHOD This study used data from the Global Angelman Syndrome Registry to explore the relationship between early and current GI symptoms and co-morbidity in children and adolescents with AS (n = 173). Two groups that experienced a high (n = 91) and a low (n = 82) frequency of GI symptoms were examined in relation to feeding and GI history in infancy, sleep and toileting problems, levels of language and communication and challenging behaviours. Predictors of GI symptoms were then investigated using a series of logistic regressions. RESULTS This analysis found that constipation and gastroesophageal reflux affected 84% and 64%, of the sample, respectively. The high frequency of GI symptoms were significantly associated with: 'refusal to nurse', 'vomiting', 'arching', 'difficulty gaining weight', gastroesophageal reflux, 'solid food transition', frequency of night-time urinary continence and sleep hyperhidrosis during infancy. GI symptoms were not significantly associated with sleep, toileting, language or challenging behaviours. Significant predictors of high frequency GI symptoms were gastroesophageal reflux and sleep hyperhidrosis. CONCLUSIONS Future research needs to investigate the association between AS and GI co-morbidity in adults with AS.
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Affiliation(s)
- G. Leader
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - S. Whelan
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - N. N. Chonaill
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - R. Coyne
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - M. Tones
- eResearch OfficeQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - H. Heussler
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - M. Bellgard
- eResearch OfficeQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - A. Mannion
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
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25
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Key AP, Roth S, Venker C. Spoken language comprehension in children and adults with Angelman Syndrome. JOURNAL OF COMMUNICATION DISORDERS 2022; 100:106272. [PMID: 36244082 PMCID: PMC9994640 DOI: 10.1016/j.jcomdis.2022.106272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Objective evaluation of receptive communication abilities in nonspeaking individuals using standardized behavioral measures can be complicated by co-occurring intellectual disabilities and motor difficulties. Eye tracking during listening may offer an informative complementary approach to directly evaluate receptive language skills. METHOD This study examined feasibility of eye gaze measures as an index of spoken language comprehension in nonspeaking children and adults with Angelman syndrome (AS; n = 23) using a looking-while-listening procedure. Typically developing children (n = 34) provided a reference data set. Primary caregivers of participants with AS completed standardized informant reports (MacArthur-Bates Communicative Development Inventory: Words and Gestures; Vineland Adaptive Behavior Scales-3; Aberrant Behavior Checklist-2) to characterize communicative skills and general adaptive functioning. RESULTS Gaze data in participants with AS, particularly in the individuals reported by caregivers to have larger receptive vocabularies and stronger adaptive communicative functioning, demonstrated the expected pattern of comprehension reflected by the increased probability of looks to the target images after vs. before they were named in a spoken sentence. However, processing speed (gaze reaction time) was significantly slower in participants with AS than in the typically developing group. CONCLUSIONS Gaze-based paradigms could be an informative measure of receptive communication processes in participants who are unable to complete traditional standardized behavioral assessments.
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Horikawa Y, Yatsuga S, Ohya T, Okamatsu Y. Laryngotracheal separation surgery in a patient with severe Angelman syndrome involving a 19.3 Mb deletion on 15q11.2–q14. Clin Case Rep 2022; 10:e6545. [PMCID: PMC9638081 DOI: 10.1002/ccr3.6545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Shuichi Yatsuga
- Iizuka Hospital Department of Pediatrics Iizuka Japan
- Fukuoka University Department of Pediatrics Fukuoka Japan
| | - Takashi Ohya
- Iizuka Hospital Department of Pediatrics Iizuka Japan
| | - Yuki Okamatsu
- Iizuka Hospital Department of Pediatrics Iizuka Japan
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Punatar R, Egense A, Mao R, Procter M, Bosworth M, Quigley DI, Angkustsiri K, Shankar SP. Atypical presentation of Angelman syndrome with intact expressive language due to low-level mosaicism. Mol Genet Genomic Med 2022; 10:e2018. [PMID: 35929060 PMCID: PMC9544204 DOI: 10.1002/mgg3.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Angelman syndrome (AS) occurs due to a lack of expression or function of the maternally inherited UBE3A gene. Individuals with AS typically have significant developmental delay, severe speech impairment with absent to minimal verbal language, gait abnormalities including ataxia, and an incongruous happy demeanor. The majority of individuals with AS also have seizures and microcephaly. Some individuals with mosaic AS have been reported to have expressive language and milder levels of developmental delay. CASE REPORT We report a male patient presenting with mild to moderate intellectual disability, hyperphagia, obesity, and the ability to communicate verbally. His phenotype was suggestive of Prader-Willi syndrome. However, methylation testing was positive for Angelman syndrome and additional methylation specific multiplex ligation-dependent amplification (MS-MLPA) study revealed low-level mosaicism for AS. CONCLUSION A broader phenotypic spectrum should be considered for AS as patients with atypical presentations may otherwise elude diagnosis.
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Affiliation(s)
- Ruchi Punatar
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of California Davis, Sacramento, California, USA.,MIND Institute, University of California Davis, Sacramento, California, USA
| | - Alena Egense
- MIND Institute, University of California Davis, Sacramento, California, USA.,Division of Genomic Medicine, Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Rong Mao
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Kathleen Angkustsiri
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of California Davis, Sacramento, California, USA.,MIND Institute, University of California Davis, Sacramento, California, USA
| | - Suma P Shankar
- MIND Institute, University of California Davis, Sacramento, California, USA.,Division of Genomic Medicine, Department of Pediatrics, University of California Davis, Sacramento, California, USA
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Kraan CM, Date P, Rattray A, Sangeux M, Bui QM, Baker EK, Morison J, Amor DJ, Godler DE. Feasibility of wearable technology for 'real-world' gait analysis in children with Prader-Willi and Angelman syndromes. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:717-725. [PMID: 35713265 DOI: 10.1111/jir.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/24/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are neurodevelopmental disorders in need of innovative 'real-world' outcome measures to evaluate treatment effects. Instrumented gait analysis (IGA) using wearable technology offers a potentially feasible solution to measure "real-world' neurological and motor dysfunction in these groups. METHODS Children (50% female; 6-16 years) diagnosed with PWS (n = 9) and AS (n = 5) completed 'real-world' IGA assessments using the Physilog®5 wearable. PWS participants completed a laboratory assessment and a 'real-world' long walk. The AS group completed 'real-world' caregiver-assisted assessments. Mean and variability results for stride time, cadence, stance percentage (%) and stride length were extracted and compared across three different data reduction protocols. RESULTS The wearables approach was found to be feasible, with all participants able to complete at least one assessment. This study also demonstrated significant agreement, using Lin's concordance correlation coefficient (CCC), between laboratory and 'real-world' assessments in the PWS group for mean stride length, mean stance % and stance % CV (n = 7, CCC: 0.782-0.847, P = 0.011-0.009). CONCLUSION 'Real-world' gait analysis using the Physilog®5 wearable was feasible to efficiently assess neurological and motor dysfunction in children affected with PWS and AS.
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Affiliation(s)
- C M Kraan
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - P Date
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - A Rattray
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Sangeux
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Laboratory for Movement Analysis, University Children's Hospital Basel, Basel, Switzerland
| | - Q M Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E K Baker
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - J Morison
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - D J Amor
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - D E Godler
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Samanta D. Pharmacotherapeutic management of seizures in patients with Angleman syndrome. Expert Opin Pharmacother 2022; 23:1511-1522. [PMID: 35862628 DOI: 10.1080/14656566.2022.2105141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Approximately 80-90% of patients with Angelman syndrome (AS) develop childhood-onset intractable seizures with major negative impact on the quality of life.Thus adequate management of seizures is the most critical priority to improve health-related quality of life in children with AS. AREAS COVERED The primary focus of the review is on pharmacotherapeutic management of seizures. The first part of the review briefly discusses epileptogenesis and polymorphic seizure phenotypes associated with AS to understand pharmacotherapeutic decision-making better. Next, the review explores individual antiseizure medicines (ASMs) and their potential therapeutic utility. Lastly, some future and emerging treatment options are discussed that can transform the management of seizures in patients with AS. EXPERT OPINION Evidence for treating seizures in AS mainly derives from low-quality studies. Levetiracetam and clobazam are the most commonly used ASMs. Although the potential utility of several other ASMs(valproate, topiramate, lamotrigine, ethosuximide, clonazepam) has been well documented for some time, the treatment landscape may rapidly evolve due to the availability of newer and better tolerated ASMs(cannabidiol oil, brivaracetam, perampanel). In addition, a better understanding of the underlying pathogenesis and the development of molecular therapeutics offer hope for precision therapies for seizures.
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Affiliation(s)
- Debopam Samanta
- Child Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Gaudin-Drouelle D, Houx L, Lempereur M, Brochard S, Pons C. Improvement in Gait and Participation in a Child with Angelman Syndrome after Translingual Neurostimulation Associated with Goal-Oriented Therapy: A Case Report. CHILDREN 2022; 9:children9050719. [PMID: 35626896 PMCID: PMC9139481 DOI: 10.3390/children9050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Angelman syndrome is a genetic neurobehavioral syndrome characterized by motor and cognitive developmental delay, with a severe reduction in activity and participation. Treatments are limited and the effects of rehabilitation have not been studied. We report on the progress made by a 7-year-old boy with Angelman syndrome following an innovative synergic intervention involving translingual neurostimulation (TLNS) and goal-oriented rehabilitation to improve gait. The parents were interviewed regarding the child’s abilities and participation level and three-dimensional gait analysis was performed before and after the 4-week intervention (five days per week, 4 h per day) and 6 months later. Spatiotemporal and kinematic gait variables improved considerably at 4 weeks, with a reduction in lower limb agonist-antagonist co-contractions, and a large increase in walking distance (from 500 m to 2 km). The child’s engagement and ability to perform activities of daily living improved, as well as several functions not targeted by the intervention. Six months after cessation of the intervention, improvements were partially sustained. The rapid and considerable improvement in motor ability was likely due to potentiation of the rehabilitation by the TLNS. Further studies are required to understand the mechanisms underlying this effect and to determine if it is generalizable to other children with similar disorders.
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Affiliation(s)
- Delphine Gaudin-Drouelle
- LaTim UMR 1101, Team Beachild, INSERM, 29200 Brest, France; (L.H.); (M.L.); (S.B.); (C.P.)
- Department of Pediatric Rehabilitation, Brest University Hospital, 29200 Brest, France
- Correspondence: or ; Tel.: +33-631471583
| | - Laetitia Houx
- LaTim UMR 1101, Team Beachild, INSERM, 29200 Brest, France; (L.H.); (M.L.); (S.B.); (C.P.)
- Department of Pediatric Rehabilitation, Brest University Hospital, 29200 Brest, France
- Department of Pediatric Rehabilitation, Ildys Fondation, 29200 Brest, France
| | - Mathieu Lempereur
- LaTim UMR 1101, Team Beachild, INSERM, 29200 Brest, France; (L.H.); (M.L.); (S.B.); (C.P.)
- Department of Pediatric Rehabilitation, Brest University Hospital, 29200 Brest, France
- Faculty of Medicine, University of Western Brittany UBO, 29200 Brest, France
| | - Sylvain Brochard
- LaTim UMR 1101, Team Beachild, INSERM, 29200 Brest, France; (L.H.); (M.L.); (S.B.); (C.P.)
- Department of Pediatric Rehabilitation, Brest University Hospital, 29200 Brest, France
- Department of Pediatric Rehabilitation, Ildys Fondation, 29200 Brest, France
- Faculty of Medicine, University of Western Brittany UBO, 29200 Brest, France
| | - Christelle Pons
- LaTim UMR 1101, Team Beachild, INSERM, 29200 Brest, France; (L.H.); (M.L.); (S.B.); (C.P.)
- Department of Pediatric Rehabilitation, Brest University Hospital, 29200 Brest, France
- Department of Pediatric Rehabilitation, Ildys Fondation, 29200 Brest, France
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Duis J. The Road to Personalized Therapies: Lessons Learned From Angelman Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:95-98. [PMID: 35180775 DOI: 10.1352/1944-7558-127.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 06/14/2023]
Abstract
Angelman syndrome (AS) is a neurogenetic disorder characterized by delays including a severe expressive language delay, motor concerns, ataxia, epilepsy, sleep disturbances, gastrointestinal problems, and characteristic behaviors, including a happy demeanor, hyperactivity, and excitability. The syndrome is one of the first neurodevelopmental disorders with a clear trajectory towards meaningful treatment with approximately 20 companies actively developing targeted therapeutics for AS. Herein, we highlight the historical context of the road to therapeutics and some of the challenges in the field with the potential to impact the success of clinical trials for Angelman syndrome and also have relevance of other neurogenetic developmental disabilities.
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Duis J, Nespeca M, Summers J, Bird L, Bindels‐de Heus KG, Valstar MJ, de Wit MY, Navis C, ten Hooven‐Radstaake M, van Iperen‐Kolk BM, Ernst S, Dendrinos M, Katz T, Diaz‐Medina G, Katyayan A, Nangia S, Thibert R, Glaze D, Keary C, Pelc K, Simon N, Sadhwani A, Heussler H, Wheeler A, Woeber C, DeRamus M, Thomas A, Kertcher E, DeValk L, Kalemeris K, Arps K, Baym C, Harris N, Gorham JP, Bohnsack BL, Chambers RC, Harris S, Chambers HG, Okoniewski K, Jalazo ER, Berent A, Bacino CA, Williams C, Anderson A. A multidisciplinary approach and consensus statement to establish standards of care for Angelman syndrome. Mol Genet Genomic Med 2022; 10:e1843. [PMID: 35150089 PMCID: PMC8922964 DOI: 10.1002/mgg3.1843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurogenetic disorder present in approximately 1/12,000 individuals and characterized by developmental delay, cognitive impairment, motor dysfunction, seizures, gastrointestinal concerns, and abnormal electroencephalographic background. AS is caused by absent expression of the paternally imprinted gene UBE3A in the central nervous system. Disparities in the management of AS are a major problem in preparing for precision therapies and occur even in patients with access to experts and recognized clinics. AS patients receive care based on collective provider experience due to limited evidence-based literature. We present a consensus statement and comprehensive literature review that proposes a standard of care practices for the management of AS at a critical time when therapeutics to alter the natural history of the disease are on the horizon. METHODS We compiled the key recognized clinical features of AS based on consensus from a team of specialists managing patients with AS. Working groups were established to address each focus area with committees comprised of providers who manage >5 individuals. Committees developed management guidelines for their area of expertise. These were compiled into a final document to provide a framework for standardizing management. Evidence from the medical literature was also comprehensively reviewed. RESULTS Areas covered by working groups in the consensus document include genetics, developmental medicine, psychology, general health concerns, neurology (including movement disorders), sleep, psychiatry, orthopedics, ophthalmology, communication, early intervention and therapies, and caregiver health. Working groups created frameworks, including flowcharts and tables, to help with quick access for providers. Data from the literature were incorporated to ensure providers had review of experiential versus evidence-based care guidelines. CONCLUSION Standards of care in the management of AS are keys to ensure optimal care at a critical time when new disease-modifying therapies are emerging. This document is a framework for providers of all familiarity levels.
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Affiliation(s)
- Jessica Duis
- Section of Genetics & Inherited Metabolic DiseaseSection of Pediatrics, Special CareDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Mark Nespeca
- Department of NeurologyRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Jane Summers
- Department of PsychiatryThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Lynne Bird
- Department of PediatricsClinical Genetics / DysmorphologyUniversity of California, San DiegoRady Children’s Hospital San DiegoSan DiegoCaliforniaUSA
| | - Karen G.C.B. Bindels‐de Heus
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - M. J. Valstar
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands
| | - Marie‐Claire Y. de Wit
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of Neurology and Pediatric NeurologyErasmus MCRotterdamThe Netherlands
| | - C. Navis
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,Department of ENT (Speech & Language Pathology)Erasmus MCRotterdamThe Netherlands
| | - Maartje ten Hooven‐Radstaake
- Department of PediatricsErasmus MC SophiaChildren’s HospitalRotterdamNetherlands,ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Bianca M. van Iperen‐Kolk
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus MC University Medical CenterRotterdamThe Netherlands,Department of Physical TherapyErasmus MCRotterdamThe Netherlands
| | - Susan Ernst
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Melina Dendrinos
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | - Terry Katz
- Developmental PediatricsDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Gloria Diaz‐Medina
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Akshat Katyayan
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Srishti Nangia
- Department of PediatricsDivision of Child NeurologyWeill Cornell MedicineNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ronald Thibert
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Daniel Glaze
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Christopher Keary
- Angelman Syndrome ProgramLurie Center for AutismMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Karine Pelc
- Department of NeurologyHôpital Universitaire des Enfants Reine FabiolaUniversité Libre de Bruxelles (ULB)BrusselsBelgium
| | - Nicole Simon
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Anjali Sadhwani
- Department of PsychiatryBoston Children’s HospitalBostonMAUSA
| | - Helen Heussler
- UQ Child Health Research CentreFaculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Anne Wheeler
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Caroline Woeber
- Audiology, Speech & Learning ServicesChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Margaret DeRamus
- Department of PsychiatryCarolina Institute for Developmental DisabilitiesUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Amy Thomas
- New York League for Early Learning William O'connor SchoolNew YorkNew YorkUSA
| | | | - Lauren DeValk
- Occupational TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Kristen Kalemeris
- Department of Pediatric RehabilitationMonroe Carell Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Kara Arps
- Department of Physical TherapyChildren’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Carol Baym
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - Nicole Harris
- Physical TherapyChildren’s Hospital ColoradoAuroraColoradoUSA
| | - John P. Gorham
- Department of Ophthalmology and Visual SciencesUniversity of MichiganAnn ArboMichiganUSA
| | - Brenda L. Bohnsack
- Division of OphthalmologyDepartment of OphthalmologyAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineAnn ArboMichiganUSA
| | - Reid C. Chambers
- Department of Orthopedic Surgery Nationwide Children’s HospitalColumbusOhioUSA
| | - Sarah Harris
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
| | - Henry G. Chambers
- Orthopedic SurgerySan Diego Department of Pediatric OrthopedicsUniversity of CaliforniaRady Children’s HospitalSan DiegoCaliforniaUSA
| | - Katherine Okoniewski
- Center for Newborn ScreeningRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Allyson Berent
- Foundation for Angelman Syndrome TherapeuticsChicagoIllinoisUSA
| | - Carlos A. Bacino
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Charles Williams
- Raymond C. Philips UnitDivision of Genetics and MetabolismDepartment of PediatricsUniversity of FloridaGainesvilleFloridaUSA
| | - Anne Anderson
- Division of Neurology and Developmental PediatricsDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA,NeurologyTexas Children's HospitalHoustonTexasUSA
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Triono A, Iskandar K, Nugrahanto AP, Hadiyanto ML, Gunadi, Herini ES. The role of whole exome sequencing in the UBE3A point mutation of Angelman Syndrome: A case report. Ann Med Surg (Lond) 2022; 73:103170. [PMID: 34976390 PMCID: PMC8683671 DOI: 10.1016/j.amsu.2021.103170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Angelman Syndrome (AS) is a rare disorder with a relatively well-defined phenotype caused by lack of expression of the maternally inherited ubiquitin-protein ligase E3A (UBE3A) gene in the brain. This article describes the role of genetic testing using whole-exome sequencing (WES) in detecting rare AS variants, a point mutation in the UBE3A gene. CASE PRESENTATION We describe a rarely reported clinical presentation of AS in a two year and ten months old girl with severe developmental delay, movement and balance disorder, frequent smiling, apparent happy demeanor, speech impairment, absence of seizure, lack of sleep, and abnormal food-related behavior. Physical examination showed microcephaly, with facial characteristics of AS, ataxia gait, and truncal hypotonia. The electroencephalogram showed medium amplitude rhythmic 2-3c/s. Brain Magnetic Resonance Imaging revealed microcephaly, corpus callosum dysgenesis, and heterotopia grey matter on the bilateral lateral ventricle. WES was conducted to search pathogenic variants and showed a heterozygous mutation in exon 9 of the UBE3A gene, c.1513C > T (p.Arg505Ter). CONCLUSION Angelman syndrome is a neurodevelopmental disorder that has several underlying genetic etiologies. WES could detect a rare variant of Angelman syndrome, identified as the point mutation of the UBE3A gene, which cannot be seen with other modalities.
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Affiliation(s)
- Agung Triono
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Kristy Iskandar
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
- Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Andika Priamas Nugrahanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
- Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Marissa Leviani Hadiyanto
- Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Gunadi
- Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Elisabeth Siti Herini
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Li S, Ma Y, Wang T, Jin H, Du X, Wang Y. Epilepsy and Molecular Phenotype Affect the Neurodevelopment of Pediatric Angelman Syndrome Patients in China. Front Psychiatry 2022; 13:886028. [PMID: 35573374 PMCID: PMC9096167 DOI: 10.3389/fpsyt.2022.886028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study investigated the mental development of children with Angelman syndrome (AS) in China and evaluated the relationship between neurodevelopment and molecular subtype, age, epilepsy, and sex using the Chinese version of the Griffith Mental Development Scale (GMDS-C) to provide detailed baseline data regarding neurodevelopment with AS in China. METHODS Participants were recruited from the AS Natural History Study. The GMDS-C was used to evaluate all participants' mental age and developmental quotients. The general quotient (GQ) and quotients of five subscales (sports, personal-social, auditory language, eye-hand coordination, and comprehensive performance) were calculated. RESULTS A total of 119 children (average age: 42.12 months; range, 7.5-95.5 months) with a genetic diagnosis of AS were enrolled. The median GQ score of the GMDS was 29.6 points (95% confidence interval, 28.6-33.25). The children had relatively good locomotor and personal-social skills but poor language skills. Overall, 89% (106/119) had mental ages younger than 24 months for all five subscales. The non-deletion group (i.e., without deletion in chromosome 15q11-13) had higher GQs and locomotor, personal-social, and performance subscale quotients. The GQ was significantly different among the three age subgroups and significantly correlated with age. Compared with the non-epilepsy group, the epilepsy group had lower GQs and lower quotients for the locomotor, personal-social, speech, language, and eye-hand coordination subscales. CONCLUSION Children with AS in China experience severe neurodevelopmental deterioration. In addition to age, molecular subtypes and the onset of seizures may also correlate with these patients' intellectual development. The GMDS-C is an accurate tool that can assess the clinical characteristics of AS. The data of this study can be used as baseline data for clinical trials performed to evaluate drug development or other AS treatment development.
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Affiliation(s)
- Shuang Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yu Ma
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Tianqi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Huimin Jin
- Shanghai YangZhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghia, China
| | - Xiaonan Du
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
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35
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Carson RP, Herber DL, Pan Z, Phibbs F, Key AP, Gouelle A, Ergish P, Armour EA, Patel S, Duis J. Nutritional Formulation for Patients with Angelman Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study of Exogenous Ketones. J Nutr 2021; 151:3628-3636. [PMID: 34510212 PMCID: PMC10103907 DOI: 10.1093/jn/nxab284] [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] [Received: 04/08/2021] [Revised: 05/22/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Angelman syndrome (AS) patients often respond to low glycemic index therapy to manage refractory seizures. These diets significantly affect quality of life and are challenging to implement. These formulations may have benefits in AS even in the absence of biomarkers suggesting ketosis. OBJECTIVES We aimed to compare an exogenous medical food ketone formulation (KF) with placebo for the dietary management of AS. METHODS This randomized, double-blind, placebo-controlled, crossover clinical trial was conducted in an academic center from 15 November, 2018 to 6 January, 2020. Thirteen participants with molecularly confirmed AS aged 4-11 y met the criteria and completed the 16-wk study. The study consisted of four 4-wk phases: a baseline phase, a blinded KF or placebo phase, a washout phase, and the crossover phase with alternate blinded KF or placebo. Primary outcomes were safety and tolerability rated by retention in the study and adherence to the formulation. Additional secondary outcomes of safety in this nonverbal population included blood chemistry, gastrointestinal health, seizure burden, cortical irritability, cognition, mobility, sleep, and developmental staging. RESULTS Data were compared between the baseline, KF, and placebo epochs. One participant exited the trial owing to difficulty consuming the formulation. Adverse events included an increase in cholesterol in 1 subject when consuming KF and a decrease in albumin in 1 subject when consuming placebo. Stool consistency improved with KF consumption, from 6.04 ± 1.61 at baseline and 6.35 ± 1.55 during placebo to 4.54 ± 1.19 during KF (P = 0.0027). Electroencephalograph trends showed a decrease in Δ frequency power during the KF arm and event-related potentials suggested a change in the frontal memory response. Vineland-3 showed improved fine motor skills in the KF arm. CONCLUSIONS The exogenous KF appears safe. More data are needed to determine the utility of exogenous ketones as a nutritional approach in children with AS.This trial was registered at clinicaltrials.gov as NCT03644693.
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Affiliation(s)
- Robert P Carson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Zhaoxing Pan
- Biostatistics Core, Children's Hospital Colorado Research Institute, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Fenna Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra P Key
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, PA, USA.,Laboratory Performance, Health, Metrology, Society (PSMS), Reims, France
| | - Patience Ergish
- Clinical Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric A Armour
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shital Patel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jessica Duis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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36
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Hipp JF, Frohlich J, Keute M, Tan WH, Bird LM. Electrophysiological Abnormalities in Angelman Syndrome Correlate With Symptom Severity. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:201-209. [PMID: 34841387 PMCID: PMC8622755 DOI: 10.1016/j.bpsgos.2021.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Angelman syndrome (AS) is a rare neurodevelopmental disorder caused by the absence of functional UBE3A in neurons. Excess low-frequency oscillations as measured with electroencephalography (EEG) have been identified as a characteristic finding, but the relationship of this EEG finding to the symptomatology of AS and its significance in the pathophysiology of AS remain unknown. Methods We used correlations and machine learning to investigate the cross-sectional and longitudinal relationship between EEG spectral power and motor, cognitive, and language skills (Bayley Scales of Infant and Toddler Development, Third Edition); adaptive behavior (Vineland Adaptive Behavior Scales, Second Edition); AS-specific symptoms (AS Clinical Severity Scale); and the age of epilepsy onset in a large sample of children (age: 1–18 years) with AS due to a chromosomal deletion of 15q11-q13 (45 individuals with 72 visits). Results We found that after accounting for age differences, participants with stronger EEG delta-band abnormality had earlier onset of epilepsy and lower performance scores across symptom domains including cognitive, motor, and communication. Combing spatial and spectral information beyond the delta frequency band increased the cross-sectional association with clinical severity on average by approximately 45%. Furthermore, we found evidence for longitudinal correlations of EEG delta-band power within several performance domains, including the mean across Bayley Scales of Infant and Toddler Development, Third Edition, scores. Conclusions Our results show an association between EEG abnormalities and symptom severity in AS, underlining the significance of the former in the pathophysiology of AS. Furthermore, our work strengthens the rationale for using EEG as a biomarker in the development of treatments for AS, a concept that may apply more generally to neurodevelopmental disorders.
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Affiliation(s)
- Joerg F Hipp
- Roche Pharma Research and Early Development (JFH, JF, MK), Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland; Center for Autism Research and Treatment (JF), Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles; Department of Pediatrics (LMB), University of California San Diego; Genetics/Dysmorphology (LMB), Rady Children's Hospital San Diego, San Diego, California; Division of Genetics and Genomics (W-HT), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Institute for Neuromodulation and Neurotechnology (MK), University of Tübingen, Tübingen, Germany
| | - Joel Frohlich
- Roche Pharma Research and Early Development (JFH, JF, MK), Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland; Center for Autism Research and Treatment (JF), Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles; Department of Pediatrics (LMB), University of California San Diego; Genetics/Dysmorphology (LMB), Rady Children's Hospital San Diego, San Diego, California; Division of Genetics and Genomics (W-HT), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Institute for Neuromodulation and Neurotechnology (MK), University of Tübingen, Tübingen, Germany
| | - Marius Keute
- Roche Pharma Research and Early Development (JFH, JF, MK), Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland; Center for Autism Research and Treatment (JF), Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles; Department of Pediatrics (LMB), University of California San Diego; Genetics/Dysmorphology (LMB), Rady Children's Hospital San Diego, San Diego, California; Division of Genetics and Genomics (W-HT), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Institute for Neuromodulation and Neurotechnology (MK), University of Tübingen, Tübingen, Germany
| | - Wen-Hann Tan
- Roche Pharma Research and Early Development (JFH, JF, MK), Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland; Center for Autism Research and Treatment (JF), Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles; Department of Pediatrics (LMB), University of California San Diego; Genetics/Dysmorphology (LMB), Rady Children's Hospital San Diego, San Diego, California; Division of Genetics and Genomics (W-HT), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Institute for Neuromodulation and Neurotechnology (MK), University of Tübingen, Tübingen, Germany
| | - Lynne M Bird
- Roche Pharma Research and Early Development (JFH, JF, MK), Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland; Center for Autism Research and Treatment (JF), Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles; Department of Pediatrics (LMB), University of California San Diego; Genetics/Dysmorphology (LMB), Rady Children's Hospital San Diego, San Diego, California; Division of Genetics and Genomics (W-HT), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Institute for Neuromodulation and Neurotechnology (MK), University of Tübingen, Tübingen, Germany
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Clinical Characterization of Epilepsy in Children With Angelman Syndrome. Pediatr Neurol 2021; 124:42-50. [PMID: 34536900 PMCID: PMC8500934 DOI: 10.1016/j.pediatrneurol.2021.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epilepsy is highly prevalent in children with Angelman syndrome (AS), and its detailed characterization and relationship to the genotype (deletion vs nondeletion) is important both for medical practice and for clinical trial design. METHODS AND MATERIALS We retrospectively analyzed the main clinical features of epilepsy in 265 children with AS who were enrolled in the AS Natural History Study, a multicenter, observational study conducted at six centers in the United States. Participants were prospectively followed up and classified by genotype. RESULTS Epilepsy was reported in a greater proportion of individuals with a deletion than a nondeletion genotype (171 of 187 [91%] vs. 48 of 78 [61%], P < 0.001). Compared with participants with a nondeletion genotype, those with deletions were younger at the time of the first seizure (age: median [95% confidence interval]: 24 [21-24] months vs. 57 [36-85] months, P < 0.001) and had a higher prevalence of generalized motor seizures. Hospitalization following a seizure was reported in more children with a deletion than a nondeletion genotype (92 of 171 [54%] vs. 17 of 48 [36%], P = 0.04). The overall prevalence of absence seizures was not significantly different between genotype groups. Forty-six percent (102/219) of the individuals reporting epilepsy were diagnosed with AS concurrently or after their first seizure. CONCLUSIONS Significant differences exist in the clinical expression of epilepsy in AS according to the underlying genotype, with earlier age of onset and more severe epilepsy in individuals with AS due to a chromosome 15 deletion.
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Judson MC, Shyng C, Simon JM, Davis CR, Punt AM, Salmon MT, Miller NW, Ritola KD, Elgersma Y, Amaral DG, Gray SJ, Philpot BD. Dual-isoform hUBE3A gene transfer improves behavioral and seizure outcomes in Angelman syndrome model mice. JCI Insight 2021; 6:144712. [PMID: 34676830 PMCID: PMC8564914 DOI: 10.1172/jci.insight.144712] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/02/2021] [Indexed: 12/23/2022] Open
Abstract
Loss of the maternal UBE3A allele causes Angelman syndrome (AS), a debilitating neurodevelopmental disorder. Here, we devised an AS treatment strategy based on reinstating dual-isoform expression of human UBE3A (hUBE3A) in the developing brain. Kozak sequence engineering of our codon-optimized vector (hUBE3Aopt) enabled translation of both short and long hUBE3A protein isoforms at a near-endogenous 3:1 (short/long) ratio, a feature that could help to support optimal therapeutic outcomes. To model widespread brain delivery and early postnatal onset of hUBE3A expression, we packaged the hUBE3Aopt vector into PHP.B capsids and performed intracerebroventricular injections in neonates. This treatment significantly improved motor learning and innate behaviors in AS mice, and it rendered them resilient to epileptogenesis and associated hippocampal neuropathologies induced by seizure kindling. hUBE3A overexpression occurred frequently in the hippocampus but was uncommon in the neocortex and other major brain structures; furthermore, it did not correlate with behavioral performance. Our results demonstrate the feasibility, tolerability, and therapeutic potential for dual-isoform hUBE3A gene transfer in the treatment of AS.
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Affiliation(s)
- Matthew C Judson
- Neuroscience Center.,Department of Cell Biology and Physiology.,Carolina Institute for Developmental Disabilities
| | - Charles Shyng
- Carolina Institute for Developmental Disabilities.,Gene Therapy Center, and
| | - Jeremy M Simon
- Neuroscience Center.,Carolina Institute for Developmental Disabilities.,Department of Genetics, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | | | - A Mattijs Punt
- Department of Clinical Genetics and.,Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Noah W Miller
- Neuroscience Center.,Department of Cell Biology and Physiology
| | - Kimberly D Ritola
- Neuroscience Center.,Department of Pharmacology, UNC, Chapel Hill, North Carolina, USA.,Scientific Operations Manager-Viral Tools, Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, Virginia, USA
| | - Ype Elgersma
- Department of Clinical Genetics and.,Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - David G Amaral
- Department of Psychiatry and Behavioral Sciences, MIND Institute, and.,California National Primate Research Center, University of California, Davis, California, USA
| | - Steven J Gray
- Gene Therapy Center, and.,Department of Pediatrics and.,Eugene McDermott Center for Human Growth and Development, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin D Philpot
- Neuroscience Center.,Department of Cell Biology and Physiology.,Carolina Institute for Developmental Disabilities
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Rayi PR, Kaphzan H. Electrophysiological Characterization of Regular and Burst Firing Pyramidal Neurons of the Dorsal Subiculum in an Angelman Syndrome Mouse Model. Front Cell Neurosci 2021; 15:670998. [PMID: 34512263 PMCID: PMC8427506 DOI: 10.3389/fncel.2021.670998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Angelman syndrome (AS) is a debilitating neurogenetic disorder characterized by severe developmental delay, speech impairment, gait ataxia, sleep disturbances, epilepsy, and a unique behavioral phenotype. AS is caused by a microdeletion or mutation in the maternal 15q11-q13 chromosome region containing UBE3A gene. The hippocampus is one of the important brain regions affected in AS mice leading to substantial hippocampal-dependent cognitive and behavioral deficits. Recent studies have suggested an abnormal increase in the α1-Na/K-ATPase (α1-NaKA) in AS mice as the precipitating factor leading to the hippocampal deficits. A subsequent study showed that the hippocampal-dependent behavioral deficits occur as a result of altered calcium (Ca+2) dynamics in the CA1 pyramidal neurons (PNs) caused by the elevated α1-NaKA expression levels in the AS mice. Nonetheless, a causal link between hippocampal deficits and major behavioral phenotypes in AS is still obscure. Subiculum, a region adjacent to the hippocampal CA1 is the major output source of the hippocampus and plays an important role in the transfer of information from the CA1 region to the cortical areas. However, in spite of the robust hippocampal deficits and several known electrophysiological alterations in multiple brain regions in AS mice, the neuronal properties of the subicular neurons were never investigated in these mice. Additionally, subicular function is also implied in many neuropsychiatric disorders such as autism, schizophrenia, Alzheimer’s disease, and epilepsy that share some common features with AS. Therefore, given the importance of the subiculum in these neuropsychiatric disorders and the altered electrophysiological properties of the hippocampal CA1 PNs projecting to the subiculum, we sought to examine the subicular PNs. We performed whole-cell recordings from dorsal subiculum of both WT and AS mice and found three distinct populations of PNs based on their ability to fire bursts or single action potentials following somatic current injection: strong bursting, weak bursting, and regular firing neurons. We found no overall differences in the distribution of these different subicular PN populations among AS and WT controls. However, the different cell types showed distinct alterations in their intrinsic membrane properties. Further, none of these populations were altered in their excitatory synaptic properties. Altogether, our study characterized the different subtypes of PNs in the subicular region of an AS mouse model.
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Affiliation(s)
- Prudhvi Raj Rayi
- Sagol Department of Neurobiology, The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Hanoch Kaphzan
- Sagol Department of Neurobiology, The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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40
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Baker EK, Arora S, Amor DJ, Date P, Cross M, O'Brien J, Simons C, Rogers C, Goodall S, Slee J, Cahir C, Godler DE. The Cost of Raising Individuals with Fragile X or Chromosome 15 Imprinting Disorders in Australia. J Autism Dev Disord 2021; 53:1682-1692. [PMID: 34292487 DOI: 10.1007/s10803-021-05193-4] [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] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
The study characterised differences in costs associated with raising a child between four rare disorders and examined the associations between these costs with clinical severity. Caregivers of 108 individuals with Prader-Willi, Angelman (AS), Chromosome 15q Duplication and fragile X (FXS) syndromes completed a modified Client Services Receipt Inventory and participants completed intellectual/developmental functioning and autism assessments. AS incurred the highest yearly costs per individual ($AUD96,994), while FXS had the lowest costs ($AUD33,221). Intellectual functioning negatively predicted total costs, after controlling for diagnosis. The effect of intellectual functioning on total costs for those with AS was significantly different to the other syndromes. The study highlights the significant costs associated with these syndromes, particularly AS, linked with severity of intellectual functioning.
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Affiliation(s)
- Emma K Baker
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, NSW, Australia
| | - David J Amor
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Perrin Date
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Meagan Cross
- Foundation for Angelman Syndrome Therapeutics (FAST), Salisbury, QLD, Australia
| | - James O'Brien
- Prader-Willi Syndrome Australia Ltd, Melbourne, VIC, Australia
| | - Chloe Simons
- Foundation for Angelman Syndrome Therapeutics (FAST), Salisbury, QLD, Australia
| | - Carolyn Rogers
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, NSW, Australia
| | - Jennie Slee
- Department of Health, Government of Western Australia, Genetic Services of Western Australia, Perth, WA, Australia
| | - Chris Cahir
- Dup15q Australia Ltd, Melbourne, VIC, Australia
| | - David E Godler
- Diagnosis and Development, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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41
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Elgersma Y, Sonzogni M. UBE3A reinstatement as a disease-modifying therapy for Angelman syndrome. Dev Med Child Neurol 2021; 63:802-807. [PMID: 33543479 PMCID: PMC8248324 DOI: 10.1111/dmcn.14831] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 01/08/2023]
Abstract
Half a century ago, Harry Angelman reported three patients with overlapping clinical features, now well known as Angelman syndrome. Angelman syndrome is caused by mutations affecting the maternally inherited UBE3A gene, which encodes an E3-ubiquitin ligase that is critical for typical postnatal brain development. Emerging evidence indicates that UBE3A plays a particularly important role in the nucleus. However, the critical substrates that are controlled by UBE3A remain elusive, which hinders the search for effective treatments. Moreover, given the multitude of signalling mechanisms that are derailed, it is unlikely that targeting a single pathway is going to be very effective. Therefore, expectations are very high for approaches that aim to restore UBE3A protein levels. A particular promising strategy is an antisense oligonucleotide approach, which activates the silenced paternal UBE3A gene. When successful, such treatments potentially offer a disease-modifying therapy for Angelman syndrome and several other neurodevelopmental disorders. What this paper adds Loss of UBE3A affects multiple signalling pathways in the brain. Emerging evidence suggests that UBE3A plays a critical role in the cell nucleus. Trials using antisense oligonucleotides to restore UBE3A levels are continuing.
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Affiliation(s)
- Ype Elgersma
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
- Deptartment of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
- The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
| | - Monica Sonzogni
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
- The ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW This review describes current understandings in the search for therapies to support children with Angelman syndrome. There is a rapid progression in particular in genetic therapies in this disorder supported by the Angelman community. RECENT FINDINGS Recent papers shed light on the timing of therapies and novel genetic therapies coming to trial as well as potential therapies still in preclinical phases. Further understanding of UBE3A and its role in neuronal development and plasticity as well as other mechanisms contributing to the Angelman phenotype is offering an opportunity for novel therapeutics. SUMMARY Greater understanding of the pathophysiology of the different phenotypes will offer an opportunity for novel therapeutics and may well change the course of this disorder over time where previously there has been minimal ability to intervene.
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Affiliation(s)
- Helen S Heussler
- Child Development Program, Children's Health Queensland
- Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Children's Health Queensland
- Centre for Children's Health Research, University of Queensland, Queensland, Australia
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Rayi PR, Bagrov AY, Kaphzan H. Chronic α1-Na/K-ATPase inhibition reverses the elongation of the axon initial segment of the hippocampal CA1 pyramidal neurons in Angelman syndrome model mice. Neuropsychopharmacology 2021; 46:654-664. [PMID: 33214655 PMCID: PMC8027375 DOI: 10.1038/s41386-020-00907-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
Angelman syndrome (AS) is a neurodevelopmental disorder caused by the loss of function of the maternal UBE3A gene. The hippocampus is one of the most prominently affected brain regions in AS model mice, manifesting in severe hippocampal-dependent memory and plasticity deficits. Previous studies in AS mice reported an elongated axon initial segment (AIS) in pyramidal neurons (PNs) of the hippocampal CA1 region. These were the first reports in mammals to show AIS elongation in vivo. Correspondingly, this AIS elongation was linked to enhanced expression of the α1 subunit of Na+/K+-ATPase (α1-NaKA). Recently, it was shown that selective pharmacological inhibition of α1-NaKA by marinobufagenin (MBG) in adult AS mice rescued the hippocampal-dependent deficits via normalizing their compromised activity-dependent calcium (Ca+2) dynamics. In the herein study, we showed that a chronic selective α1-NaKA inhibition reversed the AIS elongation in hippocampal CA1 PNs of adult AS mice, and differentially altered their excitability and intrinsic properties. Taken together, our study is the first to demonstrate in vivo structural plasticity of the AIS in a mammalian model, and further elaborates on the modulatory effects of elevated α1-NaKA levels in the hippocampus of AS mice.
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Affiliation(s)
- Prudhvi Raj Rayi
- grid.18098.380000 0004 1937 0562Sagol Department of Neurobiology, The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, 3498838 Israel
| | - Alexei Y. Bagrov
- grid.419730.80000 0004 0440 2269Sechenov Institute of Evolutionary Physiology and Biochemistry, 194223 St. Petersburg, Russian Federation
| | - Hanoch Kaphzan
- Sagol Department of Neurobiology, The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, 3498838, Israel.
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44
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den Besten I, de Jong RF, Geerts‐Haages A, Bruggenwirth HT, Koopmans M, Brooks A, Elgersma Y, Festen DAM, Valstar MJ. Clinical aspects of a large group of adults with Angelman syndrome. Am J Med Genet A 2021; 185:168-181. [PMID: 33108066 PMCID: PMC7756639 DOI: 10.1002/ajmg.a.61940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 11/06/2022]
Abstract
Descriptions of the clinical features of Angelman syndrome (AS) have mainly been focused on children. Here, we describe the evolution of the clinical phenotypes of AS in adulthood, using clinical data from 95 individuals (mean age 31.6 years, median 29.0 years, range 18-83 years), with genetically confirmed AS. Data was collected through physical examination and inspection of medical records, combined with questionnaires and interviews. Adults with AS experience substantial debilitating health problems. Constipation, reflux, visual problems, scoliosis, behavioral and sleeping problems occurred frequently and require appropriate attention. Epilepsy was reported in 57% of adults, negatively affecting the level of functioning. Non-convulsive status epilepticus was not observed in the adults, however some individuals developed prolonged episodes of rhythmic shaking while awake. A decline in mobility was noted in the majority of adults. A minority of adults with AS showed microcephaly. Taken together, this first phenotypic study of adults with AS to include in person interviews with care-givers and physical examination of patients, including the eldest adult reported to date, provides important insight in the development of the syndrome into adulthood. This knowledge is required to improve care for adult individuals with AS and to evaluate future therapies for this group.
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Affiliation(s)
- Inge den Besten
- Intellectual Disability Medicine, Department of General PracticeErasmus MCRotterdamThe Netherlands
| | - Rianne F. de Jong
- Intellectual Disability Medicine, Department of General PracticeErasmus MCRotterdamThe Netherlands
| | - Amber Geerts‐Haages
- Intellectual Disability Medicine, Department of General PracticeErasmus MCRotterdamThe Netherlands
| | - Hennie T. Bruggenwirth
- Department of Clinical GeneticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Marije Koopmans
- Department of Medical GeneticsUtrecht University Medical CenterUtrechtThe Netherlands
| | | | - Alice Brooks
- Department of Clinical GeneticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Ype Elgersma
- Department of NeuroscienceErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Dederieke A. M. Festen
- Intellectual Disability Medicine, Department of General PracticeErasmus MCRotterdamThe Netherlands
| | - Marlies J. Valstar
- Intellectual Disability Medicine, Department of General PracticeErasmus MCRotterdamThe Netherlands
- ASVZ, Medical DepartmentCare and Service Centre for People with Intellectual DisabilitiesSliedrechtThe Netherlands
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45
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Abstract
PURPOSE OF REVIEW Mammals have two complete sets of chromosomes, one from each parent with equal autosomal gene expression. Less than one percentage of human genes are imprinted or show expression from only one parent without changing gene structure, usually by DNA methylation, but reversible in gametogenesis. Many imprinted genes affect fetal growth and development accounting for several human disorders reviewed in this report. RECENT FINDINGS Disorders include Prader-Willi and Angelman syndromes, the first examples of imprinting errors in humans, chromosome 15q11.2-q13.3 duplication, Silver-Russell syndrome, Beckwith-Weidemann syndrome, GNAS gene-related inactivation disorders (e.g. Albright hereditary osteodystrophy), uniparental chromosome 14 disomy, chromosome 6q24-related transient neonatal diabetes mellitus, parent of origin effects in 15q11.2 BP1-BP2 deletion (Burnside-Butler) syndrome and 15q11-q13 single gene imprinted disorders. SUMMARY Periconceptional and intrauterine life can be influenced by environmental factors and nutrition impacting DNA methylation. This process not only alters development of the fetus, but pregnancy complications may result from large fetal size. Epigenetic processes control imprinted gene functions and regulation with susceptibility to diseases as described. A better understanding of these processes will impact on care and treatment of affected individuals.
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Affiliation(s)
- Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
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Butler MG, Duis J. Chromosome 15 Imprinting Disorders: Genetic Laboratory Methodology and Approaches. Front Pediatr 2020; 8:154. [PMID: 32478012 PMCID: PMC7235373 DOI: 10.3389/fped.2020.00154] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/20/2020] [Indexed: 01/23/2023] Open
Abstract
Chromosome 15 imprinting disorders include Prader-Willi (PWS) and Angelman (AS) syndromes, which are caused by absent expression from the paternal and maternal alleles in the chromosome 15q11. 2-q13 region, respectively. In addition, chromosome 15q duplication caused by the presence of at least one additional maternally derived copy of the 15q11.2-q13 region can lead to seizures, cognitive and behavioral problems. We focus on PWS and AS in the report, and expand the discussion of clinical care and description with genetic testing to include high-resolution studies to more specifically characterize the molecular mechanisms of disease. The importance of early diagnosis with the necessity for accurate molecular characterization through a step-wise algorithm is emphasized in an era of targeted therapeutic interventions. We present a flowchart to aid in ordering specialized genetic testing as several methods are available for patients presenting with features of PWS and/or AS.
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Affiliation(s)
- Merlin G Butler
- Division of Research and Genetics, Departments of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jessica Duis
- Section of Genetics and Inherited Metabolic Diseases, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Bindels-de Heus KGCB, Mous SE, Ten Hooven-Radstaake M, van Iperen-Kolk BM, Navis C, Rietman AB, Ten Hoopen LW, Brooks AS, Elgersma Y, Moll HA, de Wit MCY. An overview of health issues and development in a large clinical cohort of children with Angelman syndrome. Am J Med Genet A 2019; 182:53-63. [PMID: 31729827 PMCID: PMC6916553 DOI: 10.1002/ajmg.a.61382] [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] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023]
Abstract
This study presents a broad overview of health issues and psychomotor development of 100 children with Angelman syndrome (AS), seen at the ENCORE Expertise Center for AS in Rotterdam, the Netherlands. We aimed to further delineate the phenotype of AS, to evaluate the association of the phenotype with genotype and other determinants such as epilepsy and to get insight in possible targets for intervention. We confirmed the presence of a more severe phenotype in the 15q11.2‐q13 deletion subtype. Novel findings were an association of (early onset of) epilepsy with a negative effect on development, a high occurrence of nonconvulsive status epilepticus, a high rate of crouch gait in the older children with risk of deterioration of mobility, a relatively low occurrence of microcephaly, a higher mean weight for height in all genetic subtypes with a significant higher mean in the nondeletion children, and a high occurrence of hyperphagia across all genetic subtypes. Natural history data are needed to design future trials. With this large clinical cohort with structured prospective and multidisciplinary follow‐up, we provide unbiased data on AS to support further intervention studies to optimize outcome and quality of life of children with AS and their family.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Maartje Ten Hooven-Radstaake
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Bianca M van Iperen-Kolk
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Physical Therapy, Erasmus MC, Rotterdam, The Netherlands
| | - Cindy Navis
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of ENT (Speech & Language Pathology), Erasmus MC, Rotterdam, The Netherlands
| | - André B Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Child- and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Alice S Brooks
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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