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El‐Wahsh S, Fellner A, Hobbs M, Copty J, Deveson I, Stevanovski I, Stoll M, Zhu D, Narayanan RK, Grosz B, Worgan L, Cheong PL, Yeow D, Rudaks L, Hasan MM, Hayes VM, Kennerson M, Kumar KR, Hayes M. An Inversion Affecting the GCH1 Gene as a Novel Finding in Dopa-Responsive Dystonia. Mov Disord Clin Pract 2024; 11:582-585. [PMID: 38497520 PMCID: PMC11078477 DOI: 10.1002/mdc3.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Shadi El‐Wahsh
- Neurology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Avi Fellner
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
- The Neurogenetics Clinic, Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | - Matthew Hobbs
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Joe Copty
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Ira Deveson
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Igor Stevanovski
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Marion Stoll
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Danqing Zhu
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Ramesh K. Narayanan
- Northcott Neuroscience LaboratoryANZAC Research Institute—Sydney Local Health DistrictConcordNew South WalesAustralia
| | - Bianca Grosz
- Northcott Neuroscience LaboratoryANZAC Research Institute—Sydney Local Health DistrictConcordNew South WalesAustralia
| | - Lisa Worgan
- Clinical Genetics ServiceRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
- Department of Medical GenomicsRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Pak Leng Cheong
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical School, Sydney Medical School, Faculty of Health and MedicineUniversity of SydneySydneyNew South WalesAustralia
- Royal Prince Alfred Hospital, New South Wales Health PathologySydneyNew South WalesAustralia
- Institute of Precision Medicine and Bioinformatics, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Dennis Yeow
- Neurology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical School, Sydney Medical School, Faculty of Health and MedicineUniversity of SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Laura Rudaks
- Neurology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical School, Sydney Medical School, Faculty of Health and MedicineUniversity of SydneySydneyNew South WalesAustralia
| | - Md Mehedi Hasan
- Ancestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Vanessa M. Hayes
- Ancestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- School of Health Systems & Public HealthUniversity of PretoriaPretoriaSouth Africa
- Manchester Cancer Research CentreUniversity of ManchesterManchesterUK
| | - Marina Kennerson
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Northcott Neuroscience LaboratoryANZAC Research Institute—Sydney Local Health DistrictConcordNew South WalesAustralia
- Institute of Precision Medicine and Bioinformatics, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Kishore R. Kumar
- Neurology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Garvan Institute of Medical ResearchSydneyNew South WalesAustralia
- Molecular Medicine LaboratoryConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical School, Sydney Medical School, Faculty of Health and MedicineUniversity of SydneySydneyNew South WalesAustralia
- Institute of Precision Medicine and Bioinformatics, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Michael Hayes
- Neurology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
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2
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Khani S, Barzegari M, Esmaeilizadeh Z, Farsian P, Alaei M, Salehpour S, Setoodeh A, Rohani F, Samavat A, Zekri A, Mirzazadeh R, Sadeghi S, Khatami S. The treatment and clinical follow-up outcome in Iranian patients with tetrahydrobiopterin deficiency. J Pediatr Endocrinol Metab 2021; 34:1157-1167. [PMID: 34214291 DOI: 10.1515/jpem-2021-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to evaluate the biochemical factors, genetic mutations, outcome of treatment, and clinical follow-up data of Iranian patients with tetrahydrobiopterin (BH4) deficiency from April/2016 to March/2020. METHODS Forty-seven BH4 deficiency patients were included in the study and underwent biochemical and genetic analyses. The clinical outcomes of the patients were evaluated after long-term treatment. RESULTS Out of the 47 (25 females and 22 males) BH4 deficiency patients enrolled in the study, 23 were Dihydropteridine reductase (DHPR) deficient patients, 23 were 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficient patients, and one was GTP-Cyclohydrolase 1 deficiency (GTPCH-1) patient. No clinical symptoms were observed in 10 of the DHPR deficient patients (before and after the treatment). Also, most patients diagnosed at an early age had a proper response to the treatment. However, drug therapy did not improve clinical symptoms in three of the patients diagnosed at the age of over 10 years. Also, 16 PTPS deficiency patients who were detected within 6 months and received treatment no clinical symptoms were presented. One of the patients was detected with GTPCH deficiency. Despite being treated with BH4, this patient suffered from a seizure, movement disorder, mental retardation, speech difficulty, and hypotonia. CONCLUSIONS The study results showed that neonatal screening should be carried out in all patients with hyperphenylalaninemia because early diagnosis and treatment can reduce symptoms and prevent neurological impairments. Although the BH4 deficiency outcomes are highly variable, early diagnosis and treatment in the first months of life are crucial for good outcomes.
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Affiliation(s)
- Soghra Khani
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Mina Barzegari
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | | | - Pantea Farsian
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammadreza Alaei
- Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadab Salehpour
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aria Setoodeh
- Growth and Development Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Rohani
- Department of Pediatrics Endocrinology and Metabolism, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ashraf Samavat
- Genetics Office, CDC, Ministry of Health of Iran, Tehran, Iran
| | - Ali Zekri
- Department of Medical Genetics and Molecular Biology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sedigheh Sadeghi
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Shohreh Khatami
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
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3
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Opladen T, López-Laso E, Cortès-Saladelafont E, Pearson TS, Sivri HS, Yildiz Y, Assmann B, Kurian MA, Leuzzi V, Heales S, Pope S, Porta F, García-Cazorla A, Honzík T, Pons R, Regal L, Goez H, Artuch R, Hoffmann GF, Horvath G, Thöny B, Scholl-Bürgi S, Burlina A, Verbeek MM, Mastrangelo M, Friedman J, Wassenberg T, Jeltsch K, Kulhánek J, Kuseyri Hübschmann O. Consensus guideline for the diagnosis and treatment of tetrahydrobiopterin (BH 4) deficiencies. Orphanet J Rare Dis 2020; 15:126. [PMID: 32456656 PMCID: PMC7251883 DOI: 10.1186/s13023-020-01379-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tetrahydrobiopterin (BH4) deficiencies comprise a group of six rare neurometabolic disorders characterized by insufficient synthesis of the monoamine neurotransmitters dopamine and serotonin due to a disturbance of BH4 biosynthesis or recycling. Hyperphenylalaninemia (HPA) is the first diagnostic hallmark for most BH4 deficiencies, apart from autosomal dominant guanosine triphosphate cyclohydrolase I deficiency and sepiapterin reductase deficiency. Early supplementation of neurotransmitter precursors and where appropriate, treatment of HPA results in significant improvement of motor and cognitive function. Management approaches differ across the world and therefore these guidelines have been developed aiming to harmonize and optimize patient care. Representatives of the International Working Group on Neurotransmitter related Disorders (iNTD) developed the guidelines according to the SIGN (Scottish Intercollegiate Guidelines Network) methodology by evaluating all available evidence for the diagnosis and treatment of BH4 deficiencies. CONCLUSION Although the total body of evidence in the literature was mainly rated as low or very low, these consensus guidelines will help to harmonize clinical practice and to standardize and improve care for BH4 deficient patients.
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Affiliation(s)
- Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany.
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Elisenda Cortès-Saladelafont
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
- Unit of Pediatric Neurology and Metabolic Disorders, Department of Pediatrics, Hospital Germans Trias i Pujol, and Faculty of Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Toni S Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - H Serap Sivri
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Yilmaz Yildiz
- Department of Pediatrics, Section of Metabolism, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Birgit Assmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street-Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Simon Heales
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Simon Pope
- Neurometabolic Unit, National Hospital, Queen Square, London, UK
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Angeles García-Cazorla
- Inborn errors of metabolism Unit, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Tomáš Honzík
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Luc Regal
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Helly Goez
- Department of Pediatrics, University of Alberta Glenrose Rehabilitation Hospital, Edmonton, Canada
| | - Rafael Artuch
- Clinical biochemistry department, Institut de Recerca Sant Joan de Déu, CIBERER and MetabERN Hospital Sant Joan de Déu, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Gabriella Horvath
- Department of Pediatrics, Division of Biochemical Genetics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital Zurich, Zürich, Switzerland
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Medical University of Innsbruck, Anichstr 35, Innsbruck, Austria
| | - Alberto Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Dipartimento della Salute della Donna e del Bambino, Azienda Ospedaliera Universitaria di Padova - Campus Biomedico Pietro d'Abano, Padova, Italy
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Alzheimer Centre, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Mario Mastrangelo
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Jennifer Friedman
- UCSD Departments of Neuroscience and Pediatrics, Rady Children's Hospital Division of Neurology; Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Tessa Wassenberg
- Department of Pediatric, Pediatric Neurology and Metabolism Unit, UZ Brussel, Brussels, Belgium
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Jan Kulhánek
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
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4
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Weng YC, Wang CC, Wu YR. Atypical presentation of dopa-responsive dystonia in Taiwan. Brain Behav 2018; 8:e00906. [PMID: 29484265 PMCID: PMC5822572 DOI: 10.1002/brb3.906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/06/2022] Open
Abstract
The typical clinical presentation of dopa-responsive dystonia, which is also called Segawa disease, is a young age of onset, with predominance in females, diurnal fluctuation of lower limb dystonia, and fair response to low-dose levodopa. This disease has both autosomal dominant and autosomal recessive inheritance. Autosomal dominant Segawa disease is caused by GCH1 mutation on chromosome 14q22.1-q22.2. Here, we report the case of a male patient with genetically confirmed Segawa disease and atypical presentations including no diurnal symptom fluctuation and insufficient response to levodopa. The patient's father who had the same mutation presented parkinsonism in old age. We also review the literature to address the broad clinical heterogeneity of Segawa disease and the influence of onset age on clinical presentation.
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Affiliation(s)
- Yi Ching Weng
- Department of NeurologyChang Gung Memorial HospitalChang‐Gung University College of MedicineTaipeiTaiwan
| | - Chun Chieh Wang
- Department of NeurologyChang Gung Memorial HospitalChang‐Gung University College of MedicineTaipeiTaiwan
| | - Yih Ru Wu
- Department of NeurologyChang Gung Memorial HospitalChang‐Gung University College of MedicineTaipeiTaiwan
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5
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Lin JJ, Lu CS, Tsai CH. Variability of presynaptic nigrostriatal dopaminergic function and clinical heterogeneity in a dopa-responsive dystonia family with GCH-1 gene mutation. J Neurol 2017; 265:478-485. [PMID: 29290055 DOI: 10.1007/s00415-017-8723-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/24/2022]
Abstract
We studied the presynaptic nigrostriatal dopaminergic function using single photon emission computed tomography (SPECT) imaging of a 99mTc-TRODAT-1 (TRODAT) scan in a dopa-responsive dystonia (DRD) family with the guanosine triphosphate cyclohydrolase 1 (GCH-1) gene mutation. Clinically, there was presentation of intrafamilial variability in the DRD family. The index patient was a 10-year-old girl with classic DRD and normal presynaptic nigrostriatal dopaminergic function. However, her grandmother, a 79-year-old woman, presented with slowly progressive Parkinson's disease (PD) without dystonic symptoms and excellent response to dopaminergic therapy for 21 years. Her brain TRODAT SPECT imaging revealed a markedly and asymmetrically reduced uptake of dopamine transporter at the bilateral striatum. Her father, a 54-year-old man, was an asymptomatic gene carrier and his brain TRODAT SPECT imaging revealed asymmetrically reduced nigrostriatal dopaminergic transmission in the bilateral striatum. We conclude variability of presynaptic nigrostriatal dopaminergic function in patients with DRD is related to their clinical heterogeneity. Significantly, impairment of presynaptic dopamine function actually occurs in the asymptomatic gene carrier.
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Affiliation(s)
- Juei-Jueng Lin
- Department of Neurology, Chushang Show-Chwan Hospital, No. 75, Sec. 2, Chi-Shang Rd, Chushang Jenn, 557, Nantou county, Taiwan, ROC. .,Department of Neurology, Chung-Shan Medical University Hospital, Taichung City, Taiwan, ROC.
| | - Chin-Song Lu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chon-Haw Tsai
- Department of Neurology, China Medicine University Hospital, Taichung City, Taiwan, ROC
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6
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Lohmann K, Redin C, Tönnies H, Bressman SB, Subero JIM, Wiegers K, Hinrichs F, Hellenbroich Y, Rakovic A, Raymond D, Ozelius LJ, Schwinger E, Siebert R, Talkowski ME, Saunders-Pullman R, Klein C. Complex and Dynamic Chromosomal Rearrangements in a Family With Seemingly Non-Mendelian Inheritance of Dopa-Responsive Dystonia. JAMA Neurol 2017; 74:806-812. [PMID: 28558098 DOI: 10.1001/jamaneurol.2017.0666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Chromosomal rearrangements are increasingly recognized to underlie neurologic disorders and are often accompanied by additional clinical signs beyond the gene-specific phenotypic spectrum. Objective To elucidate the causal genetic variant in a large US family with co-occurrence of dopa-responsive dystonia as well as skeletal and eye abnormalities (ie, ptosis, myopia, and retina detachment). Design, Setting, and Participants We examined 10 members of a family, including 5 patients with dopa-responsive dystonia and skeletal and/or eye abnormalities, from a US tertiary referral center for neurological diseases using multiple conventional molecular methods, including fluorescence in situ hybridization and array comparative genomic hybridization as well as large-insert whole-genome sequencing to survey multiple classes of genomic variations. Of note, there was a seemingly implausible transmission pattern in this family due to a mutation-negative obligate mutation carrier. Main Outcomes and Measures Genetic diagnosis in affected family members and insight into the formation of large deletions. Results Four members were diagnosed with definite and 1 with probable dopa-responsive dystonia. All 5 affected individuals carried a large heterozygous deletion encompassing all 6 exons of GCH1. Additionally, all mutation carriers had congenital ptosis requiring surgery, 4 had myopia, 2 had retinal detachment, and 2 showed skeletal abnormalities of the hands, ie, polydactyly or syndactyly or missing a hand digit. Two individuals were reported to be free of any disease. Analyses revealed complex chromosomal rearrangements on chromosome 14q21-22 in unaffected individuals that triggered the expansion to a larger deletion segregating with affection status. The expansion occurred recurrently, explaining the seemingly non-mendelian inheritance pattern. These rearrangements included a deletion of GCH1, which likely contributes to the dopa-responsive dystonia, as well as a deletion of BMP4 as a potential cause of digital and eye abnormalities. Conclusions and Relevance Our findings alert neurologists to the importance of clinical red flags, ie, unexpected co-occurrence of clinical features that may point to the presence of chromosomal rearrangements as the primary disease cause. The clinical management and diagnostics of such patients requires an interdisciplinary approach in modern clinical-diagnostic care.
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Affiliation(s)
- Katja Lohmann
- Institute of Neurogenetics, University Lübeck, Lübeck, Germany
| | - Claire Redin
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Holger Tönnies
- Institute of Human Genetics, Christian-Albrechts-University, Kiel, Germany
| | - Susan B Bressman
- Department of Neurology, Beth Israel Medical Center, New York, New York5Department of Neurology, Albert Einstein College of Medicine, New York, New York
| | | | - Karin Wiegers
- Institute of Neurogenetics, University Lübeck, Lübeck, Germany
| | - Frauke Hinrichs
- Institute of Neurogenetics, University Lübeck, Lübeck, Germany6Institute of Human Genetics, University Lübeck, Lübeck, Germany
| | | | | | - Deborah Raymond
- Department of Neurology, Beth Israel Medical Center, New York, New York
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Charlestown
| | | | - Reiner Siebert
- Institute of Human Genetics, Christian-Albrechts-University, Kiel, Germany8Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Michael E Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston7Department of Neurology, Massachusetts General Hospital, Charlestown9Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Rachel Saunders-Pullman
- Department of Neurology, Beth Israel Medical Center, New York, New York5Department of Neurology, Albert Einstein College of Medicine, New York, New York
| | - Christine Klein
- Institute of Neurogenetics, University Lübeck, Lübeck, Germany
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7
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Armata IA, Balaj L, Kuster JK, Zhang X, Tsai S, Armatas AA, Multhaupt-Buell TJ, Soberman R, Breakefield XO, Ichinose H, Sharma N. Dopa-responsive dystonia: functional analysis of single nucleotide substitutions within the 5' untranslated GCH1 region. PLoS One 2013; 8:e76975. [PMID: 24124602 PMCID: PMC3790877 DOI: 10.1371/journal.pone.0076975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
Abstract
Background Mutations in the GCH1 gene are associated with childhood onset, dopa-responsive dystonia (DRD). Correct diagnosis of DRD is crucial, given the potential for complete recovery once treated with L-dopa. The majority of DRD associated mutations lie within the coding region of the GCH1 gene, but three additional single nucleotide sequence substitutions have been reported within the 5’ untranslated (5’UTR) region of the mRNA. The biologic significance of these 5’UTR GCH1 sequence substitutions has not been analyzed. Methodology/Principal Findings Luciferase reporter assays, quantitative real time PCR and RNA decay assays, combined with bioinformatics, revealed a pathogenic 5’UTR GCH1 substitution. The +142C>T single nucleotide 5’UTR substitution that segregates with affected status in DRD patients, substantially attenuates translation without altering RNA expression levels or stability. The +142C>T substitution disrupts translation most likely by creating an upstream initiation start codon (uAUG) and an upstream open reading frame (uORF). Conclusions/Significance This is the first GCH1 regulatory substitution reported to act at a post-transcriptional level, increasing the list of genetic diseases caused by abnormal translation and reaffirming the importance of investigating potential regulatory substitutions in genetic diseases.
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Affiliation(s)
- Ioanna A. Armata
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Leonora Balaj
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John K. Kuster
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xuan Zhang
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shelun Tsai
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Trisha J. Multhaupt-Buell
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Roy Soberman
- Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Xandra O. Breakefield
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hiroshi Ichinose
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama, Japan
| | - Nutan Sharma
- Department of Neurogenetics, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
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8
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GTP cyclohydrolase I and tyrosine hydroxylase gene mutations in familial and sporadic dopa-responsive dystonia patients. PLoS One 2013; 8:e65215. [PMID: 23762320 PMCID: PMC3675154 DOI: 10.1371/journal.pone.0065215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022] Open
Abstract
Dopa-responsive dystonia (DRD) is a rare inherited dystonia that responds very well to levodopa treatment. Genetic mutations of GTP cyclohydrolase I (GCH1) or tyrosine hydroxylase (TH) are disease-causing mutations in DRD. To evaluate the genotype-phenotype correlations and diagnostic values of GCH1 and TH mutation screening in DRD patients, we carried out a combined study of familial and sporadic cases in Chinese Han subjects. We collected 23 subjects, 8 patients with DRD, 5 unaffected family members, and 10 sporadic cases. We used PCR to sequence all exons and splicing sites of the GCH1 and TH genes. Three novel heterozygous GCH1 mutations (Tyr75Cys, Ala98Val, and Ile135Thr) were identified in three DRD pedigrees. We failed to identify any GCH1 or TH mutation in two affected sisters. Three symptom-free male GCH1 mutation carriers were found in two DRD pedigrees. For those DRD siblings that shared the same GCH1 mutation, symptoms and age of onset varied. In 10 sporadic cases, only two heterozygous TH mutations (Ser19Cys and Gly397Arg) were found in two subjects with unknown pathogenicity. No GCH1 and TH mutation was found in 40 unrelated normal Han Chinese controls. GCH1 mutation is the main etiology of familial DRD. Three novel GCH1 mutations were identified in this study. Genetic heterogeneity and incomplete penetrance were quite common in DRD patients, especially in sporadic cases. Genetic screening may help establish the diagnosis of DRD; however, a negative GCH1 and TH mutation test would not exclude the diagnosis.
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9
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Yu L, Zhou H, Hu F, Xu Y. Two novel mutations of the GTP cyclohydrolase 1 gene and genotype-phenotype correlation in Chinese Dopa-responsive dystonia patients. Eur J Hum Genet 2012; 21:731-5. [PMID: 23211702 DOI: 10.1038/ejhg.2012.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The most common form of Dopa-responsive dystonia (DRD) is caused by heterozygous mutations in the GTP cyclohydrolase I (GCH1) gene. We screened two unrelated, DRD-symptomatic Chinese Han individuals, for GCH1 gene mutations by direct sequencing. As the clinical manifestations of DRD are highly variable, we also explored the association between genotype and phenotype in all Chinese DRD patients reported so far in the literature, comprising 62 DRD-affected patients from 36 Chinese families. Two novel missense mutations (T94M, L145F) and a novel variant (c. 453+6 G>T) were identified in our two new patients. None of these variants was detected in 200 healthy controls. On the basis of this and other reports, heterozygous mutations were detected in 90.3% of Chinese Han subjects with DRD. Seeming the age of onset for males and females, the mean age was 13 years older in males than in females (P=0.006). Different mutation types did not show any significant differences in age of onset, gender composition, initial symptoms, or the L-dopa dose that abolished the symptoms. Among DRD patients lacking missense or exon-intron boundary mutations, 68.4% were found to possess a large deletion in GCH1, which were detected by multiplex ligation-dependent probe amplification. Most GCH1 mutations were found to cluster in two regions of the coding sequence, suggesting the probable existence of mutation hotspot for the first time. The genotype-phenotype correlation described here may improve our understanding of DRD in Chinese individuals.
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Affiliation(s)
- Lihua Yu
- Department of Neurology, West China Hospital, Sichuan University, Sichuan Province, Chengdu, People's Republic of China
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