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Pollini L, Greco C, Novelli M, Mei D, Pisani F, De Koning‐Tijssen MA, Guerrini R, Leuzzi V, Galosi S. Neurophysiological Analysis of Cortical Myoclonic Tremor and Excessive Startle in ARHGEF9 Deficiency. Mov Disord Clin Pract 2024; 11:434-437. [PMID: 38293791 PMCID: PMC10982589 DOI: 10.1002/mdc3.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Luca Pollini
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Carlo Greco
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Maria Novelli
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Davide Mei
- Neuroscience DepartmentChildren's Hospital Meyer IRCCSFlorenceItaly
| | - Francesco Pisani
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Marina A.J. De Koning‐Tijssen
- Expertise Centre Movement Disorders GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of NeurologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Renzo Guerrini
- Neuroscience DepartmentChildren's Hospital Meyer IRCCSFlorenceItaly
| | - Vincenzo Leuzzi
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Serena Galosi
- Department of Human NeuroscienceSapienza University of RomeRomeItaly
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Cavirani B, Spagnoli C, Caraffi SG, Cavalli A, Cesaroni CA, Cutillo G, De Giorgis V, Frattini D, Marchetti GB, Masnada S, Peron A, Rizzi S, Varesio C, Spaccini L, Vignoli A, Canevini MP, Veggiotti P, Garavelli L, Fusco C. Genetic Epilepsies and Developmental Epileptic Encephalopathies with Early Onset: A Multicenter Study. Int J Mol Sci 2024; 25:1248. [PMID: 38279250 PMCID: PMC10816990 DOI: 10.3390/ijms25021248] [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: 12/30/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
The genetic causes of epilepsies and developmental and epileptic encephalopathies (DEE) with onset in early childhood are increasingly recognized. Their outcomes vary from benign to severe disability. In this paper, we wished to retrospectively review the clinical, genetic, EEG, neuroimaging, and outcome data of patients experiencing the onset of epilepsy in the first three years of life, diagnosed and followed up in four Italian epilepsy centres (Epilepsy Centre of San Paolo University Hospital in Milan, Child Neurology and Psychiatry Unit of AUSL-IRCCS di Reggio Emilia, Pediatric Neurology Unit of Vittore Buzzi Children's Hospital, Milan, and Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia). We included 168 patients (104 with monogenic conditions, 45 with copy number variations (CNVs) or chromosomal abnormalities, and 19 with variants of unknown significance), who had been followed up for a mean of 14.75 years. We found a high occurrence of generalized seizures at onset, drug resistance, abnormal neurological examination, global developmental delay and intellectual disability, and behavioural and psychiatric comorbidities. We also documented differing presentations between monogenic issues versus CNVs and chromosomal conditions, as well as atypical/rare phenotypes. Genetic early-childhood-onset epilepsies and DEE show a very wide phenotypic and genotypic spectrum, with a high risk of complex neurological and neuropsychiatric phenotypes.
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Affiliation(s)
- Benedetta Cavirani
- Child Neuropsychiatry Unit, Azienda USL di Parma, 43121 Parma, Italy;
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlotta Spagnoli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Anna Cavalli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Carlo Alberto Cesaroni
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Gianni Cutillo
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Valentina De Giorgis
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Daniele Frattini
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Giulia Bruna Marchetti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Silvia Masnada
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
| | - Angela Peron
- Medical Genetics, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Università degli Studi di Firenze, 50121 Florence, Italy
- Medical Genetics, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy
| | - Susanna Rizzi
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
| | - Costanza Varesio
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Child Neurology and Psychiatriy, IRCCS Mondino Foundation, ERN-Epicare, 27100 Pavia, Italy
| | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and Gynecology, V. Buzzi Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Maria Paola Canevini
- Child Neuropsychiatry Unit-Epilepsy Center, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.V.); (M.P.C.)
- Department of Health Sciences, University of Milan, 20157 Milan, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Department of Pediatric Neurology, Buzzi Children’s Hospital, 20154 Milan, Italy; (G.C.); (S.M.); (P.V.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy (L.G.)
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.C.); (C.A.C.); (D.F.); (S.R.); (C.F.)
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Goodspeed K, Bailey RM, Prasad S, Sadhu C, Cardenas JA, Holmay M, Bilder DA, Minassian BA. Gene Therapy: Novel Approaches to Targeting Monogenic Epilepsies. Front Neurol 2022; 13:805007. [PMID: 35847198 PMCID: PMC9284605 DOI: 10.3389/fneur.2022.805007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Genetic epilepsies are a spectrum of disorders characterized by spontaneous and recurrent seizures that can arise from an array of inherited or de novo genetic variants and disrupt normal brain development or neuronal connectivity and function. Genetically determined epilepsies, many of which are due to monogenic pathogenic variants, can result in early mortality and may present in isolation or be accompanied by neurodevelopmental disability. Despite the availability of more than 20 antiseizure medications, many patients with epilepsy fail to achieve seizure control with current therapies. Patients with refractory epilepsy—particularly of childhood onset—experience increased risk for severe disability and premature death. Further, available medications inadequately address the comorbid developmental disability. The advent of next-generation gene sequencing has uncovered genetic etiologies and revolutionized diagnostic practices for many epilepsies. Advances in the field of gene therapy also present the opportunity to address the underlying mechanism of monogenic epilepsies, many of which have only recently been described due to advances in precision medicine and biology. To bring precision medicine and genetic therapies closer to clinical applications, experimental animal models are needed that replicate human disease and reflect the complexities of these disorders. Additionally, identifying and characterizing clinical phenotypes, natural disease course, and meaningful outcome measures from epileptic and neurodevelopmental perspectives are necessary to evaluate therapies in clinical studies. Here, we discuss the range of genetically determined epilepsies, the existing challenges to effective clinical management, and the potential role gene therapy may play in transforming treatment options available for these conditions.
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Affiliation(s)
- Kimberly Goodspeed
- Division of Child Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
| | - Rachel M. Bailey
- Division of Child Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern, Dallas, TX, United States
| | - Suyash Prasad
- Department of Research and Development, Taysha Gene Therapies, Dallas, TX, United States
| | - Chanchal Sadhu
- Department of Research and Development, Taysha Gene Therapies, Dallas, TX, United States
| | - Jessica A. Cardenas
- Department of Research and Development, Taysha Gene Therapies, Dallas, TX, United States
| | - Mary Holmay
- Department of Research and Development, Taysha Gene Therapies, Dallas, TX, United States
| | - Deborah A. Bilder
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
| | - Berge A. Minassian
- Division of Child Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
- *Correspondence: Berge A. Minassian
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Yang H, Liao H, Gan S, Xiao T, Wu L. ARHGEF9 gene variant leads to developmental and epileptic encephalopathy: Genotypic phenotype analysis and treatment exploration. Mol Genet Genomic Med 2022; 10:e1967. [PMID: 35638461 PMCID: PMC9266599 DOI: 10.1002/mgg3.1967] [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: 01/26/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background The ARHGEF9 gene variants have phenotypic heterogeneity, the number of reported clinical cases are limited and the genotype–phenotype relationship is still unpredictable. Methods Clinical data of the patients and their family members were gathered in a retrospective study. The exome sequencing that was performed on peripheral blood samples was applied for genetic analysis. We used the ARHGEF9 gene as a key word to search the PubMed database for cases of ARHGEF9 gene variants that have previously been reported and summarized the reported ARHGEF9 gene variant sites, their corresponding clinical phenotypes, and effective treatment. Results We described five patients with developmental and epileptic encephalopathy caused by ARHGEF9 gene variants. Among them, the antiepileptic treatment of valproic acid and levetiracetam was effective in two cases individually. The exome sequencing results showed five children with point mutations in the ARHGEF9 gene: p.R365H, p.M388V, p.D213E, and p.R63H. So far, a total of 40 children with ARHGEF9 gene variants have been reported. Their main clinical phenotypes include developmental delay, epilepsy, epileptic encephalopathy, and autism spectrum disorders. The variants reported in the literature, including 22 de novo variants, nine maternal variants, and one unknown variant. There were 20 variants associated with epileptic phenotypes, of which six variants are effective for valproic acid treatment. Conclusion The genotypes and phenotypes of ARHGEF9 gene variants represent a wide spectrum, and the clinical phenotype of epilepsy is often refractory and the prognosis is poor. The p.R365H, p.M388V, p.D213E, and p.R63H variants have not been reported in the current literature, and our study has expanded the genotype spectrum of ARHGEF9 gene. Our findings indicate that levetiracetam and valproic acid can effectively control seizures in children with epileptic phenotype caused by ARGHEF9 gene variations. These findings will help clinicians improve the level of diagnosis and treatment of the genetic disease.
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Affiliation(s)
- Haiyan Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, P.R. China
| | - Hongmei Liao
- Department of Neurology, Hunan Children's Hospital, Changsha, P.R. China
| | - Siyi Gan
- Department of Neurology, Hunan Children's Hospital, Changsha, P.R. China
| | - Ting Xiao
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Liwen Wu
- Department of Neurology, Hunan Children's Hospital, Changsha, P.R. China
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Hines DJ, Contreras A, Garcia B, Barker JS, Boren AJ, Moufawad El Achkar C, Moss SJ, Hines RM. Human ARHGEF9 intellectual disability syndrome is phenocopied by a mutation that disrupts collybistin binding to the GABA A receptor α2 subunit. Mol Psychiatry 2022; 27:1729-1741. [PMID: 35169261 PMCID: PMC9095487 DOI: 10.1038/s41380-022-01468-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
Abstract
Intellectual disability (ID) is a common neurodevelopmental disorder that can arise from genetic mutations ranging from trisomy to single nucleotide polymorphism. Mutations in a growing number of single genes have been identified as causative in ID, including ARHGEF9. Evaluation of 41 ARHGEF9 patient reports shows ubiquitous inclusion of ID, along with other frequently reported symptoms of epilepsy, abnormal baseline EEG activity, behavioral symptoms, and sleep disturbances. ARHGEF9 codes for the Cdc42 Guanine Nucleotide Exchange Factor 9 collybistin (Cb), a known regulator of inhibitory synapse function via direct interaction with the adhesion molecule neuroligin-2 and the α2 subunit of GABAA receptors. We mutate the Cb binding motif within the large intracellular loop of α2 replacing it with the binding motif for gephyrin from the α1 subunit (Gabra2-1). The Gabra2-1 mutation causes a strong downregulation of Cb expression, particularly at cholecystokinin basket cell inhibitory synapses. Gabra2-1 mice have deficits in working and recognition memory, as well as hyperactivity, anxiety, and reduced social preference, recapitulating the frequently reported features of ARHGEF9 patients. Gabra2-1 mice also have spontaneous seizures during postnatal development which can lead to mortality, and baseline abnormalities in low-frequency wavelengths of the EEG. EEG abnormalities are vigilance state-specific and manifest as sleep disturbance including increased time in wake and a loss of free-running rhythmicity in the absence of light as zeitgeber. Gabra2-1 mice phenocopy multiple features of human ARHGEF9 mutation, and reveal α2 subunit-containing GABAA receptors as a druggable target for treatment of this complex ID syndrome.
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Affiliation(s)
- Dustin J Hines
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - April Contreras
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Betsua Garcia
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Jeffrey S Barker
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Austin J Boren
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | | | - Stephen J Moss
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, USA
| | - Rochelle M Hines
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA.
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Qiu T, Dai Q, Wang Q. A novel de novo hemizygous ARHGEF9 mutation associated with severe intellectual disability and epilepsy: a case report. J Int Med Res 2021; 49:3000605211058372. [PMID: 34851771 PMCID: PMC8647271 DOI: 10.1177/03000605211058372] [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] [Indexed: 12/05/2022] Open
Abstract
ARHGEF9 encodes collybistin, a brain-specific guanosine diphosphate-guanosine-5′-triphosphate exchange factor that plays an important role in clustering of gephyrin and γ-aminobutyric acid type A receptors in the postsynaptic membrane. Overwhelming evidence suggests that defects in this protein can cause X-linked intellectual disability, which comprises a series of clinical phenotypes, including autism spectrum disorder, behavior disorder, intellectual disability, and febrile seizures. Here, we report a boy with clinical symptoms of severe intellectual disability, epilepsy, and developmental delay and regression. Trio exome sequencing (trio-clinical exome sequencing) identified a novel hemizygous deletion, c.656_c.669delACTTCTTTGAGGCC (p. His219Leu fs*9), in exon 5 of ARHGEF9. This variant was not reported in either the Genome Aggregation Database or our database of 309 patients with neurodevelopmental disorders. Oxcarbazepine and levetiracetam reduced the frequency of the patient’s epileptic seizures to a certain extent, but psychomotor developmental delay and developmental regression became more obvious with age. This case study seeks to report a de novo loss-of-function mutation of ARHGEF9, aiming to emphasize the genetic diagnosis of X-linked intellectual disability and further improve knowledge of the ethnic distribution of ARHGEF9 mutations.
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Affiliation(s)
- Tong Qiu
- Division of Pediatrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, China
| | - Qian Dai
- Division of Pediatrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, China
| | - Qiu Wang
- Division of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
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