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Ponger P, Kurolap A, Lerer I, Dagan J, Chai Gadot C, Mory A, Wilnai Y, Oniashvili N, Giladi N, Gurevich T, Meiner V, Lossos A, Baris Feldman H. Unique Ataxia-Oculomotor Apraxia 2 (AOA2) in Israel with Novel Variants, Atypical Late Presentation, and Possible Identification of a Poison Exon. J Mol Neurosci 2022; 72:1715-1723. [PMID: 35676594 DOI: 10.1007/s12031-022-02035-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
AOA2 is a rare progressive adolescent-onset disease characterised by cerebellar vermis atrophy, peripheral neuropathy and elevated serum alpha-fetoprotein (AFP) caused by pathogenic bi-allelic variants in SETX, encoding senataxin, involved in DNA repair and RNA maturation. Sanger sequencing of genomic DNA, co-segregation and oxidative stress functional studies were performed in Family 1. Trio whole-exome sequencing (WES), followed by SETX RNA and qRT-PCR analysis, were performed in Family 2. Sanger sequencing in Family 1 revealed two novel in-frame SETX deletion and duplication variants in trans (c.7009_7011del; p.Val2337del and c.7369_7371dup; p.His2457dup). Patients had increased induced chromosomal aberrations at baseline and following exposure to higher mitomycin-C concentration and increased sensitivity to oxidative stress at the lower mitomycin-C concentration in cell viability test. Trio WES in Family 2 revealed two novel SETX variants in trans, a nonsense variant (c.568C > T; p.Gln190*), and a deep intronic variant (c.5549-107A > G). Intronic variant analysis and SETX mRNA expression revealed activation of a cryptic exon introducing a premature stop codon (p.Met1850Lysfs*18) and resulting in aberrant splicing, as shown by qRT-PCR analysis, thus leading to higher levels of cryptic exon activation. Along with a second deleterious allele, this variant leads to low levels of SETX mRNA and disease manifestations. Our report expands the phenotypic spectrum of AOA2. Results provide initial support for the hypomorphic nature of the novel in-frame deletion and duplication variants in Family 1. Deep-intronic variant analysis of Family 2 variants potentially reveals a previously undescribed poison exon in the SETX gene, which may contribute to tailored therapy development.
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Affiliation(s)
- Penina Ponger
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. .,The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israela Lerer
- Department of Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Judith Dagan
- Department of Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Chofit Chai Gadot
- The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Mory
- The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Wilnai
- The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nino Oniashvili
- Cytogenetic Laboratory, Oncology Department, Schneider Children's Medical Center in Israel, Petah Tikva, Israel
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vardiella Meiner
- Department of Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Alexander Lossos
- Department of Neurology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Gazulla J, Orduna-Hospital E, Benavente I, Rodríguez-Valle A, Osorio-Caicedo P, Alvarez-de Andrés S, García-González E, Fraile-Rodrigo J, Fernández-Tirado FJ, Berciano J. Contributions to the study of spinocerebellar ataxia type 38 (SCA38). J Neurol 2020; 267:2288-2295. [PMID: 32314013 DOI: 10.1007/s00415-020-09840-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report clinical and ancillary findings in a kindred with spinocerebellar ataxia 38 (SCA38). PATIENTS AND METHODS Five family members spanning two generations developed gait ataxia and intermittent diplopia. On examination, a cerebellar syndrome accompanied by downbeat nystagmus and a saccadic head impulse test (HIT) were found. RESULTS Whole-exome sequencing demonstrated a heterozygous variant in ELOVL5, c.779A > G (p.Tyr260Cys), in four tested patients. Intermittent concomitant esotropia and hypertropia caused transient diplopia in one individual each. Saccadic HIT responses were found in four subjects. Sensorineural hypoacusis was present in every case. Electrophysiological studies demonstrated a sensory neuronopathy in patients from the first generation, with prolonged disease duration. Baseline serum docosahexaenoic acid (DHA) percent was diminished in four individuals. Oral 26-week dietary DHA supplementation, 650 mg/day, raised serum DHA percent and induced a statistically significant reduction in Scale for the Assessment and Rating of Ataxia (SARA) total scores, and in stance and heel-shin slide item scores. CONCLUSION The mentioned ELOVL5 variant segregated with disease in this kindred. Downbeat nystagmus, intermittent heterotropia causing transient diplopia, vestibular impairment demonstrated by abnormal HIT, and sensory neuronopathy were part of the clinical picture in this series. DHA supplementation raised serum DHA percent in cases with diminished levels, and induced a clinical amelioration and a statistically significant reduction in SARA scores in the study group. Further studies are needed to investigate the role of these findings in SCA38, and to determine the response to prolonged DHA supplementation.
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Affiliation(s)
- José Gazulla
- Department of Neurology, Hospital Universitario Miguel Servet, Isabel la Católica 1-3, 50009, Zaragoza, Spain.
| | | | - Isabel Benavente
- Department of Clinical Neurophysiology, Hospital San Jorge, Huesca, Spain
| | - Ana Rodríguez-Valle
- Section of Genetics, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Pedro Osorio-Caicedo
- Department of Clinical Neurophysiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Elena García-González
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Fraile-Rodrigo
- Department of Otolaryngology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - José Berciano
- Department of Neurology, CIBERNED, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
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Merwick Á, Mok T, McNamara B, Parfrey NA, Moore H, Sweeney BJ, Hand CK, Ryan AM. Phenotypic Variation in a Caucasian Kindred with Chorea-Acanthocytosis. Mov Disord Clin Pract 2014; 2:86-89. [PMID: 30713887 DOI: 10.1002/mdc3.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Áine Merwick
- National Neuroscience Center Cork University Hospital Cork Ireland.,National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Tzehow Mok
- National Neuroscience Center Cork University Hospital Cork Ireland.,National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Brian McNamara
- National Neuroscience Center Cork University Hospital Cork Ireland
| | | | - Helena Moore
- National Neuroscience Center Cork University Hospital Cork Ireland
| | - Brian J Sweeney
- National Neuroscience Center Cork University Hospital Cork Ireland
| | - Collette K Hand
- Department of Pathology University College Cork Cork Ireland
| | - Aisling M Ryan
- National Neuroscience Center Cork University Hospital Cork Ireland
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Brugger F, Schüpbach M, Koenig M, Müri R, Bohlhalter S, Kaelin-Lang A, Kamm CP, Kägi G. The Clinical Spectrum of Ataxia with Oculomotor Apraxia Type 2. Mov Disord Clin Pract 2014; 1:106-109. [PMID: 30363866 DOI: 10.1002/mdc3.12021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/07/2022] Open
Abstract
Ataxia with oculomotor apraxia type 2 (AOA2) is an inherited disorder caused by mutations within both alleles of the senataxin gene. First symptoms are usually recognized before the age of 30. Unlike several other autosomal recessive cerebellar ataxia syndromes, levels of alpha-fetoprotein are nearly always elevated in AOA2 and thus narrowing down the differential diagnosis list. We present 3 video cases illustrating and expanding the clinical spectrum of AOA2, with 1 case bearing a novel mutation with cervical dystonia as the first symptom, the absence of neuropathy, and a disease onset beyond the age of 40. Furthermore, all patients were assessed by oculographic analysis, which revealed distinct patterns of oculomotor abnormalities. The clinical spectrum of AOA2 might be even broader than previously described in larger series. Oculography might be a useful tool to detect subclinical oculomotor apraxia in this disorder.
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Affiliation(s)
- Florian Brugger
- Movement Disorders Center of Eastern Switzerland Department of Neurology Kantonsspital St.Gallen St.Gallen Switzerland
| | - Michael Schüpbach
- Movement Disorders Center Department of Neurology University Hospital Berne University of Berne Berne Switzerland
| | - Michel Koenig
- Laboratoire de Diagnostic Génétique Nouvel Hôpital Civil Strasbourg France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire CNRS/Université de Strasbourg/INSERM Illkirch France
| | - René Müri
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
- Neurology and Neurorehabilitation Center Department of Internal Medicine Luzerner Kantonsspital Lucerne Switzerland
| | - Alain Kaelin-Lang
- Movement Disorders Center Department of Neurology University Hospital Berne University of Berne Berne Switzerland
| | - Christian P Kamm
- Perception and Eye Movement Laboratory Departments of Neurology and Clinical Research Inselspital, University Hospital Berne Berne Switzerland
| | - Georg Kägi
- Movement Disorders Center of Eastern Switzerland Department of Neurology Kantonsspital St.Gallen St.Gallen Switzerland
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Clinical and molecular findings of ataxia with oculomotor apraxia type 2 (AOA2) in 5 Tunisian families. ACTA ACUST UNITED AC 2013; 21:241-5. [PMID: 23111195 DOI: 10.1097/pdm.0b013e318257ad9a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Ataxia with oculomotor apraxia type 2 (AOA2) is a recently described autosomal recessive cerebellar ataxia caused by mutations in the SETX gene. It is a rare monogenic disease characterized by progressive cerebellar ataxia, oculomotor apraxia, axonal sensorimotor neuropathy, and an elevated serum α-fetoprotein level. To date, >100 AOA2 patients have been described and 75 different mutations in the SETX gene have been identified. We report here the clinical and genetic findings of 13 AOA2 patients from 5 unrelated Tunisian consanguineous families. DNA was collected from probands and available family members, and the 24 SETX exons were screened by direct sequencing. Four different homozygous SETX gene mutations were identified. The missense mutation 915G>T [W305C] has been described previously in Algeria. The 3 other SETX mutations are novel, including a missense mutation c.7231C>T [R 2380 W], a nonsense mutation c.6475 C>T [R2098X], and a deletion c.7180-7183delAAAA [D2332fsX2343]. More extensive screening by molecular genetic analysis of SETX in patients with Friedreich ataxia-like phenotype may show that AOA2 is more common in Tunisia than previously thought.
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