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Benkirane M, Marelli C, Guissart C, Roubertie A, Ollagnon E, Choumert A, Fluchère F, Magne FO, Halleb Y, Renaud M, Larrieu L, Baux D, Patat O, Bousquet I, Ravel JM, Cuntz-Shadfar D, Sarret C, Ayrignac X, Rolland A, Morales R, Pointaux M, Lieutard-Haag C, Laurens B, Tillikete C, Bernard E, Mallaret M, Carra-Dallière C, Tranchant C, Meyer P, Damaj L, Pasquier L, Acquaviva C, Chaussenot A, Isidor B, Nguyen K, Camu W, Eusebio A, Carrière N, Riquet A, Thouvenot E, Gonzales V, Carme E, Attarian S, Odent S, Castrioto A, Ewenczyk C, Charles P, Kremer L, Sissaoui S, Bahi-Buisson N, Kaphan E, Degardin A, Doray B, Julia S, Remerand G, Fraix V, Haidar LA, Lazaro L, Laugel V, Villega F, Charlin C, Frismand S, Moreira MC, Witjas T, Francannet C, Walther-Louvier U, Fradin M, Chabrol B, Fluss J, Bieth E, Castelnovo G, Vergnet S, Meunier I, Verloes A, Brischoux-Boucher E, Coubes C, Geneviève D, Lebouc N, Azulay JP, Anheim M, Goizet C, Rivier F, Labauge P, Calvas P, Koenig M. High rate of hypomorphic variants as the cause of inherited ataxia and related diseases: study of a cohort of 366 families. Genet Med 2021; 23:2160-2170. [PMID: 34234304 DOI: 10.1038/s41436-021-01250-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Diagnosis of inherited ataxia and related diseases represents a real challenge given the tremendous heterogeneity and clinical overlap of the various causes. We evaluated the efficacy of molecular diagnosis of these diseases by sequencing a large cohort of undiagnosed families. METHODS We analyzed 366 unrelated consecutive patients with undiagnosed ataxia or related disorders by clinical exome-capture sequencing. In silico analysis was performed with an in-house pipeline that combines variant ranking and copy-number variant (CNV) searches. Variants were interpreted according to American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines. RESULTS We established the molecular diagnosis in 46% of the cases. We identified 35 mildly affected patients with causative variants in genes that are classically associated with severe presentations. These cases were explained by the occurrence of hypomorphic variants, but also rarely suspected mechanisms such as C-terminal truncations and translation reinitiation. CONCLUSION A significant fraction of the clinical heterogeneity and phenotypic overlap is explained by hypomorphic variants that are difficult to identify and not readily predicted. The hypomorphic C-terminal truncation and translation reinitiation mechanisms that we identified may only apply to few genes, as it relies on specific domain organization and alterations. We identified PEX10 and FASTKD2 as candidates for translation reinitiation accounting for mild disease presentation.
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Affiliation(s)
- Mehdi Benkirane
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Cecilia Marelli
- Expert Centre for Neurogenetic Diseases and Adult Mitochondrial and Metabolic Diseases, Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier; Molecular Mechanisms of Neurodegenerative Dementia (MMDN), EPHE, INSERM, Université de Montpellier, Montpellier, France
| | - Claire Guissart
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Agathe Roubertie
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France.,INSERM, Institut des Neurosciences de Montpellier, Montpellier, France
| | - Elizabeth Ollagnon
- Department of Medical Genetics and Reference Centre for Neurological and Neuromuscular Diseases, Croix-Rousse Hospital, Lyon, France
| | - Ariane Choumert
- Department of Rare Neurological Diseases, CHU de la Réunion, Saint-Pierre, France
| | - Frédérique Fluchère
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Fabienne Ory Magne
- Department of Neurology, Purpan Hospital, CHU de Toulouse, Toulouse, France
| | - Yosra Halleb
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Mathilde Renaud
- Departments of Genetics and of Neurology, CHU de Nancy, Nancy, France
| | - Lise Larrieu
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - David Baux
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Olivier Patat
- Department of Clinical Genetics, Purpan Hospital, CHU de Toulouse, Toulouse, France
| | - Idriss Bousquet
- Department of Medical Genetics and Reference Centre for Neurological and Neuromuscular Diseases, Croix-Rousse Hospital, Lyon, France
| | - Jean-Marie Ravel
- Departments of Genetics and of Neurology, CHU de Nancy, Nancy, France
| | - Danielle Cuntz-Shadfar
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Catherine Sarret
- Department of Medical Genetics, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Xavier Ayrignac
- Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Anne Rolland
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Raoul Morales
- Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Morgane Pointaux
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Cathy Lieutard-Haag
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Brice Laurens
- Departement of Neurology, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Institute for Neurodegenerative Diseases, CNRS-UMR, Université de Bordeaux, Bordeaux, France
| | - Caroline Tillikete
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Emilien Bernard
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.,Institut NeuroMyoGène, INSERM-CNRS-UMR, Université Claude Bernard, Lyon, France
| | - Martial Mallaret
- Department of Functional Explorations of the Nervous System, CHU de Grenoble, Grenoble, France
| | | | - Christine Tranchant
- Department of Neurology, Hautepierre Hospital, CHU de Strasbourg, Strasbourg, France
| | - Pierre Meyer
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France.,PhyMedExp, INSERM, University of Montpellier, CNRS, Montpellier, France
| | - Lena Damaj
- Department of Clinical Genetics, Centre de Référence Maladies Rares Anomalies du Développement, CHU de Rennes, Rennes, France
| | - Laurent Pasquier
- Department of Clinical Genetics, Centre de Référence Maladies Rares Anomalies du Développement, CHU de Rennes, Rennes, France
| | - Cecile Acquaviva
- Department of Hereditary Metabolic Diseases, Centre de Biologie et Pathologie Est, CHU de Lyon et UMR, Bron, France
| | - Annabelle Chaussenot
- Department of Medical Genetics, National Centre for Mitochondrial Diseases, CHU de Nice, Nice, France
| | - Bertrand Isidor
- Department of Medical Genetics, CHU de Nantes, Nantes, France
| | - Karine Nguyen
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - William Camu
- Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Alexandre Eusebio
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Nicolas Carrière
- Department of Neurology, Roger Salengro Hospital, CHU de Lille, Lille, France
| | - Audrey Riquet
- Department of Pediatrics Neurology, Roger Salengro Hospital, CHU de Lille, Lille, France
| | | | - Victoria Gonzales
- Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Emilie Carme
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Shahram Attarian
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Sylvie Odent
- Department of Clinical Genetics, Centre de Référence Maladies Rares Anomalies du Développement, CHU de Rennes, Rennes, France
| | - Anna Castrioto
- Department of Functional Explorations of the Nervous System, CHU de Grenoble, Grenoble, France
| | - Claire Ewenczyk
- Neurogenetics Reference Centre, Hôpital de la Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
| | - Perrine Charles
- Neurogenetics Reference Centre, Hôpital de la Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
| | - Laurent Kremer
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Samira Sissaoui
- Department of Pediatrics, Hôpital Necker-Enfant Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nadia Bahi-Buisson
- Department of Pediatrics, Hôpital Necker-Enfant Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elsa Kaphan
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Adrian Degardin
- Department of Neurology, Roger Salengro Hospital, CHU de Lille, Lille, France
| | - Bérénice Doray
- Department of Medical Genetics, CHU de la Réunion, Saint-Denis, France
| | - Sophie Julia
- Department of Clinical Genetics, Purpan Hospital, CHU de Toulouse, Toulouse, France
| | - Ganaëlle Remerand
- Department of Neonatology, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valerie Fraix
- Department of Functional Explorations of the Nervous System, CHU de Grenoble, Grenoble, France
| | - Lydia Abou Haidar
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Leila Lazaro
- Department of Pediatrics, CH de la Côte Basque-Bayonne, Bayonne, France
| | - Vincent Laugel
- Department of Pediatrics, Hautepierre Hospital, CHU de Strasbourg, Strasbourg, France
| | - Frederic Villega
- Department of Pediatrics, Groupe Hospitalier Pellegrin, CHU de Bordeaux; Institute for Interdisciplinary Neurosciences (IINS), CNRS -UMR, Université de Bordeaux, Bordeaux, France
| | - Cyril Charlin
- Department of Rare Neurological Diseases, CHU de la Réunion, Saint-Pierre, France
| | - Solène Frismand
- Departments of Genetics and of Neurology, CHU de Nancy, Nancy, France
| | - Marinha Costa Moreira
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Tatiana Witjas
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Christine Francannet
- Department of Medical Genetics, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Ulrike Walther-Louvier
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Mélanie Fradin
- Department of Clinical Genetics, Centre de Référence Maladies Rares Anomalies du Développement, CHU de Rennes, Rennes, France
| | - Brigitte Chabrol
- Departement of Pediatrics, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, Genève, Switzerland
| | - Eric Bieth
- Department of Clinical Genetics, Purpan Hospital, CHU de Toulouse, Toulouse, France
| | | | - Sylvain Vergnet
- Departement of Neurology, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Institute for Neurodegenerative Diseases, CNRS-UMR, Université de Bordeaux, Bordeaux, France
| | - Isabelle Meunier
- INSERM, Institut des Neurosciences de Montpellier, Montpellier, France.,Genetics of Sensory Diseases, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Alain Verloes
- Federation of Genetics, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elise Brischoux-Boucher
- Department of Medical Genetics, Hôpital Saint-Jacques, CHU de Besançon, Centre de Génétique Humaine, Université de Franche-Comté, Besançon, France
| | - Christine Coubes
- Department of Medical Genetics, Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France
| | - David Geneviève
- Department of Medical Genetics, Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France
| | - Nicolas Lebouc
- Department of Neuroradiology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Jean Phillipe Azulay
- Department of Neurology, La Timone Hospital, CHU de Marseille, Marseille, France
| | - Mathieu Anheim
- Department of Neurology, Hautepierre Hospital, CHU de Strasbourg, Strasbourg, France
| | - Cyril Goizet
- Department of Medical Genetics, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France
| | - François Rivier
- Department of Pediatrics, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France.,PhyMedExp, INSERM, University of Montpellier, CNRS, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Gui de Chauliac Hospital, CHU de Montpellier, Montpellier, France
| | - Patrick Calvas
- Department of Clinical Genetics, Purpan Hospital, CHU de Toulouse, Toulouse, France
| | - Michel Koenig
- PhyMedExp, Institut Universitaire de Recherche Clinique, UMR_CNRS-Université de Montpellier, INSERM, CHU de Montpellier, Montpellier, France.
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Beaudin M, Matilla-Dueñas A, Soong BW, Pedroso JL, Barsottini OG, Mitoma H, Tsuji S, Schmahmann JD, Manto M, Rouleau GA, Klein C, Dupre N. The Classification of Autosomal Recessive Cerebellar Ataxias: a Consensus Statement from the Society for Research on the Cerebellum and Ataxias Task Force. CEREBELLUM (LONDON, ENGLAND) 2019; 18:1098-1125. [PMID: 31267374 PMCID: PMC6867988 DOI: 10.1007/s12311-019-01052-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is currently no accepted classification of autosomal recessive cerebellar ataxias, a group of disorders characterized by important genetic heterogeneity and complex phenotypes. The objective of this task force was to build a consensus on the classification of autosomal recessive ataxias in order to develop a general approach to a patient presenting with ataxia, organize disorders according to clinical presentation, and define this field of research by identifying common pathogenic molecular mechanisms in these disorders. The work of this task force was based on a previously published systematic scoping review of the literature that identified autosomal recessive disorders characterized primarily by cerebellar motor dysfunction and cerebellar degeneration. The task force regrouped 12 international ataxia experts who decided on general orientation and specific issues. We identified 59 disorders that are classified as primary autosomal recessive cerebellar ataxias. For each of these disorders, we present geographical and ethnical specificities along with distinctive clinical and imagery features. These primary recessive ataxias were organized in a clinical and a pathophysiological classification, and we present a general clinical approach to the patient presenting with ataxia. We also identified a list of 48 complex multisystem disorders that are associated with ataxia and should be included in the differential diagnosis of autosomal recessive ataxias. This classification is the result of a consensus among a panel of international experts, and it promotes a unified understanding of autosomal recessive cerebellar disorders for clinicians and researchers.
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Affiliation(s)
- Marie Beaudin
- Axe Neurosciences, CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Antoni Matilla-Dueñas
- Department of Neuroscience, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Bing-Weng Soong
- Department of Neurology, Shuang Ho Hospital and Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Republic of China
- National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Jose Luiz Pedroso
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Orlando G Barsottini
- Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Shoji Tsuji
- The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Chiba, Japan
| | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, 6000, Charleroi, Belgium
- Service des Neurosciences, UMons, Mons, Belgium
| | | | | | - Nicolas Dupre
- Axe Neurosciences, CHU de Québec-Université Laval, Québec, QC, Canada.
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
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