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Vidic C, Zaniew M, Jurga S, Thiele H, Reutter H, Hilger AC. Exome sequencing implicates a novel heterozygous missense variant in DSTYK in autosomal dominant lower urinary tract dysfunction and mild hereditary spastic paraparesis. Mol Cell Pediatr 2021; 8:13. [PMID: 34608560 PMCID: PMC8490499 DOI: 10.1186/s40348-021-00122-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/25/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction DSTYK encodes dual serine/threonine and tyrosine protein kinase. DSTYK has been associated with autosomal-dominant congenital anomalies of the kidney and urinary tract and with autosomal-recessive hereditary spastic paraplegia type 23. Here, we report a father and his two dizygotic twin sons carrying a novel heterozygous missense variant in DSTYK, presenting with early onset lower urinary tract dysfunction due to dysfunctional voiding. Moreover, in the later course of the disease, both sons presented with bilateral spasticity in their lower limbs, brisk reflexes, and absence seizures. Materials and methods Exome sequencing in the affected father and his affected sons was performed. The sons presented clinically with urinary hesitancy, dysfunctional voiding, and night incontinence till adolescence, while the father reported difficulty in voiding. In the sons, cystoscopy excluded urethral valves and revealed hypertrophy of the bladder neck and trabeculated bladder. Additionally, both sons were diagnosed with absence epilepsy in early childhood. Filtering of exome data focused on rare (MAF < 0.01%), autosomal-dominant variants, predicted to be deleterious, residing in highly conserved regions of the exome. Results Exome analysis identified a novel, heterozygous missense variant (c.271C>A (p.Leu91Met)) in DSTYK segregating with the disease. In silico prediction analyses uniformly rated the variant to be deleterious suggesting the variant to be disease-causing in the family. Conclusion To the best of our knowledge, this is the first report of early onset dysfunctional voiding, seizures, and bilateral spasticity of the lower limbs associated with a novel heterozygous dominant missense variant in DSTYK. Supplementary Information The online version contains supplementary material available at 10.1186/s40348-021-00122-y.
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Affiliation(s)
- Clara Vidic
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Szymon Jurga
- Department of Neurology, University of Zielona Góra, Zielona Góra, Poland
| | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Heiko Reutter
- Department of Neonatology and Paediatric Intensive Care, University Hospital Erlangen, Erlangen, Germany
| | - Alina C Hilger
- Institute of Human Genetics, University of Bonn, Bonn, Germany. .,Department of Pediatrics, Children's Hospital, University of Bonn, Bonn, Germany.
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Roberts NA, Hilton EN, Woolf AS. From gene discovery to new biological mechanisms: heparanases and congenital urinary bladder disease. Nephrol Dial Transplant 2015; 31:534-40. [PMID: 26315301 PMCID: PMC4805131 DOI: 10.1093/ndt/gfv309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/29/2015] [Indexed: 12/29/2022] Open
Abstract
We present a scientific investigation into the pathogenesis of a urinary bladder disease. The disease in question is called urofacial syndrome (UFS), a congenital condition inherited in an autosomal recessive manner. UFS features incomplete urinary bladder emptying and vesicoureteric reflux, with a high risk of recurrent urosepsis and end-stage renal disease. The story starts from a human genomic perspective, then proceeds through experiments that seek to determine the roles of the implicated molecules in embryonic frogs and newborn mice. A future aim would be to use such biological knowledge to intelligently choose novel therapies for UFS. We focus on heparanase proteins and the peripheral nervous system, molecules and tissues that appear to be key players in the pathogenesis of UFS and therefore must also be critical for functional differentiation of healthy bladders. These considerations allow the envisioning of novel biological treatments, although the potential difficulties of targeting the developing bladder in vivo should not be underestimated.
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Affiliation(s)
- Neil A Roberts
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Royal Manchester Children's Hospital, Manchester, UK
| | - Emma N Hilton
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Royal Manchester Children's Hospital, Manchester, UK
| | - Adrian S Woolf
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Royal Manchester Children's Hospital, Manchester, UK
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Bulum B, Özçakar ZB, Duman D, Cengiz FB, Kavaz A, Burgu B, Baskın E, Çakar N, Soygür T, Ekim M, Tekin M, Yalçınkaya F. HPSE2 mutations in urofacial syndrome, non-neurogenic neurogenic bladder and lower urinary tract dysfunction. Nephron Clin Pract 2015; 130:54-8. [PMID: 25924634 DOI: 10.1159/000381465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Urofacial syndrome (UFS) is characterised by congenital bladder dysfunction accompanied by a characteristic abnormal grimace upon smiling and crying. In recent years, biallelic mutations of HPSE2 and LRIG2 have been reported in UFS patients. Non-neurogenic neurogenic bladder (NNNB) has a bladder identical to UFS without typical facial features. The aim of this study was to analyse HPSE2 mutations in patients with UFS and NNNB or severe lower urinary tract dysfunction (LUTD) without abnormal facial expression. METHODS Patients with UFS, NNNB and severe LUTD were enrolled in the study. We examined a total of 35 patients from 33 families. There were seven UFS patients from five different families, 21 patients with NNNB and seven with LUTD. HPSE2 gene mutation analysis was performed using the polymerase chain reaction protocol followed by Sanger sequencing in these patients. RESULTS A twin pair with UFS was found to be homozygous for c.457C>T (p.Arg153*) mutation. No other pathogenetic variant was detected. CONCLUSION HPSE2 mutations were found in one UFS family but not detected in patients with NNNB and severe LUTD. Considering the increasingly recognised cases of NNNB that were diagnosed in early childhood period, genetic factors appear to be responsible. Thus, further genetic studies are needed to discover novel associated gene variants in these bladder anomalies.
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Affiliation(s)
- Burcu Bulum
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Woolf AS, Stuart HM, Roberts NA, McKenzie EA, Hilton EN, Newman WG. Urofacial syndrome: a genetic and congenital disease of aberrant urinary bladder innervation. Pediatr Nephrol 2014; 29:513-8. [PMID: 23832138 DOI: 10.1007/s00467-013-2552-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 12/26/2022]
Abstract
The urofacial, or Ochoa, syndrome is characterised by congenital urinary bladder dysfunction together with an abnormal grimace upon smiling, laughing and crying. It can present as fetal megacystis. Postnatal features include urinary incontinence and incomplete bladder emptying due to simultaneous detrusor muscle and bladder outlet contractions. Vesicoureteric reflux is often present, and the condition can be complicated by urosepsis and end-stage renal disease. The syndrome has long been postulated to have neural basis, and it can be familial when it is inherited in an autosomal recessive manner. Most individuals with urofacial syndrome genetically studied to date carry biallelic, postulated functionally null mutations of HPSE2 or, less commonly, of LRIG2. Little is known about the biology of the respective encoded proteins, heparanase 2 and leucine-rich repeats and immunoglobulin-like domains 2. Nevertheless, the observations that heparanase 2 can bind heparan sulphate proteolgycans and inhibit heparanase 1 enzymatic activity and that LRIG2 can modulate receptor tyrosine kinase growth factor signalling each point to biological roles relevant to tissue differentiation. Moreover, both heparanase 2 and LRIG2 proteins are detected in autonomic nerves growing into fetal bladders. The collective evidence is consistent with the hypothesis that urofacial syndrome genes code for proteins which work in a common pathway to facilitate neural growth into, and/or function within, the bladder. This molecular pathway may also have relevance to our understanding of the pathogenesis of other lower tract diseases, including Hinman-Allen syndrome, or non-neurogenic neurogenic bladder, and of the subset of individuals who have primary vesicoureteric reflux accompanied by bladder dysfunction.
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Affiliation(s)
- Adrian S Woolf
- Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Michael Smith Building, Oxford Road, Manchester, M13 9PT, UK,
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Genetics of human congenital urinary bladder disease. Pediatr Nephrol 2014; 29:353-60. [PMID: 23584850 DOI: 10.1007/s00467-013-2472-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 01/23/2023]
Abstract
Lower urinary tract and/or kidney malformations are collectively the most common cause of end-stage renal disease in children, and they are also likely to account for a major subset of young adults requiring renal replacement therapy. Advances have been made regarding the discovery of the genetic causes of human kidney malformations. Indeed, testing for mutations of key nephrogenesis genes is now feasible for patients seen in nephrology clinics. Unfortunately, less is known about defined genetic bases of human lower urinary tract anomalies. The focus of this review is the genetic bases of congenital structural and functional disorders of the urinary bladder. Three are highlighted. First, prune belly syndrome, where mutations of CHRM3, encoding an acetylcholine receptor, HNF1B, encoding a transcription factor, and ACTA2, encoding a cytoskeletal protein, have been reported. Second, the urofacial syndrome, where mutations of LRIG2 and HPSE2, encoding proteins localised in nerves invading the fetal bladder, have been defined. Finally, we review emerging evidence that bladder exstrophy may have genetic bases, including variants in the TP63 promoter. These genetic discoveries provide a new perspective on a group of otherwise poorly understood diseases.
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Stuart H, Roberts N, Burgu B, Daly S, Urquhart J, Bhaskar S, Dickerson J, Mermerkaya M, Silay M, Lewis M, Olondriz M, Gener B, Beetz C, Varga R, Gülpınar Ö, Süer E, Soygür T, Özçakar Z, Yalçınkaya F, Kavaz A, Bulum B, Gücük A, Yue W, Erdogan F, Berry A, Hanley N, McKenzie E, Hilton E, Woolf A, Newman W. LRIG2 mutations cause urofacial syndrome. Am J Hum Genet 2013; 92:259-64. [PMID: 23313374 PMCID: PMC3567269 DOI: 10.1016/j.ajhg.2012.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/23/2012] [Accepted: 12/05/2012] [Indexed: 01/23/2023] Open
Abstract
Urofacial syndrome (UFS) (or Ochoa syndrome) is an autosomal-recessive disease characterized by congenital urinary bladder dysfunction, associated with a significant risk of kidney failure, and an abnormal facial expression upon smiling, laughing, and crying. We report that a subset of UFS-affected individuals have biallelic mutations in LRIG2, encoding leucine-rich repeats and immunoglobulin-like domains 2, a protein implicated in neural cell signaling and tumorigenesis. Importantly, we have demonstrated that rare variants in LRIG2 might be relevant to nonsyndromic bladder disease. We have previously shown that UFS is also caused by mutations in HPSE2, encoding heparanase-2. LRIG2 and heparanase-2 were immunodetected in nerve fascicles growing between muscle bundles within the human fetal bladder, directly implicating both molecules in neural development in the lower urinary tract.
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Affiliation(s)
- Helen M. Stuart
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Neil A. Roberts
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Berk Burgu
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Sarah B. Daly
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Jill E. Urquhart
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Sanjeev Bhaskar
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Jonathan E. Dickerson
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Murat Mermerkaya
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Mesrur Selcuk Silay
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Malcolm A. Lewis
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - M. Beatriz Orive Olondriz
- Unidad de Nefrología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz 01009, Spain
| | - Blanca Gener
- Servicio de Genética, Hospital Universitario Cruces, Baracaldo, Vizcaya 48903, Spain
| | - Christian Beetz
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena 07747, Germany
| | - Rita E. Varga
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena 07747, Germany
| | - Ömer Gülpınar
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Evren Süer
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Tarkan Soygür
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Zeynep B. Özçakar
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Fatoş Yalçınkaya
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Aslı Kavaz
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Burcu Bulum
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Adnan Gücük
- Department of Urology, Faculty of Medicine, Abant Izzet Baysal University, Bolu 14280, Turkey
| | - Wyatt W. Yue
- Structural Genomics Consortium, Old Road Campus Research Building, University of Oxford, Oxford OX3 7DQ, UK
| | - Firat Erdogan
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul 34718, Turkey
| | - Andrew Berry
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Neil A. Hanley
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Edward A. McKenzie
- Protein Expression Facility, Manchester Institute of Biotechnology, Faculty of Life Sciences, University of Manchester, Manchester M1 7DN, UK
| | - Emma N. Hilton
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Adrian S. Woolf
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - William G. Newman
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Banks FCL, Griffin SJ, Steinbrecher HA, Malone PS. Aetiology and treatment of symptomatic idiopathic urethral strictures in children. J Pediatr Urol 2009; 5:215-8; discussion 219-20. [PMID: 19230775 DOI: 10.1016/j.jpurol.2009.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/16/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the presentation and treatment outcomes on a series of 12 paediatric bulbar or posterior urethral strictures that were possibly congenital in origin, identified in a 9-year period. METHODS A retrospective case-note review of all cases of urethral strictures thought to be congenital in origin, prospectively collected into the departmental database. RESULTS The age at presentation had a bimodal distribution with 6/12 presenting in the first year of life of which four had antenatal hydronephrosis and 5/12 presenting after the age of 11 years. All six patients under 1-year old had a successful outcome following urethrotomy and urethral dilatation. Four of five over 11 years of age ultimately required an urethroplasty and one 3-year-old may well require an urethroplasty in the future. CONCLUSION This outcome, in conjunction with the bimodal age distribution at presentation, would suggest a different aetiology in older children, and we would urge caution in classifying strictures in ambulant children as genuinely congenital, as this population may represent the long-term manifestation of unrecorded bulbar urethral trauma or asymptomatic inflammation. Optical urethrotomy or dilatation is durable when treated in infancy, but older patients do not experience prolonged resolution and we would recommend treatment along adult lines for these.
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Affiliation(s)
- F C L Banks
- Department of Paediatric Urology, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK
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