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Percetti M, Zini M, Soliveri P, Cogiamanian F, Ferrara M, Orunesu E, Ranghetti A, Ferrarese C, Pezzoli G, Garavaglia B, Isaias IU, Sacilotto G. The Clinical Spectrum of ANO3-Report of a New Family and Literature Review. Mov Disord Clin Pract 2024; 11:289-297. [PMID: 38284143 DOI: 10.1002/mdc3.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Mutations in ANO3 are a rare cause of autosomal dominant isolated or combined dystonia, mainly presenting in adulthood. CASES We extensively characterize a new, large ANO3 family with six affected carriers. The proband is a young girl who had suffered from tremor and painful dystonic movements in her right arm since the age of 11 years. She later developed a diffuse dystonic tremor and mild extrapyramidal signs (ie, rigidity and hypodiadochokinesis) in her right arm. She also suffered from psychomotor delay and learning difficulties. Repeated structural and functional neuroimaging were unremarkable. A dystonic tremor was also present in her two sisters. Her paternal aunt, father, and a third older sister presented episodic postural tremor in the arms. The father and one sister also presented learning difficulties. The heterozygous p.G6V variant in ANO3 was identified in all affected subjects. LITERATURE REVIEW Stratification by age at onset divided ANO3 cases into two major groups, where younger patients displayed a more severe phenotype, probably due to variants near the scrambling domain. CONCLUSIONS We describe the phenotype of a new ANO3 family and highlight the need for functional studies to explore the impact of ANO3 variants on its phospholipid scrambling activity.
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Affiliation(s)
- Marco Percetti
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy
- Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Michela Zini
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
| | | | - Filippo Cogiamanian
- Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarosa Ferrara
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Orunesu
- Nuclear Medicine Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy
- Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit, National Neurological Institute Carlo Besta, Milan, Italy
| | - Ioannis Ugo Isaias
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- University Hospital of Würzburg, Würzburg, Germany
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Morales-Briceno H, Fung VSC, Bhatia KP, Balint B. Parkinsonism and dystonia: Clinical spectrum and diagnostic clues. J Neurol Sci 2021; 433:120016. [PMID: 34642024 DOI: 10.1016/j.jns.2021.120016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/20/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The links between the two archetypical basal ganglia disorders, dystonia and parkinsonism, are manifold and stem from clinical observations, imaging studies, animal models and genetics. The combination of both, i.e. the syndrome of dystonia-parkinsonism, is not uncommonly seen in movement disorders clinics and has a myriad of different underlying aetiologies, upon which treatment and prognosis depend. Based on a comprehensive literature review, we delineate the clinical spectrum of disorders presenting with dystonia-parkinsonism. The clinical approach depends primarily on the age at onset, associated neurological or systemic symptoms and neuroimaging. The tempo of disease progression, and the response to L-dopa are further important clues to tailor diagnostic approaches that may encompass dopamine transporter imaging, CSF analysis and, last but not least, genetic testing. Later in life, sporadic neurodegenerative conditions are the most frequent cause, but the younger the patient, the more likely the cause is unravelled by the recent advances of molecular genetics that are focus of this review. Here, knowledge of the associated phenotypic spectrum is key to guide genetic testing and interpretation of test results. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Hugo Morales-Briceno
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Victor S C Fung
- Neurology Department, Movement Disorders Unit, Westmead Hospital, NSW, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London WC1N 3BG, United Kingdom
| | - Bettina Balint
- Department of Neurology, University Hospital Heidelberg, Germany.
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Carvalho V, Martins J, Correia F, Costa M, Massano J, Temudo T. Another Twist in the Tale: Intrafamilial Phenotypic Heterogeneity in ANO3-Related Dystonia. Mov Disord Clin Pract 2021; 8:758-762. [PMID: 34307749 DOI: 10.1002/mdc3.13209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 11/08/2022] Open
Abstract
Background Mutations in the anoctamin 3 (ANO3) gene cause autosomal dominant craniocervical dystonia (DYT24), presenting from childhood to mid-life. However, in the past years, the clinical spectrum of this disorder has widened. We present a family with heterogeneous presentation, exemplifying phenotypic diversity in DYT24. Cases The index case presented with myoclonic dystonia at age 10. His family history was remarkable for cervical dystonia with myoclonus in his grandfather, cervical and upper limb dystonia along with dopa-responsive parkinsonism in his father and lower-limb dystonia in his teenage sister. Magnetic resonance imaging and blood work-ups of all the affected family members were normal. The genetic panel for inherited forms of dystonia disclosed a point mutation c.1787C > A (p.Ser596Tyr) segregated in all affected family members. Conclusions ANO3 mutations usually present with craniocervical dystonia and rarely generalized or leg dystonia. This family exemplifies the heterogeneous presentation of this disorder as well as a wide phenotypic variability within the same family.
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Affiliation(s)
- Vanessa Carvalho
- Department of Neurology Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos Matosinhos Portugal
| | - Joana Martins
- Department of Neuropediatrics, Centro Materno-Infantil do Norte Centro Hospitalar Universitário do Porto Porto Portugal
| | - Filipe Correia
- Department of Neurology Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos Matosinhos Portugal
| | - Manuela Costa
- Department of Neurology Hospital das Forças Armadas Porto Portugal
| | - João Massano
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal.,Department of Clinical Neurosciences and Mental Health Faculty of Medicine University of Porto Porto Portugal
| | - Teresa Temudo
- Department of Neuropediatrics, Centro Materno-Infantil do Norte Centro Hospitalar Universitário do Porto Porto Portugal.,Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal
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Keller Sarmiento IJ, Mencacci NE. Genetic Dystonias: Update on Classification and New Genetic Discoveries. Curr Neurol Neurosci Rep 2021; 21:8. [PMID: 33564903 DOI: 10.1007/s11910-021-01095-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Since the advent of next-generation sequencing, the number of genes associated with dystonia has been growing exponentially. We provide here a comprehensive review of the latest genetic discoveries in the field of dystonia and discuss how the growing knowledge of biology underlying monogenic dystonias may influence and challenge current classification systems. RECENT FINDINGS Pathogenic variants in genes without previously confirmed roles in human disease have been identified in subjects affected by isolated or combined dystonia (KMT2B, VPS16, HPCA, KCTD17, DNAJC12, SLC18A2) and complex dystonia (SQSTM1, IRF2BPL, YY1, VPS41). Importantly, the classical distinction between isolated and combined dystonias has become harder to sustain since many genes have been shown to determine multiple dystonic presentations (e.g., ANO3, GNAL, ADCY5, and ATP1A3). In addition, a growing number of genes initially linked to other neurological phenotypes, such as developmental delay, epilepsy, or ataxia, are now recognized to cause prominent dystonia, occasionally in an isolated fashion (e.g., GNAO1, GNB1, SCN8A, RHOBTB2, and COQ8A). Finally, emerging analyses suggest biological convergence of genes linked to different dystonic phenotypes. While our knowledge on the genetic basis of monogenic dystonias has tremendously grown, their clinical boundaries are becoming increasingly blurry. The current phenotype-based classification may not reflect the molecular structure of the disease, urging the need for new systems based on shared biological pathways among dystonia-linked genes.
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Affiliation(s)
| | - Niccolò Emanuele Mencacci
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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The expanding clinical and genetic spectrum of ANO3 dystonia. Neurosci Lett 2020; 746:135590. [PMID: 33388357 DOI: 10.1016/j.neulet.2020.135590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Dystonia is a movement disorder with high clinical and genetic heterogeneity. Mutations in Anoctamin-3 (ANO3) gene have been reported to cause dystonia 24 (DYT24). This study aims to clarify the spectrum and frequency of ANO3 rare variants in Chinese populations with primary dystonia and understand the clinical and genetic features of DYT24. METHODS Sanger sequencing was used to screen all exons and exon-intron boundaries of ANO3 for rare variants in 115 primary dystonia patients. The clinical manifestations of patients with ANO3 variants in our study and previously reported literatures were further characterized. RESULTS Four distinct variants of ANO3 (c.1127A > G, c.1235 T > A, c.1531-3T > C, c.-11G > T) were identified in six unrelated individuals. Combined with our work and literature review, a total of 35 different rare variants distributed in ANO3 were identified in 62 dystonia patients. The predominant phenotype is cranio-cervical dystonia and more than half of patients develop head/limb tremor. Most of patients presented with isolated dystonia whereas few of them showed combined dystonia. The age of onset ranged from 1 to 69 years and peaked in late adulthood, while for generalized dystonia it peaked in a young age. Half of patients with generalized dystonia experienced deep brain stimulation (DBS). And all of them showed improvement of dystonia by DBS. CONCLUSIONS This study confirms a relatively high frequency of rare ANO3 variants in Chinese patients with dystonia and indicates that the late adulthood-onset, cranio-cervical dystonia seems to be an important feature of the ANO3 phenotype. Further functional studies are warranted to understand the role of ANO3 in dystonia.
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Domingo A, Yadav R, Ozelius LJ. Isolated dystonia: clinical and genetic updates. J Neural Transm (Vienna) 2020; 128:405-416. [PMID: 33247415 DOI: 10.1007/s00702-020-02268-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Four genes associated with isolated dystonia are currently well replicated and validated. DYT-THAP1 manifests as young-onset generalized dystonia with predominant craniocervical symptoms; and is associated with mostly deleterious missense variation in the THAP1 gene. De novo and inherited missense and protein truncating variation in GNAL as well as primarily missense variation in ANO3 cause isolated focal and/or segmental dystonia with preference for the upper half of the body and older ages at onset. The GAG deletion in TOR1A is associated with generalized dystonia with onset in childhood in the lower limbs. Rare variation in these genes causes monogenic sporadic and inherited forms of isolated dystonia; common variation may confer risk and imply that dystonia is a polygenic trait in a subset of cases. Although candidate gene screens have been successful in the past in detecting gene-disease associations, recent application of whole-genome and whole-exome sequencing methods enable unbiased capture of all genetic variation that may explain the phenotype. However, careful variant-level evaluation is necessary in every case, even in genes that have previously been associated with disease. We review the genetic architecture and phenotype of DYT-THAP1, DYT-GNAL, DYT-ANO3, and DYT-TOR1A by collecting case reports from the literature and performing variant classification using pathogenicity criteria.
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Affiliation(s)
- Aloysius Domingo
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.,Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Rachita Yadav
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.,Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA. .,Collaborative Center for X-linked Dystonia-Parkinsonism, Massachusetts General Hospital, Charlestown, MA, 02129, USA.
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Successful Pallidal Deep Brain Stimulation Treatment in a Case of Generalized Dystonia due to a Novel ANO3 Mutation. Case Rep Neurol Med 2019; 2019:3154653. [PMID: 31871801 PMCID: PMC6906865 DOI: 10.1155/2019/3154653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/03/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Dystonia is a ubiquitous syndrome, with a growing number of genes being continually identified. Mutations in the anoctamin-3 gene have been described to cause dystonia but the management and long-term outcomes are still largely unknown. Methods We present here a long term, longitudinal follow up of a patient with generalized dystonia, who was treated with bilateral pallidal deep brain stimulation and was found to harbor a mutation in the anoctamin-3 gene. Results Ongoing adjustment of stimulation settings and medications led to good and sustained dystonia control; however the patient did suffer short term relapses, manifested as dystonic crisis, which necessitated inpatient admission. Conclusion This only the second patient to be reported with pallidal stimulation and an anoctamin-3 gene mutation. Long term outcomes seem to be favorable but larger case series are needed to confirm our findings.
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Mulroy E, Latorre A, Bhatia KP. Parkinsonism in essential tremor cases: A clinicopathological study—were they really essential tremor? Mov Disord 2019; 34:1749. [DOI: 10.1002/mds.27835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences University College London Queen Square Institute of Neurology London UK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences University College London Queen Square Institute of Neurology London UK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences University College London Queen Square Institute of Neurology London UK
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Jinnah H, Sun YV. Dystonia genes and their biological pathways. Neurobiol Dis 2019; 129:159-168. [DOI: 10.1016/j.nbd.2019.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/05/2019] [Accepted: 05/17/2019] [Indexed: 12/27/2022] Open
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Delamarre A, Chelly J, Guehl D, Drouot N, Tranchant C, Anheim M, Burbaud P. Novel anoctamin-3 missense mutation responsible for early-onset myoclonic dystonia. Parkinsonism Relat Disord 2019; 64:346-348. [DOI: 10.1016/j.parkreldis.2019.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
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