1
|
Franquelim C, Romana A, Rachão A, Martins JS, Monteiro JP, Carvalho J. Early-Onset Dystonia and Visual Impairment Preceding Epileptic Encephalopathy Associated with PIGA Gene Mutation. Neuropediatrics 2024; 55:265-268. [PMID: 38181819 DOI: 10.1055/a-2239-1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
The association between dystonia and early-onset epileptic encephalopathy (EOEE) may have a genetic basis. Phosphatidylinositol glycan biosynthesis class A protein (PIGA) germline mutations have been described in the last decade and associated with refractory EOEEs. Dysmorphisms and visceral abnormalities have also been reported. Here, we present the case of a now 8-month-old child who was evaluated for dystonia, visual impairment, and developmental delay at 2 months of age, followed by refractory focal seizures when he was 4 months old. The remaining examination was normal, besides an accelerated linear growth. His brain magnetic resonance and an extensive metabolic investigation failed to show any abnormalities. At 7 months of age, the exome sequencing found a hemizygous PIGA pathogenic variant-c.1352T > C (p.(Ile451Thr). Seizures improved after the association of carbamazepine with levetiracetam and the beginning of the ketogenic diet. To our knowledge, this is the first time the phenotype associated with this specific mutation is described. Our patient had the singularity of manifesting with remarkable dystonia, over 2 months before the onset of seizures. We also point to the utility of the gene sequencing approach in the diagnosis of patients with dystonia and EOEEs, since identification of the genetic cause may help in patient's management and families' empowerment.
Collapse
Affiliation(s)
| | - Andreia Romana
- Department of Pediatrics, Hospital Garcia de Orta, Almada, Portugal
| | - Augusto Rachão
- Department of Neurology, Hospital Garcia de Orta, Almada, Portugal
| | | | - José Paulo Monteiro
- Department of Pediatrics, Centro de Desenvolvimento da Criança, Hospital Garcia de Orta, Almada, Portugal
| | - João Carvalho
- Department of Pediatrics, Centro de Desenvolvimento da Criança, Hospital Garcia de Orta, Almada, Portugal
| |
Collapse
|
2
|
Gabaldon-Albero A, Cordon L, Sempere A, Pedrola L, Martin-Grau C, Oltra S, Monfort S, Caro-Llopis A, Dominguez-Martinez M, Hernandez-Muela S, Rosello M, Orellana C, Martinez F. Multiple Congenital Anomalies-Hypotonia-Seizures Syndrome 2 Caused by a Novel PIGA Variant Not Associated with a Skewed X-Inactivation Pattern. Genes (Basel) 2024; 15:802. [PMID: 38927738 PMCID: PMC11203057 DOI: 10.3390/genes15060802] [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: 05/06/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Germline variants in the phosphatidylinositol glycan class A (PIGA) gene, which is involved in glycosylphosphatidylinositol (GPI) biosynthesis, cause multiple congenital anomalies-hypotonia-seizures syndrome 2 (MCAHS2) with X-linked recessive inheritance. The available literature has described a pattern of almost 100% X-chromosome inactivation in mothers carrying PIGA variants. Here, we report a male infant with MCAHS2 caused by a novel PIGA variant inherited from his mother, who has a non-skewed pattern of X inactivation. Phenotypic evidence supporting the pathogenicity of the variant was obtained by flow-cytometry tests. We propose that the assessment in neutrophils of the expression of GPI-anchored proteins (GPI-APs), especially CD16, should be considered in cases with variants of unknown significance with random X-inactivation in carrier mothers in order to clarify the pathogenic role of PIGA or other gene variants linked to the synthesis of GPI-APs.
Collapse
Affiliation(s)
- Alba Gabaldon-Albero
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Pediatric Neurology Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain;
| | - Lourdes Cordon
- Hematology Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.C.); (A.S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 20029 Madrid, Spain
| | - Amparo Sempere
- Hematology Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.C.); (A.S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, 20029 Madrid, Spain
- Hematology and Hemotherapy Service, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Laia Pedrola
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Carla Martin-Grau
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Silvestre Oltra
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Sandra Monfort
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Alfonso Caro-Llopis
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Marta Dominguez-Martinez
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Sara Hernandez-Muela
- Pediatric Neurology Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain;
| | - Monica Rosello
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Carmen Orellana
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| | - Francisco Martinez
- Translational Genetics Research Group, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (A.G.-A.); (L.P.); (C.M.-G.); (S.O.); (S.M.); (A.C.-L.); (M.D.-M.); (M.R.); (C.O.)
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
| |
Collapse
|
3
|
The correlation between multiple congenital anomalies hypotonia seizures syndrome 2 and PIGA: a case of novel PIGA germline variant and literature review. Mol Biol Rep 2022; 49:10469-10477. [DOI: 10.1007/s11033-022-07614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
|
4
|
Bayat A, Kløvgaard M, Johannesen KM, Barakat TS, Kievit A, Montomoli M, Parrini E, Pietrafusa N, Schelhaas J, van Slegtenhorst M, Miya K, Guerrini R, Tranebjærg L, Tümer Z, Rubboli G, Møller RS. Deciphering the premature mortality in PIGA-CDG - An untold story. Epilepsy Res 2020; 170:106530. [PMID: 33508693 DOI: 10.1016/j.eplepsyres.2020.106530] [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: 07/11/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Congenital disorder of glycosylation (CDG) due to a defective phosphatidylinositol glycan anchor biosynthesis class A protein (PIGA) is a severe X-linked developmental and epileptic encephalopathy. Seizures are often treatment refractory, and patients have intellectual disability and global developmental delay. Previous reports have suggested that patients with PIGA-CDG have a high risk of premature mortality. This study aimed to evaluate the observed high mortality and the causes of death in PIGA-CDG patients. METHODS We reviewed the literature and collected additional unpublished patients through an international network. RESULTS In total, we reviewed the data of 88 patients of whom 30 patients born alive were deceased, and the overall mortality before the age of 20 years was 30 % (26/88). Age at death ranged from 15 days to 48 years of life. The median age at death was two years and more than half of the patients deceased in early childhood. The PIGA-specific mortality rate/1000 person-years was 44.9/1000 person-years (95 %, CI 31.4-64.3). There were no cases of definite or probable sudden unexpected death in epilepsy (SUDEP) and half of the patients died due to respiratory failure (15/30, 50 %) or possible SUDEP (3/30, 10 %). Three patients (10 %) died from severe cardiomyopathy, liver failure and gastrointestinal bleeding, respectively. The cause of death was unclassified in nine patients (30 %). Autopsies were rarely performed and the true cause of death remains unknown for the majority of patients. SIGNIFICANCE Our data indicate an increased risk of premature death in patients with PIGA-CDG when compared to most monogenic developmental and epileptic encephalopathies.
Collapse
Affiliation(s)
- Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Department for Regional Health Services, University of Southern Denmark, Odense, Denmark.
| | - Marius Kløvgaard
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Department for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Anneke Kievit
- Department of Clinical Genetics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Martino Montomoli
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Elena Parrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Nicola Pietrafusa
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Jurgen Schelhaas
- Stichting Epilepsie Instellingen Nederland (SEIN), the Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Kazushi Miya
- Department of Educational Sciences (Human Development and Welfare Course), University of Toyama, Faculty of Human Development, Toyama, Japan
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lisbeth Tranebjærg
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Guido Rubboli
- Department for Regional Health Services, University of Southern Denmark, Odense, Denmark; Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Department for Regional Health Services, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Wu T, Yin F, Guang S, He F, Yang L, Peng J. The Glycosylphosphatidylinositol biosynthesis pathway in human diseases. Orphanet J Rare Dis 2020; 15:129. [PMID: 32466763 PMCID: PMC7254680 DOI: 10.1186/s13023-020-01401-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/06/2020] [Indexed: 01/15/2023] Open
Abstract
Glycosylphosphatidylinositol biosynthesis defects cause rare genetic disorders characterised by developmental delay/intellectual disability, seizures, dysmorphic features, and diverse congenital anomalies associated with a wide range of additional features (hypotonia, hearing loss, elevated alkaline phosphatase, and several other features). Glycosylphosphatidylinositol functions as an anchor to link cell membranes and protein. These proteins function as enzymes, adhesion molecules, complement regulators, or co-receptors in signal transduction pathways. Biallelic variants involved in the glycosylphosphatidylinositol anchored proteins biosynthetic pathway are responsible for a growing number of disorders, including multiple congenital anomalies-hypotonia-seizures syndrome; hyperphosphatasia with mental retardation syndrome/Mabry syndrome; coloboma, congenital heart disease, ichthyosiform dermatosis, mental retardation, and ear anomalies/epilepsy syndrome; and early infantile epileptic encephalopathy-55. This review focuses on the current understanding of Glycosylphosphatidylinositol biosynthesis defects and the associated genes to further understand its wide phenotype spectrum.
Collapse
Affiliation(s)
- Tenghui Wu
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Fei Yin
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Shiqi Guang
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Fang He
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Li Yang
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Jing Peng
- Department of Pediatrics, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
- Hunan Children's Mental Disorders Research Center, XiangYa Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
| |
Collapse
|
6
|
Bayat A, Knaus A, Pendziwiat M, Afenjar A, Barakat TS, Bosch F, Callewaert B, Calvas P, Ceulemans B, Chassaing N, Depienne C, Endziniene M, Ferreira CR, Moura de Souza CF, Freihuber C, Ganesan S, Gataullina S, Guerrini R, Guerrot A, Hansen L, Jezela‐Stanek A, Karsenty C, Kievit A, Kooy FR, Korff CM, Kragh Hansen J, Larsen M, Layet V, Lesca G, McBride KL, Meuwissen M, Mignot C, Montomoli M, Moore H, Naudion S, Nava C, Nougues M, Parrini E, Pastore M, Schelhaas JH, Skinner S, Szczałuba K, Thomas A, Thomassen M, Tranebjærg L, Slegtenhorst M, Wolfe LA, Lal D, Gardella E, Bomme Ousager L, Brünger T, Helbig I, Krawitz P, Møller RS. Lessons learned from 40 novel
PIGA
patients and a review of the literature. Epilepsia 2020; 61:1142-1155. [DOI: 10.1111/epi.16545] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Allan Bayat
- Institute for Regional Health Services University of Southern Denmark Odense Denmark
- Department of Epilepsy Genetics and Personalized Medicine Danish Epilepsy Center Dianalund Denmark
| | - Alexej Knaus
- Institute for Genomic Statistics and Bioinformatics University Hospital Bonn Rheinische Friedrich‐Wilhelms‐University Bonn Bonn Germany
| | - Manuela Pendziwiat
- Department of Neuropediatrics University Medical Center Schleswig‐Holstein Christian Albrechts University Kiel Germany
| | - Alexandra Afenjar
- CRMR Congenital Malformations and Diseases of the Cerebellum and Rare Causes of Intellectual Disabilities Department of Genetics Sorbonne University, AP‐HP, Trousseau Hospital Paris France
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics Erasmus MC, University Medical Center Rotterdam the Netherlands
| | | | - Bert Callewaert
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
- Department of Biomolecular Medicine Ghent University Ghent Belgium
| | - Patrick Calvas
- UMR1056 INSERM‐Université de Toulouse, Department of Genetics University Hospital of Toulouse Toulouse France
| | - Berten Ceulemans
- Department of Pediatric Neurology University Hospital and University of Antwerp Antwerp Belgium
| | - Nicolas Chassaing
- UMR1056 INSERM‐Université de Toulouse, Department of Genetics University Hospital of Toulouse Toulouse France
| | - Christel Depienne
- Institute of Human Genetics University Hospital Essen University of Duisburg‐Essen Essen Germany
- UMR S1127, Inserm U1127, CNRS UMR 7225 Institute of brain and spinal cord Sorbonne University Paris France
| | - Milda Endziniene
- Neurology Department Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Carlos R. Ferreira
- Medical Genomics and Metabolic Genetics Branch National Human Genome Research Institute, National Institutes of Health Bethesda MarylandUSA
| | | | - Cécile Freihuber
- Department of Pediatric Neurology AP‐HP, GHUEP Armand Trousseau University Hospital Paris France
- GRC ConCer‐LD Sorbonne University, UPMC University of Paris 06 Paris France
| | - Shiva Ganesan
- Division of Neurology Children’s Hospital of Philadelphia Philadelphia PennsylvaniaUSA
- Epilepsy NeuroGenetics Initiative Children's Hospital of Philadelphia Philadelphia PennsylvaniaUSA
- Department of Biomedical and Health Informatics Children’s Hospital of Philadelphia Philadelphia PennsylvaniaUSA
| | - Svetlana Gataullina
- Sleep Disorders Center AP‐HP, Antoine‐Béclère Hospital Clamart France
- Department of Pediatrics and Neonatal Intensive Care André Grégoire Hospital Montreuil France
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories Department of Neuroscience, A. Meyer Children's Hospital University of Florence Florence Italy
| | - Anne‐Marie Guerrot
- Department of Genetics and Reference Center for Developmental Disorders Normandy Center for Genomic and Personalized Medicine Normandy University, UNIROUEN Inserm U1245 and Rouen University Hospital Rouen France
| | - Lars Hansen
- Department of Cellular and Molecular Medicine Faculty of Health Science Copenhagen Center for Glycomics Copenhagen Denmark
| | - Aleksandra Jezela‐Stanek
- Department of Genetics and Clinical Immunology National Institute of Tuberculosis and Lung Diseases Warsaw Poland
| | - Caroline Karsenty
- Neuropediatrics Department University Hospital of Toulouse Toulouse France
| | - Anneke Kievit
- Department of Clinical Genetics Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Frank R. Kooy
- Department of Medical Genetics University of Antwerp Antwerp Belgium
| | - Christian M. Korff
- Pediatric Neurology Unit Department of the Woman, Child, and Adolescent University Hospitals Geneva Geneva Switzerland
| | | | - Martin Larsen
- Department of Clinical Genetics Odense University Hospital Odense Denmark
- Human Genetics Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Valérie Layet
- Department of Genetics Du Havre Hospital Le Havre France
| | - Gaetan Lesca
- Department of Medical Genetics Lyon University Hospital Lyon France
- Institut Neuromyogene University Claude Bernard Lyon 1, Lyon University Lyon France
| | - Kim L. McBride
- Division of Genetic and Genomic Medicine Nationwide Children's Hospital Columbus OhioUSA
- Center for Cardiovascular Research Nationwide Children's Hospital Columbus OhioUSA
- Department of Pediatrics Ohio State University Columbus OhioUSA
| | - Marije Meuwissen
- Department of Medical Genetics University of Antwerp Antwerp Belgium
| | - Cyril Mignot
- APHP Department of Genetics Pitié‐Salpêtrière Hospital Reference Center for Rare Causes of Intellectual Disabilities Paris France
- Department of Genetics Inserm U1127, CNRS UMR 7225 Institute for brain and spinal cord ICM, AP‐HP De la Pitié Salpêtrière Hospital, Sorbonne University Paris France
| | - Martino Montomoli
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories Department of Neuroscience, A. Meyer Children's Hospital University of Florence Florence Italy
| | - Hannah Moore
- Greenwood Genetic Center Greenwood South CarolinaUSA
| | - Sophie Naudion
- Department of Genetics, University of Bordeaux Bordeaux France
| | - Caroline Nava
- Department of Genetics Inserm U1127, CNRS UMR 7225 Institute for brain and spinal cord ICM, AP‐HP De la Pitié Salpêtrière Hospital, Sorbonne University Paris France
| | | | - Elena Parrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories Department of Neuroscience, A. Meyer Children's Hospital University of Florence Florence Italy
| | - Matthew Pastore
- Division of Genetic and Genomic Medicine Nationwide Children's Hospital Columbus OhioUSA
- Department of Pediatrics Ohio State University Columbus OhioUSA
| | | | | | | | - Ashley Thomas
- Department of Neurology University of Alabama at Birmingham Birmingham AlabamaUSA
| | - Mads Thomassen
- Department of Clinical Genetics Odense University Hospital Odense Denmark
- Human Genetics Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Lisbeth Tranebjærg
- Department of Clinical Genetics Rigshospitalet/Kennedy Center Glostrup Denmark
- Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Marjon Slegtenhorst
- Department of Clinical Genetics Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Lynne A. Wolfe
- Undiagnosed Diseases Program, Common Fund National Institutes of Health Bethesda MarylandUSA
- Section of Human Biochemical Genetics National Human Genome Research Institute Bethesda MarylandUSA
| | - Dennis Lal
- Cologne Center for Genomics University Hospital Cologne, University of Cologne Cologne Germany
- Stanley Center for Psychiatric Research Broad Institute of Massachusetts Institute of Technology and Harvard Cambridge MassachusettsUSA
- Analytic and Translational Genetics Unit Massachusetts General Hospital Boston MassachusettsUSA
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OhioUSA
- Genomic Medicine Institute Lerner Research Institute Cleveland Clinic Cleveland OhioUSA
| | - Elena Gardella
- Institute for Regional Health Services University of Southern Denmark Odense Denmark
- Department of Epilepsy Genetics and Personalized Medicine Danish Epilepsy Center Dianalund Denmark
- Department of Clinical Neurophysiology Danish Epilepsy Center Dianalund Denmark
| | - Lilian Bomme Ousager
- Department of Clinical Genetics Odense University Hospital Odense Denmark
- Human Genetics Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Tobias Brünger
- Cologne Center for Genomics University Hospital Cologne, University of Cologne Cologne Germany
| | - Ingo Helbig
- Department of Neuropediatrics University Medical Center Schleswig‐Holstein Christian Albrechts University Kiel Germany
- Division of Neurology Children’s Hospital of Philadelphia Philadelphia PennsylvaniaUSA
- Epilepsy NeuroGenetics Initiative Children's Hospital of Philadelphia Philadelphia PennsylvaniaUSA
- Department of Biomedical and Health Informatics Children’s Hospital of Philadelphia Philadelphia PennsylvaniaUSA
- Department of Neurology University of Pennsylvania, Perelman School of Medicine Philadelphia PennsylvaniaUSA
| | - Peter Krawitz
- Institute for Genomic Statistics and Bioinformatics University Hospital Bonn Rheinische Friedrich‐Wilhelms‐University Bonn Bonn Germany
| | - Rikke S. Møller
- Institute for Regional Health Services University of Southern Denmark Odense Denmark
- Department of Epilepsy Genetics and Personalized Medicine Danish Epilepsy Center Dianalund Denmark
| |
Collapse
|
7
|
Analyzing clinical and genetic characteristics of a cohort with multiple congenital anomalies-hypotonia-seizures syndrome (MCAHS). Orphanet J Rare Dis 2020; 15:78. [PMID: 32220244 PMCID: PMC7099766 DOI: 10.1186/s13023-020-01365-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/18/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To summarize and extend the phenotypic characterization of Multiple Congenital Anomalies-Hypotonia-Seizures Syndrome, and to discuss genotype-phenotype correlations. Methods Collecting clinical information of 17 patients with pathogenic variants in PIGN, PIGA, and PIGT. Genetic studies were performed on all patients. Results There were 7 patients with 15 PIGN mutations (one patient carrying 3 mutations), 8 patients with 8 PIGA mutations, and 2 patients with 5 PIGT mutations (one patient carrying 3 mutations). All patients had epilepsy and developmental delay, with 71% of them showed hypotonia. And among these patients’ various seizure types, the focal seizure was the most common one. Eighty-two percent patients showed a significant relationship between seizures and fever. Serum ALP was elevated in one patient with PIGN mutations and in two patients with PIGA mutations. Brain MRI showed enlarged subarachnoid space in 56% of patients. Some other different characteristics had also been found in our patients: First, atypical absence seizures presented in three patients with PIGN mutations; Second, diffuse slow waves mixed with focal or multifocal discharges of interictal EEG in 88% cases with PIGA-deficient; Third, phenotypes of seven out of eight patients with PIGA mutations were difficult to be classified as severe or less severe group; Last, mild neurological symptoms and developmental status rather than severe conditions occurred in one patient with PIGT mutations. Conclusion With epilepsy, developmental delay, and/or hypotonia as common features, the knowledge of MCAHS in terms of phenotype and genotype has been expanded. In cases with PIGN-deficient, we expanded the types of atypical absence seizures, and described one patient with elevated serum ALP. Focal seizures with diffuse slow waves mixed with focal or multifocal discharges on EEG rather than infantile spasms with hypsarrhythmia, which as previously reported were often seen in our patients with PIGA mutations. The classifications of phenotypes caused by PIGA mutations should be more continuous than discrete. The mild phenotype of one patient with PIGT mutations expanded the clinical presentation of MCAHS3.
Collapse
|
8
|
Neuhofer CM, Funke R, Wilken B, Knaus A, Altmüller J, Nürnberg P, Li Y, Wollnik B, Burfeind P, Pauli S. A Novel Mutation in PIGA Associated with Multiple Congenital Anomalies-Hypotonia-Seizure Syndrome 2 (MCAHS2) in a Boy with a Combination of Severe Epilepsy and Gingival Hyperplasia. Mol Syndromol 2020; 11:30-37. [PMID: 32256299 DOI: 10.1159/000505797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 01/25/2023] Open
Abstract
Multiple congenital anomalies-hypotonia-seizures syndrome 2 (MCAHS2) is a rare disease caused by mutations in the X chromosomal PIGA gene. Clinically it is characterized by early-onset epilepsy, hypotonia, dysmorphic features, and variable congenital anomalies. PIGA codes for the phosphatidylinositol glycan-class A protein, which forms a subunit of an enzymatic complex involved in glycophosphatidylinositol (GPI) biosynthesis. We present a new case of MCAHS2 and perform a comprehensive review of the available literature to delineate the phenotypical traits associated with germline PIGA mutations. Furthermore, we provide functional evidence of pathogenicity of the novel missense mutation, c.154C>T; (p.His52Tyr), in the PIGA gene causative of MCAHS2 in our patient. By flow cytometry, we observed reduced expression of GPI-anchored surface proteins in patient granulocytes compared to control samples, proving GPI-biogenesis impairment. The patient's severe epilepsy with several daily attacks was refractory to treatment, but the frequency of seizures reduced temporarily under triple therapy with perampanel, rufinamide and vigabatrin. Our study delineates the known MCAHS2 phenotype and discusses challenges of diagnosis and clinical management in this complex, rare disease. Furthermore, we present a novel mutation with functional evidence of pathogenicity.
Collapse
Affiliation(s)
- Christiane M Neuhofer
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Rudolf Funke
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Alexej Knaus
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Köln, Köln, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Köln, Köln, Germany
| | - Yun Li
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Burfeind
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Pauli
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
9
|
PIGA related disorder as a range of phenotypes rather than two distinct subtypes. Brain Dev 2020; 42:205-210. [PMID: 31704190 DOI: 10.1016/j.braindev.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/21/2022]
Abstract
Patients with germline phosphatidylinositol glycan biosynthesis class A (PIGA) related disorder have historically been categorized into one of two distinct subtypes: a severe form which is often fatal, and a less severe form. However, the increasing number of cases with features indicative of both subtypes raise the possibility of a phenotypic spectrum associated with PIGA disorder. In order to further characterize this phenotypic spectrum, we present two patients with features of both the severe and less severe subtypes with a review of phenotypes reported to date in the literature. In eight year old patient 1, a maternally inherited PIGA likely pathogenic variant was discovered using exome sequencing. He presented with myoclonic epilepsy, mild intellectual disability, spastic diplegia, developmental motor delay, and autism spectrum disorder. Patient 2 is a 13 year old with focal epilepsy, profound developmental delay, coarse facial features, severe intellectual disability and autism spectrum disorder. A de novo PIGA likely pathogenic variant was found through exome sequencing. Both patients had normal alkaline phosphatase levels and are without related organ abnormalities. We conclude that pathogenic PIGA variants cause a spectrum of phenotypes rather than the categories of "severe" and "less severe" as previously posited.
Collapse
|