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Güvenoğlu M, Şimşek-Kiper PÖ, Koşukcu C, Taskiran EZ, Saltık-Temizel İN, Gucer S, Utine E, Boduroğlu K. Homozygous Missense Epithelial Cell Adhesion Molecule Variant in a Patient with Congenital Tufting Enteropathy and Literature Review. Pediatr Gastroenterol Hepatol Nutr 2022; 25:441-452. [PMID: 36451688 PMCID: PMC9679307 DOI: 10.5223/pghn.2022.25.6.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Congenital diarrheal disorders (CDDs) with genetic etiology are uncommon hereditary intestinal diseases characterized by chronic, life-threatening, intractable watery diarrhea that starts in infancy. CDDs can be mechanistically divided into osmotic and secretory diarrhea. Congenital tufting enteropathy (CTE), also known as intestinal epithelial dysplasia, is a type of secretory CDD. CTE is a rare autosomal recessive enteropathy that presents with intractable neonatal-onset diarrhea, intestinal failure, severe malnutrition, and parenteral nutrition dependence. Villous atrophy of the intestinal epithelium, crypt hyperplasia, and irregularity of surface enterocytes are the specific pathological findings of CTE. The small intestine and occasionally the colonic mucosa include focal epithelial tufts. In 2008, Sivagnanam et al. discovered that mutations in the epithelial cell adhesion molecule (EpCAM, MIM# 185535) were the genetic cause of CTE (MIM# 613217). More than a hundred mutations have been reported to date. Furthermore, mutations in the serine peptidase inhibitor Kunitz type 2 (SPINT2, MIM# 605124) have been linked to syndromic CTE. In this study, we report the case of a 17-month-old male infant with congenital diarrhea. Despite extensive etiological workup, no etiology could be established before admission to our center. The patient died 15 hours after being admitted to our center in a metabolically decompensated state, probably due to a delay in admission and diagnosis. Molecular autopsy with exome sequencing revealed a previously reported homozygous missense variant, c.757G>A, in EpCAM, which was confirmed by histopathological examination.
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Affiliation(s)
- Merve Güvenoğlu
- Department of Pediatric Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Can Koşukcu
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ekim Z Taskiran
- Department of Medical Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Safak Gucer
- Division of Pediatric Pathology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Eda Utine
- Department of Pediatric Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroğlu
- Department of Pediatric Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zhao R, Yang F, Chen X, Fu H, Li G, Cheng L, Li X. A novel compound-heterozygous EPCAM mutation in congenital tufting enteropathy. Arch Med Sci 2022; 18:1700-1704. [PMID: 36457962 PMCID: PMC9710291 DOI: 10.5114/aoms/155185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ruiqin Zhao
- Department of Gastroenterology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Fan Yang
- International Liaison Office, Hebei Children’s Hospital, Shijiazhuang, China
| | - Xinggu Chen
- Graduate student of Hebei Medical University, Shijiazhuang, China
| | - Haiyan Fu
- Department of Gastroenterology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Guigui Li
- Department of Gastroenterology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Lijuan Cheng
- Department of Gastroenterology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Xiaolei Li
- Department of Gastroenterology, Hebei Children’s Hospital, Shijiazhuang, China
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Tufting Enteropathy: A Review of Clinical and Histological Presentation, Etiology, Management, and Outcome. Gastroenterol Res Pract 2020; 2020:5608069. [PMID: 33029133 PMCID: PMC7530495 DOI: 10.1155/2020/5608069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
Congenital tufting enteropathy (CTE), also named intestinal epithelial dysplasia, is a rare, autosomal recessive enteropathy with persistent and life-threatening intractable diarrhea early in life. Intractable diarrhea is present independent of breast or formula feeding. Most CTE patients require total parenteral nutrition (TPN), and in severe cases, small bowel transplantation is needed. In the last decade, we have seen remarkable progress in certain aspects, such as the pathogenesis and diagnostic methods of the disease. Rapidly developing molecular analysis techniques have improved the diagnostic methods for CTE and reduced invasive and expensive procedures. Mutations in the gene encoding human epithelial cell adhesion molecule (EpCAM) were identified in the typical form of CTE, which usually exhibits isolated refractory diarrhea. Moreover, the syndromic form of CTE features anal and choanal atresias as well as ophthalmologic signs, which are associated with mutations in the gene encoding Serine Peptidase Inhibitor Kunitz Type 2 (SPINT2). This article reviews CTE disease based on its clinical and histological presentation, etiology and pathogenesis, and management and outcome.
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Hassan K, Sher G, Hamid E, Hazima KA, Abdelrahman H, Al Mudahka F, Al-Masri W, Sankar J, Daryaee M, Shawish R, Khan MA, Nawaz Z. Outcome associated with EPCAM founder mutation c.499dup in Qatar. Eur J Med Genet 2020; 63:104023. [PMID: 32735948 DOI: 10.1016/j.ejmg.2020.104023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 01/16/2023]
Abstract
Tufting enteropathy (TE) is a rare autosomal recessive congenital enteropathy that usually requires long-term parenteral nutrition (PN). In the Arabic Peninsula, four distinct EPCAM mutations have been identified to cause TE. As consanguineous marriages are socially favored, pre-marital and pre-conception testing has become a critical disease prevention strategy. This study aimed to identify the pathogenic EPCAM mutations causing TE in Qatari families and determine possible genotype-phenotype correlations. Twenty-two TE patients from seven multiplex families with TE were identified. Blood samples were collected from patients and first-degree relatives. Exons of the gene were amplified and sequenced. Retrospective chart review and/or family interviews were conducted to determine phenotypic characteristics of the disease. Sequence analysis revealed a single, previously described c.499dup mutation in exon 5 of all families tested, suggesting a founder effect. Of the 18 patients whose full clinical information was available, three patients (17%) were off PN with a good quality of life, without intestinal transplantation, and one (6%) was receiving partial PN. Our patients with TE were severely stunted compared to a similar group of patients receiving long-term PN for short bowel syndrome, suggesting that this could possibly be due to TE rather than secondary to inadequate nutrition. Our study identified the EPCAM mutation c.499dup as the genetic defect causing TE in all the participant Qatari families. This finding should facilitate early diagnosis of TE and genetic counseling. Furthermore, it should aid in the prevention of TE through pre-marital screening, antenatal diagnosis, and pre-implantation genetic diagnosis.
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Affiliation(s)
- Kamal Hassan
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar.
| | - Gulab Sher
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, 3050, Qatar
| | - Eman Hamid
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Khalid Abou Hazima
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar
| | - Hatim Abdelrahman
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar
| | - Fatma Al Mudahka
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar
| | - Wesam Al-Masri
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar
| | - Jisha Sankar
- Pediatric Gastroenterology Section, Hamad General Hospital, P.O. Box 3050, Doha, Qatar; Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar
| | - Mahlah Daryaee
- Patient & Family Department, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Rana Shawish
- Pediatric Gastroenterology Section, Sidra Medicine, P.O. Box 269999, Doha, Qatar; Patient & Family Department, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Muzammil Ahmad Khan
- Diagnostic Genomic Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, 3050, Qatar; Gomal Centre of Biochemistry and Biotechnology, Gomal University Dera Ismail Khan, Khyber-Pakhtoonkhwa, 29050, Pakistan
| | - Zafar Nawaz
- Diagnostic Genomic Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, 3050, Qatar
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Pathak SJ, Mueller JL, Okamoto K, Das B, Hertecant J, Greenhalgh L, Cole T, Pinsk V, Yerushalmi B, Gurkan OE, Yourshaw M, Hernandez E, Oesterreicher S, Naik S, Sanderson IR, Axelsson I, Agardh D, Boland CR, Martin MG, Putnam CD, Sivagnanam M. EPCAM mutation update: Variants associated with congenital tufting enteropathy and Lynch syndrome. Hum Mutat 2018; 40:142-161. [PMID: 30461124 PMCID: PMC6328345 DOI: 10.1002/humu.23688] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/24/2018] [Accepted: 11/14/2018] [Indexed: 12/30/2022]
Abstract
The epithelial cell adhesion molecule gene (EPCAM, previously known as TACSTD1 or TROP1) encodes a membrane‐bound protein that is localized to the basolateral membrane of epithelial cells and is overexpressed in some tumors. Biallelic mutations in EPCAM cause congenital tufting enteropathy (CTE), which is a rare chronic diarrheal disorder presenting in infancy. Monoallelic deletions of the 3′ end of EPCAM that silence the downstream gene, MSH2, cause a form of Lynch syndrome, which is a cancer predisposition syndrome associated with loss of DNA mismatch repair. Here, we report 13 novel EPCAM mutations from 17 CTE patients from two separate centers, review EPCAM mutations associated with CTE and Lynch syndrome, and structurally model pathogenic missense mutations. Statistical analyses indicate that the c.499dupC (previously reported as c.498insC) frameshift mutation was associated with more severe treatment regimens and greater mortality in CTE, whereas the c.556‐14A>G and c.491+1G>A splice site mutations were not correlated with treatments or outcomes significantly different than random simulation. These findings suggest that genotype–phenotype correlations may be useful in contributing to management decisions of CTE patients. Depending on the type and nature of EPCAM mutation, one of two unrelated diseases may occur, CTE or Lynch syndrome.
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Affiliation(s)
- Sagar J Pathak
- Department of Pediatrics, University of California, San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - James L Mueller
- Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Kevin Okamoto
- Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Barun Das
- Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Jozef Hertecant
- Genetics/Metabolics Service, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Trevor Cole
- West Midlands Regional Genetics Service and Birmingham Health Partners, Birmingham Women's Hospital, Birmingham, UK
| | - Vered Pinsk
- Division of Pediatrics, Pediatric Gastroenterology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Baruch Yerushalmi
- Division of Pediatrics, Pediatric Gastroenterology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Odul E Gurkan
- Department of Pediatrics, Gazi University School of Medicine, Ankara, Turkey
| | - Michael Yourshaw
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, California
| | - Erick Hernandez
- Pediatric Gastroenterology, Miami Children's Health System, Miami, Florida
| | | | - Sandhia Naik
- Paediatric Gastroenterology, Barts and the London School of Medicine, London, UK
| | - Ian R Sanderson
- Paediatric Gastroenterology, Barts and the London School of Medicine, London, UK
| | - Irene Axelsson
- Department of Pediatrics, Skane University Hospital, Malmo, Sweden
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
| | - C Richard Boland
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Martin G Martin
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Christopher D Putnam
- Department of Medicine, University of California, San Diego, La Jolla, California.,San Diego Branch, Ludwig Institute for Cancer Research, La Jolla, California
| | - Mamata Sivagnanam
- Department of Pediatrics, University of California, San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
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