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Kowkabi S, Yavarian M, Kaboodkhani R, Mohammadi M, Shervin Badv R. PCDH19-clustering epilepsy, pathophysiology and clinical significance. Epilepsy Behav 2024; 154:109730. [PMID: 38521028 DOI: 10.1016/j.yebeh.2024.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
PCDH19 clustering epilepsy (PCDH19-CE) is an X-linked epilepsy disorder associated with intellectual disability (ID) and behavioral disturbances, which is caused by PCDH19 gene variants. PCDH19 pathogenic variant leads to epilepsy in heterozygous females, not in hemizygous males and the inheritance pattern is unusual. The hypothesis of cellular interference was described as a key pathogenic mechanism. According to that, males do not develop the disease because of the uniform expression of PCDH19 (variant or wild type) unless they have a somatic variation. We conducted a literature review on PCDH19-CE pathophysiology and concluded that other significant mechanisms could contribute to pathogenesis including: asymmetric cell division and heterochrony, female-related allopregnanolone deficiency, altered steroid gene expression, decreased Gamma-aminobutyric acid receptor A (GABAA) function, and blood-brain barrier (BBB) dysfunction. Being aware of these mechanisms helps us when we should decide which therapeutic option is more suitable for which patient.
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Affiliation(s)
- Safoura Kowkabi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran; Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Majid Yavarian
- Hematology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mahmood Mohammadi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
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2
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Peall KJ, Owen MJ, Hall J. Rare genetic brain disorders with overlapping neurological and psychiatric phenotypes. Nat Rev Neurol 2024; 20:7-21. [PMID: 38001363 DOI: 10.1038/s41582-023-00896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Understanding rare genetic brain disorders with overlapping neurological and psychiatric phenotypes is of increasing importance given the potential for developing disease models that could help to understand more common, polygenic disorders. However, the traditional clinical boundaries between neurology and psychiatry result in frequent segregation of these disorders into distinct silos, limiting cross-specialty understanding that could facilitate clinical and biological advances. In this Review, we highlight multiple genetic brain disorders in which neurological and psychiatric phenotypes are observed, but for which in-depth, cross-spectrum clinical phenotyping is rarely undertaken. We describe the combined phenotypes observed in association with genetic variants linked to epilepsy, dystonia, autism spectrum disorder and schizophrenia. We also consider common underlying mechanisms that centre on synaptic plasticity, including changes to synaptic and neuronal structure, calcium handling and the balance of excitatory and inhibitory neuronal activity. Further investigation is needed to better define and replicate these phenotypes in larger cohorts, which would help to gain greater understanding of the pathophysiological mechanisms and identify common therapeutic targets.
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Affiliation(s)
- Kathryn J Peall
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK.
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
| | - Michael J Owen
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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3
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Giansante G, Mazzoleni S, Zippo AG, Ponzoni L, Ghilardi A, Maiellano G, Lewerissa E, van Hugte E, Nadif Kasri N, Francolini M, Sala M, Murru L, Bassani S, Passafaro M. Neuronal network activity and connectivity are impaired in a conditional knockout mouse model with PCDH19 mosaic expression. Mol Psychiatry 2023:10.1038/s41380-023-02022-1. [PMID: 36997609 DOI: 10.1038/s41380-023-02022-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
Mutations in PCDH19 gene, which encodes protocadherin-19 (PCDH19), cause Developmental and Epileptic Encephalopathy 9 (DEE9). Heterogeneous loss of PCDH19 expression in neurons is considered a key determinant of the disorder; however, how PCDH19 mosaic expression affects neuronal network activity and circuits is largely unclear. Here, we show that the hippocampus of Pcdh19 mosaic mice is characterized by structural and functional synaptic defects and by the presence of PCDH19-negative hyperexcitable neurons. Furthermore, global reduction of network firing rate and increased neuronal synchronization have been observed in different limbic system areas. Finally, network activity analysis in freely behaving mice revealed a decrease in excitatory/inhibitory ratio and functional hyperconnectivity within the limbic system of Pcdh19 mosaic mice. Altogether, these results indicate that altered PCDH19 expression profoundly affects circuit wiring and functioning, and provide new key to interpret DEE9 pathogenesis.
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Affiliation(s)
| | - Sara Mazzoleni
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Antonio G Zippo
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy
| | - Luisa Ponzoni
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
| | - Anna Ghilardi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Greta Maiellano
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | - Elly Lewerissa
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Eline van Hugte
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Nael Nadif Kasri
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Nijmegen, Netherlands
| | - Maura Francolini
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20129, Milano, Italy
| | | | - Luca Murru
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy
| | - Silvia Bassani
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy.
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy.
| | - Maria Passafaro
- Institute of Neuroscience, CNR, 20854, Vedano al Lambro, Italy.
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy.
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4
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Scheffer IE, Bennett CA, Gill D, de Silva MG, Boggs K, Marum J, Baker N, Palmer EE, Howell KB. Exome sequencing for patients with developmental and epileptic encephalopathies in clinical practice. Dev Med Child Neurol 2023; 65:50-57. [PMID: 35701389 PMCID: PMC10952465 DOI: 10.1111/dmcn.15308] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the clinical utility of exome sequencing for patients with developmental and epileptic encephalopathies (DEEs). METHOD Over 2 years, patients with DEEs were recruited for singleton exome sequencing. Parental segregation was performed where indicated. RESULTS Of the 103 patients recruited (54 males, 49 females; aged 2 weeks-17 years), the genetic aetiology was identified in 36 out of 103 (35%) with management implications in 13 out of 36. Exome sequencing revealed pathogenic or likely pathogenic variants in 30 out of 103 (29%) patients, variants of unknown significance in 39 out of 103 (38%), and 34 out of 103 (33%) were negative on exome analysis. After the description of new genetic diseases, a molecular diagnosis was subsequently made for six patients or through newly available high-density chromosomal microarray testing. INTERPRETATION We demonstrate the utility of exome sequencing in routine clinical care of children with DEEs. We highlight that molecular diagnosis often leads to changes in management and informs accurate prognostic and reproductive counselling. Our findings reinforce the need for ongoing analysis of genomic data to identify the aetiology in patients in whom the cause is unknown. The implementation of genomic testing in the care of children with DEEs should become routine in clinical practice. WHAT THIS PAPER ADDS The cause was identified in 35% of patients with developmental and epileptic encephalopathies. KCNQ2, CDKL5, SCN1A, and STXBP1 were the most frequently identified genes. Reanalysis of genomic data found the cause in an additional six patients. Genetic aetiology was identified in 41% of children with seizure onset under 2 years, compared to 18% with older onset. Finding the molecular cause led to management changes in 36% of patients with DEEs.
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Affiliation(s)
- Ingrid E. Scheffer
- Epilepsy Research Centre, Department of Medicine, Austin HealthThe University of MelbourneHeidelbergVictoria
- Department of PaediatricsThe University of MelbourneVictoria
- Florey Institute of Neuroscience and Mental HealthHeidelbergVictoria
- Murdoch Children's Research InstituteParkvilleVictoria
| | - Caitlin A. Bennett
- Epilepsy Research Centre, Department of Medicine, Austin HealthThe University of MelbourneHeidelbergVictoria
| | - Deepak Gill
- TY Nelson Department of Neurology and NeurosurgeryThe Children's Hospital at WestmeadNew South Wales
| | - Michelle G. de Silva
- Victorian Clinical Genetics Services, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleVictoria
- Australian Genomics Health AllianceMelbourne
| | - Kirsten Boggs
- Australian Genomics Health AllianceMelbourne
- Sydney Children's Hospitals NetworkSydney
| | - Justine Marum
- Victorian Clinical Genetics Services, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleVictoria
| | - Naomi Baker
- Department of PaediatricsThe University of MelbourneVictoria
- Victorian Clinical Genetics Services, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleVictoria
| | | | - Katherine B. Howell
- Department of PaediatricsThe University of MelbourneVictoria
- Murdoch Children's Research InstituteParkvilleVictoria
- Department of NeurologyThe Royal Children's HospitalParkvilleVictoriaAustralia
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Moncayo JA, Vargas MN, Castillo I, Granda PV, Duque AM, Argudo JM, Matcheswalla S, Lopez Dominguez GE, Monteros G, Andrade AF, Ojeda D, Yepez M. Adjuvant Treatment for Protocadherin 19 (PCDH19) Syndrome. Cureus 2022; 14:e27154. [PMID: 36004035 PMCID: PMC9392850 DOI: 10.7759/cureus.27154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
Protocadherin 19 (PCDH19) syndrome is inherited as an X-linked pattern and affects mainly females. This syndrome is caused by a mutation in the PCDH19 gene encoding for the protocadherin protein. It is characterized by refractory seizures during febrile episodes with neuropsychiatric manifestations. There is no consensus on the treatment of PCDH19. We conducted a literature review to investigate the main drugs used for this syndrome, and to evaluate the best possible course of adjuvant treatment for these patients. We used an advanced PubMed search strategy with the following inclusion criteria: a) full-text papers, b) English Language, and c) studies conducted in humans. Exclusion criteria: a) literature reviews, b) systematic reviews, and c) metanalysis. We gathered 26 observational papers to conduct this literature review on clobazam and bromide which have been shown to reduce seizures by 50%. Corticosteroids improved neurological symptoms during the episodes in a few patients. Nevertheless, they recurred after a few months. Preliminary results of ganaxolone, which is still under study, demonstrated a reduction of 60% in seizure episodes. A ketogenic diet has been studied to treat several refractory epilepsies, including PCDH19; it has promising results as effective adjuvant therapy in the resolution of status epilepticus, suggesting it could be used as part of the treatment in early childhood. Stiripentol was given as adjuvant therapy in a patient with PCDH19 epilepsy resulting in the most extended period of seizure-free episodes, but more studies must be performed to assess its efficacy.
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Lamers D, Landi S, Mezzena R, Baroncelli L, Pillai V, Cruciani F, Migliarini S, Mazzoleni S, Pasqualetti M, Passafaro M, Bassani S, Ratto GM. Perturbation of Cortical Excitability in a Conditional Model of PCDH19 Disorder. Cells 2022; 11:cells11121939. [PMID: 35741068 PMCID: PMC9222106 DOI: 10.3390/cells11121939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
PCDH19 epilepsy (DEE9) is an X-linked syndrome associated with cognitive and behavioral disturbances. Since heterozygous females are affected, while mutant males are spared, it is likely that DEE9 pathogenesis is related to disturbed cell-to-cell communication associated with mosaicism. However, the effects of mosaic PCDH19 expression on cortical networks are unknown. We mimicked the pathology of DEE9 by introducing a patch of mosaic protein expression in one hemisphere of the cortex of conditional PCDH19 knockout mice one day after birth. In the contralateral area, PCDH19 expression was unaffected, thus providing an internal control. In this model, we characterized the physiology of the disrupted network using local field recordings and two photon Ca2+ imaging in urethane anesthetized mice. We found transient episodes of hyperexcitability in the form of brief hypersynchronous spikes or bursts of field potential oscillations in the 9–25 Hz range. Furthermore, we observed a strong disruption of slow wave activity, a crucial component of NREM sleep. This phenotype was present also when PCDH19 loss occurred in adult mice, demonstrating that PCDH19 exerts a function on cortical circuitry outside of early development. Our results indicate that a focal mosaic mutation of PCDH19 disrupts cortical networks and broaden our understanding of DEE9.
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Affiliation(s)
- Didi Lamers
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Silvia Landi
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy;
| | - Roberta Mezzena
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Laura Baroncelli
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy;
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Vinoshene Pillai
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Federica Cruciani
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
| | - Sara Migliarini
- Unit of Cellular and Developmental Biology, Department of Biology, University of Pisa, 56127 Pisa, Italy; (S.M.); (M.P.)
| | - Sara Mazzoleni
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Massimo Pasqualetti
- Unit of Cellular and Developmental Biology, Department of Biology, University of Pisa, 56127 Pisa, Italy; (S.M.); (M.P.)
| | - Maria Passafaro
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Silvia Bassani
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; (S.M.); (M.P.); (S.B.)
- NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gian Michele Ratto
- National Enterprise for NanoScience and NanoTchnology (NEST), Istituto Nanoscienze, Consiglio Nazionale delle Ricerche (CNR) and Scuola Normale Superiore Pisa, 56127 Pisa, Italy; (D.L.); (S.L.); (R.M.); (V.P.); (F.C.)
- Correspondence:
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7
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Gerosa L, Mazzoleni S, Rusconi F, Longaretti A, Lewerissa E, Pelucchi S, Murru L, Giannelli SG, Broccoli V, Marcello E, Kasri NN, Battaglioli E, Passafaro M, Bassani S. The epilepsy-associated protein PCDH19 undergoes NMDA receptor-dependent proteolytic cleavage and regulates the expression of immediate-early genes. Cell Rep 2022; 39:110857. [PMID: 35613587 PMCID: PMC9152703 DOI: 10.1016/j.celrep.2022.110857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 02/11/2022] [Accepted: 05/01/2022] [Indexed: 12/02/2022] Open
Abstract
Protocadherin-19 (PCDH19) is a synaptic cell-adhesion molecule encoded by X-linked PCDH19, a gene linked with epilepsy. Here, we report a synapse-to-nucleus signaling pathway through which PCDH19 bridges neuronal activity with gene expression. In particular, we describe the NMDA receptor (NMDAR)-dependent proteolytic cleavage of PCDH19, which leads to the generation of a PCDH19 C-terminal fragment (CTF) able to enter the nucleus. We demonstrate that PCDH19 CTF associates with chromatin and with the chromatin remodeler lysine-specific demethylase 1 (LSD1) and regulates expression of immediate-early genes (IEGs). Our results are consistent with a model whereby PCDH19 favors maintenance of neuronal homeostasis via negative feedback regulation of IEG expression and provide a key to interpreting PCDH19-related hyperexcitability. PCDH19 undergoes NMDAR-dependent cleavage by ADAM10 and possibly gamma secretase In the nucleus, PCDH19 C-terminal fragment (CTF) associates with the chromatin remodeler LSD1 PCDH19 CTF favors immediate-early gene (IEG) repression PCDH19 downregulation affects LSD1 splicing by NOVA1 and increases IEG expression
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Affiliation(s)
- Laura Gerosa
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy
| | - Sara Mazzoleni
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129 Milano, Italy
| | - Francesco Rusconi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129 Milano, Italy
| | - Alessandra Longaretti
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129 Milano, Italy
| | - Elly Lewerissa
- Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Silvia Pelucchi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milano, Italy
| | - Luca Murru
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Serena Gea Giannelli
- Stem Cell and Neurogenesis Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milano, Italy
| | - Vania Broccoli
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; Stem Cell and Neurogenesis Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milano, Italy
| | - Elena Marcello
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milano, Italy
| | - Nael Nadif Kasri
- Donders Institute for Brain, Cognition, and Behaviour, Department of Human Genetics, Department of Human Genetics Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Elena Battaglioli
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129 Milano, Italy
| | - Maria Passafaro
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Silvia Bassani
- Institute of Neuroscience, CNR, 20854 Vedano al Lambro, Italy; NeuroMI Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy.
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8
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Cwetsch AW, Ziogas I, Narducci R, Savardi A, Bolla M, Pinto B, Perlini LE, Bassani S, Passafaro M, Cancedda L. A rat model of a focal mosaic expression of PCDH19 replicates human brain developmental abnormalities and behaviors. Brain Commun 2022; 4:fcac091. [PMID: 35528232 PMCID: PMC9070467 DOI: 10.1093/braincomms/fcac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/04/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
Protocadherin 19 gene-related epilepsy or protocadherin 19 clustering epilepsy is an infantile-onset epilepsy syndrome characterized by psychiatric (including autism-related), sensory, and cognitive impairment of varying degrees. Protocadherin 19 clustering epilepsy is caused by X-linked protocadherin 19 protein loss of function. Due to random X-chromosome inactivation, protocadherin 19 clustering epilepsy-affected females present a mosaic population of healthy and protocadherin 19-mutant cells. Unfortunately, to date, no current mouse model can fully recapitulate both the brain histological and behavioural deficits present in people with protocadherin 19 clustering epilepsy. Thus, the search for a proper understanding of the disease and possible future treatment is hampered. By inducing a focal mosaicism of protocadherin 19 expression using in utero electroporation in rats, we found here that protocadherin 19 signalling in specific brain areas is implicated in neuronal migration, heat-induced epileptic seizures, core/comorbid behaviours related to autism and cognitive function.
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Affiliation(s)
- Andrzej W Cwetsch
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Università degli Studi di Genova, Via Balbi, 5, 16126 Genova, Italy
- Instituto de Biotecnologia y Biomedicina (BIOTECMED), Universidad de Valencia, 46100 Burjassot, Spain
| | - Ilias Ziogas
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Università degli Studi di Genova, Via Balbi, 5, 16126 Genova, Italy
| | - Roberto Narducci
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
| | - Annalisa Savardi
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Dulbecco Telethon Institute, Italy
| | - Maria Bolla
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Università degli Studi di Genova, Via Balbi, 5, 16126 Genova, Italy
| | - Bruno Pinto
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Bio@SNS, Scuola Normale Superiore, Piazza dei Cavalieri 7, 56126, Pisa, Italy
| | - Laura E Perlini
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
| | | | | | - Laura Cancedda
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genova, Italy
- Dulbecco Telethon Institute, Italy
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9
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Borghi R, Magliocca V, Trivisano M, Specchio N, Tartaglia M, Bertini E, Compagnucci C. Modeling PCDH19-CE: From 2D Stem Cell Model to 3D Brain Organoids. Int J Mol Sci 2022; 23:ijms23073506. [PMID: 35408865 PMCID: PMC8998847 DOI: 10.3390/ijms23073506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
PCDH19 clustering epilepsy (PCDH19-CE) is a genetic disease characterized by a heterogeneous phenotypic spectrum ranging from focal epilepsy with rare seizures and normal cognitive development to severe drug-resistant epilepsy associated with intellectual disability and autism. Unfortunately, little is known about the pathogenic mechanism underlying this disease and an effective treatment is lacking. Studies with zebrafish and murine models have provided insights on the function of PCDH19 during brain development and how its altered function causes the disease, but these models fail to reproduce the human phenotype. Induced pluripotent stem cell (iPSC) technology has provided a complementary experimental approach for investigating the pathogenic mechanisms implicated in PCDH19-CE during neurogenesis and studying the pathology in a more physiological three-dimensional (3D) environment through the development of brain organoids. We report on recent progress in the development of human brain organoids with a particular focus on how this 3D model may shed light on the pathomechanisms implicated in PCDH19-CE.
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Affiliation(s)
- Rossella Borghi
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Valentina Magliocca
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Marina Trivisano
- Department of Neurosciences, Rare and Complex Epilepsy Unit, Division of Neurology, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (M.T.); (N.S.)
| | - Nicola Specchio
- Department of Neurosciences, Rare and Complex Epilepsy Unit, Division of Neurology, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (M.T.); (N.S.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Enrico Bertini
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
| | - Claudia Compagnucci
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy; (R.B.); (V.M.); (M.T.); (E.B.)
- Correspondence:
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10
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Nagarajan L, Ghosh S, Dyke J, Lee S, Silberstein J, Azmanov D, Richard W. Epilepsy surgery in PCDH 19 related developmental and epileptic encephalopathy: A case report. Epilepsy Behav Rep 2022; 19:100560. [PMID: 35856042 PMCID: PMC9287778 DOI: 10.1016/j.ebr.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/26/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022] Open
Abstract
PCDH19 pathogenic variants may be associated with DEE in females. Epilepsy Surgery may be an option for PCDH19 related drug-resistant epilepsy.
We report a female child with PCDH19 related developmental and epileptic encephalopathy with drug-resistant seizures, cognitive and language impairment, autism spectrum disorder and sleep dysfunction. Her seizures, which started at 10 months of age, were resistant to multiple anti-seizure medications. Developmental stagnation followed by regression occurred after the onset of recurrent seizures. Her ictal EEGS suggested left temporal lobe origin for her recorded seizures. MRI upon expert re-review showed a subtle abnormality in the left temporal lobe. In view of the severe nature and frequency of her seizures, a left temporal lobectomy was undertaken at the age of 2 years and 3 months. Though her seizure outcome was Engel class 3, her seizure frequency and severity were significantly reduced. She has been seizure-free for 10 months at her last outpatient assessment when she was 4 years and 8 months of age (2 years and 5 months after epilepsy surgery). However she recently had an admission for COVID19 infection, with a breakthrough cluster of seizures. Her developmental trajectory changed, though she is making good progress with her cognitive and language skills.
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Affiliation(s)
- Lakshmi Nagarajan
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- School of Medicine, University of Western Australia, WA 6009, Australia
- Corresponding author at: Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia.
| | - Soumya Ghosh
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Perron Institute for Neurological and Translational Science, University of Western Australia. WA 6009, Australia
| | - Jason Dyke
- School of Medicine, University of Western Australia, WA 6009, Australia
- PathWest Neuropathology, Royal Perth Hospital, Victoria Street, Perth, WA 6000, Australia
| | - Sharon Lee
- School of Medicine, University of Western Australia, WA 6009, Australia
- Dept of Neurosurgery, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Jonathan Silberstein
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Dimitar Azmanov
- Dept of Neurosurgery, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Warne Richard
- WA State Wide Neurosurgery Service, WA 6009, Australia
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11
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Elwan M, Fowkes R, Lewis-Smith D, Winder A, Baker MR, Thomas RH. Late-onset cluster seizures and intellectual disability associated with a novel truncation variant in SMC1A. Epilepsy Behav Rep 2022; 19:100556. [PMID: 35712061 PMCID: PMC9194849 DOI: 10.1016/j.ebr.2022.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Epilepsy due to truncating SMC1A variants can present with onset in later childhood. People with to truncating SMC1A variants can have normal development prior to presentation. Seizures occur periodically in clusters and are poorly responsive to antiseizure medications.
SMC1A variants are known to cause Cornelia de Lange Syndrome (CdLS) which encompasses a clinical spectrum of intellectual disability, dysmorphic features (long or thick eyebrows, a hypomorphic philtrum and small nose) and, in some cases, epilepsy. More recently, SMC1A truncating variants have been described as the cause of a neurodevelopmental disorder with early-childhood onset drug-resistant epilepsy with seizures that occur in clusters, similar to that seen in PCDH19-related epilepsy, but without the classical features of CdLS. Here, we report the case of a 28-year-old woman with a de novo heterozygous truncating variant in SMC1A who unusually presented with seizures at the late age of 12 years and had normal development into adulthood.
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Affiliation(s)
- Menatalla Elwan
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Ross Fowkes
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - David Lewis-Smith
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Amy Winder
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Mark R. Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Rhys H. Thomas
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Corresponding author at: Intermediate Clinical Lecturer and Honorary Consultant in Epilepsy, Translational and Clinical Research Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne NE2 4HH.
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12
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de Nys R, Kumar R, Gecz J. Protocadherin 19 Clustering Epilepsy and Neurosteroids: Opportunities for Intervention. Int J Mol Sci 2021; 22:9769. [PMID: 34575929 PMCID: PMC8469663 DOI: 10.3390/ijms22189769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/23/2023] Open
Abstract
Steroids yield great influence on neurological development through nuclear hormone receptor (NHR)-mediated gene regulation. We recently reported that cell adhesion molecule protocadherin 19 (encoded by the PCDH19 gene) is involved in the coregulation of steroid receptor activity on gene expression. PCDH19 variants cause early-onset developmental epileptic encephalopathy clustering epilepsy (CE), with altered steroidogenesis and NHR-related gene expression being identified in these individuals. The implication of hormonal pathways in CE pathogenesis has led to the investigation of various steroid-based antiepileptic drugs in the treatment of this disorder, with mixed results so far. Therefore, there are many unmet challenges in assessing the antiseizure targets and efficiency of steroid-based therapeutics for CE. We review and assess the evidence for and against the implication of neurosteroids in the pathogenesis of CE and in view of their possible clinical benefit.
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Affiliation(s)
- Rebekah de Nys
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; (R.d.N.); (R.K.)
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Raman Kumar
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; (R.d.N.); (R.K.)
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; (R.d.N.); (R.K.)
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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13
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Mazzurco M, Pulvirenti G, Caccamo M, Presti S, Soma R, Salafia S, Praticò ER, Filosco F, Falsaperla R, Praticò AD. PCDH19-Related Epilepsies. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1728641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractProtocadherin-19 (PCDH19) is considered one of the most relevant genes related to epilepsy. To date, more than 150 mutations have been identified as causative for PCDH19-female epilepsy (also known as early infantile epileptic encephalopathy-9, EIEE9), which is characterized by early onset epilepsy, intellectual disabilities, and behavioral disturbances. More recently, mosaic-males (i.e., exhibiting the variants in less than 25% of their cells) have been described as affected by infant-onset epilepsy associated with intellectual disability, as well as compulsive or aggressive behavior and autistic features. Although little is known about the physiological role of PCDH19 protein and the pathogenic mechanisms that lead to EIEE9, many reports and clinical observation seem to suggest a relevant role of this protein in the development of cellular hyperexcitability. However, a genotype–phenotype correlation is difficult to establish. The main feature of EIEE9 consists in early onset of seizures, which generally occur in clusters lasting 1 to 5 minutes and repeating up to 10 times a day for several days. Seizures tend to present during febrile episodes, similarly to the first phases of Dravet syndrome and PCDH19 variants have been found in ∼25% of females who present with features of Dravet syndrome and testing negative for SCN1A variants. There is no “standardized” treatment for PCDH19-related epilepsy and most of the patients receiving a combination of several drugs. In this review, we focus on the latest researches on these aspects, with regard to protein expression, its known functions, and the mechanisms by which the protein acts. The clinical phenotypes related to PCDH19 mutations are also discussed.
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Affiliation(s)
| | - Giulio Pulvirenti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Martina Caccamo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Santiago Presti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rachele Soma
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | | | | | - Federica Filosco
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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14
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Selvarajah A, Zulfiqar-Ali Q, Marques P, Rong M, Andrade DM. A systematic review of adults with Dravet syndrome. Seizure 2021; 87:39-45. [PMID: 33677403 DOI: 10.1016/j.seizure.2021.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Dravet Syndrome (DS) is a rare and severe infantile-onset epileptic encephalopathy. DS research focuses mainly on children. We did a systematic review, completed on January 18th, 2021, examining the number of clinical DS studies. We show that there are 208 studies on children exclusively, 28 studies on adults exclusively, and 116 studies involving adults and children combined. This 7:1 ratio of children to adult studies exclusively shows the dearth of research that addresses long-term natural history of DS into adulthood. Through this systematic review, we examine the most up-to-date information in DS adults as it pertains to seizures, electroencephalogram, imaging, treatment, motor abnormalities, cognitive and social behavior outcomes, cardiac abnormalities, sleep disturbances, diagnosis in adults, and mortality. Overall, the frequency of seizures increases in the first decade of life and then myoclonic, atypical absences and focal seizures with impaired awareness tend to decrease in frequency or even disappear in adulthood. Adults tend to have a notable reduction in status epilepticus, especially after 30 years of age. Parkinsonian features were seen in patients as young as 19 years old and are more severe in older patients, suggesting a progression of the parkinsonian symptoms. In adulthood, patients continue to present with behavior problems, associated with a lower health-related quality of life. The leading reported cause of death in DS adults is Sudden Unexpected Death in Epilepsy (SUDEP). Further studies in older adults are needed to understand the long-term outcomes of patients with DS.
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Affiliation(s)
- Arunan Selvarajah
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Adult Epilepsy Genetics Program, Division of Neurology, Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Quratulain Zulfiqar-Ali
- Adult Epilepsy Genetics Program, Division of Neurology, Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Paula Marques
- Adult Epilepsy Genetics Program, Division of Neurology, Krembil Research Institute, Toronto Western Hospital, Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, ON, Canada
| | - Marlene Rong
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Adult Epilepsy Genetics Program, Division of Neurology, Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Danielle M Andrade
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Adult Epilepsy Genetics Program, Division of Neurology, Krembil Research Institute, Toronto Western Hospital, Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, ON, Canada; Krembil Neurosciences Institute, University Health Network, Toronto, ON, Canada.
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15
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Right Place at the Right Time: How Changes in Protocadherins Affect Synaptic Connections Contributing to the Etiology of Neurodevelopmental Disorders. Cells 2020; 9:cells9122711. [PMID: 33352832 PMCID: PMC7766791 DOI: 10.3390/cells9122711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
During brain development, neurons need to form the correct connections with one another in order to give rise to a functional neuronal circuitry. Mistakes during this process, leading to the formation of improper neuronal connectivity, can result in a number of brain abnormalities and impairments collectively referred to as neurodevelopmental disorders. Cell adhesion molecules (CAMs), present on the cell surface, take part in the neurodevelopmental process regulating migration and recognition of specific cells to form functional neuronal assemblies. Among CAMs, the members of the protocadherin (PCDH) group stand out because they are involved in cell adhesion, neurite initiation and outgrowth, axon pathfinding and fasciculation, and synapse formation and stabilization. Given the critical role of these macromolecules in the major neurodevelopmental processes, it is not surprising that clinical and basic research in the past two decades has identified several PCDH genes as responsible for a large fraction of neurodevelopmental disorders. In the present article, we review these findings with a focus on the non-clustered PCDH sub-group, discussing the proteins implicated in the main neurodevelopmental disorders.
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16
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Kolc KL, Sadleir LG, Depienne C, Marini C, Scheffer IE, Møller RS, Trivisano M, Specchio N, Pham D, Kumar R, Roberts R, Gecz J. A standardized patient-centered characterization of the phenotypic spectrum of PCDH19 girls clustering epilepsy. Transl Psychiatry 2020; 10:127. [PMID: 32366910 PMCID: PMC7198503 DOI: 10.1038/s41398-020-0803-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
Protocadherin-19 (PCDH19) pathogenic variants cause an early-onset seizure disorder called girls clustering epilepsy (GCE). GCE is an X-chromosome disorder that affects heterozygous females and mosaic males, however hemizygous ("transmitting") males are spared. We aimed to define the neuropsychiatric profile associated with PCDH19 pathogenic variants and determine if a clinical profile exists for transmitting males. We also examined genotype- and phenotype-phenotype associations. We developed an online PCDH19 survey comprising the following standardized assessments: The Behavior Rating Inventory of Executive Function; the Social Responsiveness Scale, 2nd edition; the Strengths and Difficulties Questionnaire; and the Dimensional Obsessive-Compulsive Scale. Genetic, seizure, and developmental information were also collected. The survey was completed by patients or by caregivers on behalf of patients. Of the 112 individuals represented (15 males), there were 70 unique variants. Thirty-five variants were novel and included a newly identified recurrent variant Ile781Asnfs*3. There were no significant differences in phenotypic outcomes between published and unpublished cases. Seizures occurred in clusters in 94% of individuals, with seizures resolving in 28% at an average age of 17.5 years. Developmental delay prior to seizure onset occurred in 18% of our cohort. Executive dysfunction and autism spectrum disorder (ASD) occurred in approximately 60% of individuals. The ASD profile included features of attention-deficit hyperactivity disorder. In addition, 21% of individuals met criteria for obsessive-compulsive disorder that appeared to be distinct from ASD. There were no phenotypic differences between heterozygous females and mosaic males. We describe a mosaic male and two hemizygous males with atypical clinical profiles. Earlier seizure onset age and increased number of seizures within a cluster were associated with more severe ASD symptoms (p = 0.001), with seizure onset also predictive of executive dysfunction (p = 4.69 × 10-4) and prosocial behavior (p = 0.040). No clinical profile was observed for transmitting males. This is the first patient-derived standardized assessment of the neuropsychiatric profile of GCE. These phenotypic insights will inform diagnosis, management, and prognostic and genetic counseling.
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Affiliation(s)
- Kristy L. Kolc
- grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia
| | - Lynette G. Sadleir
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany ,grid.425274.20000 0004 0620 5939Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris, 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
| | - Carla Marini
- grid.415845.9Child Neurology and Psychiatric Unit, Pediatric Hospital G. Salesi, Ospedali Riuniti Ancona, Ancona, Italy
| | - Ingrid E. Scheffer
- grid.1008.90000 0001 2179 088XDepartment of Medicine, Epilepsy Research Centre, The University of Melbourne, Austin Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Melbourne, VIC Australia ,The Florey Neuroscience and Murdoch Childrens Research Institutes, Melbourne, VIC Australia
| | - Rikke S. Møller
- grid.452376.1Department of Epilepsy Genetics and Personalized Medicine, The Danish Epilepsy Centre, Dianalund, Denmark ,grid.10825.3e0000 0001 0728 0170Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Marina Trivisano
- grid.414125.70000 0001 0727 6809Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Nicola Specchio
- grid.414125.70000 0001 0727 6809Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Duyen Pham
- grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia ,grid.1010.00000 0004 1936 7304Robinson Research Institute, The University of Adelaide, Adelaide, SA Australia
| | - Raman Kumar
- grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia ,grid.1010.00000 0004 1936 7304Robinson Research Institute, The University of Adelaide, Adelaide, SA Australia
| | - Rachel Roberts
- grid.1010.00000 0004 1936 7304School of Psychology, The University of Adelaide, Adelaide, SA Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia. .,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia. .,Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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17
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PCDH19-Related Epilepsy Syndrome: A Comprehensive Clinical Review. Pediatr Neurol 2020; 105:3-9. [PMID: 32057594 DOI: 10.1016/j.pediatrneurol.2019.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
Abstract
PCDH19-related epilepsy is a distinct childhood-onset epilepsy syndrome characterized by brief clusters of febrile and afebrile seizures with onset primarily before the age of three years, cognitive impairment, autistic traits, and behavioral abnormalities. PCDH19 gene is located in Xq22 and produces nonclustered delta protocadherin. This disorder primarily manifests in heterozygote females due to random X chromosome inactivation leading to somatic mosaicism and abnormal cellular interference between cells with and without delta-protocadherin. This article reviews the clinical features based on a comprehensive literature review (MEDLINE using PubMed and OvidSP vendors with appropriate keywords to incorporate recent evidence), personal practice, and experience. Significant progress has been made in the past 10 years, including identification of the gene responsible for the condition, characterization of clinical phenotypes, and development of animal models. More rigorous studies involving quality-of-life measures as well as standardized neuropsychiatric testing are necessary to understand the full spectrum of the disease. The recent discovery of allopregnanolone deficiency in patients with PCDH19-related epilepsy leads to opportunities in precision therapy. A phase 3 clinical study is currently active to evaluate the efficacy, safety, and tolerability of adjunctive ganaxolone (an allopregnanolone analog) therapy.
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18
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Sadleir LG, Kolc KL, King C, Mefford HC, Dale RC, Gecz J, Scheffer IE. Levetiracetam efficacy in PCDH19 Girls Clustering Epilepsy. Eur J Paediatr Neurol 2020; 24:142-147. [PMID: 31928905 DOI: 10.1016/j.ejpn.2019.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/18/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND PCDH19 Girls clustering epilepsy (GCE) has a phenotypic spectrum that includes developmental and epileptic encephalopathy. PCDH19-GCE presents with clusters of seizures in the first years of life. Although patients typically outgrow their seizures, many are left with intellectual disability. Here we retrospectively assess the effect of levetiracetam in two independent cohorts of females with PCDH19-GCE. METHODS Cohort A was identified by searching our epilepsy genetics research database for girls with PCDH19-GCE who had trialled levetiracetam. Cohort B consisted of girls aged 2 years or older, including women, participating in an international online questionnaire. Information regarding seizure frequency and levetiracetam use was obtained by in-person patient interview and review of clinical records for cohort A, and by patient report for cohort B. RESULTS Cohort A consisted of 17 females, aged 3-37 years, who had a trial of levetiracetam at an average age of 10.7 years. 13/17 females became seizure free for >12 months; while 10/17 remained seizure free for >24 months. Cohort B comprised 62 females, aged 1.5-41 years. 26/62 became seizure free for >12 months, and 19/62 for >24 months on levetiracetam therapy. DISCUSSION Levetiracetam was effective in two cohorts of females with PCDH19-GCE where 42% and 76% of females became seizure free for >12 months, respectively. Levetiracetam is an effective therapy for females with PCDH19-GCE and should be considered early in the management of the highly refractory clusters of seizures that characterise this genetic disease.
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Affiliation(s)
- Lynette G Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
| | - Kristy L Kolc
- Adelaide Medical School, The University of Adelaide, SA, Australia
| | - Chontelle King
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Heather C Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Russell C Dale
- Kids Neuroscience Centre. Children's Hospital at Westmead, University of Sydney, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, SA, Australia; Healthy Mothers and Babies, South Australian Health and Medical Research Institute, SA, Australia
| | - Ingrid E Scheffer
- Department of Medicine, Epilepsy Research Centre, The University of Melbourne, Austin Health, Melbourne, VIC, Australia; Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, VIC, Australia; The Florey Institute and Murdoch Children's Research Institute, Melbourne, VIC, Australia
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19
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Yang L, Liu J, Su Q, Li Y, Yang X, Xu L, Tong L, Li B. Novel and de novo mutation of PCDH19 in Girls Clustering Epilepsy. Brain Behav 2019; 9:e01455. [PMID: 31714027 PMCID: PMC6908879 DOI: 10.1002/brb3.1455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND PCDH19 has become the second most relevant gene in epilepsy after SCN1A. Seizures often provoked by fever. METHODS We screened 152 children with fever-sensitive epilepsy for gene detection. Their clinical information was followed up. RESULTS We found eight PCDH19 point mutations (four novel and four reported) and one whole gene deletion in 10 female probands (seven sporadic cases and three family cases) who also had cluster seizures. The common clinical features of 16 patients in 10 families included fever-sensitive and cluster seizures, mainly focal or tonic-clonic seizures, and absence of status epilepticus, normal intelligence, or mild-to-moderate cognitive impairment, the onset age ranges from 5 months to 20 years. Only four patients had multiple or focal transient discharges in interictal EEG. Focal seizures originating in the frontal region were recorded in four patients, two from the parietal region, and one from the occipital region. CONCLUSION PCDH19 mutation can be inherited or de novo. The clinical spectrum of PCDH19 mutation includes PCDH19 Girls Clustering Epilepsy with or without mental retardation, psychosis, and asymptomatic male. The onset age of PCDH19 Girls Clustering Epilepsy can range from infancy to adulthood. Sisters in the same family may be sensitive to the same antiepileptic drugs. And our report expands the mutation spectrum of PCDH19 Girls Clustering Epilepsy.
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Affiliation(s)
- Li Yang
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China.,Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Jing Liu
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Quanping Su
- Central Laboratory, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Yufen Li
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Xiaofan Yang
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Liyun Xu
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi, China
| | - Lili Tong
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
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