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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.
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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
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2
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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.
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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
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3
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Salinas-Marín R, Murakami Y, González-Domínguez CA, Cruz-Muñoz ME, Mora-Montes HM, Morava E, Kinoshita T, Monroy-Santoyo S, Martínez-Duncker I. Case report: Functional characterization of a de novo c.145G>A p.Val49Met pathogenic variant in a case of PIGA-CDG with megacolon. Front Genet 2022; 13:971473. [PMID: 36324500 PMCID: PMC9619068 DOI: 10.3389/fgene.2022.971473] [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: 06/20/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
A subgroup of congenital disorders of glycosylation (CDGs) includes inherited GPI-anchor deficiencies (IGDs) that affect the biosynthesis of glycosylphosphatidylinositol (GPI) anchors, including the first reaction catalyzed by the X-linked PIGA. Here, we show the first PIGA-CDG case reported in Mexico in a male child with a moderate-to-severe phenotype characterized by neurological and gastrointestinal symptoms, including megacolon. Exome sequencing identified the hemizygous variant PIGA c.145G>A (p.Val49Met), confirmed by Sanger sequencing and characterized as de novo. The pathogenicity of this variant was characterized by flow cytometry and complementation assays in PIGA knockout (KO) cells.
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Affiliation(s)
- Roberta Salinas-Marín
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular, Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | - Yoshiko Murakami
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Carlos Alberto González-Domínguez
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular, Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, México
| | | | - Héctor Manuel Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, México
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, United States
- Department of Medical Genetics, University of Pecs Medical School, Pecs, Hungary
- Frontiers in Congenital Disorders of Glycosylation Consortium, National Institute of Neurological Diseases and Stroke (NINDS), National Institute of Child Health and Human Development (NICHD) and the National Center for Advancing Translational Sciences (NCATS), and the Rare Disorders Clinical Research Network (RDCRN), Bethesda, MD, United States
| | - Taroh Kinoshita
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Susana Monroy-Santoyo
- Centro de Investigación Traslacional, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, México
- *Correspondence: Iván Martínez-Duncker, ; Susana Monroy-Santoyo,
| | - Iván Martínez-Duncker
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular, Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
- Frontiers in Congenital Disorders of Glycosylation Consortium, National Institute of Neurological Diseases and Stroke (NINDS), National Institute of Child Health and Human Development (NICHD) and the National Center for Advancing Translational Sciences (NCATS), and the Rare Disorders Clinical Research Network (RDCRN), Bethesda, MD, United States
- *Correspondence: Iván Martínez-Duncker, ; Susana Monroy-Santoyo,
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4
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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]
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Paprocka J, Hutny M, Hofman J, Tokarska A, Kłaniewska M, Szczałuba K, Stembalska A, Jezela-Stanek A, Śmigiel R. Spectrum of Neurological Symptoms in Glycosylphosphatidylinositol Biosynthesis Defects: Systematic Review. Front Neurol 2022; 12:758899. [PMID: 35058872 PMCID: PMC8763846 DOI: 10.3389/fneur.2021.758899] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mutations of genes involved in the synthesis of glycosylphosphatidylinositol and glycosylphosphatidylinositol-anchored proteins lead to rare syndromes called glycosylphosphatidylinositol-anchored proteins biosynthesis defects. Alterations of their structure and function in these disorders impair often fundamental processes in cells, resulting in severe clinical image. This study aimed to provide a systematic review of GPIBD cases reports published in English-language literature. Methods: The browsing of open-access databases (PubMed, PubMed Central. and Medline) was conducted, followed by statistical analysis of gathered information concerning neurological symptomatology. The inclusion criteria were: studies on humans, age at onset (<18 y.o.), and report of GPIBD cases with adequate data on the genetic background and symptomatology. Exclusion criteria were: publication type (manuscripts, personal communication, review articles); reports of cases of GPI biosynthesis genes mutations in terms of other disorders; reports of GPIBD cases concentrating on non-neurological symptoms; or articles concentrating solely on the genetic issues of GPI biosynthesis. Risk of bias was assessed using Joanna Brigs Institute Critical Appraisal Checklists. Data synthesis was conducted using STATISTICA 13.3.721.1 (StatSoft Polska Sp. z.o.o.). Used tests were chi-square, Fisher's exact test (for differences in phenotype), and Mann-Whitney U test (for differences in onset of developmental delay). Results: Browsing returned a total of 973 articles which, after ruling out the repetitions and assessing the inclusion and exclusion criteria, led to final inclusion of 77 articles (337 GPIBD cases) in the analysis. The main outcomes were prevalence of neurological symptoms, onset and semiology of seizures and their response to treatment, and onset of developmental delay. Based on this data a synthesis of phenotypical differences between the groups of GPIBD cases and the general GPIBD cases population was made. Discussion: A synthetical analysis of neurological components in clinical image of GPIBD patients was presented. It highlights the main features of these disorders, which might be useful in clinical practice for consideration in differential diagnosis with children presenting with early-onset seizures and developmental delay. The limitation of this review is the scarcity of the specific data in some reports, concerning the semiology and onset of two main features of GPIBD.
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Affiliation(s)
- Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Hutny
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jagoda Hofman
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Tokarska
- Department of Pediatrics and Developmental Age Neurology, Upper Silesian Child Health Centre, Katowice, Poland
| | | | - Krzysztof Szczałuba
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | | | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Robert Śmigiel
- Department of Pediatrics, Medical University of Wroclaw, Wroclaw, Poland
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6
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Kandasamy LC, Tsukamoto M, Banov V, Tsetsegee S, Nagasawa Y, Kato M, Matsumoto N, Takeda J, Itohara S, Ogawa S, Young LJ, Zhang Q. Limb-clasping, cognitive deficit and increased vulnerability to kainic acid-induced seizures in neuronal glycosylphosphatidylinositol deficiency mouse models. Hum Mol Genet 2021; 30:758-770. [PMID: 33607654 PMCID: PMC8161520 DOI: 10.1093/hmg/ddab052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
Posttranslational modification of a protein with glycosylphosphatidylinositol (GPI) is a conserved mechanism exists in all eukaryotes. Thus far, >150 human GPI-anchored proteins have been discovered and ~30 enzymes have been reported to be involved in the biosynthesis and maturation of mammalian GPI. Phosphatidylinositol glycan biosynthesis class A protein (PIGA) catalyzes the very first step of GPI anchor biosynthesis. Patients carrying a mutation of the PIGA gene usually suffer from inherited glycosylphosphatidylinositol deficiency (IGD) with intractable epilepsy and intellectual developmental disorder. We generated three mouse models with PIGA deficits specifically in telencephalon excitatory neurons (Ex-M-cko), inhibitory neurons (In-M-cko) or thalamic neurons (Th-H-cko), respectively. Both Ex-M-cko and In-M-cko mice showed impaired long-term fear memory and were more susceptible to kainic acid-induced seizures. In addition, In-M-cko demonstrated a severe limb-clasping phenotype. Hippocampal synapse changes were observed in Ex-M-cko mice. Our Piga conditional knockout mouse models provide powerful tools to understand the cell-type specific mechanisms underlying inherited GPI deficiency and to test different therapeutic modalities.
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Affiliation(s)
- Lenin C Kandasamy
- Laboratory of Social Neural Networks, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Mina Tsukamoto
- Laboratory of Social Neural Networks, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Vitaliy Banov
- Laboratory for Behavioral Genetics, CBS, RIKEN, Wako 351-0198, Japan.,Institute of Neuroinformatics, University of Zürich, ETH Zürich, Zürich 8057, Switzerland
| | - Sambuu Tsetsegee
- Laboratory of Social Neural Networks, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Yutaro Nagasawa
- Laboratory of Social Neural Networks, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Junji Takeda
- Yabumoto Department of Intractable Disease Research, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | | | - Sonoko Ogawa
- Laboratory of Behavioral Neuroendocrinology, Faculty of Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Larry J Young
- Faculty of Human Sciences, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan.,Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, Atlanta GA 30329, USA
| | - Qi Zhang
- Laboratory of Social Neural Networks, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan.,Laboratory for Behavioral Genetics, CBS, RIKEN, Wako 351-0198, Japan.,Faculty of Human Sciences, Center for Social Neural Networks, University of Tsukuba, Tsukuba 305-8577, Japan
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7
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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.
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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
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