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Zhang J, Huang Y, Hu Y, Bai B. Compound heterozygous mutations in three Chinese patients of Segawa syndrome and their treatment outcomes. Int J Dev Neurosci 2024; 84:305-313. [PMID: 38566307 DOI: 10.1002/jdn.10328] [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: 10/19/2023] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Segawa syndrome is a rare autosomal recessive form of dopa-responsive dystonia resulting from TH gene dysfunction. Patients typically exhibit symptoms such as generalized dystonia, rigidity, tremors, infantile Parkinsonism, and pseudo-spastic paraplegia. Levodopa is often an effective treatment. Due to its rarity, high heterogeneity, and poorly understood pathological mutation and phenotype spectrums, as well as genotype-phenotype and genotype-treatment outcome correlations, Segawa syndrome poses diagnostic and therapeutic challenges. In our study, through clinical and molecular analyses of three Chinese Segawa patients, we re-evaluated the pathogenicity of a TH mutation (c.880G>C;p.G294R) previously categorized as "Conflicting classifications of pathogenicity" in ClinVar. Also, we summarized the clinical phenotypes of all reported Segawa syndrome cases until 2023 and compared them with our patients. We identified a novel phenotype, "cafe-au-lait macules," not previously observed in Segawa patients. Additionally, we discussed the correlation between specific genotypes and phenotypes, as well as genotypes and treatment outcomes of our three cases. Our findings aim to enhance the understanding of Segawa syndrome, contributing to improved diagnosis and treatment approaches in the future.
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Affiliation(s)
- Jie Zhang
- State Key Laboratory of Primate Biomedical Research, Kunming University of Science and Technology, Kunming, China
- Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming, China
- Department of Medical Genetics, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, National Health Commission Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Kunming, China
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
- Medical school, Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yaxin Huang
- Department of Medical Genetics, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, National Health Commission Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Kunming, China
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
- Medical school, Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yulei Hu
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Bing Bai
- State Key Laboratory of Primate Biomedical Research, Kunming University of Science and Technology, Kunming, China
- Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming, China
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Jung-Klawitter S, Richter P, Yuan Y, Welzel K, Kube M, Bähr S, Leibner A, Flory E, Opladen T. Tyrosine hydroxylase variants influence protein expression, cellular localization, stability, enzymatic activity and the physical interaction between tyrosine hydroxylase and GTP cyclohydrolase 1. J Inherit Metab Dis 2024; 47:517-532. [PMID: 38084654 DOI: 10.1002/jimd.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 05/16/2024]
Abstract
Tyrosine hydroxylase (TH) is the rate-limiting enzyme in dopamine biosynthesis catalyzing the tetrahydrobiopterin (BH4)-dependent hydroxylation of tyrosine to L-DOPA. Here, we analyzed 25 TH variants associated with various degrees of dopa-responsive dystonia and evaluate the effect of each variant on protein stability, activity and cellular localization. Furthermore, we investigated the physical interaction between TH and human wildtype (wt) GTP cyclohydrolase 1 (GTPCH) and the effect of variants on this interaction. Our in vitro results classify variants according to their resistance to proteinase K digestion into three groups (stable, intermediate, unstable). Based on their cellular localization, two groups of variants can be identified, variant group one with cytoplasmic distribution and variant group two forming aggregates. These aggregates do not correlate with loss of enzymatic activity but nevertheless might be a good target for molecular chaperones. Unfortunately, no obvious correlation between the half-life of a variant and its enzymatic activity or between solubility, stability and enzymatic activity of a given variant could be found. Excitingly, some variants disrupt the physical interaction between TH and human wildtype GTPCH, thereby interfering with enzymatic activity and offering new druggable targets for therapy. Taken together, our results highlight the importance of an in-depth molecular analysis of each variant in order to be able to classify groups of disease variants and to find specific therapies for each subgroup. Stand-alone in silico analyses predict less precise the effect of specific variants and should be combined with other in vitro analyses in cellular model systems.
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Affiliation(s)
- Sabine Jung-Klawitter
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Petra Richter
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Yuheng Yuan
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Karin Welzel
- Division of Hematology, Cell and Gene Therapy, Paul-Ehrlich-Institute, Langen, Germany
| | - Marie Kube
- Institute of Molecular Biology, Mainz, Germany
| | - Stella Bähr
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Alexander Leibner
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Egbert Flory
- Division of Hematology, Cell and Gene Therapy, Paul-Ehrlich-Institute, Langen, Germany
| | - Thomas Opladen
- Medical Faculty, Center for Child and Adolescent Medicine, Pediatric Clinic I, Section of Neuropediatrics and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
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Reyes ZMD, Lynch E, Henry J, De Simone LM, Sobotka SA. Diagnosis of autism in a rare case of tyrosine hydroxylase deficiency: a case report. BMC Med Genomics 2023; 16:78. [PMID: 37041529 PMCID: PMC10088295 DOI: 10.1186/s12920-023-01510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Tyrosine hydroxylase deficiency (THD) is a rare movement disorder with broad phenotypic expression caused by bi-allelic mutations in the TH gene, which encode for tyrosine hydroxylase (TH) protein. Some patients with THD have improvement in dystonia with carbidopa-levodopa, a synthetic form of dopamine typically used in Parkinson's disease, and are considered to have dopa-responsive THD. THD has been found in 0.5-1 per million persons, although due to overlapping symptoms with other disorders and the need for genetic testing, prevalence is likely underestimated. Existing literature describes some patients with THD having intellectual disability, but comorbid autism spectrum disorder (ASD) has not been reported. CASE PRESENTATION A nearly 3-year-old boy was referred to pediatric neurology due to hypotonia, delayed motor milestones, and expressive speech delay. Whole exome sequencing confirmed tyrosine hydroxylase deficiency, detecting a novel variant p.S307C first reported here. The child was treated with carbidopa-levodopa with an excellent response, resulting in improved balance, fewer falls, and improved ability to jump, run and climb stairs. He was determined to have dopa-responsive THD. Due to his delays in expressive speech, the boy also had an assessment with a developmental and behavioral pediatrician, who identified a pattern of social pragmatic speech delay, sensory sensitivities, and restricted interests, and determined that he met criteria for a diagnosis of ASD. CONCLUSIONS While ASD can stand alone as a clinical diagnosis, it is also a cardinal feature of other genetically-based neurological disorders. To our knowledge, this is the first case that describes a patient with both disorders. Perhaps THD may be among the genetic disorders linked with ASD.
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Affiliation(s)
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61St Street, Suite 207, Chicago, IL, 60637, USA
| | - Julia Henry
- Section of Pediatric Neurology, Department of Pediatrics, The University of Chicago, Chicago, USA
| | | | - Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61St Street, Suite 207, Chicago, IL, 60637, USA.
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Mastrangelo M, Tolve M, Artiola C, Bove R, Carducci C, Carducci C, Angeloni A, Pisani F, Leuzzi V. Phenotypes and Genotypes of Inherited Disorders of Biogenic Amine Neurotransmitter Metabolism. Genes (Basel) 2023; 14:genes14020263. [PMID: 36833190 PMCID: PMC9957200 DOI: 10.3390/genes14020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Inherited disorders of biogenic amine metabolism are genetically determined conditions resulting in dysfunctions or lack of enzymes involved in the synthesis, degradation, or transport of dopamine, serotonin, adrenaline/noradrenaline, and their metabolites or defects of their cofactor or chaperone biosynthesis. They represent a group of treatable diseases presenting with complex patterns of movement disorders (dystonia, oculogyric crises, severe/hypokinetic syndrome, myoclonic jerks, and tremors) associated with a delay in the emergence of postural reactions, global development delay, and autonomic dysregulation. The earlier the disease manifests, the more severe and widespread the impaired motor functions. Diagnosis mainly depends on measuring neurotransmitter metabolites in cerebrospinal fluid that may address the genetic confirmation. Correlations between the severity of phenotypes and genotypes may vary remarkably among the different diseases. Traditional pharmacological strategies are not disease-modifying in most cases. Gene therapy has provided promising results in patients with DYT-DDC and in vitro models of DYT/PARK-SLC6A3. The rarity of these diseases, combined with limited knowledge of their clinical, biochemical, and molecular genetic features, frequently leads to misdiagnosis or significant diagnostic delays. This review provides updates on these aspects with a final outlook on future perspectives.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
| | - Manuela Tolve
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Artiola
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rossella Bove
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-649972930; Fax: +39-64440232
| | - Vincenzo Leuzzi
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
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Dong HY, Feng JY, Yue XJ, Shan L, Jia FY. Dopa-responsive dystonia caused by tyrosine hydroxylase deficiency: Three cases report and literature review. Medicine (Baltimore) 2020; 99:e21753. [PMID: 32872068 PMCID: PMC7437766 DOI: 10.1097/md.0000000000021753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONAL Tyrosine hydroxylase deficiency (THD) is a rare cause of dopa-responsive dystonia (DRD). Although the symptoms of DRD may be improved by treatment with L-dopa, the low morbidity of THD can lead to its misdiagnosis. Thus, it is important for physicians to be aware of THD as a cause of DRD. PATIENT CONCERNS We report 3 cases of THD. A 5-year-old boy with DRD was diagnosed with THD and found to have compound heterozygous mutations of the TH gene, including TH:c.647G>C from his mother and TH:c.646G>A from his father. Two female siblings also were found to have TH:c.698G>A from their mother and TH:c.710T>C from their father. The younger daughter, at age 3.5 years, was diagnosed with DRD caused by THD, and then the diagnosis of the older daughter, at age 11 years, was changed from cerebral palsy to DRD caused by THD. DIAGNOSIS The diagnosis of dopa-responsive dystonia caused by tyrosine hydroxylase deficiency was determined by whole exome sequencing. INTERVENTION They all treated with low dose levodopa and benserazide tablets. OUTCOMES The boy had a very good therapeutic effect, and he could walk very well by the second day of treatment. The younger sister of the siblings had a partial therapeutic effect, but her elder sister was only little effective with a milder improvement of dystonia and improvement of myodynamia. CONCLUSION The characteristics of THD are heterogeneous, and its phenotypes are classified as type A or type B according to increasing severity. Generally, L-dopa has a good therapeutic effect in cases with type A phenotypes. We reviewed 87 cases of reported in the literature and found that c.698G>A and c.707T>C are hot spot mutations. Changes on cerebral magnetic resonance imaging were nonspecific. Analysis of neurotransmitter levels in cerebrospinal fluid is an invasive means of achieving a biochemical diagnosis.
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Malek N, Fletcher N, Newman E. Diagnosing dopamine-responsive dystonias. Pract Neurol 2015; 15:340-5. [DOI: 10.1136/practneurol-2015-001101] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/04/2022]
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Ortez C, Duarte ST, Ormazábal A, Serrano M, Pérez A, Pons R, Pineda M, Yapici Z, Fernández-Álvarez E, Domingo-Jiménez R, De Castro P, Artuch R, García-Cazorla A. Cerebrospinal fluid synaptic proteins as useful biomarkers in tyrosine hydroxylase deficiency. Mol Genet Metab 2015; 114:34-40. [PMID: 25468651 DOI: 10.1016/j.ymgme.2014.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
Abstract
Tyrosine hydroxylase (TH) deficiency is an inborn error of dopamine biosynthesis and a cause of early parkinsonism. Two clinical phenotypes have been described. Type "B": early onset severe encephalopathy; type "A": later onset, less severe and better response to L-dopa. We aimed to study the expression of several key dopaminergic and gabaergic synaptic proteins in the cerebrospinal fluid (CSF) of a series of patients with TH deficiency and their possible relation with the clinical phenotype and response to L-DOPA. Dopamine transporter (DAT), D2-receptor and vesicular monoamine transporter (VMAT2) were measured in the CSF of 10 subjects with TH deficiency by Western blot analysis. In 3 patients, data of pre- and post-treatment with L-DOPA were available, and in one of them, GABA vesicular transporter was determined. Results were compared to an age-matched control population. The concentration of D2-receptors in CSF was significantly higher in patients with TH deficiency than in controls. Similarly, DAT and vesicular monoamine transporter type 2 were up-regulated. Studies performed before L-DOPA, and on L-DOPA therapy showed a paradoxical response with D2 receptor expression increase as L-Dopa doses and homovanillic concentration gradually raised in a B phenotype patient. The opposite results were found in two patients with A phenotype. However, this is a very small sample, and further studies are needed to conclude robust differences between phenotypes. Synaptic proteins are detectable in the CSF and their quantification can be useful for understanding the pathophysiology of neurotransmitter defects and potentially to adjust and personalize treatments in the future.
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Affiliation(s)
- C Ortez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - S T Duarte
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Hospital Dona Estefânia, CHLC, Lisbon, Portugal
| | - A Ormazábal
- Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - M Serrano
- Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - A Pérez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Pons
- Department of Pediatrics, University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - M Pineda
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - Z Yapici
- Istanbul Faculty of Medicine, Department of Child Neurology, Istanbul, Turkey
| | - E Fernández-Álvarez
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Domingo-Jiménez
- Departament of Pediatric Neurology, Hospital V. Arrixaca, Murcia, Spain
| | - P De Castro
- Department of Pediatric Neurology, Hospital Gregorio Marañón, Madrid, Spain
| | - R Artuch
- Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Hospital Sant Joan de Déu (HSJD), CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | - A García-Cazorla
- Department of Neurology, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Department of Biochemistry, CIBER-ER Biomedical Network Research Centre on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain.
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Fossbakk A, Kleppe R, Knappskog PM, Martinez A, Haavik J. Functional studies of tyrosine hydroxylase missense variants reveal distinct patterns of molecular defects in Dopa-responsive dystonia. Hum Mutat 2014; 35:880-90. [PMID: 24753243 PMCID: PMC4312968 DOI: 10.1002/humu.22565] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/10/2014] [Indexed: 11/23/2022]
Abstract
Congenital tyrosine hydroxylase deficiency (THD) is found in autosomal-recessive Dopa-responsive dystonia and related neurological syndromes. The clinical manifestations of THD are variable, ranging from early-onset lethal disease to mild Parkinson disease-like symptoms appearing in adolescence. Until 2014, approximately 70 THD patients with a total of 40 different disease-related missense mutations, five nonsense mutations, and three mutations in the promoter region of the tyrosine hydroxylase (TH) gene have been reported. We collected clinical and biochemical data in the literature for all variants, and also generated mutant forms of TH variants previously not studied (N = 23). We compared the in vitro solubility, thermal stability, and kinetic properties of the TH variants to determine the cause(s) of their impaired enzyme activity, and found great heterogeneity in all these properties among the mutated forms. Some TH variants had specific kinetic anomalies and phenylalanine hydroxylase, and Dopa oxidase activities were measured for variants that showed signs of altered substrate binding. p.Arg233His, p.Gly247Ser, and p.Phe375Leu had shifted substrate specificity from tyrosine to phenylalanine and Dopa, whereas p.Cys359Phe had an impaired activity toward these substrates. The new data about pathogenic mechanisms presented are expected to contribute to develop individualized therapy for THD patients.
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Affiliation(s)
- Agnete Fossbakk
- Department of Biomedicine, University of Bergen, Bergen, Norway; K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
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