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Kokubun N, Tsuchiya T, Hamaguchi M, Ueda Y, Matsuda H, Ishida K, Funakoshi K, Suzuki K, Yuki N. IgG subclass shifts occurring at acute exacerbations in autoimmune nodopathies. J Neurol 2024:10.1007/s00415-024-12597-6. [PMID: 39093334 DOI: 10.1007/s00415-024-12597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Autoimmune nodopathy associated with anti-contactin1 (CNTN1) IgG4 antibodies frequently manifests as acute axonal degeneration in addition to detachment of the paranodal myelin loops. The acute destruction of myelinated nerve fibers does not match the function of IgG4, which cannot activate the complement pathway. IgG subclass switching from IgG1 or IgG3 to IgG4 has been observed in some patients with autoimmune diseases associated with IgG4 throughout their disease course. METHODS Serial changes in IgG subclasses, clinico-neurophysiological features, and nerve and renal pathology were reviewed in three patients with anti-CNTN1-associated autoimmune nodopathy and one patient with anti-contactin-associated protein1 (Caspr1) autoimmune nodopathy. RESULTS All four patients had predominantly IgG4 autoantibodies, whereas they showed evidence of acute axonal degeneration. The IgG1 subclass was present in all patients at their progressing stage but then disappeared at follow-up. Nerve pathology in the patients with anti-CNTN1 and anti-Caspr1 autoimmune nodopathies showed both structural changes in the paranodes and evidence of acute axonal degeneration. Renal biopsy specimens from two patients with membranous glomerulonephritis and anti-CNTN1 autoimmune nodopathy showed deposition of IgG1 and complement on the glomerular basement membrane, as well as IgG4. DISCUSSION In patients with autoimmune nodopathies associated with anti-CNTN1 and anti-Caspr1 IgG4 antibodies, IgG1 subclass autoantibodies were present at their acute exacerbations and might have contributed to the axonal degeneration and glomerular injury. IgG1 disappeared with the cessation of disease progression, which indicates that the IgG1 subclass is a possible biomarker of disease activity.
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Affiliation(s)
- Norito Kokubun
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
| | - Tomohiro Tsuchiya
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Mai Hamaguchi
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Yoshihiko Ueda
- Department of Diagnostic Pathology, Dokkyo Medical University, Shimotsuga, Mibu, Tochigi, Japan
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hadzki Matsuda
- Department of Diagnostic Pathology, Dokkyo Medical University, Shimotsuga, Mibu, Tochigi, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Shimotsuga, Mibu, Tochigi, Japan
| | - Kei Funakoshi
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Nobuhiro Yuki
- Department of Neurology, Takai Hospital, Tenri, Nara, Japan
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2
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Arumugam SK, Subbarayan S. A Neonate with Recurrent Extubation Failure. Neoreviews 2024; 25:e163-e165. [PMID: 38425199 DOI: 10.1542/neo.25-3-e163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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3
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Chang C, Sell LB, Shi Q, Bhat MA. Mouse models of human CNTNAP1-associated congenital hypomyelinating neuropathy and genetic restoration of murine neurological deficits. Cell Rep 2023; 42:113274. [PMID: 37862170 PMCID: PMC10873044 DOI: 10.1016/j.celrep.2023.113274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023] Open
Abstract
The Contactin-associated protein 1 (Cntnap1) mouse mutants fail to establish proper axonal domains in myelinated axons. Human CNTNAP1 mutations are linked to hypomyelinating neuropathy-3, which causes severe neurological deficits. To understand the human neuropathology and to model human CNTNAP1C323R and CNTNAP1R764C mutations, we generated Cntnap1C324R and Cntnap1R765C mouse mutants, respectively. Both Cntnap1 mutants show weight loss, reduced nerve conduction, and progressive motor dysfunction. The paranodal ultrastructure shows everted myelin loops and the absence of axo-glial junctions. Biochemical analysis reveals that these Cntnap1 mutant proteins are nearly undetectable in the paranodes, have reduced surface expression and stability, and are retained in the neuronal soma. Postnatal transgenic expression of Cntnap1 in the mutant backgrounds rescues the phenotypes and restores the organization of axonal domains with improved motor function. This study uncovers the mechanistic impact of two human CNTNAP1 mutations in a mouse model and provides proof of concept for gene therapy for CNTNAP1 patients.
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Affiliation(s)
- Cheng Chang
- Department of Cellular and Integrative Physiology University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Lacey B Sell
- Department of Cellular and Integrative Physiology University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; IBMS Neuroscience Graduate Program, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Qian Shi
- Department of Cellular and Integrative Physiology University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; IBMS Neuroscience Graduate Program, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Manzoor A Bhat
- Department of Cellular and Integrative Physiology University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; IBMS Neuroscience Graduate Program, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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4
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Lepiarczyk E, Paukszto Ł, Wiszpolska M, Łopieńska-Biernat E, Bossowska A, Majewski MK, Majewska M. Molecular Influence of Resiniferatoxin on the Urinary Bladder Wall Based on Differential Gene Expression Profiling. Cells 2023; 12:cells12030462. [PMID: 36766804 PMCID: PMC9914288 DOI: 10.3390/cells12030462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Resiniferatoxin (RTX) is a potent capsaicin analog used as a drug for experimental therapy to treat neurogenic disorders associated with enhanced nociceptive transmission, including lower urinary tract symptoms. The present study, for the first time, investigated the transcriptomic profile of control and RTX-treated porcine urinary bladder walls. We applied multistep bioinformatics and discovered 129 differentially expressed genes (DEGs): 54 upregulated and 75 downregulated. Metabolic pathways analysis revealed five significant Kyoto Encyclopedia of Genes and Genomes (KEGG) items ('folate biosynthesis', 'metabolic pathways', 'sulfur relay system', 'sulfur metabolism' and 'serotonergic synapse') that were altered after RTX intravesical administration. A thorough analysis of the detected DEGs indicated that RTX treatment influenced the signaling pathways regulating nerve growth, myelination, axon specification, and elongation. Many of the revealed DEGs are involved in the nerve degeneration process; however, some of them were implicated in the initiation of neuroprotective mechanisms. Interestingly, RTX intravesical installation was followed by changes in the expression of genes involved in synaptic plasticity and neuromodulation, including 5-HT, H2S, glutamate, and GABA transmission. The obtained results suggest that the toxin may exert a therapeutic, antinociceptive effect not only by acting on TRPV1 receptors.
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Affiliation(s)
- Ewa Lepiarczyk
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Correspondence: ; Tel.: +48-89-524-53-34; Fax: +48-89-524-53-07
| | - Łukasz Paukszto
- Department of Botany and Nature Protection, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland
| | - Marta Wiszpolska
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
| | - Elżbieta Łopieńska-Biernat
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Agnieszka Bossowska
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
| | - Mariusz Krzysztof Majewski
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
| | - Marta Majewska
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
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5
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Garel P, Lesca G, Ville D, Poulat AL, Chatron N, Sanlaville D, Des Portes V, Arzimanoglou A, Lion-François L. CNTNAP1-encephalopathy: Six novel patients surviving the neonatal period. Eur J Paediatr Neurol 2022; 37:98-104. [PMID: 35182943 DOI: 10.1016/j.ejpn.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/29/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
CNTNAP1 encodes CASPR1, involved in the paranodal junction. Thirty-three patients, with CNTNAP1 biallelic mutations have been described previously. Most of them had a very severe neurological impairment and passed away in the first months of life. We identified four patients, from two unrelated families, who survived over the neonatal period. Exome sequencing showed compound heterozygous or homozygous variants. Severe hypotonia was a constant feature. When compared to previous reports, the most important clinical differences observed in our patients were the absence of antenatal problems and, in two of them, the lack of respiratory distress. Less commonly reported characteristics such as epileptic seizures, dystonia, and impaired communication skills were also observed. MRIs revealed hypomyelination or abnormal white matter signal, cerebral or cerebellar atrophy. The present observations support a wider than initially reported clinical spectrum, including survival after the neonatal period and additional neurological features. They contribute to better delineate the phenotype-genotype correlations for CNTNAP1. In addition, we report one more family with two sibs who carry a missense variant of uncertain significance which we propose could be associated with a milder phenotype.
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Affiliation(s)
- Pauline Garel
- Department of Pediatrics, Centre Hospitalier Universitaire de Saint Etienne, Saint-Priest-en-Jarez, France.
| | - Gaetan Lesca
- Genetics Department, Member of the ERN EpiCARE, HFME, University Hospitals of Lyon (HCL), Lyon, France; INMG (Institut Neuromyogene), Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Dorothée Ville
- Pediatric Neurology Department, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Anne-Lise Poulat
- Pediatric Neurology Department, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Nicolas Chatron
- Department of Biology and Pathology, University Hospitals of Lyon (HCL), Lyon, France; INMG (Institut Neuromyogene), Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Damien Sanlaville
- Department of Biology and Pathology, University Hospitals of Lyon (HCL), Lyon, France; INMG (Institut Neuromyogene), Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Des Portes
- Pediatric Neurology Department, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
| | - Laurence Lion-François
- Pediatric Neurology Department, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
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6
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Rebelo AP, Cortese A, Abraham A, Eshed-Eisenbach Y, Shner G, Vainshtein A, Buglo E, Camarena V, Gaidosh G, Shiekhattar R, Abreu L, Courel S, Burns DK, Bai Y, Bacon C, Feely SME, Castro D, Peles E, Reilly MM, Shy ME, Zuchner S. A CADM3 variant causes Charcot-Marie-Tooth disease with marked upper limb involvement. Brain 2021; 144:1197-1213. [PMID: 33889941 DOI: 10.1093/brain/awab019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
The CADM family of proteins consists of four neuronal specific adhesion molecules (CADM1, CADM2, CADM3 and CADM4) that mediate the direct contact and interaction between axons and glia. In the peripheral nerve, axon-Schwann cell interaction is essential for the structural organization of myelinated fibres and is primarily mediated by the binding of CADM3, expressed in axons, to CADM4, expressed by myelinating Schwann cells. We have identified-by whole exome sequencing-three unrelated families, including one de novo patient, with axonal Charcot-Marie-Tooth disease (CMT2) sharing the same private variant in CADM3, Tyr172Cys. This variant is absent in 230 000 control chromosomes from gnomAD and predicted to be pathogenic. Most CADM3 patients share a similar phenotype consisting of autosomal dominant CMT2 with marked upper limb involvement. High resolution mass spectrometry analysis detected a newly created disulphide bond in the mutant CADM3 potentially modifying the native protein conformation. Our data support a retention of the mutant protein in the endoplasmic reticulum and reduced cell surface expression in vitro. Stochastic optical reconstruction microscopy imaging revealed decreased co-localization of the mutant with CADM4 at intercellular contact sites. Mice carrying the corresponding human mutation (Cadm3Y170C) showed reduced expression of the mutant protein in axons. Cadm3Y170C mice showed normal nerve conduction and myelin morphology, but exhibited abnormal axonal organization, including abnormal distribution of Kv1.2 channels and Caspr along myelinated axons. Our findings indicate the involvement of abnormal axon-glia interaction as a disease-causing mechanism in CMT patients with CADM3 mutations.
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Affiliation(s)
- Adriana P Rebelo
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Andrea Cortese
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Amit Abraham
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Yael Eshed-Eisenbach
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Gal Shner
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Anna Vainshtein
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Elena Buglo
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Vladimir Camarena
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Gabriel Gaidosh
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
| | - Ramin Shiekhattar
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
| | - Lisa Abreu
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Steve Courel
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Dennis K Burns
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yunhong Bai
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Chelsea Bacon
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Shawna M E Feely
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Diana Castro
- Departments of Pediatrics, Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Elior Peles
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics, John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
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7
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Abstract
The nodes of Ranvier have clustered Na+ and K+ channels necessary for rapid and efficient axonal action potential conduction. However, detailed mechanisms of channel clustering have only recently been identified: they include two independent axon-glia interactions that converge on distinct axonal cytoskeletons. Here, we discuss how glial cell adhesion molecules and the extracellular matrix molecules that bind them assemble combinations of ankyrins, spectrins and other cytoskeletal scaffolding proteins, which cluster ion channels. We present a detailed molecular model, incorporating these overlapping mechanisms, to explain how the nodes of Ranvier are assembled in both the peripheral and central nervous systems.
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8
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Li W, Yang L, Tang C, Liu K, Lu Y, Wang H, Yan K, Qiu Z, Zhou W. Mutations of CNTNAP1 led to defects in neuronal development. JCI Insight 2020; 5:135697. [PMID: 33148880 PMCID: PMC7710280 DOI: 10.1172/jci.insight.135697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Mutations of CNTNAP1 were associated with myelination disorders, suggesting the role of CNTNAP1 in myelination processes. Whether CNTNAP1 may have a role in early cortical neuronal development is largely unknown. In this study, we identified 4 compound heterozygous mutations of CNTNAP1 in 2 Chinese families. Using mouse models, we found that CNTNAP1 is highly expressed in neurons and is located predominantly in MAP2+ neurons during the early developmental stage. Importantly, Cntnap1 deficiency results in aberrant dendritic growth and spine development in vitro and in vivo, and it delayed migration of cortical neurons during early development. Finally, we found that the number of parvalbumin+ neurons in the cortex and hippocampus of Cntnap1–/– mice is strikingly increased by P15, suggesting that excitation/inhibition balance is impaired. Together, this evidence elucidates a critical function of CNTNAP1 in cortical development, providing insights underlying molecular and circuit mechanisms of CNTNAP1-related disease. Deficiency of CNTNAP1 causes severe cortical developmental deficits, leading to human lethal perinatal symptoms.
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Affiliation(s)
| | - Lin Yang
- Key Laboratory of Birth Defects.,Division of Endocrinology, Genetics and Metabolic Disease, and
| | - Chuanqing Tang
- Stem Cell Research Center, Institute of Pediatrics, Children's Hospital, Fudan University, Shanghai, China
| | | | | | | | | | - Zilong Qiu
- Institute of Neuroscience, State Key Laboratory of Neuroscience.,CAS Center for Excellence in Brain Science and Intelligence Technology.,Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology.,Chinese Academy of Sciences, and.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhao Zhou
- Division of Neonatology.,Key Laboratory of Birth Defects.,Key Laboratory of Neonatal Diseases, Ministry of Health, Children's Hospital of Fudan University, Shanghai, China
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10
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Abstract
PURPOSE OF REVIEW Charcot-Marie-Tooth (CMT) disease and related disorders are the commonest group of inherited neuromuscular diseases and represent a heterogeneous group of disorders. This review will cover recent advances in genetic diagnosis and the evolving genetic and phenotype landscape of this disease group. We will review recent evidence of the increasingly recognized phenotypic overlap with other neurodegenerative conditions including hereditary spastic paraplegia, hereditary ataxias and mitochondrial diseases and highlight the importance of deep phenotyping to inform genetic diagnosis and prognosis. RECENT FINDINGS Through whole exome sequencing and multicentre collaboration new genes are being identified as causal for CMT expanding the genetic heterogeneity of this condition. In addition, an increasing number of variants have been identified in genes known to cause complex inherited diseases in which the peripheral neuropathy is part of the disorder and may be the presenting feature. The recent discovery of a repeat expansion in the RFC1 gene in cerebellar ataxia, neuropathy, vestibular areflexia syndrome highlights the prevalence of late-onset recessive conditions which have historically been considered to cause early-onset disease. SUMMARY CMT is an evolving field with considerable phenotypic and genetic heterogeneity and deep phenotyping remains a cornerstone in contemporary CMT diagnostics.
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11
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CNTNAP1 Mutations and Their Clinical Presentations: New Case Report and Systematic Review. Case Rep Med 2020; 2020:8795607. [PMID: 32328110 PMCID: PMC7174947 DOI: 10.1155/2020/8795607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 01/11/2023] Open
Abstract
Lethal congenital contracture syndrome type 7 (LCCS7) and congenital hypomyelinating neuropathy type 3 (CHN3) are rare autosomal recessive diseases, characterized by severe neonatal hypotonia, polyhydramnios, arthrogryposis, facial diplegia, and severe motor paralysis, leading to death in early infancy. They are related to mutations in the CNTNAP1 (contactin associated protein 1) gene, playing an important role in myelination. Recent studies have shown that both diseases could present with a wide phenotypic spectrum, with promising survival up to early childhood. We report on a 7-year-old boy from a nonconsanguineous Lebanese family presenting with neonatal hypotonia, respiratory distress, and arthrogryposis. Molecular analysis revealed the presence of a pathogenic variant in the CNTNAP1 gene leading to a premature stop codon: NM_003632.2:c.3361C>T p.(Arg1121∗). A review of the literature is discussed.
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12
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First-line exome sequencing in Palestinian and Israeli Arabs with neurological disorders is efficient and facilitates disease gene discovery. Eur J Hum Genet 2020; 28:1034-1043. [PMID: 32214227 PMCID: PMC7382450 DOI: 10.1038/s41431-020-0609-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
A high rate of consanguinity leads to a high prevalence of autosomal recessive disorders in inbred populations. One example of inbred populations is the Arab communities in Israel and the Palestinian Authority. In the Palestinian Authority in particular, due to limited access to specialized medical care, most patients do not receive a genetic diagnosis and can therefore neither receive genetic counseling nor possibly specific treatment. We used whole-exome sequencing as a first-line diagnostic tool in 83 Palestinian and Israeli Arab families with suspected neurogenetic disorders and were able to establish a probable genetic diagnosis in 51% of the families (42 families). Pathogenic, likely pathogenic or highly suggestive candidate variants were found in the following genes extending and refining the mutational and phenotypic spectrum of these rare disorders: ACO2, ADAT3, ALS2, AMPD2, APTX, B4GALNT1, CAPN1, CLCN1, CNTNAP1, DNAJC6, GAMT, GPT2, KCNQ2, KIF11, LCA5, MCOLN1, MECP2, MFN2, MTMR2, NT5C2, NTRK1, PEX1, POLR3A, PRICKLE1, PRKN, PRX, SCAPER, SEPSECS, SGCG, SLC25A15, SPG11, SYNJ1, TMCO1, and TSEN54. Further, this cohort has proven to be ideal for prioritization of new disease genes. Two separately published candidate genes (WWOX and PAX7) were identified in this study. Analyzing the runs of homozygosity (ROHs) derived from the Exome sequencing data as a marker for the rate of inbreeding, revealed significantly longer ROHs in the included families compared with a German control cohort. The total length of ROHs correlated with the detection rate of recessive disease-causing variants. Identification of the disease-causing gene led to new therapeutic options in four families.
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13
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Morelli KH, Hatton CL, Harper SQ, Burgess RW. Gene therapies for axonal neuropathies: Available strategies, successes to date, and what to target next. Brain Res 2020; 1732:146683. [PMID: 32001243 DOI: 10.1016/j.brainres.2020.146683] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/20/2022]
Abstract
Nearly one-hundred loci in the human genome have been associated with different forms of Charcot-Marie-Tooth disease (CMT) and related inherited neuropathies. Despite this wealth of gene targets, treatment options are still extremely limited, and clear "druggable" pathways are not obvious for many of these mutations. However, recent advances in gene therapies are beginning to circumvent this challenge. Each type of CMT is a monogenic disorder, and the cellular targets are usually well-defined and typically include peripheral neurons or Schwann cells. In addition, the genetic mechanism is often also clear, with loss-of-function mutations requiring restoration of gene expression, and gain-of-function or dominant-negative mutations requiring silencing of the mutant allele. These factors combine to make CMT a good target for developing genetic therapies. Here we will review the state of relatively established gene therapy approaches, including viral vector-mediated gene replacement and antisense oligonucleotides for exon skipping, altering splicing, and gene knockdown. We will also describe earlier stage approaches for allele-specific knockdown and CRIPSR/Cas9 gene editing. We will next describe how these various approaches have been deployed in clinical and preclinical studies. Finally, we will evaluate various forms of CMT as candidates for gene therapy based on the current understanding of their genetics, cellular/tissue targets, validated animal models, and availability of patient populations and natural history data.
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Affiliation(s)
- Kathryn H Morelli
- The Jackson Laboratory, Bar Harbor, ME 04609, USA; The Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME 04469, USA
| | | | - Scott Q Harper
- Center for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert W Burgess
- The Jackson Laboratory, Bar Harbor, ME 04609, USA; The Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME 04469, USA.
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14
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Efthymiou S, Salpietro V, Malintan N, Poncelet M, Kriouile Y, Fortuna S, De Zorzi R, Payne K, Henderson LB, Cortese A, Maddirevula S, Alhashmi N, Wiethoff S, Ryten M, Botia JA, Provitera V, Schuelke M, Vandrovcova J, Walsh L, Torti E, Iodice V, Najafi M, Karimiani EG, Maroofian R, Siquier-Pernet K, Boddaert N, De Lonlay P, Cantagrel V, Aguennouz M, El Khorassani M, Schmidts M, Alkuraya FS, Edvardson S, Nolano M, Devaux J, Houlden H. Biallelic mutations in neurofascin cause neurodevelopmental impairment and peripheral demyelination. Brain 2019; 142:2948-2964. [PMID: 31501903 PMCID: PMC6763744 DOI: 10.1093/brain/awz248] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/19/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022] Open
Abstract
Axon pathfinding and synapse formation are essential processes for nervous system development and function. The assembly of myelinated fibres and nodes of Ranvier is mediated by a number of cell adhesion molecules of the immunoglobulin superfamily including neurofascin, encoded by the NFASC gene, and its alternative isoforms Nfasc186 and Nfasc140 (located in the axonal membrane at the node of Ranvier) and Nfasc155 (a glial component of the paranodal axoglial junction). We identified 10 individuals from six unrelated families, exhibiting a neurodevelopmental disorder characterized with a spectrum of central (intellectual disability, developmental delay, motor impairment, speech difficulties) and peripheral (early onset demyelinating neuropathy) neurological involvement, who were found by exome or genome sequencing to carry one frameshift and four different homozygous non-synonymous variants in NFASC. Expression studies using immunostaining-based techniques identified absent expression of the Nfasc155 isoform as a consequence of the frameshift variant and a significant reduction of expression was also observed in association with two non-synonymous variants affecting the fibronectin type III domain. Cell aggregation studies revealed a severely impaired Nfasc155-CNTN1/CASPR1 complex interaction as a result of the identified variants. Immunofluorescence staining of myelinated fibres from two affected individuals showed a severe loss of myelinated fibres and abnormalities in the paranodal junction morphology. Our results establish that recessive variants affecting the Nfasc155 isoform can affect the formation of paranodal axoglial junctions at the nodes of Ranvier. The genetic disease caused by biallelic NFASC variants includes neurodevelopmental impairment and a spectrum of central and peripheral demyelination as part of its core clinical phenotype. Our findings support possible overlapping molecular mechanisms of paranodal damage at peripheral nerves in both the immune-mediated and the genetic disease, but the observation of prominent central neurological involvement in NFASC biallelic variant carriers highlights the importance of this gene in human brain development and function.
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Affiliation(s)
- Stephanie Efthymiou
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - Nancy Malintan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - Mallory Poncelet
- INSERM U1051, Institut de Neurosciences de Montpellier (INM), Université de Montpellier, Montpellier, France
| | - Yamna Kriouile
- Unit of Neuropediatrics and Neurometabolism, Pediatric Department 2, Rabat Children's Hospital, and Faculty of Medicine and Pharmacy of Rabat, University Mohammed V of Rabat, Morocco
| | - Sara Fortuna
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste, Italy
| | - Rita De Zorzi
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste, Italy
| | - Katelyn Payne
- Riley Hospital for Children, Indianapolis, Indiana, IN, USA
| | | | - Andrea Cortese
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Sateesh Maddirevula
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nadia Alhashmi
- Department of Genetics, College of Medicine, Sultan Qaboos University, Sultanate of Oman
| | - Sarah Wiethoff
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
- Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard Karls-University, Tübingen, Germany
| | - Mina Ryten
- Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | - Juan A Botia
- Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square, London, UK
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, E, Spain
| | - Vincenzo Provitera
- Department of Neurology, Istituti Clinici Scientifici Maugeri IRCCS, Italy
| | - Markus Schuelke
- Department of Neuropediatrics, Charité Universitätsmedizin Berlin, Germany
| | - Jana Vandrovcova
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Laurence Walsh
- Riley Hospital for Children, Indianapolis, Indiana, IN, USA
| | | | - Valeria Iodice
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK
- Autonomic Unit, National Hospital Neurology and Neurosurgery, UCL NHS Trust, London, UK
| | - Maryam Najafi
- Genome Research Division, Human Genetics Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Ehsan Ghayoor Karimiani
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's, University of London, Cranmer Terrace, London, UK
| | - Reza Maroofian
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's, University of London, Cranmer Terrace, London, UK
| | - Karine Siquier-Pernet
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
- Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Nathalie Boddaert
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
- Department of Pediatric Radiology, Necker Enfants Malades University Hospital, APHP, Paris, France
| | - Pascale De Lonlay
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
- Inserm, U1151, Institut Necker-Enfants Malades, Paris, France
| | - Vincent Cantagrel
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
- Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Mhammed Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Sicily
| | - Mohamed El Khorassani
- Unit of Neuropediatrics and Neurometabolism, Pediatric Department 2, Rabat Children's Hospital, and Faculty of Medicine and Pharmacy of Rabat, University Mohammed V of Rabat, Morocco
| | - Miriam Schmidts
- Genome Research Division, Human Genetics Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
- Center for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg University, Faculty of Medicine, Mathildenstrasse 1, Freiburg, Germany
| | - Fowzan S Alkuraya
- Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Simon Edvardson
- Paediatric Neurology Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Maria Nolano
- Department of Neurology, Istituti Clinici Scientifici Maugeri IRCCS, Italy
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Italy
| | - Jérôme Devaux
- INSERM U1051, Institut de Neurosciences de Montpellier (INM), Université de Montpellier, Montpellier, France
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Institute of Neurology, Queen Square, London, UK
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15
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Karakaya M, Wirth B. Hereditary nodo-paranodopathies: genomic variants, not just autoantibodies, hit the protein. Brain 2019; 142:2895-2897. [PMID: 31560060 DOI: 10.1093/brain/awz273] [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] [Indexed: 02/15/2024] Open
Abstract
The scientific commentary refers to ‘Biallelic mutations in neurofascin cause neurodevelopmental impairment and peripheral demyelination’, by Efthymiou et al. (doi:10.1093/brain/awz248).
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Affiliation(s)
- Mert Karakaya
- Institute of Human Genetics, Center for Molecular Medicine Cologne (CMMC), Institute of Genetics, and Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Brunhilde Wirth
- Institute of Human Genetics, Center for Molecular Medicine Cologne (CMMC), Institute of Genetics, and Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
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16
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Dahan-Oliel N, Cachecho S, Barnes D, Bedard T, Davison AM, Dieterich K, Donohoe M, Fąfara A, Hamdy R, Hjartarson HT, S Hoffman N, Kimber E, Komolkin I, Lester R, Pontén E, van Bosse HJP, Hall JG. International multidisciplinary collaboration toward an annotated definition of arthrogryposis multiplex congenita. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:288-299. [PMID: 31282072 PMCID: PMC6771513 DOI: 10.1002/ajmg.c.31721] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) has been described and defined in thousands of articles, but the terminology used has been inconsistent in clinical and research communities. A definition of AMC was recently developed using a modified Delphi consensus method involving 25 experts in the field of AMC from 8 countries. Participants included health care professionals, researchers, and individuals with AMC. An annotation of the definition provides more in-depth explanations of the different sentences of the AMC definition and is useful to complement the proposed definition. The aim of this study was to provide an annotation of the proposed consensus-based AMC definition. For the annotation process, 17 experts in AMC representing 10 disciplines across 7 countries participated. A paragraph was developed for each sentence of the definition using an iterative process involving multiple authors with varied and complementary expertise, ensuring all points of view were taken into consideration. The annotated definition provides an overview of the different topics related to AMC and is intended for all stakeholders, including youth and adults with AMC, their families, and clinicians and researchers, with the hopes of unifying the understanding of AMC in the international community.
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Affiliation(s)
- Noémi Dahan-Oliel
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sarah Cachecho
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | | | - Tanya Bedard
- Clinical Genetics, Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Ann M Davison
- Biology Department, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Klaus Dieterich
- Department of Medical Genetics, Reference Center for Developmental Anomalies, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Maureen Donohoe
- Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware
| | - Alicja Fąfara
- Faculty of Health Science, Jagiellonian University Medical College, Institute of Physiotherapy, Arthrogryposis Treatment Centre, University Children's Hospital, Krakow, Poland
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada.,Division of Pediatric Orthopaedics, McGill University, Montreal, Quebec, Canada
| | - Helgi T Hjartarson
- Department of Neuropediatrics, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | | | - Eva Kimber
- Department of Pediatrics, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Igor Komolkin
- Department of Children Surgery, Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
| | - Ruth Lester
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Eva Pontén
- Department of Pediatric Orthopaedic Surgery, Institute of Women's and Children's Health, Karolinska University Hospital, Solna, Sweden
| | - Harold J P van Bosse
- Department of Orthopaedics, Temple University, Philadelphia, Pennsylvania.,Shriners Hospital for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Judith G Hall
- Department of Pediatrics and Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Lesmana H, Vawter Lee M, Hosseini SA, Burrow TA, Hallinan B, Bove K, Schapiro M, Hopkin RJ. CNTNAP1-Related Congenital Hypomyelinating Neuropathy. Pediatr Neurol 2019; 93:43-49. [PMID: 30686628 DOI: 10.1016/j.pediatrneurol.2018.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Congenital hypomyelinating neuropathy is a rare form of hereditary peripheral neuropathy characterized by nonprogressive weakness, areflexia, hypotonia, severely reduced nerve conduction velocities, and hypomyelination. Mutations in contactin-associated protein 1 (CNTNAP1) were recently described as a cause of congenital hypomyelinating neuropathy. CNTNAP1-associated congenital hypomyelinating neuropathy is characterized by severe hypotonia, multiple distal joint contractures, and high mortality in the first few months of life. METHODS Whole-exome sequencing was performed in two siblings with congenital hypotonia. Detailed phenotyping data were compared with previously reported cases. RESULTS A novel, heterozygous compound mutation of CNTNAP1 was identified in both siblings. We also reviewed 17 patients harboring 10 distinct mutations from previously published studies. All patients presented with severe hypotonia, respiratory distress, and multiple cranial nerve palsies at birth. Six of 19 patients survived beyond infancy and required chronic mechanical ventilation. Seizures were common in the surviving patients. CONCLUSIONS These findings suggest that CNTNAP1-related congenital hypomyelinating neuropathy is a distinct form of hereditary neuropathy that affects both the central and peripheral nervous systems with no clear phenotype-genotype correlation. Our findings also indicate that arthrogryposis multiplex congenita and early lethality are not universal outcomes for patients with congenital hypomyelinating neuropathy.
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Affiliation(s)
- Harry Lesmana
- Department of Hematology, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Oncology, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Marissa Vawter Lee
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - T Andrew Burrow
- Section of Genetics and Metabolism, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Barbara Hallinan
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Kevin Bove
- Division of Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio; Division of Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Mark Schapiro
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio.
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18
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Conant A, Curiel J, Pizzino A, Sabetrasekh P, Murphy J, Bloom M, Evans SH, Helman G, Taft RJ, Simons C, Whitehead MT, Moore SA, Vanderver A. Absence of Axoglial Paranodal Junctions in a Child With CNTNAP1 Mutations, Hypomyelination, and Arthrogryposis. J Child Neurol 2018; 33:642-650. [PMID: 29882456 PMCID: PMC6800098 DOI: 10.1177/0883073818776157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leukodystrophies and genetic leukoencephalopathies are a heterogeneous group of heritable disorders that affect the glial-axonal unit. As more patients with unsolved leukodystrophies and genetic leukoencephalopathies undergo next generation sequencing, causative mutations in genes leading to central hypomyelination are being identified. Two such individuals presented with arthrogryposis multiplex congenita, congenital hypomyelinating neuropathy, and central hypomyelination with early respiratory failure. Whole exome sequencing identified biallelic mutations in the CNTNAP1 gene: homozygous c.1163G>C (p.Arg388Pro) and compound heterozygous c.967T>C (p.Cys323Arg) and c.319C>T (p.Arg107*). Sural nerve and quadriceps muscle biopsies demonstrated progressive, severe onion bulb and axonal pathology. By ultrastructural evaluation, septate axoglial paranodal junctions were absent from nodes of Ranvier. Serial brain magnetic resonance images revealed hypomyelination, progressive atrophy, and reduced diffusion in the globus pallidus in both patients. These 2 families illustrate severe progressive peripheral demyelinating neuropathy due to the absence of septate paranodal junctions and central hypomyelination with neurodegeneration in CNTNAP1-associated arthrogryposis multiplex congenita.
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Affiliation(s)
- Alexander Conant
- 1 Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Julian Curiel
- 2 Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy Pizzino
- 1 Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Parisa Sabetrasekh
- 1 Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Jennifer Murphy
- 3 National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Miriam Bloom
- 4 Department of Pediatric Hospitalist Medicine, Children's National Health System, Washington, DC, USA
| | - Sarah H Evans
- 5 Department of Physical Medicine and Rehabilitation, Children's National Health System, Washington, DC, USA
| | - Guy Helman
- 1 Department of Neurology, Children's National Health System, Washington, DC, USA.,6 Center for Genetic Medicine, Children's National Health System, Washington DC, USA.,7 Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Ryan J Taft
- 8 Illumina, San Diego, CA, USA.,9 Institute for Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Australia
| | - Cas Simons
- 7 Murdoch Children's Research Institute, Parkville, Melbourne, Australia.,9 Institute for Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Australia
| | - Matthew T Whitehead
- 10 Neuroradiology Department, Children's National Health System, Washington, DC, USA.,11 George Washington University School of Medicine, Washington, DC, USA
| | - Steven A Moore
- 12 Department of Pathology, University of Iowa Carver College of Medicine and Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, Iowa City, IA, USA
| | - Adeline Vanderver
- 1 Department of Neurology, Children's National Health System, Washington, DC, USA.,2 Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,3 National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,11 George Washington University School of Medicine, Washington, DC, USA
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19
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Beecroft SJ, Lombard M, Mowat D, McLean C, Cairns A, Davis M, Laing NG, Ravenscroft G. Genetics of neuromuscular fetal akinesia in the genomics era. J Med Genet 2018; 55:505-514. [PMID: 29959180 DOI: 10.1136/jmedgenet-2018-105266] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 12/27/2022]
Abstract
Fetal hypokinesia or akinesia encompasses a broad spectrum of disorders, united by impaired movement in utero. Often, the underlying aetiology is genetic in origin, affecting part of the neuromuscular system. The affordable and high-throughput nature of next-generation DNA sequencing has led to an explosion in disease gene discovery across rare diseases, including fetal akinesias. A genetic diagnosis has clinical utility as it may affect management and prognosis and informs recurrence risk, facilitating family planning decisions. More broadly, knowledge of disease genes increasingly allows population-based preconception carrier screening, which has reduced the incidence of recessive diseases in several populations. Despite gains in knowledge of the genetics of fetal akinesia, many families lack a genetic diagnosis. In this review, we describe the developments in Mendelian genetics of neuromuscular fetal akinesia in the genomics era. We examine genetic diagnoses with neuromuscular causes, specifically including the lower motor neuron, peripheral nerve, neuromuscular junction and muscle.
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Affiliation(s)
- Sarah Jane Beecroft
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Marcus Lombard
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Catriona McLean
- Victorian Neuromuscular Laboratory, Alfred Health, Melbourne, Victoria, Australia
| | - Anita Cairns
- Department of Neurology, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Mark Davis
- Neurogenetics Laboratory, Department of Diagnostic Genomics, PP Block, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Nigel G Laing
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Gianina Ravenscroft
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, Western Australia, Australia
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20
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Mathis S, Magy L, Le Masson G, Richard L, Soulages A, Solé G, Duval F, Ghorab K, Vallat JM, Duchesne M. Value of nerve biopsy in the management of peripheral neuropathies. Expert Rev Neurother 2018; 18:589-602. [DOI: 10.1080/14737175.2018.1489240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Laurent Magy
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Gwendal Le Masson
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Laurence Richard
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Antoine Soulages
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
| | - Guilhem Solé
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Fanny Duval
- Department of Neurology (Nerve-Muscle Unit), CHU Bordeaux (Pellegrin Hospital), Bordeaux, France
- National Reference Center ‘maladies neuromusculaires du grand sud-ouest’, CHU Bordeaux (Pellegrin Hospital), University of Bordeaux, Bordeaux, France
| | - Karima Ghorab
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Jean-Michel Vallat
- Department of Neurology, University hospital, Limoges, France
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
| | - Mathilde Duchesne
- National Reference Center for ‘rare peripheral neuropathies’, University Hospital, Limoges, France
- Department of Pathology, University Hospital, Limoges, France
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21
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Low KJ, Stals K, Caswell R, Wakeling M, Clayton-Smith J, Donaldson A, Foulds N, Norman A, Splitt M, Urankar K, Vijayakumar K, Majumdar A, Study D, Ellard S, Smithson SF. Phenotype of CNTNAP1: a study of patients demonstrating a specific severe congenital hypomyelinating neuropathy with survival beyond infancy. Eur J Hum Genet 2018; 26:796-807. [PMID: 29511323 PMCID: PMC5974240 DOI: 10.1038/s41431-018-0110-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
CHN is genetically heterogeneous and its genetic basis is difficult to determine on features alone. CNTNAP1 encodes CASPR, integral in the paranodal junction high molecular mass complex. Nineteen individuals with biallelic variants have been described in association with severe congenital hypomyelinating neuropathy, respiratory compromise, profound intellectual disability and death within the first year. We report 7 additional patients ascertained through exome sequencing. We identified 9 novel CNTNAP1 variants in 6 families: three missense variants, four nonsense variants, one frameshift variant and one splice site variant. Significant polyhydramnios occurred in 6/7 pregnancies. Severe respiratory compromise was seen in 6/7 (tracheostomy in 5). A complex neurological phenotype was seen in all patients who had marked brain hypomyelination/demyelination and profound developmental delay. Additional neurological findings included cranial nerve compromise: orobulbar dysfunction in 5/7, facial nerve weakness in 4/7 and vocal cord paresis in 5/7. Dystonia occurred in 2/7 patients and limb contractures in 5/7. All had severe gastroesophageal reflux, and a gastrostomy was required in 5/7. In contrast to most previous reports, only one patient died in the first year of life. Protein modelling was performed for all detected CNTNAP1 variants. We propose a genotype-phenotype correlation, whereby hypomorphic missense variants partially ameliorate the phenotype, prolonging survival. This study suggests that biallelic variants in CNTNAP1 cause a distinct recognisable syndrome, which is not caused by other genes associated with CHN. Neonates presenting with this phenotype will benefit from early genetic definition to inform clinical management and enable essential genetic counselling for their families.
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Affiliation(s)
- K J Low
- Department of Clinical Genetics, St Michaels Hospital, Bristol, UK
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - K Stals
- Department of Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - R Caswell
- Institute for Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - M Wakeling
- Institute for Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - J Clayton-Smith
- Manchester Centre for Genomic Medicine, St Marys' Hospital, Manchester, UK
- Institute of Human Development, University of Manchester, Manchester, UK
| | - A Donaldson
- Department of Clinical Genetics, St Michaels Hospital, Bristol, UK
| | - N Foulds
- Wessex Clinical Genetics Service, Southampton, UK
| | - A Norman
- Department of Clinical Genetics, St Michaels Hospital, Bristol, UK
| | - M Splitt
- Northern Genetics Service, Institute of Genetics Medicine, Newcastle upon Tyne, UK
| | - K Urankar
- Department of Neuropathology, North Bristol NHS Trust, Bristol, UK
| | - K Vijayakumar
- Paediatric Neuromuscular Service, Bristol Royal Hospital for Children, Bristol, UK
| | - A Majumdar
- Paediatric Neuromuscular Service, Bristol Royal Hospital for Children, Bristol, UK
| | - Ddd Study
- Wellcome Trust Sanger Institute, Cambridge, UK
| | - S Ellard
- Department of Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Institute for Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - S F Smithson
- Department of Clinical Genetics, St Michaels Hospital, Bristol, UK.
- School of Clinical Sciences, University of Bristol, Bristol, UK.
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22
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Fernández-Marmiesse A, Gouveia S, Couce ML. NGS Technologies as a Turning Point in Rare Disease Research , Diagnosis and Treatment. Curr Med Chem 2018; 25:404-432. [PMID: 28721829 PMCID: PMC5815091 DOI: 10.2174/0929867324666170718101946] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/19/2017] [Accepted: 07/14/2017] [Indexed: 01/17/2023]
Abstract
Approximately 25-50 million Americans, 30 million Europeans, and 8% of the Australian population have a rare disease. Rare diseases are thus a common problem for clinicians and account for enormous healthcare costs worldwide due to the difficulty of establishing a specific diagnosis. In this article, we review the milestones achieved in our understanding of rare diseases since the emergence of next-generation sequencing (NGS) technologies and analyze how these advances have influenced research and diagnosis. The first half of this review describes how NGS has changed diagnostic workflows and provided an unprecedented, simple way of discovering novel disease-associated genes. We focus particularly on metabolic and neurodevelopmental disorders. NGS has enabled cheap and rapid genetic diagnosis, highlighted the relevance of mosaic and de novo mutations, brought to light the wide phenotypic spectrum of most genes, detected digenic inheritance or the presence of more than one rare disease in the same patient, and paved the way for promising new therapies. In the second part of the review, we look at the limitations and challenges of NGS, including determination of variant causality, the loss of variants in coding and non-coding regions, and the detection of somatic mosaicism variants and epigenetic mutations, and discuss how these can be overcome in the near future.
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Affiliation(s)
- Ana Fernández-Marmiesse
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sofía Gouveia
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María L. Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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23
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Duchesne M, Mathis S, Richard L, Magdelaine C, Corcia P, Nouioua S, Tazir M, Magy L, Vallat JM. Nerve Biopsy Is Still Useful in Some Inherited Neuropathies. J Neuropathol Exp Neurol 2017; 77:88-99. [DOI: 10.1093/jnen/nlx111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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