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Selamioğlu A, Doğan BY, Balcı MC, Kalaycı T, Karaca M, Ak B, Durmuş A, Körbeyli HK, Gökçay G. Clinical Presentation and Molecular Characterization of 3 Patients with Vici Syndrome: Two Novel Variants in the EPG5 Gene. Mol Syndromol 2024; 15:257-268. [PMID: 38841323 PMCID: PMC11149970 DOI: 10.1159/000536069] [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: 08/01/2023] [Accepted: 12/30/2023] [Indexed: 06/07/2024] Open
Abstract
Introduction Vici syndrome is an ultra-rare, congenital disorder of autophagy characterized by agenesis of the corpus callosum, cataracts, cardiomyopathy, combined immunodeficiency, developmental delay, and hypopigmentation. Patients usually present in the neonatal period or infancy with profound hypotonia, based on information available from the nearly 100 cases reported to date. Case Presentation We present 3 new cases of Vici syndrome confirmed by genetic analysis of EPG5 gene. The 3 male patients had neonatal hypotonia, progressive microcephaly, psychomotor retardation, recurrent respiratory tract infections, optic atrophy, and failure to thrive, but no cataracts or hepatomegaly. Three disease-causing variants in homozygous state were detected in the EPG5 gene: two novel c.1652C>T and c.7557+2T>C forms; and one previously reported c.7447C>T. The patient, who was homozygous for the c.1652C>T mutation, presented with neonatal onset seizures that had not been reported previously. Discussion/Conclusion The present study provides data for the evaluation of the natural history and genotype-phenotype correlations for treatment options that are expected to be available in the future.
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Affiliation(s)
- Arzu Selamioğlu
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burcu Yeter Doğan
- Division of Pediatric Genetics, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Cihan Balcı
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tuğba Kalaycı
- Division of Medical Genetics, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Belkıs Ak
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aslı Durmuş
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hüseyin Kutay Körbeyli
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gülden Gökçay
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Neveu MM, Padhy SK, Ramamurthy S, Takkar B, Jalali S, Cp D, Padhi TR, Robson AG. Ophthalmological Manifestations of Oculocutaneous and Ocular Albinism: Current Perspectives. Clin Ophthalmol 2022; 16:1569-1587. [PMID: 35637898 PMCID: PMC9148211 DOI: 10.2147/opth.s329282] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
Albinism describes a heterogeneous group of genetically determined disorders characterized by disrupted synthesis of melanin and a range of developmental ocular abnormalities. The main ocular features common to both oculocutaneous albinism (OCA), and ocular albinism (OA) include reduced visual acuity, refractive errors, foveal hypoplasia, congenital nystagmus, iris and fundus hypopigmentation and visual pathway misrouting, but clinical signs vary and there is phenotypic overlap with other pathologies. This study reviews the prevalence, genetics and ocular manifestations of OCA and OA, including abnormal development of the optic chiasm. The role of visual electrophysiology in the detection of chiasmal dysfunction and visual pathway misrouting is emphasized, highlighting how age-associated changes in visual evoked potential (VEP) test results must be considered to enable accurate diagnosis, and illustrated further by the inclusion of novel VEP data in genetically confirmed cases. Differential diagnosis is considered in the context of suspected retinal and other disorders, including rare syndromes that may masquerade as albinism.
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Affiliation(s)
- Magella M Neveu
- Department Electrophysiology, Moorfields Eye Hospital, London, EC1V 2PD, UK.,Institute of Ophthalmology, University College London, London, UK
| | | | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Deepika Cp
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Tapas Ranjan Padhi
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, India
| | - Anthony G Robson
- Department Electrophysiology, Moorfields Eye Hospital, London, EC1V 2PD, UK.,Institute of Ophthalmology, University College London, London, UK
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Rafei MA, Harikrishna B, Al Thihli K, Al-Mujaini AS, Ganesh A. Ophthalmic findings as clues for early diagnosis of Vici syndrome in a neonate. Ophthalmic Genet 2021; 42:780-783. [PMID: 34264147 DOI: 10.1080/13816810.2021.1952621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To report the earliest diagnosis of Vici syndrome in a three-week-old Omani girl. METHODS A three-week-old baby girl with blond hair and agenesis of the corpus callosum was born to consanguineous parents. An older sibling with similar findings had died at the age of six months with recurrent seizures and aspiration pneumonia without a diagnosis of the underlying systemic condition. After a standard ophthalmic and comprehensive systemic evaluation, full sequencing of the EPG5 gene was carried out. RESULTS The findings of bilateral anterior polar cataracts and oculocutaneous albinism in the child with agenesis of corpus callosum raised a suspicion of Vici syndrome. Immunology, neurology, cardiology, and genetic consultations were requested and revealed the presence of immunodeficiency, psychomotor retardation, and hypertrophic cardiomyopathy. Full sequencing of the EPG5 gene led to the detection of a homozygous c.6084 G > A (Trp2028Ter) mutation, confirming the diagnosis of Vici syndrome. Parental heterozygosity was confirmed. On follow-up, progressive microcephaly, failure to thrive, and significant developmental delay were noted, and a clinical decision not to resuscitate was made at the age of 22 months. CONCLUSIONS We report the earliest diagnosis of Vici syndrome in the literature. Ophthalmic findings are a cardinal feature of this condition. The diagnosis should be considered in infants with hallmark features of oculocutaneous albinism, cataracts, and agenesis of the corpus callosum. Vici syndrome has a very poor prognosis due to progressive neuroregression superimposed on the neurodevelopmental anomaly.
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Affiliation(s)
| | | | - Khalid Al Thihli
- Department of Genetics and Developmental Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdullah S Al-Mujaini
- Department of Ophthalmology, Sultan Qaboos University, Muscat, Oman.,Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University, Muscat, Oman
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Abidi KT, Kamal NM, Bakkar AA, Almarri S, Abdullah R, Alsufyani M, Alharbi A. Vici syndrome with pathogenic homozygous EPG5 gene mutation: A case report and literature review. Medicine (Baltimore) 2020; 99:e22302. [PMID: 33120733 PMCID: PMC7581136 DOI: 10.1097/md.0000000000022302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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
RATIONALE Vici syndrome (VICIS) is a rare, autosomal recessive neurodevelopmental disorder with multisystem involvement characterized by agenesis of the corpus callosum, congenital cataracts, cardiomyopathy, combined immunodeficiency, significant developmental delay, and hypopigmentation and in some cases loss of hearing. It is caused by mutations in Ectopic P-granules protein 5 gene, which is responsible for regulating autophagy activity. PATIENT CONCERN We report a 6-month-old Saudi female patient who was the second-born baby of first cousins. She was born by normal spontaneous vertex vaginal delivery. Parents noticed that she had global developmental delay and recurrent hospital admissions due to chest infections. DIAGNOSIS Brain magnetic resonance imaging showed brain atrophy with corpus callosum agenesis. Ophthalmology examination revealed bilateral congenital cataract. Molecular genetic testing identified the pathogenic homozygous variant c.4751T>A p. (Leu1584*) on exon 27 of the EPG5 gene and confirmed the diagnosis of Vici syndrome. INTERVENTIONS Supportive multidisciplinary care plan was initiated to this untreatable syndrome. OUTCOMES The patient died at the age of 6 months due to sepsis with uncompensated septic shock. LESSONS VICIS is a rare untreatable disorder with worldwide distribution. High index of suspicion is needed to diagnose it and family genetic counselling is crucial.
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Affiliation(s)
- Kamal T. Abidi
- Associate Professor of Pediatrics and Pediatric Nephrology. Faculty of Medecine, Al Manar University, Tunis, Tunisia
| | - Naglaa M. Kamal
- Professor of Pediatrics and Pediatric Hepatology, Pediatric Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | | | - Arwa Alharbi
- Medical Student, Faculty of Medicine, Taif University, Taif, KSA
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Alzahrani A, Alghamdi AA, Waggass R. A Saudi Infant with Vici Syndrome: Case Report and Literature Review. Open Access Maced J Med Sci 2018; 6:1081-1084. [PMID: 29983806 PMCID: PMC6026433 DOI: 10.3889/oamjms.2018.271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/30/2018] [Accepted: 06/12/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION: Vici syndrome, a rare autosomal recessive disorder, was first described in 1988 by Vici et al. Only 78 cases have been reported to date. The syndrome is characterised by agenesis of the corpus callosum, hypopigmentation, cardiomyopathy, progressive failure to thrive, dysmorphic features, immunodeficiency and cataracts. Mutations in the gene epg5 have been identified as the cause of Vici syndrome. CASE DESCRIPTION: The parents are a consanguineous Saudi couple with two other children diagnosed with Gaucher disease. The patient was born at term and in the first 5 months had many hospital admissions for a recurrent chest infection. Physical examination, investigations and imaging studies revealed that the patient had agenesis of the corpus callosum, cataracts, psychomotor delay, immunodeficiency and hypopigmentation. The initial echocardiogram was normal. At 7 months, genetic testing confirmed the diagnosis of Vici syndrome with a c.3693G>Ap (Gln1231Gln) mutation in the gene EPG5. The patient developed a chest infection and was admitted to the pediatric intensive care unit. An echocardiogram was repeated and showed significant left ventricular dilation with a Z-score of 3.1, moderate mitral and tricuspid regurgitation, and depressed ventricular function with a fractional shortening of 17% and ejection fraction 37%. The patient’s condition deteriorated, and he died aged 8 months. CONCLUSION: The symptoms of extensive system involvement in Vici syndrome have been present in the majority of reported cases and should prompt careful evaluation of this syndrome when such symptoms are present in an infant. In confirmed cases, close monitoring of the immune status and cardiac function, the two main causes of death among Vici syndrome patients, is vital to prevent rapid deterioration and improve life expectancy.
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Affiliation(s)
- Alhussain Alzahrani
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Abdulrahman Abdullah Alghamdi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
| | - Rahaf Waggass
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia
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Cardiomyopathy in Vici syndrome. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hori I, Otomo T, Nakashima M, Miya F, Negishi Y, Shiraishi H, Nonoda Y, Magara S, Tohyama J, Okamoto N, Kumagai T, Shimoda K, Yukitake Y, Kajikawa D, Morio T, Hattori A, Nakagawa M, Ando N, Nishino I, Kato M, Tsunoda T, Saitsu H, Kanemura Y, Yamasaki M, Kosaki K, Matsumoto N, Yoshimori T, Saitoh S. Defects in autophagosome-lysosome fusion underlie Vici syndrome, a neurodevelopmental disorder with multisystem involvement. Sci Rep 2017; 7:3552. [PMID: 28615637 PMCID: PMC5471274 DOI: 10.1038/s41598-017-02840-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/18/2017] [Indexed: 02/08/2023] Open
Abstract
Vici syndrome (VICIS) is a rare, autosomal recessive neurodevelopmental disorder with multisystem involvement characterized by agenesis of the corpus callosum, cataracts, cardiomyopathy, combined immunodeficiency, developmental delay, and hypopigmentation. Mutations in EPG5, a gene that encodes a key autophagy regulator, have been shown to cause VICIS, however, the precise pathomechanism underlying VICIS is yet to be clarified. Here, we describe detailed clinical (including brain MRI and muscle biopsy) and genetic features of nine Japanese patients with VICIS. Genetic dissection of these nine patients from seven families identified 14 causative mutations in EPG5. These included five nonsense, two frameshift, three splicing, one missense, and one multi-exon deletion mutations, and two initiation codon variants. Furthermore, cultured skin fibroblasts (SFs) from two affected patients demonstrated partial autophagic dysfunction. To investigate the function of EPG5, siRNA based EPG5 knock-down, and CRISPR/Cas9 mediated EPG5 knock-out HeLa cells were generated. EPG5-depleted cells exhibited a complete block of autophagic flux caused by defective autophagosome-lysosome fusion. Unexpectedly, endocytic degradation was normal in both VICIS SFs and EPG5 depleted cells, suggesting that EPG5 function is limited to the regulation of autophagosome-lysosome fusion.
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Affiliation(s)
- Ikumi Hori
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Takanobu Otomo
- Department of Genetics, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
- Research Center for Autophagy, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Mitsuko Nakashima
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Fuyuki Miya
- Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
- Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
| | - Yutaka Negishi
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Japan
| | - Yutaka Nonoda
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, 252-0373, Japan
| | - Shinichi Magara
- Department of Pediatrics, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, 950-2085, Japan
| | - Jun Tohyama
- Department of Pediatrics, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, 950-2085, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, 594-1101, Japan
| | - Takeshi Kumagai
- Department of Pediatrics, Wakayama Medical University, Wakayama, 641-8509, Japan
| | - Konomi Shimoda
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Yoshiya Yukitake
- Department of Neonatology, Ibaraki Children's Hospital, Mito, 311-4145, Japan
| | - Daigo Kajikawa
- Department of Child Health, Faculty of Medicine, Tsukuba University, Tsukuba, 305-8576, Japan
| | - Tomohiro Morio
- Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Ayako Hattori
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Naoki Ando
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Tatsuhiko Tsunoda
- Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
- Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
| | - Hirotomo Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Yonehiro Kanemura
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, 540-0006, Japan
| | - Mami Yamasaki
- Department of Neurosurgery, Takatsuki General Hospital, Osaka, 569-1192, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Tamotsu Yoshimori
- Department of Genetics, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
- Research Center for Autophagy, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
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Miki M, Miyamoto M, Mitsutsuji T, Watanabe H, Shimizu K, Matsuo J, Tonari M, Kida T, Sugasawa J, Ikeda T. A Case of a Newborn with Agenesis of the Corpus Callosum Complicated with Ocular Albinism. Case Rep Ophthalmol 2016; 7:268-73. [PMID: 27462254 PMCID: PMC4943767 DOI: 10.1159/000446102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of ocular albinism found in a newborn infant in whom agenesis of the corpus callosum (ACC) was indicated in utero. Case Report This study involved a female newborn who was delivered after a gestational period of 41 weeks. The patient was referred to the Obstetrics Department at Takatsuki Hospital, Takatsuki City, Japan, after the indication of ACC by magnetic resonance imaging (MRI) at a nearby clinic during the fetal period. At birth, the baby's weight was 2,590 g, and ACC and ventricular enlargement were found by cranial sonography and cranial MRI. While initial ophthalmic findings noted partial loss of pigmentation of the iris and hypopigmentation of broad areas of the fundus in both eyes, nystagmus was not observed. The patient's hair pigment was slightly diluted, and the color of her skin was slightly off-white. At 2 years after birth, obvious mental retardation was observed. With regard to other systemic findings, no apparent heart, kidney, or immune system abnormalities were found. Conclusion Although the patient in question is presently growing without any major systemic problems, it will be necessary in the future to pay attention to any changes in systemic and ophthalmic findings.
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Affiliation(s)
- Michiko Miki
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
| | - Makiko Miyamoto
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
- Takatsuki Hospital, Takatsuki City, Japan
| | - Tatsuma Mitsutsuji
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
- Takatsuki Hospital, Takatsuki City, Japan
| | - Hiroko Watanabe
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
- Takatsuki Hospital, Takatsuki City, Japan
| | - Kazuhiro Shimizu
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
- Takatsuki Hospital, Takatsuki City, Japan
| | - Junko Matsuo
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
| | - Masahiro Tonari
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
| | - Jun Sugasawa
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takatsuki City, Japan
- *Tsunehiko Ikeda, MD, Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686 (Japan), E-Mail
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Byrne S, Jansen L, U-King-Im JM, Siddiqui A, Lidov HGW, Bodi I, Smith L, Mein R, Cullup T, Dionisi-Vici C, Al-Gazali L, Al-Owain M, Bruwer Z, Al Thihli K, El-Garhy R, Flanigan KM, Manickam K, Zmuda E, Banks W, Gershoni-Baruch R, Mandel H, Dagan E, Raas-Rothschild A, Barash H, Filloux F, Creel D, Harris M, Hamosh A, Kölker S, Ebrahimi-Fakhari D, Hoffmann GF, Manchester D, Boyer PJ, Manzur AY, Lourenco CM, Pilz DT, Kamath A, Prabhakar P, Rao VK, Rogers RC, Ryan MM, Brown NJ, McLean CA, Said E, Schara U, Stein A, Sewry C, Travan L, Wijburg FA, Zenker M, Mohammed S, Fanto M, Gautel M, Jungbluth H. EPG5-related Vici syndrome: a paradigm of neurodevelopmental disorders with defective autophagy. Brain 2016; 139:765-81. [PMID: 26917586 PMCID: PMC4766378 DOI: 10.1093/brain/awv393] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/31/2015] [Accepted: 11/12/2015] [Indexed: 01/07/2023] Open
Abstract
Vici syndrome is a progressive neurodevelopmental multisystem disorder due to recessive mutations in the key autophagy gene EPG5. We report genetic, clinical, neuroradiological, and neuropathological features of 50 children from 30 families, as well as the neuronal phenotype of EPG5 knock-down in Drosophila melanogaster. We identified 39 different EPG5 mutations, most of them truncating and predicted to result in reduced EPG5 protein. Most mutations were private, but three recurrent mutations (p.Met2242Cysfs*5, p.Arg417*, and p.Gln336Arg) indicated possible founder effects. Presentation was mainly neonatal, with marked hypotonia and feeding difficulties. In addition to the five principal features (callosal agenesis, cataracts, hypopigmentation, cardiomyopathy, and immune dysfunction), we identified three equally consistent features (profound developmental delay, progressive microcephaly, and failure to thrive). The manifestation of all eight of these features has a specificity of 97%, and a sensitivity of 89% for the presence of an EPG5 mutation and will allow informed decisions about genetic testing. Clinical progression was relentless and many children died in infancy. Survival analysis demonstrated a median survival time of 24 months (95% confidence interval 0-49 months), with only a 10th of patients surviving to 5 years of age. Survival outcomes were significantly better in patients with compound heterozygous mutations (P = 0.046), as well as in patients with the recurrent p.Gln336Arg mutation. Acquired microcephaly and regression of skills in long-term survivors suggests a neurodegenerative component superimposed on the principal neurodevelopmental defect. Two-thirds of patients had a severe seizure disorder, placing EPG5 within the rapidly expanding group of genes associated with early-onset epileptic encephalopathies. Consistent neuroradiological features comprised structural abnormalities, in particular callosal agenesis and pontine hypoplasia, delayed myelination and, less frequently, thalamic signal intensity changes evolving over time. Typical muscle biopsy features included fibre size variability, central/internal nuclei, abnormal glycogen storage, presence of autophagic vacuoles and secondary mitochondrial abnormalities. Nerve biopsy performed in one case revealed subtotal absence of myelinated axons. Post-mortem examinations in three patients confirmed neurodevelopmental and neurodegenerative features and multisystem involvement. Finally, downregulation of epg5 (CG14299) in Drosophila resulted in autophagic abnormalities and progressive neurodegeneration. We conclude that EPG5-related Vici syndrome defines a novel group of neurodevelopmental disorders that should be considered in patients with suggestive features in whom mitochondrial, glycogen, or lysosomal storage disorders have been excluded. Neurological progression over time indicates an intriguing link between neurodevelopment and neurodegeneration, also supported by neurodegenerative features in epg5-deficient Drosophila, and recent implication of other autophagy regulators in late-onset neurodegenerative disease.
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Affiliation(s)
- Susan Byrne
- 1 Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Lara Jansen
- 2 Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Jean-Marie U-King-Im
- 3 Department of Neuroradiology, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ata Siddiqui
- 3 Department of Neuroradiology, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Hart G W Lidov
- 4 Department of Pathology, Boston Children's Hospital, Boston MA 02115, USA
| | - Istvan Bodi
- 5 Department of Clinical Neuropathology, King's College Hospital, London, UK
| | - Luke Smith
- 6 Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | | | - Thomas Cullup
- 8 Regional Molecular Genetics Laboratory, Great Ormond Street Hospital, London, UK
| | - Carlo Dionisi-Vici
- 9 Division of Metabolism, Department of Paediatric Medicine, Bambino Gesù Children's Research Hospital, Rome
| | - Lihadh Al-Gazali
- 10 Departments of Paediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Mohammed Al-Owain
- 11 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia 12 Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Zandre Bruwer
- 13 Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Khalid Al Thihli
- 13 Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | | | - Kevin M Flanigan
- 15 Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kandamurugu Manickam
- 16 Center for Human and Molecular Genetics at The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erik Zmuda
- 16 Center for Human and Molecular Genetics at The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Wesley Banks
- 16 Center for Human and Molecular Genetics at The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ruth Gershoni-Baruch
- 17 Institute of Human Genetics, Rambam Health Care Campus and the Technion Faculty of Medicine, Haifa, Israel
| | - Hanna Mandel
- 18 Metabolic Disease Unit, Meyer Children's Hospital, Rambam Health Care Campus and the Technion Faculty of Medicine, Haifa, Israel
| | - Efrat Dagan
- 19 Department of Nursing, University of Haifa, Haifa, Israel
| | - Annick Raas-Rothschild
- 20 Institute of Rare Diseases, Institute of Genetics; Sheba Medical Centre, Tel Hashomer and the Sackler school of Medicine Tel Aviv University Ramat Aviv, Israel
| | - Hila Barash
- 20 Institute of Rare Diseases, Institute of Genetics; Sheba Medical Centre, Tel Hashomer and the Sackler school of Medicine Tel Aviv University Ramat Aviv, Israel
| | - Francis Filloux
- 21 Division of Pediatric Neurology, University of Utah School of Medicine and Primary Children's Medical Centre, Salt Lake City, Utah, USA
| | - Donnell Creel
- 22 University of Utah School of Medicine, Moran Eye Centre, Salt Lake City, Utah, USA
| | - Michael Harris
- 23 Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington DC, USA
| | - Ada Hamosh
- 24 McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, USA
| | - Stefan Kölker
- 25 Division of Child Neurology and Metabolic Medicine, University Children's Hospital, Heidelberg, Germany
| | - Darius Ebrahimi-Fakhari
- 25 Division of Child Neurology and Metabolic Medicine, University Children's Hospital, Heidelberg, Germany
| | - Georg F Hoffmann
- 25 Division of Child Neurology and Metabolic Medicine, University Children's Hospital, Heidelberg, Germany
| | - David Manchester
- 26 Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, USA
| | - Philip J Boyer
- 27 Department of Pathology, East Carolina University, Brody School of Medicine, Brody Medical Sciences Building, Greenville, NC 27834, USA
| | | | | | - Daniela T Pilz
- 30 Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Arveen Kamath
- 30 Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Prab Prabhakar
- 31 Department of Paediatric Neurology, Great Ormond Street Children's Hospital, London, UK
| | - Vamshi K Rao
- 32 University of Nebraska Medical Center and Childrens Hospital and Medical Center, Omaha, Nebraska, USA
| | - R Curtis Rogers
- 33 Greenwood Genetic Center, Greenville, South Carolina, USA
| | - Monique M Ryan
- 34 Departments of Neurology, Royal Children's Hospital and Paediatrics, University of Melbourne, and Murdoch Childrens Research Institute, Melbourne Australia
| | - Natasha J Brown
- 35 Victorian Clinical Genetics Services, Murdoch Childrens Research Institute Parkville, Australia 36 Department of Paediatrics, University of Melbourne, Parkville, Australia 37 Department of Clinical Genetics, Austin Health, Australia
| | | | - Edith Said
- 39 Department of Anatomy and Cell Biology, University of Malta, Msida, Malta 40 Section of Medical Genetics, Mater dei Hospital, Msida, Malta
| | - Ulrike Schara
- 41 Pediatric Neurology, University Childrens Hospital, University of Duisburg-Essen University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- 42 Department of Neonatology, University Childrens Hospital, University of Duisburg-Essen, Essen, Germany
| | - Caroline Sewry
- 43 Dubowitz Neuromuscular Centre, Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Laura Travan
- 44 Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Frits A Wijburg
- 45 Department of Paediatrics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Zenker
- 46 Institute of Human Genetics, University Hospital Magdeburg, Germany
| | - Shehla Mohammed
- 47 Department of Clinical Genetics, Guy's Hospital, London, UK
| | - Manolis Fanto
- 2 Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Mathias Gautel
- 6 Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - Heinz Jungbluth
- 1 Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK 6 Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK 48 Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
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10
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Byrne S, Dionisi-Vici C, Smith L, Gautel M, Jungbluth H. Vici syndrome: a review. Orphanet J Rare Dis 2016; 11:21. [PMID: 26927810 PMCID: PMC4772338 DOI: 10.1186/s13023-016-0399-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/08/2016] [Indexed: 11/29/2022] Open
Abstract
Vici syndrome [OMIM242840] is a severe, recessively inherited congenital disorder characterized by the principal features of callosal agenesis, cataracts, oculocutaneous hypopigmentation, cardiomyopathy, and a combined immunodeficiency. Profound developmental delay, progressive failure to thrive and acquired microcephaly are almost universal, suggesting an evolving (neuro) degenerative component. In most patients there is additional variable multisystem involvement that may affect virtually any organ system, including lungs, thyroid, liver and kidneys. A skeletal myopathy is consistently associated, and characterized by marked fibre type disproportion, increase in internal nuclei, numerous vacuoles, abnormal mitochondria and glycogen storage. Life expectancy is markedly reduced.Vici syndrome is due to recessive mutations in EPG5 on chromosome 18q12.3, encoding ectopic P granules protein 5 (EPG5), a key autophagy regulator in higher organisms. Autophagy is a fundamental cellular degradative pathway conserved throughout evolution with important roles in the removal of defective proteins and organelles, defence against infections and adaptation to changing metabolic demands. Almost 40 EPG mutations have been identified to date, most of them truncating and private to individual families.The differential diagnosis of Vici syndrome includes a number of syndromes with overlapping clinical features, neurological and metabolic disorders with shared CNS abnormalities (in particular callosal agenesis), and primary neuromuscular disorders with a similar muscle biopsy appearance. Vici syndrome is also the most typical example of a novel group of inherited neurometabolic conditions, congenital disorders of autophagy.Management is currently largely supportive and symptomatic but better understanding of the underlying autophagy defect will hopefully inform the development of targeted therapies in future.
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Affiliation(s)
- Susan Byrne
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Carlo Dionisi-Vici
- Division of Metabolism and Laboratory of Molecular Medicine, Bambino Gesu Children's Hospital IRCCS, Rome, Italy
| | - Luke Smith
- Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - Mathias Gautel
- Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.
- Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK.
- Department of Clinical and Basic Neuroscience, IoPPN, King's College, London, UK.
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11
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Ebrahimi-Fakhari D, Saffari A, Wahlster L, Lu J, Byrne S, Hoffmann GF, Jungbluth H, Sahin M. Congenital disorders of autophagy: an emerging novel class of inborn errors of neuro-metabolism. Brain 2015; 139:317-37. [PMID: 26715604 DOI: 10.1093/brain/awv371] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/02/2015] [Indexed: 12/12/2022] Open
Abstract
Single gene disorders of the autophagy pathway are an emerging, novel and diverse group of multisystem diseases in children. Clinically, these disorders prominently affect the central nervous system at various stages of development, leading to brain malformations, developmental delay, intellectual disability, epilepsy, movement disorders, and neurodegeneration, among others. Frequent early and severe involvement of the central nervous system puts the paediatric neurologist, neurogeneticist, and neurometabolic specialist at the forefront of recognizing and treating these rare conditions. On a molecular level, mutations in key autophagy genes map to different stages of this highly conserved pathway and thus lead to impairment in isolation membrane (or phagophore) and autophagosome formation, maturation, or autophagosome-lysosome fusion. Here we discuss 'congenital disorders of autophagy' as an emerging subclass of inborn errors of metabolism by using the examples of six recently identified monogenic diseases: EPG5-related Vici syndrome, beta-propeller protein-associated neurodegeneration due to mutations in WDR45, SNX14-associated autosomal-recessive cerebellar ataxia and intellectual disability syndrome, and three forms of hereditary spastic paraplegia, SPG11, SPG15 and SPG49 caused by SPG11, ZFYVE26 and TECPR2 mutations, respectively. We also highlight associations between defective autophagy and other inborn errors of metabolism such as lysosomal storage diseases and neurodevelopmental diseases associated with the mTOR pathway, which may be included in the wider spectrum of autophagy-related diseases from a pathobiological point of view. By exploring these emerging themes in disease pathogenesis and underlying pathophysiological mechanisms, we discuss how congenital disorders of autophagy inform our understanding of the importance of this fascinating cellular pathway for central nervous system biology and disease. Finally, we review the concept of modulating autophagy as a therapeutic target and argue that congenital disorders of autophagy provide a unique genetic perspective on the possibilities and challenges of pathway-specific drug development.
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Affiliation(s)
- Darius Ebrahimi-Fakhari
- 1 The F.M. Kirby Neurobiology Centre, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA 2 Division of Paediatric Neurology and Inherited Metabolic Diseases, Department of Paediatrics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Afshin Saffari
- 2 Division of Paediatric Neurology and Inherited Metabolic Diseases, Department of Paediatrics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Lara Wahlster
- 2 Division of Paediatric Neurology and Inherited Metabolic Diseases, Department of Paediatrics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany 3 Department of Haematology and Oncology, Stem Cell Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jenny Lu
- 1 The F.M. Kirby Neurobiology Centre, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Byrne
- 4 Department of Paediatric Neurology, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Georg F Hoffmann
- 2 Division of Paediatric Neurology and Inherited Metabolic Diseases, Department of Paediatrics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Heinz Jungbluth
- 4 Department of Paediatric Neurology, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK 5 Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College London, London, UK 6 Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - Mustafa Sahin
- 1 The F.M. Kirby Neurobiology Centre, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Tasdemir S, Sahin I, Cayır A, Yuce I, Ceylaner S, Tatar A. Vici syndrome in siblings born to consanguineous parents. Am J Med Genet A 2015; 170A:220-5. [DOI: 10.1002/ajmg.a.37398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Sener Tasdemir
- Department of Medical Genetics; Ataturk University; Erzurum Turkey
| | - Ibrahim Sahin
- Department of Medical Genetics; Ataturk University; Erzurum Turkey
| | - Atilla Cayır
- Department of Pediatrics; Departments of Pediatric Endocrinology; Regional Training and Research Hospital; Erzurum Turkey
| | - Ihsan Yuce
- Department of Radiology; Ataturk University; Erzurum Turkey
| | | | - Abdulgani Tatar
- Department of Medical Genetics; Ataturk University; Erzurum Turkey
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