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Sun D, Wang Y, Wang J, Wang S, Zhu L, Xia K, Zhang Y, Wang X. Primary familial brain calcification presenting with parkinsonism and motor complications caused by a novel SLC20A2 variant: a case report. Front Neurol 2024; 15:1382534. [PMID: 39036637 PMCID: PMC11257840 DOI: 10.3389/fneur.2024.1382534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Primary familial brain calcification (PFBC), also known as Fahr's disease, is a central nervous system calcium deposition disorder with symmetrical basal ganglia calcification. Most PFBC cases are caused by SLC20A2 gene variant. We report a Chinese female patient with PFBC and dopamine-responsive parkinsonism who had motor fluctuations and dyskinesia and recovered effectively after symptomatic medication adjustment. A novel heterozygous missense variant was found by whole-exome sequencing and proven harmful by family validation and genetic analysis. This example expands the phenotype of SLC20A2-associated PFBC patients and shows the clinical efficacy of dopaminergic replacement treatment.
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Affiliation(s)
- Dandan Sun
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, China
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Yu Wang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiawei Wang
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Shijing Wang
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Ling Zhu
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Kun Xia
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Yunyun Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xun Wang
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
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Shahid N, Dosu A, Nasser F. Fahr's Disease: Case Presentation With Facial Numbness. Cureus 2023; 15:e43786. [PMID: 37731412 PMCID: PMC10507657 DOI: 10.7759/cureus.43786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
Fahr's disease is a rare hereditary neurological disorder characterized by idiopathic basal ganglia and cerebral cortex calcifications. It presents a wide range of neurological manifestations, including motor dysfunction, sensory deficits, seizures, headaches, visual disturbances, and movement disorders. We present a case report of a 42-year-old female who presented to the accident and emergency department with a stroke alert. Her main symptom was left facial numbness. Otherwise, she was fit and well. A CT scan of her head revealed significant bilateral basal ganglia calcifications rather than ischaemic or haemorrhagic changes. Blood tests showed normal serum calcium, normal phosphate, and normal parathyroid hormone levels. Upon further inquiry, she mentioned that her sister had been diagnosed with similar findings on a brain scan. Subsequently, an MRI scan of her brain was performed, which suggested Fahr's disease. Currently, there is no definitive management available, so a conservative management approach is usually employed based on symptomatology. This case is particularly interesting due to its rarity, strong genetic inheritance, and the development of a management plan.
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Affiliation(s)
- Nimra Shahid
- Medicine, University Hospital of North Tees, Stockton-on-Tees, GBR
| | - Ayodeji Dosu
- Internal Medicine, Wrexham Maelor Hospital, Wrexham, GBR
| | - Fazeen Nasser
- Medicine, University Hospital of North Tees, Stockton-on-Tees, GBR
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Chen SY, Ho CJ, Lu YT, Lin CH, Lan MY, Tsai MH. The Genetics of Primary Familial Brain Calcification: A Literature Review. Int J Mol Sci 2023; 24:10886. [PMID: 37446066 DOI: 10.3390/ijms241310886] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Primary familial brain calcification (PFBC), also known as Fahr's disease, is a rare inherited disorder characterized by bilateral calcification in the basal ganglia according to neuroimaging. Other brain regions, such as the thalamus, cerebellum, and subcortical white matter, can also be affected. Among the diverse clinical phenotypes, the most common manifestations are movement disorders, cognitive deficits, and psychiatric disturbances. Although patients with PFBC always exhibit brain calcification, nearly one-third of cases remain clinically asymptomatic. Due to advances in the genetics of PFBC, the diagnostic criteria of PFBC may need to be modified. Hitherto, seven genes have been associated with PFBC, including four dominant inherited genes (SLC20A2, PDGFRB, PDGFB, and XPR1) and three recessive inherited genes (MYORG, JAM2, and CMPK2). Nevertheless, around 50% of patients with PFBC do not have pathogenic variants in these genes, and further PFBC-associated genes are waiting to be identified. The function of currently known genes suggests that PFBC could be caused by the dysfunction of the neurovascular unit, the dysregulation of phosphate homeostasis, or mitochondrial dysfunction. An improved understanding of the underlying pathogenic mechanisms for PFBC may facilitate the development of novel therapies.
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Affiliation(s)
- Shih-Ying Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Chen-Jui Ho
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Yan-Ting Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Chih-Hsiang Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Min-Yu Lan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
- Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
- Center for Mitochondrial Research and Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Meng-Han Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
- Genomics and Proteomics Core Laboratory, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
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Tang LO, Hou BH, Zhang XN, Xi ZY, Li CX, Xu L. Biallelic XPR1 mutation associated with primary familial brain calcification presenting as paroxysmal kinesigenic dyskinesia with infantile convulsions. Brain Dev 2021; 43:331-336. [PMID: 33433330 DOI: 10.1016/j.braindev.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mutations in the XPR1 gene are associated with primary familial brain calcifications (PFBC). All reported mutations are missense and inherited as an autosomal dominant trait. PFBC patients exhibited movement disorders, neuropsychiatric symptoms, and other associated symptoms with diverse severity, even within the same family. MATERIALS AND METHODS We identified and enrolled a patient with PFBC. Clinical data were comprehensively collected, including the age of onset, seizure types and frequency, trigger factors of paroxysmal dyskinesia, response to drugs, and general and neurological examination results. Whole-exome sequencing (WES) was performed to detect pathogenic variants. We further systematically reviewed the phenotypic and genetic features of patients with XPR1 mutations. RESULTS The patient showed bilateral calcification involving basal ganglia and cerebellar dentate. Clinically, he presented as paroxysmal kinesigenic dyskinesia with infantile convulsions (PKD/IC) with favorable outcome. We identified a compound heterozygous XPR1 mutation (c.786_789delTAGA/p.D262Efs*6, c.1342C>T/p.R448W), which were inherited from unaffected parents respectively. Further literature review shows a wide range of clinical manifestations of patients with XPR1 mutations, with movement disorders being the most common. CONCLUSIONS This is the first report of biallelic mutations in XPR1. The findings suggest for the first time a possible link between PKD/IC and XPR1 mutations.
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Affiliation(s)
- Li-Ou Tang
- Department of Neurology, The Affiliated Hospital of QingDao University, China
| | - Bing-Hui Hou
- Department of Neurology, The Affiliated Hospital of QingDao University, China
| | - Xiao-Na Zhang
- Department of Neurology, The Affiliated Hospital of QingDao University, China
| | - Zhao-Yan Xi
- Department of Neurology, The Affiliated Hospital of QingDao University, China
| | - Chun-Xiao Li
- Department of Neurology, The Affiliated Hospital of QingDao University, China
| | - Lin Xu
- Department of Neurology, The Affiliated Hospital of QingDao University, China.
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5
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Berger ER, Kreutzer L, Halverson A, Yang AD, Reinhart S, Leary KJO, Williams MV, Bilimoria KY, Johnson JK. Evaluation of Changes in Quality Improvement Knowledge Following a Formal Educational Curriculum Within a Statewide Learning Collaborative. JOURNAL OF SURGICAL EDUCATION 2020; 77:1534-1541. [PMID: 32553540 DOI: 10.1016/j.jsurg.2020.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Our objectives were to (1) develop a curriculum based upon participants' needs, (2) evaluate baseline QI knowledge of the Illinois Surgical Quality Improvement Collaborative (ISQIC) members, and (3) evaluate the effectiveness of the educational curriculum. DESIGN The Surgeon Champion (SC), Surgical Clinical Reviewer (SCR), and QI Designee at each ISQIC hospital completed a QI curriculum containing online modules and in-person trainings. A surgical adaptation of QI-KAT, a validated QI knowledge assessment with multiple-choice and free-response sections, was administered pre- and postcurriculum. Three blinded educators scored each exam using a rubric-based scoring tool (54 total points). SETTING The ISQIC is a 52-hospital learning collaborative. Generally, ISQIC participants had little prior formal training or experience with quality improvement. RESULTS Among 52 hospitals, 144 pretests and 112 post-tests were collected. Mean scores increased from 66% (35.6 points) to 77% (41.6 points; p < 0.001). Across all hospitals, all participant groups scored higher on the post-test (SCs 15%, SCRs 21%, QI Designees 17%). There was no significant difference in post-test mean scores among different team members: SCs 44 points, SCRs 42 points, QI Designees 44 points, (p = 0.76). When the post-test scores were aggregated at the hospital level, hospitals with new surgical QI programs improved more than hospitals with established programs (new 18%, established 11%, p < 0.05). CONCLUSIONS QI knowledge significantly improved after completion of the ISQIC curriculum. These data support the value of formalized curricula to rapidly advance QI knowledge and application skills as a foundation for implementing QI initiatives.
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Affiliation(s)
- Elizabeth R Berger
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois; Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsey Kreutzer
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Anthony D Yang
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Stephen Reinhart
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Ambulatory Quality, NorthShore University Healthsystem, Evanston, Illinois
| | - Kevin J O' Leary
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Department of Medicine, Northwestern University, Chicago, Illinois
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky
| | - Karl Y Bilimoria
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Julie K Johnson
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois.
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Auffray-Calvier E, Lintia-Gaultier A, Bourcier R, Aguilar Garcia J. [Basal ganglia calcification]. Rev Med Interne 2020; 41:404-412. [PMID: 32165049 DOI: 10.1016/j.revmed.2020.02.016] [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: 07/09/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Calcifications of the basal ganglia are frequently seen on the cerebral CT scans and particularly in the globus pallidus. Their frequency increases physiologically with age after 50 years old. However, pathological processes can also be associated with calcium deposits in the gray nuclei, posterior fossa or white matter. Unilateral calcification is often related to an acquired origin whereas bilateral ones are mostly linked to an acquired or genetic origin that will be sought after eliminating a perturbation of phosphocalcic metabolism. In pathological contexts, these calcifications may be accompanied by neurological symptoms related to the underlying disease: Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy or headache. The purpose of this article is to provide a diagnostic aid, in addition to clinical and biology, through the analysis of calcification topography and the study of different MRI sequences.
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Affiliation(s)
- E Auffray-Calvier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France.
| | - A Lintia-Gaultier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - R Bourcier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - J Aguilar Garcia
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
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7
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Ichikawa Y, Tanaka M, Kurita E, Nakajima M, Tanaka M, Oishi C, Goto J, Tsuji S, Chiba A. Novel SLC20A2 variant in a Japanese patient with idiopathic basal ganglia calcification-1 (IBGC1) associated with dopa-responsive parkinsonism. Hum Genome Var 2019; 6:44. [PMID: 31645982 PMCID: PMC6804589 DOI: 10.1038/s41439-019-0073-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022] Open
Abstract
Idiopathic basal ganglia calcification-1 (IBGC1) is an autosomal dominant disorder characterized by calcification in the basal ganglia, which can manifest a range of neuropsychiatric symptoms, including parkinsonism. We herein describe a 64-year-old Japanese IBGC1 patient with bilateral basal ganglia calcification carrying a novel SLC20A2 variant (p.Val322Glufs*92). The patient also presented with dopa-responsive parkinsonism with decreased dopamine transporter (DAT) density in the bilateral striatum and decreased cardiac 123I-meta-iodobenzylguanidine uptake.
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Affiliation(s)
- Yaeko Ichikawa
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masaki Tanaka
- 2Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan.,3Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Eriko Kurita
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Nakajima
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masaki Tanaka
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Chizuko Oishi
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Goto
- 4Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shoji Tsuji
- 2Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan.,3Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan.,5Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuro Chiba
- 1Department of Neurology, Kyorin University School of Medicine, Tokyo, Japan
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8
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Chen S, Cen Z, Fu F, Chen Y, Chen X, Yang D, Wang H, Wu H, Zheng X, Xie F, Ouyang Z, Tang W, Zhang S, Yin L, Zhang Y, Meng P, Zhu X, Zhang H, Jiang F, Zhang K, He J, Zhang D, Ming H, Song D, Zhou Z, Luo Y, Gu Q, Su Y, Wu X, Tang H, Wu C, Chen W, Liu JY, Luo W. Underestimated disease prevalence and severe phenotypes in patients with biallelic variants: A cohort study of primary familial brain calcification from China. Parkinsonism Relat Disord 2019; 64:211-219. [PMID: 31003906 DOI: 10.1016/j.parkreldis.2019.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary familial brain calcification (PFBC) is a rare calcifying disorder of the brain with extensive clinical and genetic heterogeneity. Its prevalence is underestimated due to clinical selection bias (compared with symptomatic PFBC patients, asymptomatic ones are less likely to undergo genetic testing). METHODS A total of 273 PFBC probands were enrolled in a multicenter retrospective cohort study by two different approaches. In Group I (nonsystematic approach), 37 probands diagnosed at our clinic were enrolled. In Group II (systematic approach), 236 probands were enrolled by searching the medical imaging databases of 50 other hospitals using specific keywords. Genetic testing of four genes known to be causative of autosomal dominant PFBC was performed in all probands using cDNA. All identified variants were further confirmed using genomic DNA and classified according to ACMG-AMP recommendations. RESULTS Thirty-two variants including 22 novel variants were detected in 37 probands. Among these probands, 83.8% (31/37) were asymptomatic. Two probands with homozygous pathogenic SLC20A2 variants presented more severe brain calcification and symptoms. Based on the variant detection rate of probands in Group II, we extrapolated an overall minimal prevalence of PFBC of 6.6 per 1,000, much higher than previously reported (2.1 per 1000). CONCLUSIONS We identified a higher proportion of genetically confirmed PFBC probands who were asymptomatic. These patients would be overlooked due to clinical selection bias, leading to underestimation of the disease prevalence. Considering that PFBC patients with biallelic variants had more severe phenotypes, this specific condition should be focused on in genetic counseling.
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Affiliation(s)
- Si Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feng Fu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Neurology, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang, China
| | - You Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinhui Chen
- Chu Kochen Honors College, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haotian Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongwei Wu
- Department of Neurology, Lishui People's Hospital, Lishui, Zhejiang, China
| | - Xiaosheng Zheng
- Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fei Xie
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiguo Tang
- Department of Neurology, Zhoushan Hospital, Zhoushan, Zhejiang, China
| | - Shuhong Zhang
- Department of Neurology, Longyou People's Hospital, Quzhou, Zhejiang, China
| | - Lili Yin
- Department of Neurology, Sanmen People's Hospital, Taizhou, Zhejiang, China
| | - Yunqian Zhang
- Department of Neurology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Peiying Meng
- Department of Neurology, Zhuji Central Hospital, Shaoxing, Zhejiang, China
| | - Xuzhen Zhu
- Department of Neurology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Hongwei Zhang
- Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Feifei Jiang
- Department of Neurology, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Kaiyu Zhang
- Department of Neurology, Huangyan District Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang, China
| | - Juping He
- Department of Neurology, Dongyang People's Hospital, Jinhua, Zhejiang, China
| | - Danhong Zhang
- Department of Neurology, Taizhou Central Hospital, Taizhou, Zhejiang, China
| | - Hanqiao Ming
- Department of Neurology, Jiangshan People's Hospital, Quzhuo, Zhejiang, China
| | - Daqiao Song
- Department of Neurology, Yiwu Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang, China
| | - Zhiping Zhou
- Department of Neurology, Taishun People's Hospital, Wenzhou, Zhejiang, China
| | - Yong Luo
- Department of Neurology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Qun Gu
- Department of Neurology, Huzhou First People's Hospital, Huzhou, Zhejiang, China
| | - Yongkun Su
- Department of Neurology, Tianzhu People's Hospital, Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Xinxiao Wu
- Department of Neurology, Qingyuan People's Hospital, Lishui, Zhejiang, China
| | - Haiyan Tang
- Department of Neurology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Chenglong Wu
- Department of Neurology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Weiqing Chen
- Department of Neurology, Xianju People's Hospital, Taizhou, Zhejiang, China
| | - Jing-Yu Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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9
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Guo XX, Zou XH, Wang C, Yao XP, Su HZ, Lai LL, Chen HT, Lai JH, Liu YB, Chen DP, Deng YC, Lin P, Lin HS, Hong BC, Yao QY, Chen XJ, Huang DQ, Fu HX, Peng JD, Niu YF, Zhao YY, Zhu XQ, Lu XP, Lin HL, Li YK, Liu CY, Huang GB, Wang N, Chen WJ. Spectrum of SLC20A2, PDGFRB, PDGFB, and XPR1 mutations in a large cohort of patients with primary familial brain calcification. Hum Mutat 2019; 40:392-403. [PMID: 30609140 DOI: 10.1002/humu.23703] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022]
Abstract
Primary familial brain calcification (PFBC) is a rare neurodegenerative disorder with four causative genes (SLC20A2, PDGFRB, PDGFB, and XPR1) that have been identified. Here, we aim to describe the mutational spectrum of four causative genes in a series of 226 unrelated Chinese PFBC patients. Mutations in four causative genes were detected in 16.8% (38/226) of PFBC patients. SLC20A2 mutations accounted for 14.2% (32/226) of all patients. Mutations in the other three genes were relatively rare, accounting for 0.9% (2/226) of all patients, respectively. Clinically, 44.8% of genetically confirmed patients (probands and relatives) were considered symptomatic. The most frequent symptoms were chronic headache, followed by movement disorders and vertigo. Moreover, the total calcification score was significantly higher in the symptomatic group compared to the asymptomatic group. Functionally, we observed impaired phosphate transport induced by seven novel missense mutations in SLC20A2 and two novel mutations in XPR1. The mutation p.D164Y in XPR1 might result in low protein expression through an enhanced proteasome pathway. In conclusion, our study further confirms that mutations in SLC20A2 are the major cause of PFBC and provides additional evidence for the crucial roles of phosphate transport impairment in the pathogenies of PFBC.
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Affiliation(s)
- Xin-Xin Guo
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Huan Zou
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chong Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiang-Ping Yao
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hui-Zhen Su
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lu-Lu Lai
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hai-Ting Chen
- Department of Neurology, The Third Hospital of Xiamen, Xiamen, China
| | - Jing-Hui Lai
- Department of Neurology, Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, China
| | - Yao-Bin Liu
- Department of Neurology, Sanming Hospital of Integrated Traditional and Western Medicine, Sanming, China
| | - Dong-Ping Chen
- Department of Neurology, The Affiliated Longyan First Hospital of Fujian Medical University, Longyan, China
| | - Yu-Chun Deng
- Department of Neurology, Longyan People Hospital, Longyan, China
| | - Pan Lin
- Department of Neurology, The Second Hospital of Longyan City, Longyan, China
| | - Hua-Song Lin
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Bing-Cong Hong
- Department of Neurology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Qing-Yang Yao
- Department of Neurology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Xue-Jiao Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Dan-Qin Huang
- Department of Neurology, Wuyishan Municipal Hospital, Wuyishan, China
| | - Hong-Xia Fu
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China
| | - Ji-Dong Peng
- Department of Medical Imaging, Ganzhou People's Hospital, Ganzhou, China
| | - Yan-Fang Niu
- Department of Neurology, The Affiliated Hospital of Medical school, Ningbo University, Ningbo, China
| | - Yu-Ying Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao-Qun Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Pei Lu
- Department of Neurology, The First Hospital of Fuzhou, Fuzhou, China
| | - Hai-Liang Lin
- Department of Neurology, Fuzhou Second Hospital, Fuzhou, China
| | - Yong-Kun Li
- Department of Neurology, Fujian Provincial Hospital, Provincial Clinical Department of Fujian Medical University, Fuzhou, China
| | - Chang-Yun Liu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Gen-Bin Huang
- Department of Internal Neurology, Ningde Municipal Hospital, Fujian Medical University, Ningde, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
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