Whole-Exome sequencing identifies GYS2 biallelic variants in individuals with suspected epilepsy

BACKGROUND

Adequate glucose supply is essential for brain function, therefore hypoglycemic states may lead to seizures. Since blood glucose supply for brain is buffered by liver glycogen, an impairment of liver glycogen synthesis by mutations in the liver glycogen synthase gene (GYS2) might result in a substantial neurological involvement. Here, we describe the phenotypes of affected siblings of two families harboring biallelic mutations in GYS2.

METHODS

Two suspected families - a multiplex Pakistani family (family A) with three affected siblings and a family of Moroccan origin (family B) with a single affected child who presented with seizures and reduced fasting blood glucose levels were genetically characterized. Whole exome sequencing (WES) was performed on the index patients, followed by Sanger sequencing-based segregation analyses on all available members of both families.

RESULTS

The variant prioritization of WES and later Sanger sequencing confirmed three mutations in the GYS2 gene (12p12.1) consistent with an autosomal recessive pattern of inheritance. A homozygous splice acceptor site variant (NM_021957.3, c. 1646 -2A>G) segregated in family A. Two novel compound heterozygous variants (NM_021957.3: c.343G>A; p.Val115Met and NM_021957.3: c.875A>T; p.Glu292Val) were detected in family B, suggesting glycogen storage disorder. A special diet designed to avoid hypoglycemia, in addition to change of the anti-seizure medication led to reduction in seizure frequency.

CONCLUSIONS

This study suggests that the seizures in patients initially diagnosed with epilepsy might be directly caused, or influenced by hypoglycemia due to pathogenic variants in the GYS2 gene.

Genetic Susceptibility to Chronic Liver Disease in Individuals from Pakistan

Chronic liver disease, with viral or non-viral etiology, is endemic in many countries and is a growing burden in Asia. Among the Asian countries, Pakistan has the highest prevalence of chronic liver disease. Despite this, the genetic susceptibility to chronic liver disease in this country has not been investigated. We performed a comprehensive analysis of the most robustly associated common genetic variants influencing chronic liver disease in a cohort of individuals from Pakistan. A total of 587 subjects with chronic liver disease and 68 healthy control individuals were genotyped for the HSD17B13 rs7261356, MBOAT7 rs641738, GCKR rs1260326, PNPLA3 rs738409, TM6SF2 rs58542926 and PPP1R3B rs4841132 variants. The variants distribution between case and control group and their association with chronic liver disease were tested by chi-square and binary logistic analysis, respectively. We report for the first time that HSD17B13 variant results in a 50% reduced risk for chronic liver disease; while MBOAT7; GCKR and PNPLA3 variants increase this risk by more than 35% in Pakistani individuals. Our genetic analysis extends the protective role of the HSD17B13 variant against chronic liver disease and disease risk conferred by the MBOAT7; GCKR and PNPLA3 variants in the Pakistani population.

The immunohistochemical identification of human oral mucosal melanocytes

With the aim of identifying melanocytes, 60 samples of wax-embedded palatal and buccal mucosa front 30 autopsies were analysed for expression of S100, HMB-45 and NKI/C3 in combination with a Masson Fontana stain. The counts of positive cells were compared with those derived from 3,4 dihydroxyphenylalanine (DOPA) staining in fresh samples of gingiva. Polyclonal antisera to S100 stained dendritic cells throughout the epithelium, but monoclonal antibodies to S100, HMB-45 and NKI/C3 labelled cells that were restricted to the basal layer, often in clusters with some sections negative. The mean counts of positive basal dendritic cells per millimetre basement-membrane length were 4.3 (polyclonal S100+. range 0-19). 0.8 (monoclonal S100+. range 0-7.3), 2.0 (HMB-45, range 0-17.8) and 0.9 (NKI/C3, range 0-14.9). Of the last three, HMB-45 produced the clearest and most specific staining. Counts of basal dendritic cells were significantly higher (p < 0.0005) with polyclonal antisera to S100 than with all other markers except DOPA but HLA-DR staining showed that Langerhans cells may also be located in the basal layer. The highest values were always in buccal mucosa, but statistically significantly so (p < 0.0005) only with polyclonal anti-S100. Basally located DOPA+ cells had a mean density of 4.6 per millimetre basement-membrane length, but in five cases DOPA also labelled suprabasal dendritic cells, presumably Langerhans cells. The mean basal DOPA+ values were significantly higher than those with monoclonal antibodies to S100. HMB-45 and NKI/C3 (p < 0.001). The variable cell counts suggest that S100, HMB-45 and NKI/C3 are markers of melanocytes in normal oral mucosa, but are not constitutively expressed and may be induced during function.