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Borrie SC, Plasschaert E, Callaerts-Vegh Z, Yoshimura A, D'Hooge R, Elgersma Y, Kushner SA, Legius E, Brems H. MEK inhibition ameliorates social behavior phenotypes in a Spred1 knockout mouse model for RASopathy disorders. Mol Autism 2021; 12:53. [PMID: 34311771 PMCID: PMC8314535 DOI: 10.1186/s13229-021-00458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND RASopathies are a group of disorders that result from mutations in genes coding for proteins involved in regulating the Ras-MAPK signaling pathway, and have an increased incidence of autism spectrum disorder (ASD). Legius syndrome is a rare RASopathy caused by loss-of-function mutations in the SPRED1 gene. The patient phenotype is similar to, but milder than, Neurofibromatosis type 1-another RASopathy caused by loss-of-function mutations in the NF1 gene. RASopathies exhibit increased activation of Ras-MAPK signaling and commonly manifest with cognitive impairments and ASD. Here, we investigated if a Spred1-/- mouse model for Legius syndrome recapitulates ASD-like symptoms, and whether targeting the Ras-MAPK pathway has therapeutic potential in this RASopathy mouse model. METHODS We investigated social and communicative behaviors in Spred1-/- mice and probed therapeutic mechanisms underlying the observed behavioral phenotypes by pharmacological targeting of the Ras-MAPK pathway with the MEK inhibitor PD325901. RESULTS Spred1-/- mice have robust increases in social dominance in the automated tube test and reduced adult ultrasonic vocalizations during social communication. Neonatal ultrasonic vocalization was also altered, with significant differences in spectral properties. Spred1-/- mice also exhibit impaired nesting behavior. Acute MEK inhibitor treatment in adulthood with PD325901 reversed the enhanced social dominance in Spred1-/- mice to normal levels, and improved nesting behavior in adult Spred1-/- mice. LIMITATIONS This study used an acute treatment protocol to administer the drug. It is not known what the effects of longer-term treatment would be on behavior. Further studies titrating the lowest dose of this drug that is required to alter Spred1-/- social behavior are still required. Finally, our findings are in a homozygous mouse model, whereas patients carry heterozygous mutations. These factors should be considered before any translational conclusions are drawn. CONCLUSIONS These results demonstrate for the first time that social behavior phenotypes in a mouse model for RASopathies (Spred1-/-) can be acutely reversed. This highlights a key role for Ras-MAPK dysregulation in mediating social behavior phenotypes in mouse models for ASD, suggesting that proper regulation of Ras-MAPK signaling is important for social behavior.
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Affiliation(s)
- Sarah C Borrie
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | - Ellen Plasschaert
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | | | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Rudi D'Hooge
- Laboratory for Biological Psychology, KU Leuven, Leuven, Belgium
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Steven A Kushner
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eric Legius
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium
| | - Hilde Brems
- Department of Human Genetics, KU Leuven, O&N1 Herestraat 49, Box 607, 3000, Leuven, Belgium.
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Rietman AB, van der Vaart T, Plasschaert E, Nicholson BA, Oostenbrink R, Krab LC, Descheemaeker MJ, Wit MCYD, Moll HA, Legius E, Nijs PFAD. Emotional and behavioral problems in children and adolescents with neurofibromatosis type 1. Am J Med Genet B Neuropsychiatr Genet 2018; 177:319-328. [PMID: 29243874 DOI: 10.1002/ajmg.b.32612] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
To assess emotional and behavioral problems in children and adolescents with neurofibromatosis type 1,parents of 183 individuals aged 10.8 ± 3.1 years (range 6-17) completed the Child Behavior Checklist (CBCL). Also, 173 teachers completed the Teacher's Report Form (TRF), and 88 adolescents (children from 11 to 17 years) completed the Youth Self-Report (YSR). According to parental ratings, 32% scored in the clinical range (above the 90th percentile). This percentage was much lower when rated by teachers or adolescents themselves. Scores from all informants on scales for Somatic complaints, Social problems, and Attention problems were significantly different from normative scores. Attentional problems were associated with lower verbal IQ, male gender, younger age, and ADHD-symptoms. Disease-related factors did not predict behavioral problems scores. Substantial emotional and behavioral problems were reported by parents, teachers, and to a lesser extent by adolescents with NF1 themselves. Possibly, a positive illusory bias affects the observation of behavioral problems by adolescents with NF1.
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Affiliation(s)
- André B Rietman
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Thijs van der Vaart
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neuroscience, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ellen Plasschaert
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Bethany A Nicholson
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lianne C Krab
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Marie-Claire Y de Wit
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Neurology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Henriëtte A Moll
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Eric Legius
- Centre for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Pieter F A de Nijs
- ENCORE Expertise Centre for Neurodevelopmental Disorders, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Vandezande L, Reymen M, Coppens L, Plasschaert E, Skevee A, Cusumano P, Leunen K, Vanhoudt R, Bossuyt H, Dehasque E, Christiaens M, Legius E, Nevelsteen I. Genetic testing for breast cancer: Optimizing care for patients and their healthcare workers Development of a theoretical framework. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Van Eylen L, Plasschaert E, Wagemans J, Boets B, Legius E, Steyaert J, Noens I. Visuoperceptual processing in children with neurofibromatosis type 1: True deficit or artefact? Am J Med Genet B Neuropsychiatr Genet 2017; 174:342-358. [PMID: 28512747 DOI: 10.1002/ajmg.b.32522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
Impairments in visuoperceptual processing have long been considered a hallmark deficit of individuals with Neurofibromatosis type 1 (NF1). However, it is unclear which specific visuoperceptual subprocesses are impaired and whether impairments on these tasks really result from visuoperceptual impairments or rather from confounding factors like Executive Functioning (EF) impairments, lower intelligence (IQ) and/or co-occurring symptoms of Autism Spectrum Disorder (ASD). To answer these questions, we administered four visuoperceptual tasks and two control tasks in 39 children with NF1, 52 typically developing children and 52 children with ASD (8-18 years), all matched for age and gender. Furthermore, EF, IQ, and symptoms of ASD were assessed. Children with NF1 displayed intact visual form discrimination and intact information integration along the dorsal visual pathway. Moreover, their reduced performance on a task requiring integration of information along the ventral visual stream and their more detail-oriented processing style appeared to result from confounding EF impairments and not from visuoperceptual impairments per se. The co-occurring ASD symptoms and lower IQ of the children with NF1 did not impact substantially upon their visuoperceptual performance. These findings point to the large impact of EF impairments on the performance of visuoperceptual task and suggest that individuals with NF1 show intact visual form discrimination, intact visual integration, and typical visual processing style when potential confounding factors are controlled for. This may have large repercussions for the interpretation of other findings on visuoperceptual processing in individuals with NF1. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Lien Van Eylen
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium.,Research Group Psychiatry, UPC-KU Leuven, Leuven, Belgium
| | - Ellen Plasschaert
- Department of Human Genetics, KU Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospital Leuven, Leuven, Belgium
| | - Johan Wagemans
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Bart Boets
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Research Group Psychiatry, UPC-KU Leuven, Leuven, Belgium
| | - Eric Legius
- Department of Human Genetics, KU Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospital Leuven, Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Department of Child Psychiatry, UPC-KU Leuven, Leuven, Belgium.,Department of Clinical Genetics, University Hospital Maastricht, Maastricht, the Netherlands
| | - Ilse Noens
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
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5
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Borrie S, Plasschaert E, Elgersma Y, Kushner S, Legius E, Brems H. Social deficits in mouse models of Neurofibromatosis type 1 and Legius syndrome. Front Neurosci 2017. [DOI: 10.3389/conf.fnins.2017.94.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morris SM, Acosta MT, Garg S, Green J, Huson S, Legius E, North KN, Payne JM, Plasschaert E, Frazier TW, Weiss LA, Zhang Y, Gutmann DH, Constantino JN. Disease Burden and Symptom Structure of Autism in Neurofibromatosis Type 1: A Study of the International NF1-ASD Consortium Team (INFACT). JAMA Psychiatry 2016; 73:1276-1284. [PMID: 27760236 PMCID: PMC5298203 DOI: 10.1001/jamapsychiatry.2016.2600] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Recent reports have demonstrated a higher incidence of autism spectrum disorder (ASD) and substantially elevated autistic trait burden in individuals with neurofibromatosis type 1 (NF1). However, important discrepancies regarding the distribution of autistic traits, sex predominance, and association between ASD symptoms and attentional problems have emerged, and critical features of the ASD phenotype within NF1 have never been adequately explored. Establishing NF1 as a monogenic cause for ASD has important implications for affected patients and for future research focused on establishing convergent pathogenic mechanisms relevant to the potential treatment targets for ASD. OBJECTIVE To characterize the quantitative autistic trait (QAT) burden in a pooled NF1 data set. DESIGN, SETTING, AND PARTICIPANTS Anonymized, individual-level primary data were accumulated from 6 tertiary referral centers in the United States, Belgium, United Kingdom, and Australia. A total of 531 individuals recruited from NF1 clinical centers were included in the study. MAIN OUTCOMES AND MEASURES Distribution of ASD traits (Social Responsiveness Scale, second edition [SRS-2], with T scores of ≥75 associated with a categorical ASD diagnosis); attention-deficit/hyperactivity disorder (ADHD) traits (4 versions of Conners Rating Scale, with T scores of ≥65 indicating clinically significant ADHD symptoms); ASD symptom structure, latent structure, base rate derived from mixture modeling; and familiality. RESULTS Of the 531 patients included in the analysis, 247 were male (46.5%); median age was 11 years (range, 2.5-83.9 years). QAT scores were continuously distributed and pathologically shifted; 13.2% (95% CI, 10.3%-16.1%) of individuals scored within the most severe range (ie, above the first percentile of the general population distribution) in which the male to female ratio was markedly attenuated (1.6:1) relative to idiopathic ASD. Autistic symptoms in this NF1 cohort demonstrated a robust unitary factor structure, with the first principal component explaining 30.9% of the variance in SRS-2 scores, and a strong association with ADHD symptoms (r = 0.61). Within-family correlation for QAT burden (intraclass correlation coefficient, 0.73 in NF1-affected first-degree relatives) exceeded that observed in the general population and ASD family samples. CONCLUSIONS AND RELEVANCE This study provides confirmation that the diversity of mutations that give rise to NF1 function as quantitative trait loci for ASD. Moreover, the within-family correlation implicates a high degree of mutational specificity for this associated phenotype. Clinicians should be alerted to the increased frequency of this disabling comorbidity, and the scientific community should be aware of the potential for this monogenic disorder to help elucidate the biological features of idiopathic autism.
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Affiliation(s)
- Stephanie M. Morris
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Maria T. Acosta
- Center for Neuroscience and Behavioral Medicine at Children’s National Health System, Washington, DC
| | - Shruti Garg
- Institute of Brain Behavior and Mental Health, The University of Manchester, Manchester, England4Manchester Academic Health Sciences Centre, Manchester, England5Central Manchester University NHS Foundation Trust, Manchester, England
| | - Jonathan Green
- Institute of Brain Behavior and Mental Health, The University of Manchester, Manchester, England4Manchester Academic Health Sciences Centre, Manchester, England5Central Manchester University NHS Foundation Trust, Manchester, England
| | - Susan Huson
- Central Manchester University NHS Foundation Trust, Manchester, England
| | - Eric Legius
- Department of Human Genetics, Laboratory for Neurofibromatosis Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathryn N. North
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia8Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jonathan M. Payne
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia8Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ellen Plasschaert
- Department of Human Genetics, Laboratory for Neurofibromatosis Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thomas W. Frazier
- Center for Pediatric Behavioral Health, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren A. Weiss
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - David H. Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - John N. Constantino
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri12Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
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Cassiman C, Casteels I, Jacob J, Plasschaert E, Brems H, Dubron K, Keer K, Legius E. Choroidal abnormalities in café-au-lait syndromes: a new differential diagnostic tool? Clin Genet 2016; 91:529-535. [DOI: 10.1111/cge.12873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/29/2022]
Affiliation(s)
- C. Cassiman
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - I. Casteels
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - J. Jacob
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - E. Plasschaert
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
| | - H. Brems
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
| | - K. Dubron
- Faculty of Medicine; Catholic University of Leuven; Leuven Belgium
| | - K.V. Keer
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - E. Legius
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
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Plasschaert E, Van Eylen L, Descheemaeker MJ, Noens I, Legius E, Steyaert J. Executive functioning deficits in children with neurofibromatosis type 1: The influence of intellectual and social functioning. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:348-62. [PMID: 26773288 DOI: 10.1002/ajmg.b.32414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Abstract
The aim of this study was to provide a broad picture of Executive Functioning (EF) in NF1 children, while taking into account their lower average IQ and increased Autism Spectrum Disorder (ASD) symptoms. This was done by administering an extended battery of tasks and questionnaires, designed to reduce task impurity, that measures five EF domains (inhibition, cognitive flexibility, working memory, generativity and planning) in a laboratory setting and in daily life. Data are presented for 42 age- and gender-matched NF1, 52 typically developing, and 52 ASD children (8-18 years). Our results indicated that although EF is highly influenced by IQ and severity of ASD symptoms, EF deficits seem to be a core feature of NF1 and not merely a secondary effect of a lower IQ and/or increased ASD symptoms. However, additional research is needed to confirm these findings.
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Affiliation(s)
- Ellen Plasschaert
- Department of Human Genetics, KU Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospitals of Leuven, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Lien Van Eylen
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | | | - Ilse Noens
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Eric Legius
- Department of Human Genetics, KU Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospitals of Leuven, Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Department of Child Psychiatry, UPC-KU Leuven, Leuven, Belgium
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Garg S, Plasschaert E, Descheemaeker MJ, Huson S, Borghgraef M, Vogels A, Evans DG, Legius E, Green J. Autism spectrum disorder profile in neurofibromatosis type I. J Autism Dev Disord 2015; 45:1649-57. [PMID: 25475362 DOI: 10.1007/s10803-014-2321-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neurofibromatosis Type 1 (NF1) is a common autosomal dominant single-gene disorder, in which the co-occurrence of autism spectrum disorder (ASD) has attracted considerable research interest recently with prevalence estimates of 21-40%. However, detailed characterization of the ASD behavioral phenotype in NF1 is still lacking. This study characterized the phenotypic profile of ASD symptomatology presenting in 4-16 year old children with NF1 (n = 36) using evidence from parent-rated Social Responsiveness Scale and researcher autism diagnostic observation Scale-2. Compared to IQ-matched reference groups of children with autism and ASD, the NF1 profile shows overall similarity but improved eye contact, less repetitive behaviors and better language skills.
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Affiliation(s)
- Shruti Garg
- Institute of Brain Behaviour and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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van der Vaart T, Rietman AB, Plasschaert E, Legius E, Elgersma Y, Moll HA. Behavioral and cognitive outcomes for clinical trials in children with neurofibromatosis type 1. Neurology 2015; 86:154-60. [PMID: 26519538 DOI: 10.1212/wnl.0000000000002118] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the appropriateness of cognitive and behavioral outcome measures in clinical trials in neurofibromatosis type 1 (NF1) by analyzing the degree of deficits compared to reference groups, test-retest reliability, and how scores correlate between outcome measures. METHODS Data were analyzed from the Simvastatin for cognitive deficits and behavioral problems in patients with neurofibromatosis type 1 (NF1-SIMCODA) trial, a randomized placebo-controlled trial of simvastatin for cognitive deficits and behavioral problems in children with NF1. Outcome measures were compared with age-specific reference groups to identify domains of dysfunction. Pearson r was computed for before and after measurements within the placebo group to assess test-retest reliability. Principal component analysis was used to identify the internal structure in the outcome data. RESULTS Strongest mean score deviations from the reference groups were observed for full-scale intelligence (-1.1 SD), Rey Complex Figure Test delayed recall (-2.0 SD), attention problems (-1.2 SD), and social problems (-1.1 SD). Long-term test-retest reliability were excellent for Wechsler scales (r > 0.88), but poor to moderate for other neuropsychological tests (r range 0.52-0.81) and Child Behavioral Checklist subscales (r range 0.40-0.79). The correlation structure revealed 2 strong components in the outcome measures behavior and cognition, with no correlation between these components. Scores on psychosocial quality of life correlate strongly with behavioral problems and less with cognitive deficits. CONCLUSIONS Children with NF1 show distinct deficits in multiple domains. Many outcome measures showed weak test-retest correlations over the 1-year trial period. Cognitive and behavioral outcomes are complementary. This analysis demonstrates the need to include reliable outcome measures on a variety of cognitive and behavioral domains in clinical trials for NF1.
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Affiliation(s)
- Thijs van der Vaart
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - André B Rietman
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Ellen Plasschaert
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Eric Legius
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Ype Elgersma
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium
| | - Henriëtte A Moll
- From the Departments of Neuroscience (T.v.d.V., Y.E.), Pediatrics (T.v.d.V., H.A.M.), and Neurology (A.B.R.), and ENCORE-Expertise Center for Neurodevelopmental Disorders (T.v.d.V., A.B.R., Y.E., H.A.M.), Erasmus MC: University Medical Centre, Rotterdam, the Netherlands; the Department of Human Genetics (E.P., E.L.), Catholic University Leuven; and the Centre for Human Genetics at University Hospital Leuven (E.P., E.L.), Belgium.
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11
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Plasschaert E, Descheemaeker MJ, Van Eylen L, Noens I, Steyaert J, Legius E. Prevalence of Autism Spectrum Disorder symptoms in children with neurofibromatosis type 1. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:72-80. [PMID: 25388972 DOI: 10.1002/ajmg.b.32280] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/09/2014] [Indexed: 11/11/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition. While considerable work has focused on cognitive functioning, several research groups also observed difficulties in social functioning as a prominent feature of NF1. These problems and the possible link between NF1 and Autism Spectrum Disorder (ASD) have become increasingly important in recent NF1 literature. The aim of the current study was to assess ASD characteristics in a hospital-based NF1 pediatric population (n = 82) using the standardized Children Social Behavior Questionnaire (CSBQ) and Social Responsiveness Scale (SRS) to account for the prevalence, severity, and nature of social problems. In a parallel study, comprehensive ASD assessment was performed in a subgroup of NF1 children with a strong suspicion of ASD (n = 31). Results indicate that NF1 children have more social problems than typical controls, more frequently reported above 8 years. The SRS shows that 63% is at risk of ASD symptoms. According to item analyses, most problems were observed on items measuring orientation in, understanding of and being tuned onto a social situation (CSBQ) and social cognition and communication (SRS). In the parallel study, 27 NF1 children were diagnosed with ASD. These children have a distinct phenotype compared to a heterogeneous ASD group, with pronounced social-communicative impairments and fewer restrictive/repetitive behaviors. This study provides a better understanding of social problems in NF1 and the phenotypical overlap with ASD symptomatology. Despite their willingness to engage with others, NF1 children with or without ASD encounter various difficulties in their social-communicative life.
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Affiliation(s)
- Ellen Plasschaert
- Department of Human Genetics, Laboratory for Neurofibromatosis Research, KU Leuven, Leuven, Belgium; Center for Human Genetics, UZ Leuven, Leuven, Belgium
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Debrabant J, Plasschaert E, Caeyenberghs K, Vingerhoets G, Legius E, Janssens S, Van Waelvelde H. Deficient motor timing in children with neurofibromatosis type 1. Res Dev Disabil 2014; 35:3131-3138. [PMID: 25145806 DOI: 10.1016/j.ridd.2014.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common single-gene disorders affecting fine and visual-motor skills. This case-control study investigated motor timing as a possible related performance deficit in children with NF1. A visual-motor reaction time (VRT) test was administered in 20 NF1 children (mean age 9 years 7 months) and 20 age- and gender-matched typically developing (TD) children. Copying and tracing performance were evaluated using the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). Children with NF1 responded with an increased reaction time (RT) to temporally predictive stimuli compared to TD children, whereas RT at unpredictive stimuli did not differ between groups. Motor timing indexed by the RT decrease at predictive stimuli significantly associated with the Beery VMI copy and tracing outcomes. Deficient motor timing as an actual symptom may add to further research on the pathogenesis of NF1-associated motor impairment and the development of more effective treatment.
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Affiliation(s)
- Julie Debrabant
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Campus Heymans, Ghent University Hospital, 2B3, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Ellen Plasschaert
- Centre of Human Genetics, University Hospitals Leuven, & Department of Human Genetics, KU Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | - Karen Caeyenberghs
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Campus Heymans, Ghent University Hospital, 2B3, De Pintelaan 185, B-9000 Ghent, Belgium; Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium
| | - Guy Vingerhoets
- Department of Experimental Psychology, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| | - Eric Legius
- Centre of Human Genetics, University Hospitals Leuven, & Department of Human Genetics, KU Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | - Sandra Janssens
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Hilde Van Waelvelde
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Campus Heymans, Ghent University Hospital, 2B3, De Pintelaan 185, B-9000 Ghent, Belgium
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van der Vaart T, Plasschaert E, Rietman AB, Renard M, Oostenbrink R, Vogels A, de Wit MCY, Descheemaeker MJ, Vergouwe Y, Catsman-Berrevoets CE, Legius E, Elgersma Y, Moll HA. Simvastatin for cognitive deficits and behavioural problems in patients with neurofibromatosis type 1 (NF1-SIMCODA): a randomised, placebo-controlled trial. Lancet Neurol 2013; 12:1076-83. [PMID: 24090588 DOI: 10.1016/s1474-4422(13)70227-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 is a common genetic disorder characterised by neurocutaneous manifestations and cognitive and behavioural problems. Statins were shown to reduce analogous learning deficits in a mouse model of the disease, but a short-term trial in humans was inconclusive. We aimed to assess the use of simvastatin for the improvement of cognitive and behavioural deficits in children with neurofibromatosis type 1 for 12 months. METHODS In this randomised, double-masked, placebo-controlled trial, we recruited children with genetically confirmed neurofibromatosis type 1 aged 8-16 years from two national referral centres in the Netherlands and Belgium. Those with symptomatic CNS abnormalities or on neurotropic medication, including stimulants, were excluded. Eligible patients were randomly assigned (1:1) via a computer-generated, permuted-block list to simvastatin (10 mg per day in month 1, 20 mg per day in month 2, and 20-40 mg per day in months 3-12) or placebo for 12 months. Investigators, participants, and parents were masked to treatment assignment. Primary outcome measures were full-scale intelligence (Wechsler intelligence scale for children), attention problems (child behaviour checklist, parent-rated [CBCL]), and internalising behavioural problems (CBCL). We did intention-to-treat analyses (of all patients who had outcome data) using linear regression of the 12 month outcome scores, adjusted for baseline performance. This trial is registered with the Netherlands Trial Register, number NTR2150. FINDINGS We randomly assigned 84 children to a treatment group (43 to simvastatin, 41 to placebo) between March 9, 2010, and March 6, 2012. We did not assess outcomes in two patients in the placebo group because they needed additional drug therapy. Simvastatin for 12 months had no effect on full-scale intelligence (treatment effect compared with placebo -1·3 IQ points [95% CI -3·8 to 1·3]; p=0·33), attention problems (-1·6 T-score points [-4·3 to 1·0]; p=0·23), and internalising behavioural problems (-0·1 T-score points [-3·3 to 3·1]; p=0·96). 38 (88%) of 43 patients on simvastatin and 39 (95%) of 41 patients on placebo reported adverse events, which were serious in two and four patients, respectively. INTERPRETATION 12 month simvastatin treatment did not ameliorate cognitive deficits or behavioural problems in children with neurofibromatosis type 1. The use of 20-40 mg simvastatin per day for cognitive enhancement in children with neurofibromatosis type 1 is not recommended. FUNDING The Netherlands Organization for Health Research and Development (ZonMw), Research Foundation Flanders (FWO-Vlaanderen), Marguerite-Marie Delacroix Foundation, and the Dutch Neurofibromatosis Association (NFVN).
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Affiliation(s)
- Thijs van der Vaart
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, Netherlands; Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, Netherlands; ENCORE Expertise Centre For Neurodevelopmental Disorders, Erasmus University Medical Centre, Rotterdam, Netherlands
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Descheemaeker MJ, Plasschaert E, Frijns JP, Legius E. Neuropsychological profile in adults with neurofibromatosis type 1 compared to a control group. J Intellect Disabil Res 2013; 57:874-886. [PMID: 23095048 DOI: 10.1111/j.1365-2788.2012.01648.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a common inherited autosomal dominant condition, characterised by multiple café-au-lait macules, axillary and/or inguinal freckling, iris Lisch nodules and tumours of the nervous system such as neurofibromas and optic pathway gliomas. At the same time, NF1 is frequently associated with intellectual disabilities across several neuropsychological domains. Existing neuropsychological data in NF1 adults are limited and sometimes contradictory. Moreover, most studies use a non-IQ-controlled norm group for comparison. This study sought to investigate specific neuropsychological characteristics in intellectual abilities unrelated to the global intellectual capacity. METHOD Twenty NF1 adults and an IQ-, age- and gender-matched control group completed a comprehensive neuropsychological test battery composed of specific cognitive tests investigating visual-spatial abilities and memory, auditory memory, selective and sustained attention and executive functioning. A short version of the Wechsler Adult Intelligence Scale - III was also administered to both groups. RESULTS Norm comparison showed that both groups perform poorly on most neuropsychological functions, except for sustained attention. However, comparison with the IQ-matched control group showed significantly lower scores on visual-spatial abilities and memory, on auditory working memory and on tests for cognitive flexibility in NF1 adults. Nevertheless, as the significant difference in average estimated IQ score between the NF1 group and the selected control group almost reaches the 5% significance level, further analysis is needed to include IQ as a covariate. Eventually, problems in visual-spatial skills and auditory long-term memory seem to be specific NF1-related deficits, while problems in attention and executive functioning are particularly related to their general lowered intellectual abilities. CONCLUSION Taking into account that primary visual perception problems could be part of a more general central coherence deficit while interpreting auditory memory problems as possibly related to deficits in language use and comprehension, this idea also fits with the observation of several problems in social information processing and functioning of NF1 persons.
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Affiliation(s)
- M-J Descheemaeker
- Center of Human Genetics, University Hospitals of Leuven, Leuven, Belgium
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Denayer E, Descheemaeker MJ, Stewart DR, Keymolen K, Plasschaert E, Ruppert SL, Snow J, Thurm AE, Joseph LA, Fryns JP, Legius E. Observations on intelligence and behavior in 15 patients with Legius syndrome. Am J Med Genet C Semin Med Genet 2011; 157C:123-8. [PMID: 21495177 DOI: 10.1002/ajmg.c.30297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Legius syndrome is a RAS-MAPK syndrome characterized by pigmentary findings similar to neurofibromatosis type 1 (NF1), but without tumor complications. Learning difficulties and behavioral problems have been reported to be associated with Legius syndrome, but have not been studied systematically. We investigated intelligence and behavior in 15 patients with Legius syndrome and 7 unaffected family members. We report a mean full-scale IQ of 101.57 in patients with Legius syndrome, which does not differ from the control group. We find a significantly lower Performance IQ in children with Legius syndrome compared to their unaffected family members. Few behavioral problems are present as assessed by the Child Behavior Checklist (CBCL) questionnaire. Our observations suggest that, akin to the milder somatic phenotype, the cognitive phenotype in Legius syndrome is less severe than that of NF1.
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Affiliation(s)
- Ellen Denayer
- Center of Human Genetics from the Catholic University of Leuven, Belgium
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