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Çelik FÇ, Soyöz Ö, Bölük SÖ, Taşkırdı İ, Hacı İA, Kaya MŞ, Demir A, Uzunoğlu B, Yıldırım AT, Onay H, Gözmen S, Gülez N, Genel F. Successful management of delayed-onset adenosine deaminase deficiency with novel mutation. Per Med 2024; 21:11-19. [PMID: 38088159 DOI: 10.2217/pme-2023-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
A 4-year-old boy presented with acute-onset autoimmune cytopenia with severe, persistent lymphopenia, autoimmune thyroiditis, elevated IgE and glucose 6-phosphate dehydrogenase enzyme deficiency. In immunologic evaluation, lower T, B and natural killer cells and higher levels of adenosine deaminase (ADA) metabolites were observed. The compound heterozygous novel ADA gene mutations causing ADA deficiency were detected. Successful immunologic and metabolic cure was achieved with enzyme replacement therapy, followed by reduced intensity conditioning hematopoietic stem cell transplantation from a matched unrelated donor. An interesting aspect of this patient is the detection of novel compound heterozygous mutations without consanguinity and a secondary outcome is the recovery of glucose 6-phosphate dehydrogenase deficiency after hematopoietic stem cell transplantation.
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Affiliation(s)
- Figen Çelebi Çelik
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Özgen Soyöz
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Selime Özen Bölük
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - İlke Taşkırdı
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - İdil Akay Hacı
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Mehmet Şirin Kaya
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ayça Demir
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Berna Uzunoğlu
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ayşen Türedi Yıldırım
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Department of Pediatric Hematology, Manisa, Turkey
| | | | - Salih Gözmen
- Katip Celebi University Faculty of Medicine, Department of Pediatric Hematology, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital Hematopoietic Stem Cell Transplantation Unit, İzmir, Turkey
| | - Nesrin Gülez
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ferah Genel
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
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2
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Er E, Aşıkovalı S, Özışık H, Sağsak E, GÖkşen D, Onay H, Saygılı F, Darcan Ş, Özen S. Investigation of the molecular genetic causes of non-syndromic primary ovarian ınsufficiency by next generation sequencing analysis. Arch Endocrinol Metab 2023; 68:e220475. [PMID: 37988663 PMCID: PMC10916837 DOI: 10.20945/2359-4292-2022-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/29/2022] [Accepted: 05/23/2023] [Indexed: 11/23/2023]
Abstract
Objective The aim of this study is to investigate the molecular genetic causes of non-syndromic primary ovarian insufficiency (POI) cases with the gene panel basedon next generation sequencing analysis and to establish the relationship between genotype and phenotype. Materials and methods Twenty three cases aged 14-40 years followed up with POI were included. Patients with a karyotype of 46, XX, primary or secondary amenorrhea before the age of 40, with elevated FSH (>40 IU/mL) and low AMH levels (<0.03 ng/mL) were included in the study. Molecular genetic analyzes were performed by the next generation sequencing analysis method targeted with the TruSight TM Exome panel. Results Median age of the cases was 17.8 (14.0-24.3) years, and 12 (52%) cases admitted before the age of 18. Fifteen (65%) patients had consanguineous parents. In2 (8.6%) cases, variants detected were in genes that have been previously proven to cause POI. One was homozygous variant in FIGLA gene and the other was homozygous variant in PSMC3IP gene. Heterozygous variants were detected in PROK2, WDR11 and CHD7 associated with hypogonadotropic hypogonadism, but these variants are insufficient to contribute to the POI phenotype. Conclusion Genetic panels based on next generation sequencing analysis technologies can be used to determine the molecular genetic diagnosis of POI, which has a highly heterogeneous genetic basis.
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Affiliation(s)
- Eren Er
- Tepecik Training and Research Hospital, Department of Pediatric Endocrinology, Izmir, Turkey,
| | - Semih Aşıkovalı
- Ege University Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Hatice Özışık
- Ege University Faculty of Medicine, Department of Endocrinology and Metabolism, Izmir, Turkey
| | - Elif Sağsak
- University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Clinic of Pediatric Endocrinology, Istanbul, Turkey
| | - Damla GÖkşen
- Tepecik Training and Research Hospital, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Füsun Saygılı
- Ege University Faculty of Medicine, Department of Endocrinology and Metabolism, Izmir, Turkey
| | - Şükran Darcan
- Tepecik Training and Research Hospital, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Samim Özen
- Tepecik Training and Research Hospital, Department of Pediatric Endocrinology, Izmir, Turkey
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3
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Oktay V, Tüfekçioğlu O, Çicek Yılmaz D, Onrat E, Karabulut D, Çelik M, Serhat Balcıoğlu A, Murat Sucu M, Özdemir G, Kaya H, Kış M, Güven B, Bağdatoğlu O, Nihan Turhan Çağlar F, Çağdaş Yüksel U, Veysel Düzen İ, Barutçu A, Semih Şimşir Ö, Başarıcı İ, Parspur A, Dalgıç O, Özlem Arıcan Özlük F, Evlice M, Sağ S, Furkan Deniz M, Öcal A, Gazi E, Şen T, Özdabakoğlu O, Bayar Çakıcı N, Ozan Bakır E, Ülgen Kunak A, Çaylı G, Gül Taşdelen A, Akşit E, Uslu Çil Ş, Onay H. The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye. Anatol J Cardiol 2023; 27:628-638. [PMID: 37466024 PMCID: PMC10621609 DOI: 10.14744/anatoljcardiol.2023.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/29/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy. METHODS A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes. RESULTS The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease. CONCLUSIONS Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.
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Affiliation(s)
- Veysel Oktay
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | | | - Dilek Çicek Yılmaz
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ersel Onrat
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Türkiye
| | - Dilay Karabulut
- Clinic of Cardiology, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Murat Çelik
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Akif Serhat Balcıoğlu
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
| | - Mehmet Murat Sucu
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Güllü Özdemir
- Clinic of Cardiology, Private Çekirge Heart and Arrhythmia Hospital, Bursa, Türkiye
| | - Hakkı Kaya
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Mehmet Kış
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Barış Güven
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | | | | | - Uygar Çağdaş Yüksel
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - İrfan Veysel Düzen
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Ahmet Barutçu
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | | | - İbrahim Başarıcı
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Afşin Parspur
- Clinic of Cardiology, Kütahya University of Health Sciences, Evliya Çelebi Training and Research Hospital, Kütahya, Türkiye
| | - Onur Dalgıç
- Clinic of Cardiology, Private Kardiya Cardiology Center, İzmir, Türkiye
| | | | - Mert Evlice
- Clinics of Cardiology, Adana City Hospital, Adana, Türkiye
| | - Saim Sağ
- Clinic of Cardiology, Acıbadem Bursa Hospital, Bursa, Türkiye
| | - Muhammed Furkan Deniz
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | - Arslan Öcal
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Taner Şen
- Clinic of Cardiology, Kütahya University of Health Sciences, Evliya Çelebi Training and Research Hospital, Kütahya, Türkiye
| | | | - Nermin Bayar Çakıcı
- Department of Cardiology, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Eren Ozan Bakır
- Department of Cardiology, Faculty of Medicine, Celal Bayar University, Manisa, Türkiye
| | | | - Gizem Çaylı
- Medical Affairs Rare Diseases, Sanofi, İstanbul, Türkiye
| | - Aybike Gül Taşdelen
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | - Ercan Akşit
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | | | - Hüseyin Onay
- Gene2Info Health Informatics, İstanbul, Türkiye
- Multigen Genetic Diseases Diagnosis Center, İzmir, Türkiye
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Özalkak Ş, Demiral M, Ünal E, Taş FF, Onay H, Demirbilek H, Özbek MN. Metreleptin Treatment in a Boy with Congenital Generalized Lipodystrophy due to Homozygous c.465_468delGACT (p.T156Rfs*8) Mutation in the BSCL2 Gene: Results From the First-year. J Clin Res Pediatr Endocrinol 2023; 15:329-333. [PMID: 35735786 PMCID: PMC10448557 DOI: 10.4274/jcrpe.galenos.2022.2022-1-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Congenital generalized lipodystrophy (CGL) is a rare, autosomal recessive disorder characterized by an almost complete absence of body fat. In CGL, patients may have hyperphagia due to leptin deficiency. Recombinant human leptin (metreleptin) has been suggested as an effective treatment option. We present successful treatment with metreleptin in a boy with CGL and results from the first year of follow-up. An eight-month-old boy presented with excessive hair growth and a muscular appearance. On examination he had hypertrichosis, decreased subcutaneous adipose tissue over the whole body and hepatomegaly. Laboratory investigations revealed hypertriglyceridemia, hyperinsulinemia, elevated liver transaminases and low leptin levels. Molecular genetic analysis detected a homozygous, c.465_468delGACT (p.T156Rfs*8) mutation in the BSCL2 gene. A diagnosis of CGL type 2 was considered. Despite dietary intervention, exercise, and treatment with additional omega-3 and metformin, the hypertriglyceridemia, hyperinsulinemia, and elevated liver transaminase levels worsened. Metreleptin treatment was started and after one year hyperphagia had disappeared, and there was dramatic improvement in levels of insulin, hemoglobin A1c, triglycerides and liver transaminases. Hepatosteatosis was lessened and hepatosplenomegaly was much improved. Metreleptin appears to be an effective treatment option in children with CGL that remarkably improved metabolic complications in the presented case. Initiation of metreleptin treatment in the early period may decrease mortality and morbidity, and increase the quality of life in children with CGL.
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Affiliation(s)
- Şervan Özalkak
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Meliha Demiral
- Balıkesir City Hospital, Clinic of Pediatric Endocrinology, Balıkesir, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Funda Feryal Taş
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Hüseyin Onay
- Multigen Genetic Diseases Diagnosis Center, Department of Medical Genetics, İzmir Turkey
| | - Hüseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
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5
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Oktay V, Tüfekçioğlu O, Yılmaz DÇ, Onrat E, Karabulut D, Çelik M, Balcıoğlu AS, Sucu MM, Özdemir G, Kaya H, Kış M, Güven B, Bağdatoğlu O, Turhan Çağlar FN, Yüksel UÇ, Düzen İV, Barutçu A, Şimşir ÖS, Başarıcı İ, Parspur A, Dalgıç O, Arıcan Özlük FÖ, Evlice M, Sağ S, Deniz MF, Öcal A, Gazi E, Şen T, Özdabakoğlu O, Bayar Çakıcı N, Bakır EO, Ülgen Kunak A, Çaylı G, Gül Taşdelen A, Akşit E, Uslu Çil Ş, Onay H. The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye. Anatol J Cardiol 2023. [PMID: 37466024 DOI: oi10.14744/anatoljcardiol.2023.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy. METHODS A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes. RESULTS The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease. CONCLUSIONS Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.
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Affiliation(s)
- Veysel Oktay
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | | | - Dilek Çicek Yılmaz
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ersel Onrat
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Türkiye
| | - Dilay Karabulut
- Clinic of Cardiology, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Murat Çelik
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Akif Serhat Balcıoğlu
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
| | - Mehmet Murat Sucu
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Güllü Özdemir
- Clinic of Cardiology, Private Çekirge Heart and Arrhythmia Hospital, Bursa, Türkiye
| | - Hakkı Kaya
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Mehmet Kış
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Barış Güven
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | - Oktay Bağdatoğlu
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | | | - Uygar Çağdaş Yüksel
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - İrfan Veysel Düzen
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Ahmet Barutçu
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | | | - İbrahim Başarıcı
- Clinic of Cardiology, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Afşin Parspur
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Onur Dalgıç
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Fatma Özlem Arıcan Özlük
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Mert Evlice
- Medical Affairs Rare Diseases, Sanofi, İstanbul, Türkiye
| | - Saim Sağ
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Muhammed Furkan Deniz
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | - Arslan Öcal
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Taner Şen
- Department of Cardiology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
| | - Osman Özdabakoğlu
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Nermin Bayar Çakıcı
- Clinic of Cardiology, Kütahya University of Health Sciences, Evliya Çelebi Training and Research Hospital, Kütahya, Türkiye
| | - Eren Ozan Bakır
- Clinic of Cardiology, Private Kardiya Cardiology Center, İzmir, Türkiye
| | | | - Gizem Çaylı
- Clinic of Nephrology, Ankara City Hospital, Ankara, Türkiye
| | - Aybike Gül Taşdelen
- Department of Cardiology, İstanbul University-Cerrahpaşa, Institute of Cardiology, İstanbul, Türkiye
| | - Ercan Akşit
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | | | - Hüseyin Onay
- Clinics of Cardiology, Adana City Hospital, Adana, Türkiye
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Evin F, Işık E, Onay H, Özen S, Darcan Ş, Gökşen D. ABCC8-related maturity-onset diabetes of the young: switching from insulin to sulphonylurea therapy: how long do we need for a good metabolic control? J Pediatr Endocrinol Metab 2023:jpem-2022-0642. [PMID: 37071846 DOI: 10.1515/jpem-2022-0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/03/2023] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES Activating variants of the ABCC8 gene cause neonatal diabetes or maturity-onset diabetes of the young (MODY). We report three cases of MODY type 12 caused by variants in the ABCC8 encoding sulphonylurea receptor 1, and the experience of switching from insulin therapy to sulphonylurea therapy. CASE PRESENTATIONS We describe a 12.5-year-old girl with permanent neonatal diabetes mellitus, and two diabetes mellitus cases with variants in the ABCC8 gene. Two of these cases were successfully switched from subcutaneous insulin to oral glibenclamide, with a marked improvement in glycemic control. In permanent neonatal diabetes case, glibenclamide dose was progressively increased to achieve a full dose (2 mg/kg/day) in 9 days. Nine months after starting oral sulphonylurea therapy, her blood glucose control dramatically improved and insulin therapy was discontinued. CONCLUSIONS We conclude that patients with ABCC8 gene variants can successfully switch from insulin to sulphonylureas.
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Affiliation(s)
- Ferda Evin
- Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ege University, İzmir, Türkiye
| | - Esra Işık
- Faculty of Medicine, Department of Pediatric Genetics, Ege University, İzmir, Türkiye
| | - Hüseyin Onay
- Multigen Genetic Diseases Diagnosis Center, Izmir, Türkiye
| | - Samim Özen
- Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ege University, İzmir, Türkiye
| | - Şükran Darcan
- Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ege University, İzmir, Türkiye
| | - Damla Gökşen
- Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ege University, İzmir, Türkiye
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7
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Taskin DG, Civan HA, Sari EE, Altuntaş C, Ersoy M, Tuncel T, Onay H, Selimoğlu A. Prevalence of congenital sucrase-isomaltase deficiency in Turkey may be much higher than the estimates. J Genet 2023; 102:31. [PMID: 37349966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Congenital sucrase-isomaltase deficiency (CSID) is a rare autosomal carbohydrate malabsorption disorder caused by mutations in the sucrase-isomaltase gene. While the prevalence of CSID is high in the indigenous populations of Alaska and Greenland, it is imprecise and ambiguous in the Turkish pediatric population. In this cross-sectional case-control study, which is retrospective in nature, next-generation sequencing (NGS) results obtained from records of 94 pediatric patients with chronic nonspecific diarrhea were reviewed. Demographic characteristics, clinical symptoms and treatment responses of those diagnosed with CSID were evaluated. We identified one new, homozygous frame-shift mutation and 10 other heterozygous mutations. Two cases were from the same family and nine were from different families. While the median age at onset of symptoms was 6 months (0-12), median age at diagnosis was 60 months (18-192) with a median delay of 5 years and 5 months (10 months -15 years and 5 months) in diagnosis. Clinical symptoms included diarrhea (100%), abdominal pain (54.5%), vomiting after consuming sucrose (27.2%), diaper dermatitis (36.3%) and growth retardation (81%). Our clinical study revealed that sucrase-isomaltase deficiency may have been underdiagnosed in patients with chronic diarrhea in Turkey. In addition, the frequency of heterozygous mutation carriers was significantly higher than that of homozygous mutation carriers and those with a heterozygous mutations responded well to the treatment.
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Affiliation(s)
- Didem Gulcu Taskin
- Pediatric Gastroenterology, Adana City Training and Research Hospital, Dr. Mithatozsan Bulvari Kisla Mah. 4522 Sok. No: 1, 01415 Yuregir/Adana, Turkey.
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8
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Bolat H, Sağer SG, Türkyılmaz A, Çebi AH, Akın Y, Onay H, Özkınay F, Ünsel-Bolat G. Autosomal Recessive Primary Microcephaly (MCPH) and Novel Pathogenic Variants in ASPM and WDR62 Genes. Mol Syndromol 2022; 13:363-369. [PMID: 36588751 PMCID: PMC9801316 DOI: 10.1159/000524391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/31/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Autosomal recessive primary microcephaly (MCPH) is a disorder characterized by congenital microcephaly and intellectual disability without extra-central nervous system malformation. MCPH is a disease with heterogeneity in genotype and phenotype. For this reason, it is important to determine the genetic causes and genotype-phenotype relationship in MCPH, which causes lifelong impairment. In this study, we aimed to evaluate the clinical, genetic, and brain imaging findings of cases diagnosed with MCPH. Methods Electroencephalogram and brain magnetic resonance imaging were performed for all cases. We evaluated genetic results of the 39 families including cases with suspected MCPH diagnosis. Results Genetic diagnosis related to MCPH was provided in 11/39 (28.2%) of these families including 13/41 cases (31.7%). Variants of the WDR62 gene were the most common (61.5%) cause, and variants of the ASPM gene were the second most common cause (38.5%). We have found 6 novel variants and 4 previously reported variants in ASPM and WDR62 genes. Main brain imaging findings in our cases were lissencephaly, polymicrogyria, schizencephaly, pachygyria, and cortical dysplasia. Genetic counseling in 2 families whose genetic diagnosis was determined prevented them from having another child with MCPH. Discussion/Conclusion Detection and reporting of novel variants is an important step in eliminating this disorder by providing families with appropriate genetic counseling.
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Affiliation(s)
- Hilmi Bolat
- Department of Medical Genetics, Balıkesir University Faculty of Medicine, Balıkesir, Turkey,*Hilmi Bolat,
| | - Safiye G. Sağer
- Clinics of Pediatric Neurology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Ayberk Türkyılmaz
- Department of Medical Genetics, Faculty of Medicine, Karadeniz Technical University Trabzon, Trabzon, Turkey
| | - Alper H. Çebi
- Department of Medical Genetics, Faculty of Medicine, Karadeniz Technical University Trabzon, Trabzon, Turkey
| | - Yasemin Akın
- Clinics of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | | | - Ferda Özkınay
- Department of Pediatrics, Division of Pediatric Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Gül Ünsel-Bolat
- Department of Child and Adolescent Psychiatry, Balıkesir University Faculty of Medicine, Balıkesir, Turkey,Department of Neuroscience, Ege University, Izmir, Turkey
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9
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Kalkan Uçar S, Yazıcı H, Canda E, Er E, Bulut FD, Eraslan C, Onay H, Bax BE, Çoker M. Clinical spectrum of early onset "Mediterranean" (homozygous p.P131L mutation) mitochondrial neurogastrointestinal encephalomyopathy. JIMD Rep 2022; 63:484-493. [PMID: 36101829 PMCID: PMC9458607 DOI: 10.1002/jmd2.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive mitochondrial disorder characterized by cumulative and progressive gastrointestinal and neurological findings. This retrospective observational study, aimed to explore the time of presentation, diagnosis and clinical follow-up of 13 patients with a confirmed MNGIE disease of Mediterranean origin. The mean age of symptom onset was 7 years (6 months-21 years) and the average diagnosis age was 15.4 years ±8.4. Four of 13 patients (30%) died before 30 years at the mean age of 19.7 years ±6.8. Cachexia and gastrointestinal symptoms were observed in all patients (100%). The mean body mass index standard deviation score at diagnosis was 4.8 ± 2.8. At least three subocclusive episodes were presented in patients who died in last year of their life. The main neurological symptom found in most patients was peripheral neuropathy (92%). Ten patients (77%) had leukoencephalopathy and the remaining three patients without were under 10 years of age. The new homozygous "Mediterranean" TYMP mutation, p.P131L (c.392 C > T) was associated with an early presentation and poor prognosis in nine patients (69%) from five separates families. Based on the observations from this Mediterranean MNGIE cohort, we propose that the unexplained abdominal pain combined with cachexia is an indicator of MNGIE. High-platelet counts and nerve conduction studies may be supportive laboratory findings and the frequent subocclusive episodes could be a negative prognostic factor for mortality. Finally, the homozygous p.P131L (c.392 C > T) mutation could be associated with rapid progressive disease with poor prognosis.
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Affiliation(s)
- Sema Kalkan Uçar
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Havva Yazıcı
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Ebru Canda
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Esra Er
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Fatma Derya Bulut
- Department of Pediatrics, Division of Metabolism and NutritionÇukurova University Medical FacultyAdanaTurkey
| | - Cenk Eraslan
- Department of Radiology, Division of NeuroradiologyEge University Medical FacultyBornovaTurkey
| | - Hüseyin Onay
- Department of GeneticsEge University Medical FacultyIzmirTurkey
| | - Bridget Elizabeth Bax
- Institute of Molecular and Clinical SciencesSt George's University of LondonLondonUK
| | - Mahmut Çoker
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
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Almacan B, Ozdemir N, Onay H, Hekimsoy Z. CONGENITAL ADRENAL HYPERPLASIA WITH COMPOUND HETEROZYGOUS I2 SPLICE AND P453S MUTATIONS. Acta Endocrinol (Buchar) 2022; 18:228-231. [PMID: 36212252 PMCID: PMC9512366 DOI: 10.4183/aeb.2022.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder caused by congenital deficiency of enzymes involved in cortisol biosynthesis from cholesterol in the adrenal cortex. In this article, we aimed to present a 29-year-old female patient with I2 splice point mutation detected in one allele and P453S mutation on the other allele of CYP21A2 gene associated with 21-hydroxylase deficiency. Her further investigation revealed that her mother had P453S mutation and her father had I2 splice mutation. CASE REPORT A 29-year-old woman with CAH was admitted to our clinic with the request of pregnancy. Her physical examination revealed a height of 151 cm, weight 59 kg, body mass index 25.8 kg/m2. According to Tanner staging, she had Stage 3 breast development and pubic hair. Her laboratory test results were as follows: Glucose: 79 mg/dL (70-100 mg/dL), Creatinine: 0.6 (0.5-0.95 mg/dL), Sodium: 138 mEq/L (135-145 mEq/L), Potassium: 4.4 mEq/L (3.5-5.1 mEq/L), Cortisol: 0.05 µg/dL, ACTH: <5.00 pg/mL (5-46 pg/mL), 17-OH progesterone: 7.67 ng/mL (0-3 ng/mL). Chromosome analysis revealed a 46, XX karyotype. CYP21A2 gene mutation analysis was performed for the patient whose clinical history and laboratory results were compatible with congenital adrenal hyperplasia. During the reverse dot blot analysis, I2 splice mutation in one allele and P453S mutation in the other allele were detected. CONCLUSION Although the I2 splice mutation detected in our case was mostly associated with a salt-wasting form of CAH, it was thought that the other P453S mutation detected may explain the relatively good clinical course in our case.
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Affiliation(s)
- B. Almacan
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
| | - N. Ozdemir
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
| | - H. Onay
- Ege University, Izmir, Turkey
| | - Z. Hekimsoy
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
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11
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Yazıcı H, Canda E, Onay H, Uçar SK, Habif S, Çoker M. Persistent moderate methylmalonic aciduria in a patient with methylmalonyl coa epimerase deficiency. Turk J Pediatr 2022; 64:946-950. [DOI: 10.24953/turkjped.2021.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Fırat SN, Onay H. Early-onset severe obesity due to homozygous p.R105W (c313C> T) mutation in leptin gene in Turkish siblings: Two cases reports. Obes Res Clin Pract 2021; 15:600-603. [PMID: 34802983 DOI: 10.1016/j.orcp.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/16/2021] [Revised: 10/23/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
Congenital leptin deficiency (CLD) is a rare cause of monogenic form obesity due to homozygous or compound heterozygous mutations in the LEP gene. To date, nine pathogenic mutations have been reported. In this study, we present are; an 18-year-old morbidly obese girl and a 14-year-old obese brother, both with homozygous mutation in the LEP gene [p.R105W (c313C> T)] and their data after three years of recombinant leptin treatment. To date, few cases of CLD have been reported in the literature. The cases reported here were siblings who were not diagnosed despite presentation at the clinic due to obesity in childhood, and diagnosis was delayed until adolescence. Clinicians need to consider CLD, a monogenic form of obesity in children with early severe obesity onset, especially if they are the child of a consanguineous marriage.
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Affiliation(s)
- Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey.
| | - Hüseyin Onay
- Department of Medical Genetics, MULTIGEN Genetic Diseases Evaluation Center, İzmir, Turkey.
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Öztürk T, Karataş Yiğitaslan E, Teke Kısa P, Onay H, Saatci AO. Lipemia Retinalis Diagnosed Incidentally After Laser Photocoagulation Treatment for Retinopathy of Prematurity. Turk J Ophthalmol 2021; 51:313-316. [PMID: 34702847 PMCID: PMC8558691 DOI: 10.4274/tjo.galenos.2021.50051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 12/04/2022] Open
Abstract
A preterm infant who underwent bilateral laser photocoagulation for the treatment of stage 3 retinopathy of prematurity (ROP) is presented because she was incidentally diagnosed with grade 3 lipemia retinalis by dilated fundoscopy at post-laser 2 weeks. Meticulous ophthalmologic examination is imperative in premature newborns for not only ROP screening but also detecting any concomitant ocular abnormalities, which can be sight-threatening or even life-threatening.
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Affiliation(s)
- Taylan Öztürk
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | | | - Pelin Teke Kısa
- Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, İzmir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Ali Osman Saatci
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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14
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Acar S, Erbaş İM, Paketçi A, Onay H, Çankaya T, Gürsoy S, Özhan B, Abacı A, Özer E, Olguner M, Böber E, Demir K. A novel compound heterozygous variant in CYP19A1 resulting in aromatase deficiency with normal ovarian tissue. Turk J Pediatr 2021; 62:826-830. [PMID: 33108086 DOI: 10.24953/turkjped.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aromatase deficiency leading to virilization in mother and female fetuses during pregnancy is a rare disease. It is characterized by impaired estrogen production, increased gonadotropins, and ovarian cysts. CASE Herein, we report a clinical phenotype of the virilized female due to a novel compound heterozygous variant in CYP19A1 [IVS10 + 1 G > A; c.344 G > A (p.R115Q)], with normal gonadotropin levels at the time of admission and histologically normal ovarian tissues. CONCLUSION Aromatase deficiency should also be considered even if the initial follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels are normal, and ovarian cysts are lacking.
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Affiliation(s)
- Sezer Acar
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İbrahim Mert Erbaş
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ahu Paketçi
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Tufan Çankaya
- Departments of Medical Genetics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Semra Gürsoy
- Departments of Pediatric Genetics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Bayram Özhan
- Department of Pediatric Endocrinology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ayhan Abacı
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Erdener Özer
- Departments of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Olguner
- Departments of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ece Böber
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Korcan Demir
- Departments of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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15
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Unal E, Karakaya AA, Beştaş A, Yıldırım R, Taş FF, Onay H, Özkınay F, Haspolat YK. Identification of four novel variant in the AMHR2 gene in six unrelated Turkish families. J Endocrinol Invest 2021; 44:1301-1307. [PMID: 33025551 DOI: 10.1007/s40618-020-01437-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Persistent Müllerian duct syndrome (PMDS) is characterized by the persistence of Müllerian structures in male with normal phenotype. Most cases occur as a result of mutations in the anti-Müllerian hormone (AMH) or AMHR2 genes. In this study, we aim to discuss the results of clinical, laboratory, and molecular genetic analysis of cases detected to have AMHR2 gene mutation. METHODS A total of 11 cases from 6 families were included in the study. AMHR2 gene mutation analyses were performed by sequencing of the coding exons and the exon-intron boundaries of the genes. The American College of Medical Genetics guidelines were used for the classification of the detected variants. RESULTS Six of the 11 cases were admitted due to bilateral undescended testes and five cases due to inguinal hernia (three transverse testicular ectopia and two hernia uterus inguinalis). All cases had normal AMH levels. Seven different variants were identified in the six families. The variants detected in four cases were considered novel (c.78del, c.71G > A, c.1460dup, c.1319A > G). Two of the novel variants were missense (exon 2 and exon 10) mutations, one was deletion (exon 2), and one duplication (exon 11). CONCLUSION We identified four novel mutations in the AMHR2 gene resulting in PMDS. Duplication mutation (c.1460dup) in the AMHR2 gene causing PMDS was demonstrated for the first time. The most important complications of PMDS are infertility and malignancy. Early diagnosis is vital to preventing malignancy. Vas deferens and vascular structures may be injured during orchiopexy. Therefore, patients should always be referred to experienced clinics.
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MESH Headings
- Anti-Mullerian Hormone/blood
- Child, Preschool
- Consanguinity
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Early Diagnosis
- Humans
- Infertility, Male/diagnosis
- Infertility, Male/etiology
- Male
- Mutation
- Neoplasms/diagnosis
- Neoplasms/etiology
- Neoplasms/prevention & control
- Pedigree
- Receptors, Peptide/genetics
- Receptors, Transforming Growth Factor beta/genetics
- Turkey
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Affiliation(s)
- E Unal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
| | - A A Karakaya
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - A Beştaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - R Yıldırım
- Department of Pediatric Endocrinology, Diyarbakır Children's Hospital, Diyarbakir, Turkey
| | - F F Taş
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - H Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - F Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Y K Haspolat
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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16
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Bozaci AE, Er E, Yazici H, Canda E, Kalkan Uçar S, Güvenc Saka M, Eraslan C, Onay H, Habif S, Thöny B, Coker M. Tetrahydrobiopterin deficiencies: Lesson from clinical experience. JIMD Rep 2021; 59:42-51. [PMID: 33977029 PMCID: PMC8100404 DOI: 10.1002/jmd2.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The present study describes clinical, biochemical, molecular genetic data, current treatment strategies and follow-up in nine patients with tetrahydrobiopterin (BH4) deficiency due to various inherited genetic defects. METHODS We analyzed clinical, biochemical, and molecular data of nine patients with suspected BH4 deficiency. All patients were diagnosed at Ege University Faculty of Medicine in Izmir, Turkey and comprised data collected from 2006 to 2019. The diagnostic laboratory examinations included blood phenylalanine and urinary or plasma pterins, dihydropteridine reductase (DHPR) enzyme activity measurement in dried blood spots, folic acid and monoamine neurotransmitter metabolites in cerebrospinal fluid, as well as DNA sequencing. RESULTS Among the nine patients, we identified one with autosomal recessive GTP cyclohydrolase I (ar GTPCH) deficiency, two with 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, three with sepiapterin reductase (SR) deficiency, and three with DHPR deficiency. Similar to previous observations, the most common clinical symptoms are developmental delay, intellectual disability, and movement disorders. All patients received treatment with l-dopa and 5-hydroxytryptophan, while only the ar GTPCH, the PTPS, and one DHPR deficient patients were supplemented in addition with BH4. The recommended dose range varies among patients and depends on the type of disease. The consequences of BH4 deficiencies are quite variable; however, early diagnosis and treatment will improve outcomes. CONCLUSIONS As BH4 deficiencies are rare group of treatable neurometabolic disorders, it is essential to diagnose the underlying (genetic) defect in newborns with hyperphenylalaninemia. Irreversible brain damage and progressive neurological deterioration may occur in untreated or late diagnosed patients. Prognosis could be satisfying in the cases with early diagnose and treatment.
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Affiliation(s)
- Ayse Ergul Bozaci
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Esra Er
- Tepecik Research and Training Hospital, Department of GeneticsIzmirTurkey
| | - Havva Yazici
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Ebru Canda
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Sema Kalkan Uçar
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Merve Güvenc Saka
- Tepecik Research and Training Hospital, Department of GeneticsIzmirTurkey
| | - Cenk Eraslan
- Department of RadiologyEge University Faculty of MedicineIzmirTurkey
| | - Hüseyin Onay
- Department of Medical GeneticsEge University Faculty of MedicineIzmirTurkey
| | - Sara Habif
- Department of Medical BiochemistryEge University Faculty of MedicineIzmirTurkey
| | - Beat Thöny
- Division of MetabolismUniversity Children's Hospital Zurich and Children's Research CenterZurichSwitzerland
| | - Mahmut Coker
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
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17
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Kose M, Isik E, Aykut A, Durmaz A, Kose E, Ersoy M, Diniz G, Adebali O, Ünalp A, Yilmaz Ü, Karaoğlu P, Edizer S, Tekin HG, Özdemir TR, Atik T, Onay H, Özkınay F. The utility of next-generation sequencing technologies in diagnosis of Mendelian mitochondrial diseases and reflections on clinical spectrum. J Pediatr Endocrinol Metab 2021; 34:417-430. [PMID: 33629572 DOI: 10.1515/jpem-2020-0410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/11/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Diagnostic process of mitochondrial disorders (MD) is challenging because of the clinical variability and genetic heterogeneity of these conditions. Next-Generation Sequencing (NGS) technology offers a high-throughput platform for nuclear MD. METHODS We included 59 of 72 patients that undergone WES and targeted exome sequencing panel suspected to have potential PMDs. Patients who were included in the analysis considering the possible PMD were reviewed retrospectively and scored according to the Mitochondrial Disease Criteria Scale. RESULTS Sixty-one percent of the patients were diagnosed with whole-exome sequencing (WES) (36/59) and 15% with targeted exome sequencing (TES) (9/59). Patients with MD-related gene defects were included in the mito group, patients without MD-related gene defects were included in the nonmito group, and patients in whom no etiological cause could be identified were included in the unknown etiology group. In 11 out of 36 patients diagnosed with WES, a TES panel was applied prior to WES. In 47 probands in 39 genes (SURF1, SDHAF1, MTO1, FBXL4, SLC25A12, GLRX5, C19oRF12, NDUFAF6, DARS2, BOLA3, SLC19A3, SCO1, HIBCH, PDHA1, PDHAX, PC, ETFA, TRMU, TUFM, NDUFS6, WWOX, UBCD TREX1, ATL1, VAC14, GFAP, PLA2G6, TPRKB, ATP8A2, PEX13, IGHMBP2, LAMB2, LPIN1, GFPT1, CLN5, DOLK) (20 mito group, 19 nonmito group) 59 variants (31 mito group, 18 nonmito group) were detected. Seven novel variants in the mito group (SLC25A12, GLRX5, DARS2, SCO1, PC, ETFA, NDUFS6), nine novel variants in the nonmito group (IVD, GCDH, COG4, VAC14, GFAP, PLA2G6, ATP8A2, PEX13, LPIN1) were detected. CONCLUSIONS We explored the feasibility of identifying pathogenic alleles using WES and TES in MD. Our results show that WES is the primary method of choice in the diagnosis of MD until at least all genes responsible for PMD are found and are highly effective in facilitating the diagnosis process.
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Affiliation(s)
- Melis Kose
- Department of Pediatrics, Division of Inborn Errors of Metabolism, İzmir Katip Çelebi University, Izmir, Turkey.,Department of Pediatrics, Division of Genetics, Ege University, Izmir, Turkey
| | - Esra Isik
- Department of Pediatrics, Division of Genetics, Ege University, Izmir, Turkey
| | - Ayça Aykut
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Asude Durmaz
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Engin Kose
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Ankara University, Ankara, Turkey
| | - Melike Ersoy
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Health Sciences University, Bakırkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Gulden Diniz
- Department of Pathology, İzmir Democrasy University, Izmir, Turkey
| | - Ogun Adebali
- Adebali Lab, Molecular Biology, Genetics and Bioengineering Program, Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Health Sciences University Dr. Behçet Uz Children Research and Training Hospital, Izmir, Turkey
| | - Ünsal Yilmaz
- Department of Pediatric Neurology, Health Sciences University Dr. Behçet Uz Children Research and Training Hospital, Izmir, Turkey
| | - Pakize Karaoğlu
- Department of Pediatric Neurology, Health Sciences University Dr. Behçet Uz Children Research and Training Hospital, Izmir, Turkey
| | - Selvinaz Edizer
- Department of Pediatrics, Division of Pediatric Neurology, Kanuni Sultan Suleyman University, Istanbul, Turkey
| | - Hande Gazeteci Tekin
- Department of Pediatrics, Division of Pediatric Neurology, Çiğli Training and Research Hospital, Izmir, Turkey
| | - Taha Reşid Özdemir
- Department of Medical Genetics, Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tahir Atik
- Department of Pediatrics, Division of Genetics, Ege University, Izmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Ferda Özkınay
- Department of Pediatrics, Division of Genetics, Ege University, Izmir, Turkey
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18
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Ece Solmaz A, Yeniay L, Gökmen E, Zekioğlu O, Haydaroğlu A, Bilgen I, Özkınay F, Onay H. Clinical Contribution of Next-Generation Sequencing Multigene Panel Testing for BRCA Negative High-Risk Patients With Breast Cancer. Clin Breast Cancer 2021; 21:e647-e653. [PMID: 33980423 DOI: 10.1016/j.clbc.2021.04.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy in women and thought to be hereditary in 10% of patients. Recent next-generation sequencing studies have increased the detection of pathogenic or likely pathogenic (P/LP) variants in genes other than BRCA1/2 in patients with breast cancer. This study evaluated pathogenic variants, likely pathogenic variants, and variants of unknown significance in 18 hereditary cancer susceptibility genes in patients with BRCA1/2-negative breast cancer. PATIENTS AND METHODS This retrospective study included 188 high-risk BRCA1/2-negative patients with breast cancer tested with a multigene cancer panel using next-generation sequencing. RESULTS Among 188 proband cases, 18 variants in 21 patients (11.1%) were classified as P/LP in PALB2 (n = 6), CHEK2 (n = 5), MUTYH (n = 4), ATM (n = 3), TP53 (n = 2), BRIP1 (n = 1), and MSH2 (n = 1). Three novel P/LP variants were identified. An additional 28 variants were classified as variants of unknown significance and detected in 30 different patients (15.9%). CONCLUSION This is one of the largest study from Turkey to investigate the mutation spectrum in non-BRCA hereditary breast cancer susceptibility genes. A multigene panel test increased the likelihood of identifying a molecular diagnosis in patients with BRCA 1/2-negative breast cancer at risk for a hereditary breast cancer syndrome. More studies are needed to enable the clinical interpretation of these P/LP variants in hereditary patients with breast cancer.
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Affiliation(s)
- Aslı Ece Solmaz
- Department of Medical Genetic, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Levent Yeniay
- Department of General Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Erhan Gökmen
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Osman Zekioğlu
- Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ayfer Haydaroğlu
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Işıl Bilgen
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ferda Özkınay
- Department of Medical Genetic, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetic, Ege University Faculty of Medicine, Izmir, Turkey
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19
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Ozkinay F, Emecen DA, Kose M, Isik E, Bozaci AE, Canda E, Tuysuz B, Zubarioglu T, Atik T, Onay H. Clinical and genetic features of 13 patients with mucopolysaccarhidosis type IIIB: Description of two novel NAGLU gene mutations. Mol Genet Metab Rep 2021; 27:100732. [PMID: 33747789 PMCID: PMC7966861 DOI: 10.1016/j.ymgmr.2021.100732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Aim Mucopolysaccharidosis type III B (MPS IIIB) is an autosomal recessive lysosomal storage disease caused by mutations in the NAGLU gene which codes the lysosomal enzyme alpha-N-acetylglucosaminidase. The major symptoms of the disease are cognitive and neurological defects. In this study, the molecular spectrums of 13 MPS IIIB patients were evaluated. Material and methods Thirteen MPS IIIB patients from 11 families were included in this study. All patients were both clinically and molecularly diagnosed. NAGLU gene sequencing was performed using a next generation sequencing platform (Illumina MiSeq). Demographic, clinical and laboratory findings of the patients were obtained via the hospital records. Results Ten different mutations from the 13 MPS IIIB patients were identified. Eight of the 10 mutations were missense, one was splice site, and one large deletion was also observed. Two mutations c.509G>T (p.Gly170Val) and c.700C>G (p.Arg234Gly) have been defined for the first time in this study. Conclusion Our study expanded the mutation spectrum of the NAGLU gene thereby contributing to the improved genetic counselling of MPS IIIB patients. Confirming the literature, missense mutations were also found to be the most common NAGLU mutations in our study.
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Affiliation(s)
- F Ozkinay
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - D A Emecen
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - M Kose
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - E Isik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - A E Bozaci
- Subdivision of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - E Canda
- Subdivision of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - B Tuysuz
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Cerrahpasa University, Izmir, Turkey
| | - T Zubarioglu
- Subdivision of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Cerrahpasa University, Izmir, Turkey
| | - T Atik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - H Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
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20
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Şentürk Pilan B, Özbaran B, Çelik D, Özcan T, Özen S, Gökşen D, Ulman İ, Avanoğlu A, Tiryaki S, Onay H, Çoğulu Ö, Özkınay F, Darcan Ş. Quality of Life and Psychological Well-being in Children and Adolescents with Disorders of Sex Development. J Clin Res Pediatr Endocrinol 2021; 13:23-33. [PMID: 32938579 PMCID: PMC7947730 DOI: 10.4274/jcrpe.galenos.2020.2020.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the quality of life (QoL) and psychological well-being in child and adolescent with disorders of sex development (DSD). METHODS Sixty-two cases, aged 2-18 years, who were followed by a multidisciplinary DSD team were included. All participants and their parents were requested the complete the Pediatric Quality Of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire. The psychiatric diagnoses of the patients were evaluated according to Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Turkish Version. RESULTS There was no significant difference between the 46,XX DSD and 46,XY DSD groups for both child and parent in Total PedsQL score. In the subscale scores, the PedsQL Physical Functionality Score reported by children was significantly lower for the 46,XX DSD group than for the 46,XY DSD group (p=0.01). There was a psychiatric diagnosis in 25.8% of cases. The PedsQL School Functionality Score reported by children in the group with psychiatric diagnosis was significantly lower than the group without psychiatric diagnosis (p=0.018). In the group with psychiatric diagnosis, the PedsQL Total Score and the subscale scores (Emotional Functionality Score, Social Functionality Score, School Functionality) reported by parents were significantly lower than in parents of the group without psychiatric diagnosis. CONCLUSION This study emphasized that psychiatric disorders in DSD patients negatively affect the QoL. Psychiatric support and counseling from a multidisciplinary team are very important for families affected by DSD.
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Affiliation(s)
- Birsen Şentürk Pilan
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey Phone: +90 505 525 09 39 E-mail:
| | - Burcu Özbaran
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | - Didem Çelik
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | - Tuğçe Özcan
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - İbrahim Ulman
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Ali Avanoğlu
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Sibel Tiryaki
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Özgür Çoğulu
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Ferda Özkınay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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21
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Ata A, Özen S, Onay H, Uzun S, Gökşen D, Özkınay F, Özbaran NB, Ulman İ, Darcan Ş. A large cohort of disorders of sex development and their genetic characteristics: 6 novel mutations in known genes. Eur J Med Genet 2021; 64:104154. [PMID: 33516834 DOI: 10.1016/j.ejmg.2021.104154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/03/2020] [Accepted: 01/25/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Disorders of sex development (DSD) constitutes a group of congenital conditions that affect urogenital differentiation and are associated with chromosomal, gonadal and phenotypic sex abnormalities. OBJECTIVE To evaluate the clinical and genetic features of childhood DSD cases. MATERIALS AND METHODS DSD patients followed up between the years of 2002-2018 were evaluated in terms of their complaints, demographic, clinical features and genetic diagnoses. RESULTS Out of 289 patients, 143(49.5%) were classified as 46XY DSD, 62(21.5%) as 46XX DSD and 84(29%) as sex chromosomal DSD. Genetic diagnosis was achieved in 150 patients (51.9%). The distribution of the molecular diagnosis of the 46XY DSD patients were; 12 (26.6%) SRD5A2, 10 (22.2%) AR, 7 (15.5%) HSD17B3, 3 (6.6%) WT-1, 2 (4.4%) AMHR2, 2 (4.4%) AMH, 2 (4.4%) LHCGR, 2 (4.4%) HSD3B2, 1 (2.2%) NR5A1, 1 (2.2%) CYP17A1 and 1 (2.2%) SRY mutation. Fifty (80.6%) of the 46XX DSD patients received a diagnosis with clinical and laboratory findings. Twenty-four (38.7%) of them were 21-hydroxylase deficiency, 9(14.5%) Rokitansky-Küster-Hauser Syndrome, 4 (6.5%) 11-β hydroxylase deficiency, 3 (4.8%) gonadal dysgenesis and 2 (3.2%) aromatase deficiency. In 46XX group pathogenic mutations were detected in 21(33.8%) of the patients. Eighty-four (29%) patients were diagnosed as sex chromosomal disorder. Of these 66 (78.5%) were Turner Syndrome, 6 (7.2%) Klinefelter Syndrome and 10 (11.9%) mix gonadal dysgenesis. Gender re-assignment was decided in 11 patients. Malignant and pre-invasive lesions was diagnosed in 8 (2.7%) patients. CONCLUSION Many of DSD's are clinically similar and etiology of numerous of them still cannot be established. A multi-disciplinary approach and new rapid genetic diagnostic methods are needed in the process from diagnosis to gender assignment and follow-up.
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Affiliation(s)
- Aysun Ata
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Hüseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Selin Uzun
- Department of Child Health and Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Damla Gökşen
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey; Department of Pediatric Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Nazlı Burcu Özbaran
- Department of Pediatric and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - İbrahim Ulman
- Department of Pediatric Urology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
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22
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Pelletier F, Perrier S, Cayami FK, Mirchi A, Saikali S, Tran LT, Ulrick N, Guerrero K, Rampakakis E, van Spaendonk RML, Naidu S, Pohl D, Gibson WT, Demos M, Goizet C, Tejera-Martin I, Potic A, Fogel BL, Brais B, Sylvain M, Sébire G, Lourenço CM, Bonkowsky JL, Catsman-Berrevoets C, Pinto PS, Tirupathi S, Strømme P, de Grauw T, Gieruszczak-Bialek D, Krägeloh-Mann I, Mierzewska H, Philippi H, Rankin J, Atik T, Banwell B, Benko WS, Blaschek A, Bley A, Boltshauser E, Bratkovic D, Brozova K, Cimas I, Clough C, Corenblum B, Dinopoulos A, Dolan G, Faletra F, Fernandez R, Fletcher J, Garcia Garcia ME, Gasparini P, Gburek-Augustat J, Gonzalez Moron D, Hamati A, Harting I, Hertzberg C, Hill A, Hobson GM, Innes AM, Kauffman M, Kirwin SM, Kluger G, Kolditz P, Kotzaeridou U, La Piana R, Liston E, McClintock W, McEntagart M, McKenzie F, Melançon S, Misbahuddin A, Suri M, Monton FI, Moutton S, Murphy RPJ, Nickel M, Onay H, Orcesi S, Özkınay F, Patzer S, Pedro H, Pekic S, Pineda Marfa M, Pizzino A, Plecko B, Poll-The BT, Popovic V, Rating D, Rioux MF, Rodriguez Espinosa N, Ronan A, Ostergaard JR, Rossignol E, Sanchez-Carpintero R, Schossig A, Senbil N, Sønderberg Roos LK, Stevens CA, Synofzik M, Sztriha L, Tibussek D, Timmann D, Tonduti D, van de Warrenburg BP, Vázquez-López M, Venkateswaran S, Wasling P, Wassmer E, Webster RI, Wiegand G, Yoon G, Rotteveel J, Schiffmann R, van der Knaap MS, Vanderver A, Martos-Moreno GÁ, Polychronakos C, Wolf NI, Bernard G. Endocrine and Growth Abnormalities in 4H Leukodystrophy Caused by Variants in POLR3A, POLR3B, and POLR1C. J Clin Endocrinol Metab 2021; 106:e660-e674. [PMID: 33005949 PMCID: PMC7823228 DOI: 10.1210/clinem/dgaa700] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 12/22/2022]
Abstract
CONTEXT 4H or POLR3-related leukodystrophy is an autosomal recessive disorder typically characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism, caused by biallelic pathogenic variants in POLR3A, POLR3B, POLR1C, and POLR3K. The endocrine and growth abnormalities associated with this disorder have not been thoroughly investigated to date. OBJECTIVE To systematically characterize endocrine abnormalities of patients with 4H leukodystrophy. DESIGN An international cross-sectional study was performed on 150 patients with genetically confirmed 4H leukodystrophy between 2015 and 2016. Endocrine and growth abnormalities were evaluated, and neurological and other non-neurological features were reviewed. Potential genotype/phenotype associations were also investigated. SETTING This was a multicenter retrospective study using information collected from 3 predominant centers. PATIENTS A total of 150 patients with 4H leukodystrophy and pathogenic variants in POLR3A, POLR3B, or POLR1C were included. MAIN OUTCOME MEASURES Variables used to evaluate endocrine and growth abnormalities included pubertal history, hormone levels (estradiol, testosterone, stimulated LH and FSH, stimulated GH, IGF-I, prolactin, ACTH, cortisol, TSH, and T4), and height and head circumference charts. RESULTS The most common endocrine abnormalities were delayed puberty (57/74; 77% overall, 64% in males, 89% in females) and short stature (57/93; 61%), when evaluated according to physician assessment. Abnormal thyroid function was reported in 22% (13/59) of patients. CONCLUSIONS Our results confirm pubertal abnormalities and short stature are the most common endocrine features seen in 4H leukodystrophy. However, we noted that endocrine abnormalities are typically underinvestigated in this patient population. A prospective study is required to formulate evidence-based recommendations for management of the endocrine manifestations of this disorder.
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Affiliation(s)
- Félixe Pelletier
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
- Division of Child Neurology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Stefanie Perrier
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ferdy K Cayami
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Centers, and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Center of Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Amytice Mirchi
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
| | - Stephan Saikali
- Department of Pathology, Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada
| | - Luan T Tran
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicole Ulrick
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kether Guerrero
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Rosalina M L van Spaendonk
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sakkubai Naidu
- Department of Neurogenetics, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Daniela Pohl
- Division of Neurology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - William T Gibson
- Department of Medical Genetics, University of British Columbia, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Michelle Demos
- Division of Neurology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, BC, Canada
| | - Cyril Goizet
- Centre de Référence Neurogénétique, Service de Génétique Médicale, Bordeaux University Hospital, and Laboratoire MRGM, INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Ingrid Tejera-Martin
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Canary Islands, Spain
| | - Ana Potic
- Department of Neurology, Clinic for Child Neurology and Psychiatry, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Brent L Fogel
- Departments of Neurology and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute, Montreal, QC, Canada
| | - Michel Sylvain
- Centre Mère Enfant, CHU de Québec, Québec City, QC, Canada
| | - Guillaume Sébire
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charles Marques Lourenço
- Faculdade de Medicina, Centro Universitario Estácio de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Joshua L Bonkowsky
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus University Hospital - Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | - Pedro S Pinto
- Neuroradiology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Sandya Tirupathi
- Department of Paediatric Neurology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Petter Strømme
- Division of Pediatrics and Adolescent Medicine, Oslo University Hospital, Ullevål, 0450 Oslo, and University of Oslo, Oslo, Norway
| | - Ton de Grauw
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA, USA
| | - Dorota Gieruszczak-Bialek
- Department of Medical Genetics, Children’s Memorial Health Institute, Warsaw, Poland
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Ingeborg Krägeloh-Mann
- Department of Child Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Hanna Mierzewska
- Department of Child and Adolescent Neurology, Institute of Mother and Child, Warsaw, Poland
| | - Heike Philippi
- Center of Developmental Neurology (SPZ Frankfurt Mitte), Frankfurt, Germany
| | - Julia Rankin
- Peninsula Clinical Genetics Service, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tahir Atik
- Division of Genetics, Department of Pediatrics, School of Medicine, Ege University, Izmir, Turkey
| | - Brenda Banwell
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - William S Benko
- Division of Pediatric Neurology, Department of Neurology, UC Davis Health System, Sacramento, CA, USA
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Annette Bley
- University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eugen Boltshauser
- Department of Child Neurology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Drago Bratkovic
- Metabolic Clinic, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Klara Brozova
- Department of Child Neurology, Thomayers Hospital, Prague, Czech Republic
| | - Icíar Cimas
- Department of Neurology, Povisa Hospital, Vigo, Spain
| | | | - Bernard Corenblum
- Division of Endocrinology & Metabolism, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Argirios Dinopoulos
- Third Department of Pediatrics, National and Kapodistrian University of Athens, “Attikon” Hospital, Athens, Greece
| | | | - Flavio Faletra
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Janice Fletcher
- Genetics and Molecular Pathology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | | | - Paolo Gasparini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, and University of Trieste, Trieste, Italy
| | - Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Leipzig, Leipzig, Germany
| | - Dolores Gonzalez Moron
- Neurogenetics Unit, Department of Neurology, Hospital JM Ramos Mejia, ADC, Buenos Aires, Argentina
| | - Aline Hamati
- Department of Child Neurology, Indiana University, Indianapolis, IN, USA
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Alan Hill
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Grace M Hobson
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Marcelo Kauffman
- Neurogenetics Unit, Department of Neurology, Hospital JM Ramos Mejia and CONICET, ADC, Buenos Aires, Argentina
| | - Susan M Kirwin
- Molecular Diagnostics Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Gerhard Kluger
- PMU Salzburg, 5020 Salzburg, Austria; Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Petra Kolditz
- Department of Child Neurology, Kantonsspital Luzern, Luzern, Switzerland
| | - Urania Kotzaeridou
- Department of Child Neurology, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Roberta La Piana
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Eriskay Liston
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - William McClintock
- Pediatric Specialists of Virginia, Fairfax, VA, USA
- Department of Neurology, Children’s National Medical Center, Washington, DC, USA
| | - Meriel McEntagart
- South West Thames Regional Genetics Service, St. George’s Hospital, London, UK
| | - Fiona McKenzie
- Genetic Services of Western Australia, Subiaco, WA, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Serge Melançon
- Department of Medical Genetics, McGill University Health Centre, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Anjum Misbahuddin
- Essex Centre for Neurological Sciences, Queen’s Hospital, Romford, UK
| | - Mohnish Suri
- Nottingham Clinical Genetics Service, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fernando I Monton
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Canary Islands, Spain
| | | | - Raymond P J Murphy
- Department of Neurology, Tallaght University Hospital, Tallaght, Ireland
| | - Miriam Nickel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Ferda Özkınay
- Department of Pediatrics, Subdivision of Pediatric Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Steffi Patzer
- Children’s Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Helio Pedro
- Department of Pediatrics, The Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sandra Pekic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, Belgrade & School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Amy Pizzino
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Genetics, MetroHealth Hospital, Cleveland, OH, USA
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Bwee Tien Poll-The
- Department of Pediatric Neurology, Emma Children’s Hospital, 1105 Amsterdam, The Netherlands
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Dietz Rating
- Department of Paediatric Neurology, University Children’s Hospital, Heidelberg, Germany
| | - Marie-France Rioux
- Centre Hospitalier Universitaire de Sherbrooke - Hôpital Fleurimont, Sherbrooke, QC, Canada
| | - Norberto Rodriguez Espinosa
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Canary Islands, Spain
| | - Anne Ronan
- Hunter New England LHD, University of Newcastle, NSW, Australia
| | - John R Ostergaard
- Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Elsa Rossignol
- Departments of Neurosciences and Pediatrics, CHU-Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Rocio Sanchez-Carpintero
- Pediatric Neurology Unit, Department of Pediatrics, Clinica Universidad de Navarra, Pamplona, Spain
| | - Anna Schossig
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - Nesrin Senbil
- Department of Child Neurology, Kırıkkale University Medical Faculty, Kırıkkale, Turkey
| | - Laura K Sønderberg Roos
- Applied Human Molecular Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Cathy A Stevens
- Department of Pediatrics, Division of Medical Genetics, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, German Research Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - László Sztriha
- Department of Paediatrics, University of Szeged, Szeged, Hungary
| | - Daniel Tibussek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children’s Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Davide Tonduti
- Child Neurology Unit, V. Buzzi Children’s Hospital, Milano, Italy
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maria Vázquez-López
- Sección Neuropediatría. Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain
| | - Sunita Venkateswaran
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Pontus Wasling
- Department of Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Richard I Webster
- T. Y. Nelson Department of Neurology and Neurosurgery and the Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gert Wiegand
- Department of Pediatric Neurology, University Hospital Kiel, Germany
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg Nord-Heidberg, Hamburg, Germany
| | - Grace Yoon
- Division of Clinical and Metabolic Genetics, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joost Rotteveel
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Marjo S van der Knaap
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Centers, and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gabriel Á Martos-Moreno
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- CIBER de Fisiopatologia de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Constantin Polychronakos
- Division of Endocrinology, Montreal Children’s Hospital and the Endocrine Genetics Lab, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicole I Wolf
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Centers, and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Geneviève Bernard
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
- Correspondence and Reprint Requests: Geneviève Bernard, Research Institute of the McGill University Health Centre, 1001 boul Décarie, EM02224 (CHHD Mail Drop Point #EM03211 (Cubicle C)), Montréal, QC H4A 3J1, Canada. E-mail:
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Kose M, Kose E, Ünalp A, Yılmaz Ü, Edizer S, Tekin HG, Karaoğlu P, Özdemir TR, Er E, Onay H, Yildirim ES. Neuronal ceroid lipofuscinosis: genetic and phenotypic spectrum of 14 patients from Turkey. Neurol Sci 2021; 42:1103-1111. [PMID: 33486620 DOI: 10.1007/s10072-021-05067-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/16/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND PURPOSE Neuronal ceroid lipofuscinoses (NCLs) is a group of congenital metabolic diseases where the neurodegenerative process with the accumulation of ceroid and lipofuscin autofluorescent storage materials is at the forefront. According to the age of presentation, NCLs are classified as congenital, infantile (INCL), late infantile (LINCL), juvenile (JNCL), and adult (ANCL) NCLs. In our study, it was aimed to discuss the clinical and molecular characteristics of our patients diagnosed with NCL. MATERIAL AND METHOD This is a descriptive cross-sectional study which was conducted in 14 patients from 10 unrelated families who were diagnosed with different types of NCL based on clinical presentation, neuroimaging, biochemical measurements, and molecular analyses, at the department of pediatric metabolism between June 2015 and June 2020. RESULTS A total of 14 patients were diagnosed with different types of NCL. Of those, 4 patients were diagnosed with NCL7 (4/14; 30%), 3/14 (23%) with NCL1, 3/14 (23%) with NCL2, 2/14 (14.2%) with NCL13, and 1/14 (7.1%) with NCL10. Eleven pathogenic variants were detected, 5 of which are novel (c.721G>T [p.Gly241Ter] and c.301G>C [p.Ala146Pro] in MFDS8 gene; c.316C>T [p.Gln106Ter] in PPT1 gene; c.341C>T [p.Ala114Val] in TPP1 gene; c.686A>T [p.Glu229Val] in CTSD gene) CONCLUSION: This study is one of the pioneer comprehensive researches from Turkey that provides information about disease-causing variants and clinical presentation of different and rare types of NCLs. The identification of novel variants and phenotypic expansion is important for genetic counselling in Turkey and expected to improve understanding of NCLs.
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Affiliation(s)
- Melis Kose
- Department of Pediatrics, Division of Metabolism and Nutrition, Izmir Katip Çelebi University Faculty of Medicine, Ismet Kaptan Street, 35100, Izmir, Turkey.
| | - Engin Kose
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aycan Ünalp
- Pediatric Neurology Department, University of Health Sciences, Behçet Uz Children Training and Research Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Pediatric Neurology Department, University of Health Sciences, Behçet Uz Children Training and Research Hospital, Izmir, Turkey
| | - Selvinaz Edizer
- Pediatric Neurology Department, University of Health Sciences, Behçet Uz Children Training and Research Hospital, Izmir, Turkey
| | - Hande Gazeteci Tekin
- Faculty of Medicine, Çiğli Research and Training Hospital, Department of Pediatrics, Division of Neurology, Bakırçay University, Izmir, Turkey
| | - Pakize Karaoğlu
- Pediatric Neurology Department, University of Health Sciences, Behçet Uz Children Training and Research Hospital, Izmir, Turkey
| | - Taha Reşid Özdemir
- Genetics Department, University of Health Sciences Tepecik Training & Research Hospital, Izmir, Turkey
| | - Esra Er
- Department of Pediatrics, Division of Nutrition and Metabolism, Izmir Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Eser Sozmen Yildirim
- Clinical Chemistry Department, Ege University Faculty of Medicine, İzmir, Turkey
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Çavuşoğlu Y, Özpelit E, Arslan N, Demir M, Kahveci G, Onay H, Ökçün EÖB, Tufekcioglu O, Tülüce SY, Yıldırım GK. [Fabry disease in cardiology: Diagnosis and therapeutic approaches]. Turk Kardiyol Dern Ars 2021; 48:1-42. [PMID: 33476309 DOI: 10.5543/tkda.2020.38262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fabry disease is a rare, progressive, X-linked inherited storage disorder due to absent or deficient of lysosomal alfa galactosidase A activity. Deficient activity of alfa-galactosidase A results in progressive accumulation of globotriaosylceramide in a variety of tissues and organs including myocardium, kidney and nerve system. This disorder predominantly affects males; however, female heterozygotes may also be affected with a less severe clinical picture. Classic Fabry disease is usually diagnosed in early age of childhood because of multiorgan involvement whereas cardiac and renal variants of Fabry are manifested in 30-50 years of age because of late onset of clinical picture in which other organs involvement are uncommon. Although Fabry is known as a very rare disease, its prevalence is reported to be higher in patients with ventricular hypertrophy, chronic kidney disease and cryptogenic stroke. From the cardiology point of view, the most important key finding of the disease is unexplained ventricular hypertrophy. However, in clinical practice, ventricular hypertrophy is usually thought to be due to hypertrophic cardiomyopathy in the absence of hypertension or aortic stenosis and Fabry disease is often undiagnosed or overlooked. Early diagnosis and enzyme replacement therapy have been shown to significantly improve prognosis. The aim of this paper is to provide a comprehensive review including epidemiology, prognosis, clinical presentation, diagnosis and therapeutic approaches of cardiac variant of Fabry based on the available data in the literature.
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Aktar Karakaya A, Unal E, Beştaş A, Taş F, Onay H, Haspolat YK. A novel variant in LCHGR gene in 3 siblings with type 1 Leydig cell hypoplasia. Gynecol Endocrinol 2020; 36:1136-1139. [PMID: 32654531 DOI: 10.1080/09513590.2020.1789859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Leydig cell hypoplasia (LCH) is an autosomal recessive disease that causes 46, XY sex development disorder. The patients with LCH are usually in the female phenotype and are presented with the complaints of no breast development and primary amenorrhea. In this article, the cases of three siblings who presented with primary amenorrhea and who had LCH were presented. CASE A 16-year-old patient with female phenotype is presented with primary amenorrhea. Breast development was at Tanner stage 1, the external genitalia were completely in female phenotype. The karyotype was determined as 46, XY. The hormonal analyses revealed that the testosterone synthesis was insufficient despite the high level of luteinizing hormone (LH). Cortisol, ACTH, 17-Hydroxyprogesterone, and AMH levels were normal. LCH diagnosis was considered in the patient with elevated LH and no testosterone synthesis. A new mutation of homozygous c.161 + 4A > G was detected in LHCGR gene. The same mutation was detected in the patient's two siblings with female phenotype and 46, XY karyotype. CONCLUSION In patients presenting with primary amenorrhea and karyotype 46, XY, there is no testosterone synthesis and if there is LH elevation, LCH should be considered. We found a novel variant in the LHCGR gene in three siblings with karyotype 46, XY and female phenotype.
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Affiliation(s)
- Amine Aktar Karakaya
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Edip Unal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Aslı Beştaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Funda Taş
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Yusuf Kenan Haspolat
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Altay C, Seçil M, Adıyaman SC, Özgen Saydam B, Demir T, Akıncı G, Simsir IY, Eren E, Temeloğlu Keskin E, Demir L, Onay H, Topaloğlu H, Sarer Yürekli B, Özdemir Kutbay N, Gen R, Akıncı B. Magnetic resonance spectroscopy to assess hepatic steatosis in patients with lipodystrophy. Turk J Gastroenterol 2020; 31:588-595. [PMID: 32915147 DOI: 10.5152/tjg.2020.19114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Lipodystrophy is a rare metabolic disorder characterized by near total or partial lack of subcutaneous adipose tissue and associated with insulin resistance. We aimed to evaluate the efficacy of magnetic resonance spectroscopy imaging (MRS) to explore the fat content of the liver in patients with lipodystrophy and to determine the relationship between the liver fat accumulation and clinical presentations of lipodystrophy. MATERIALS AND METHODS Between July 2014 and February 2016, 34 patients with lipodystrophy were assessed by MRS for quantification of hepatic steatosis. All patients had metabolic abnormalities associated with insulin resistance. Metabolic parameters and the MRS findings were analyzed to identify potential correlations between the liver fat content and disease severity. RESULTS The MRS fat ratios (MRS-FR) were markedly higher, indicating severe hepatic steatosis in lipodystrophy. Patients with generalized and partial lipodystrophy had comparable levels of MRS-FRs, although patients with generalized lipodystrophy were significantly younger. Patients with genetically based lipodystrophy had elevated MRS-FR compared to those with acquired lipodystrophy (p=0.042). The MRS-FR was positively correlated with liver enzyme alanine aminotransferase (p=0.028) and serum adiponectin (p=0.043). CONCLUSION Our data suggest that MRS might be an effective, noninvasive imaging method to quantify hepatic fat content in patients with lipodystrophy. Further studies are needed to validate the technique and threshold values which would allow accurate comparison of data acquired by different machines and centers.
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Affiliation(s)
- Canan Altay
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | | | - Başak Özgen Saydam
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Tevfik Demir
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Gülçin Akıncı
- Division of Pediatric Neurology, Dr. Behçet Uz Childrens' Hospital, İzmir, Turkey
| | | | - Erdal Eren
- Division of Pediatric Endocrinology, Uludağ University School of Medicine, Bursa, Turkey
| | - Ela Temeloğlu Keskin
- Division of Endocrinology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Leyla Demir
- Department of Biochemistry, Atatürk Training Hospital, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Haluk Topaloğlu
- Division of Pediatric Neurology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Banu Sarer Yürekli
- Division of Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | | | - Ramazan Gen
- Division of Endocrinology, Mersin University School of Medicine, Mersin, Turkey
| | - Barış Akıncı
- Division of Endocrinology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Onay H, Bolat H, Kılıç Yıldırım G, Kose E, Kalkan Uçar S, Aşıkovalı S, Özkınay F, Çoker M. Analysis of the alpha galactosidase gene: mutation profile and description of two novel mutations with extensive literature review in Turkish population. J Pediatr Endocrinol Metab 2020; 33:1245-1250. [PMID: 32813676 DOI: 10.1515/jpem-2020-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/05/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022]
Abstract
Objectives Fabry disease (FD, OMIM #301500) is a rare and progressive X-linked lysosomal storage disorder. FD is caused by mutations in the GLA gene on chromosome Xq22. Methods In this article, we aimed to present the largest sample of GLA mutation spectrum including common and novel variants in Turkish population. GLA gene sequence analysis was performed on the subjects who applied to the department of medical genetics with the preliminary diagnosis of FD between 2013 and 2018. Results We detected 22 different mutations as two novel [(p.F69S(c.206T>C), p.P205A (c.613C>G)] and 20 previously reported GLA mutations in 47 individuals from 22 unrelated families. These mutations included 14 missense mutations, four nonsense mutations, two small deletions, one small deletion/insertion and one small insertion. Major clinical findings of the female case with p.F69S(c.206T>C) mutation were cornea verticillata, acroparesthesia, angiokeratoma, psychiatric and gastrointestinal symptoms. Other novel mutation (p.P205A [c.613C>G]) was carried by a male case presenting gastrointestinal symptoms. Conclusions We described clinical findings of two cases that had novel mutations to provide more insight in genotype-phenotype correlation. We presented the largest mutation spectrum in Turkish population and reviewed previous mutations in this article.
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Affiliation(s)
- Hüseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hilmi Bolat
- Department of Medical Genetics, Balıkesir Atatürk City Hospital, Balikesir, Turkey
| | - Gonca Kılıç Yıldırım
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Engin Kose
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sema Kalkan Uçar
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
| | - Semih Aşıkovalı
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ferda Özkınay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey.,Department of Pediatrics, Division of Pediatric Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mahmut Çoker
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
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Şentürk Pilan B, Özbaran B, Çelik D, Özcan T, Özen S, Gökşen D, Ulman İ, Avanoğlu A, Tiryaki S, Onay H, Çoğulu Ö, Özkınay F, Darcan Ş. Psychiatric view for disorders of sex development: a 12-year experience of a multidisciplinary team in a university hospital. J Pediatr Endocrinol Metab 2020; 33:605-611. [PMID: 32238607 DOI: 10.1515/jpem-2019-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/30/2019] [Accepted: 02/24/2020] [Indexed: 11/15/2022]
Abstract
Background Psychiatric consultation is important in the follow-up of disorders of sex development (DSD) patients. In this study, we aimed to present the 12-year psychiatric follow-up data of the patients who were referred by Ege University Medical Faculty DSD Multidisciplinary Team and followed up in Child and Adolescent Psychiatry. Methods Psychiatric data of 118 patients, who were followed by the DSD multidisciplinary team between 2007 and 2019, were reviewed retrospectively. The psychiatric diagnoses of the patients were evaluated according to semi-structured interview form Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Turkish Version. Results The mean age of the 118 cases was 13.21 years (±7.18). Endocrine diagnoses of the cases were 46 XX DSD in 35 (29.6%), 46 XY DSD in 81 (68.7%), and chromosome disorders in 2 (1.7%). There was at least psychiatric diagnosis in 36 (30.5%) cases. The most common psychiatric diagnosis was attention deficit and hyperactivity disorder (ADHD) (n = 18, 15.3%). ADHD was most common in congenital adrenal hyperplasia (n = 4, 22.4%) and androgen synthesis defects (ASD) (n = 4, 22.4%); depression was most common in complete gonadal dysgenesis and ASD (n = 3, 23.1%); and mental retardation was most common in ASD (n = 3, 37.5%). Conclusions In order to provide a healthy perspective for cases with DSD, it is important to make a psychiatric evaluation and to share observations and clinical findings in regular team meetings.
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Affiliation(s)
- Birsen Şentürk Pilan
- Ege University Faculty of Medicine, Child and Adolescent Psychiatry, İzmir, Turkey
| | - Burcu Özbaran
- Ege University Faculty of Medicine, Child and Adolescent Psychiatry, İzmir, Turkey
| | - Didem Çelik
- Ege University Faculty of Medicine, Child and Adolescent Psychiatry, İzmir, Turkey
| | - Tuğçe Özcan
- Ege University Faculty of Medicine, Child and Adolescent Psychiatry, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - İbrahim Ulman
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Ali Avanoğlu
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Sibel Tiryaki
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Medical Genetics, İzmir, Turkey
| | - Özgür Çoğulu
- Ege University Faculty of Medicine, Medical Genetics, İzmir, Turkey
| | - Ferda Özkınay
- Ege University Faculty of Medicine, Medical Genetics, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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29
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Mete Gökmen N, Rodríguez-Alcalde C, Gülbahar O, Lopez-Trascasa M, Onay H, López-Lera A. Novel homozygous variants in the SERPING1 gene in two Turkish families with hereditary angioedema of recessive inheritance. Immunol Cell Biol 2020; 98:693-699. [PMID: 32445210 DOI: 10.1111/imcb.12362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
Hereditary angioedema as a result of deficiency of the C1 inhibitor (HAE-C1INH; MIM# 106100) is a rare autosomal disorder and affected individuals are generally heterozygous for dominant negative variants in the SERPING1 gene. Homozygosity for SERPING1 pathogenic variants was long considered to be embryonically lethal; however, five nonrelated families with a recessive HAE pattern have been described in the last decade. In this report, we functionally characterized two newly reported nonrelated, consanguineous families with a recessive presentation of HAE attributed to SERPING1 variants in the reactive center loop (family D; S438F) and gate (family A; I379T) regions. S438F heterozygotes (family D) showed variable levels of intact 105-kDa and cleaved/inactive 96-kDa isoforms of C1INH, whereas their homozygous relative presented only the 96-kDa band. Functional studies showed that S438F reduced C1INH interaction with target proteases in heterozygous (C1s, 32-38% of controls and FXIIa, 28-35% of controls) and homozygous (C1s, 18-24% of controls and FXIIa, 4-8% of controls) carriers, which is consistent with the more severe presentation of HAE in the family and decreased C1q levels in homozygous patients. By contrast, plasma C1INH from I379T heterozygotes (family A) showed normal C1INH/C1s binding (84-94% of controls) and no significant reduction in C1INH/FXIIa complexes (50-70% of controls). However, the homozygote failed to inhibit both C1s (25-42% of controls) and FXIIa (14-18% of controls). This profile is concordant with the less severe presentation of HAE in the family and the conserved C4 and C1q levels in heterozygous and homozygous patients.
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Affiliation(s)
- Nihal Mete Gökmen
- Department of Internal Medicine, Division of Allergy and Immunology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Okan Gülbahar
- Department of Internal Medicine, Division of Allergy and Immunology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Margarita Lopez-Trascasa
- Departamento de Medicina, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Alberto López-Lera
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
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Pehlivanoğlu B, Ardeniz Ö, Hassoy H, Sezak M, Özdemir H, Ünal NG, Onay H, Doğanavşargil B. Gastrointestinal findings in 26 adults with common variable immunodeficiency: The fickle nature of the disease manifests in gastrointestinal biopsies. Turk J Gastroenterol 2020; 30:789-800. [PMID: 31530523 DOI: 10.5152/tjg.2019.18777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS The aim of the present study was to demonstrate the histopathological findings in gastrointestinal (GI) biopsies in adults with common variable immunodeficiency (CVID). MATERIALS AND METHODS A total of 172 GI biopsies of 26 patients with CVID obtained over a 16-year period were reevaluated. Findings were analyzed using descriptive analyzes and χ2 test. RESULTS Female-to-male ratio was 1.36. The median age at diagnosis was 36±13.94 (16-72) years. Chronic esophagitis was noted in 3 patients. The absence of plasma cells in the stomach, duodenum, and colon was observed in 16, 14, and 9 patients, respectively. Divergent results for the presence of plasma cells in concurrent stomach and duodenum samples were found in 11 (44%) patients. Nodular lymphoid hyperplasia (NLH) was notable in the duodenum (56%). The mean number of eosinophils in one high-power field was significantly higher in duodenal biopsies with NLH (27.21 vs. 14.37, p=0.002). Active inflammation was more prominent in the colon (91%) than in the stomach (65%) and duodenum (60%). Helicobacter pylori infection was found in 57.6%, including a case with persistent infection by the coccoid form. Celiac-like villous blunting and increased intraepithelial lymphocytes were seen in 40% and 24%, respectively. In addition, 23% had giardiasis associated with acute duodenitis and duodenal NLH (p<0.05). CONCLUSION CVID gastroenteropathy is a challenging entity, and due to the heterogeneity in the presence and distribution of plasma cells throughout the GI tract and diverse disease course, multiple concurrent biopsies may be needed for tissue diagnosis. Duodenal CVID may present with villous alterations and giardiasis, and NLH appears to be an important clue in the duodenum. The association between duodenal NLH and eosinophil infiltration deserves further investigation.
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Affiliation(s)
- Buçin Pehlivanoğlu
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | - Ömür Ardeniz
- Division of Immunology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Hür Hassoy
- Department of Public Health, Ege University School of Medicine, İzmir, Turkey
| | - Murat Sezak
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | - Hafize Özdemir
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | - Nalan Gülşen Ünal
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
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Yilmaz Karapinar D, Özdemir HH, Akinci B, Yaşar AŞ, Siviş ZÖ, Onay H, Özkinay F. Management of a Patient With Congenital Biallelic CSF3R Mutation With GM-CSF. J Pediatr Hematol Oncol 2020; 42:e164-e166. [PMID: 30499904 DOI: 10.1097/mph.0000000000001359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/12/2023]
Abstract
Severe Congenital Neutropenia (SCN) is a rare inherited disease characterized by an absolute neutrophil count (ANC) lower than 500/μL. Genetic heterogeneity and biallelic CSF3R mutation has rarely been identified as an underlying genetic defect in SCN. The majority of SCN patients respond to granulocyte colony stimulating factor treatment; however, in patients with inherited CSF3R mutation, ANC cannot generally be increased with granulocyte colony stimulating factor treatment. In such cases, granulocyte macrophage colony stimulating factor presents as an effective treatment option. Herein, we report a case of a 5-year-old SCN girl with homozygous c610-611 del ins AG (p.Q204R) mutation in the CSF3R gene, who was successfully treated with granulocyte macrophage colony stimulating factor.
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Affiliation(s)
| | | | | | | | | | - Hüseyin Onay
- Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Özkinay
- Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
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Abstract
Neurofibromatosis Noonan syndrome (NFNS) is a rare RASopathy syndrome, resulting from NF1 gene mutations. NFNS is characterized by phenotypic features of both neurofibromatosis type 1 (NF1) and Noonan syndrome. Plexiform neurofibromas (PNFs) are an unusual finding in NFNS. A seven year-old girl with typical clinical features of NF1 was referred to our clinic due to short stature and abnormal genital appearance. Due to dysmorphic features, a clinical diagnosis of NFNS was considered in the patient and, following molecular analysis, revealed a novel heterozygous c.3052_3056delTTAGT (p.L1018X) variant in the NF1 gene. Although evaluation for genital virilization, including karyotype and hormonal studies were normal, imaging studies revealed a diffuse genital PNF. Although PNFs are seen rarely in NFNS, this should be considered in the differential diagnosis of genital virilization in these patients to prevent unnecessary testing.
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Affiliation(s)
- Esra Işık
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey Phone: +90 232 390 14 42 E-mail:
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Tahir Atik
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey
| | - Aslı Ece Solmaz
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Özgür Çoğulu
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Ferda Özkınay
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
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Özen S, Atik T, Korkmaz Ö, Onay H, Gökşen D, Özkınay F, Çoğulu Ö, Darcan Ş. Aromatase Deficiency in Two Siblings with 46,XX Karyotype Raised as Different Genders: A Novel Mutation (p.R115X) in the CYP19A1 Gene. J Clin Res Pediatr Endocrinol 2020; 12:109-112. [PMID: 30968679 PMCID: PMC7127884 DOI: 10.4274/jcrpe.galenos.2019.2018.0198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aromatase deficiency rarely causes a 46,XX sexual differentiation disorder. The CYP19A1 gene encodes the aromatase enzyme which catalyses the conversion of androgens to oestrogens. In cases with 46,XX karyotype, mutations in the CYP19A1 gene can lead to disorders of sex development. Clinical findings in aromatase deficiency vary depending on the degree of deficiency. The effect of increased androgens, including acne, cliteromegaly and hirsutism, can be observed in mothers with placental aromatase deficiency. A decrease in maternal virilisation symptoms is observable in the postpartum period. It is rarely reported that there is no virilization in pregnancy. In this study, two 46,XX sibling having the p.R115X (c.343 C>T) novel pathogenic variant in the CYP19A1 gene and raised as different genders, with no maternal virilisation during pregnancy, are presented. In conclusion, 46,XX virilised females should be examined in terms of aromatase deficiency once congenital adrenal hyperplasia has been excluded, even if there is no history of maternal virilisation during pregnancy.
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Affiliation(s)
- Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Tahir Atik
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey Phone: +90 232 390 12 30 E-mail:
| | - Özlem Korkmaz
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ferda Özkınay
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Özgür Çoğulu
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, İzmir, Turkey,Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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34
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Atik T, Işık E, Onay H, Akgün B, Shamsali M, Kavaklı K, Evim M, Tüysüz G, Özbek NY, Şahin F, Salcıoğlu Z, Albayrak C, Oymak Y, Ünal E, Belen FB, Yılmaz Keskin E, Balkan C, Baytan B, Küpesiz A, Culha V, Tahtakesen Güçer TN, Güneş AM, Özkınay F. Factor 8 Gene Mutation Spectrum of 270 Patients with Hemophilia A: Identification of 36 Novel Mutations. Turk J Haematol 2020; 37:145-153. [PMID: 32026663 PMCID: PMC7463214 DOI: 10.4274/tjh.galenos.2020.2019.0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/01/2022] Open
Abstract
Objective Hemophilia A (HA) is the most severe X-linked inherited bleeding disorder caused by hemizygous mutations in the factor 8 (F8) gene. The aim of this study is to determine the mutation spectrum of the F8 gene in a large HA cohort from Turkey, and then to establish a phenotype-genotype correlation. Materials and Methods All HA cases (270 patients) analyzed molecularly in the Ege University Pediatric Genetics Molecular Laboratory between March 2017 and March 2018 were included in this study. To identify intron 22 inversion (Inv22), intron 1 inversion (Inv1), small deletion/insertions, and point mutations, molecular analyses of F8 were performed using a sequential application of molecular techniques. Results The mutation detection success rate was 95.2%. Positive Inv22 was found in 106 patients (39.3%), Inv1 was found in 4 patients (1.5%), and 106 different disease-causing sequence variants were identified in 137 patients (50.6%). In 10 patients (3.7%), amplification failures involving one or more exonic regions, considered to be large intragenic deletions, were identified. Of 106 different F8 mutations, 36 were novel. The relationship between F8 genotype and inhibitor development was considered significant. Conclusion A high mutation detection rate was achieved via the broad molecular techniques applied in this study, including 36 novel mutations. With regard to mutation types, mutation distribution and their impact on clinical severity and inhibitor development were found to be similar to those previously reported in other hemophilia population studies.
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Affiliation(s)
- Tahir Atik
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey,Equal contributors
| | - Esra Işık
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey,Equal contributors
| | - Hüseyin Onay
- Ege University, School of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Bilçağ Akgün
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey
| | - Moharram Shamsali
- Ege University, Institute of Health Sciences, Division of Health Bioinformatics, Izmir, Turkey
| | - Kaan Kavaklı
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Melike Evim
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Gülen Tüysüz
- Akdeniz University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Antalya, Turkey
| | - Namık Yaşar Özbek
- Health Sciences University Ankara Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology, Ankara, Turkey
| | - Fahri Şahin
- Ege University, School of Medicine, Department of Internal Medicine, Division of Hematology, Izmir, Turkey
| | - Zafer Salcıoğlu
- Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Canan Albayrak
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Hematology and Oncology, Samsun, Turkey
| | - Yeşim Oymak
- Dr. Behcet Uz Children’s Hospital, Division of Pediatric Hematology, Izmir, Turkey
| | - Ekrem Ünal
- Erciyes University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kayseri, Turkey
| | - Fatma Burcu Belen
- Katip Celebi University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Ebru Yılmaz Keskin
- Suleyman Demirel University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Isparta, Turkey
| | - Can Balkan
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Birol Baytan
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Alphan Küpesiz
- Akdeniz University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Antalya, Turkey
| | - Vildan Culha
- Health Sciences University Ankara Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology, Ankara, Turkey
| | - Tuba Nur Tahtakesen Güçer
- Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Adalet Meral Güneş
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Ferda Özkınay
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey
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Solmaz AE, Onay H, Yeniay L, Gökmen E, Özdemir N, Alanyalı S, Oktay A, Özsaran Z, Kapkaç M, Özkınay F. BRCA1-BRCA2 mutation analysis results in 910 individuals: Mutation distribution and 8 novel mutations. Cancer Genet 2020; 241:20-24. [PMID: 31954625 DOI: 10.1016/j.cancergen.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/12/2019] [Accepted: 12/27/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Aslı Ece Solmaz
- Ege University Faculty of Medicine, Department of Medical Genetic, 35100 Bornova, Izmir, Turkey.
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetic, 35100 Bornova, Izmir, Turkey
| | - Levent Yeniay
- Ege University Faculty of Medicine, Department of General Surgery, Izmir, Turkey
| | - Erhan Gökmen
- Ege University Faculty of Medicine, Department of Medical Oncology, Izmir, Turkey
| | - Necmettin Özdemir
- Ege University Faculty of Medicine, Department of Pathology, Izmir, Turkey
| | - Senem Alanyalı
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey
| | - Ayşenur Oktay
- Ege University Faculty of Medicine, Department of Radiology, Izmir, Turkey
| | - Zeynep Özsaran
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey
| | - Murat Kapkaç
- Ege University Faculty of Medicine, Department of General Surgery, Izmir, Turkey
| | - Ferda Özkınay
- Ege University Faculty of Medicine, Department of Medical Genetic, 35100 Bornova, Izmir, Turkey
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Aykut A, Özen S, Gökşen D, Ata A, Onay H, Atik T, Darcan Ş, Özkinay F. Melanocortin 4 receptor (MC4R) gene variants in children and adolescents having familial early-onset obesity: genetic and clinical characteristics. Eur J Pediatr 2020; 179:1445-1452. [PMID: 32185475 PMCID: PMC7223532 DOI: 10.1007/s00431-020-03630-7] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022]
Abstract
Melanocortin 4 receptor gene plays an important role in food intake, energy balance, and weight control. The autosomal dominantly inherited MC4R variants cause obesity by causing hyperphagia and decreased sense of satiety. Homozygous variants are rarely reported, and they cause earlier/severe obesity. Our objective is to determine the MC4R gene variant frequency in children and adolescents with familial early-onset obesity. One hundred thirty-nine children and adolescents (57 girls/82 boys) whose weight increase started before the age of 5 years and who had early-onset obesity in at least one of their first-degree relatives were included in the study. Obesity is defined as body mass index (BMI) of ≥ 95th percentile, and as extreme obesity is defined if the BMI ≥ 120% of the 95th percentile or ≥ 35 kg/m2. Children having genetic syndromes associated with obesity and mental retardation or taking drugs that promote changes in eating behavior or weight were excluded from the study. Coding region of the MC4R gene was sequenced by using the Illumina MiSeq Next Generation Sequencing System. The mean age of the patients was 7.3 ± 3.7 years, and the mean BMI SDS was 3.7 ± 0.7. While 118 patients (85%) were prepubertal, 21 patients (15%) were pubertal. Seven different variants were identified in 12 patients by giving a variant detection rate of 8.6%, of these five were previously identified missense variants p.N274S, p.S136F, p.V166I, p.R165W, and p.I291SfsX10. One homozygous variant p.I291SfsX10 (c.870delG) was detected in a severely obese 2-year-old boy, and other variants were heterozygous. Two novel variants were found: p.M200del and p.S188L. By using the in silico analysis software, these novel variants were predicted to be disease causing.Conclusion: MC4R gene variants are quite common in childhood obesity in Turkish population. Screening the variants in MC4R gene is necessary in patients with severe childhood-onset obesity. In such patients, comorbidities of obesity can be seen from early years. What is known • The frequency of MC4R mutations in obese patients was approximately 0-6.3%. What is new • In obese Turkish pediatric population, unlike other European countries, MC4R gene variants are quite common as we found a variant rate of 8.6% • We believe it is necessary to screen the variants in MC4R gene in patients with severe childhood-onset obesity and who had early-onset obesity in at least one of their first-degree relatives in Turkish population.
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Affiliation(s)
- Ayça Aykut
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey.
| | - Damla Gökşen
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Aysun Ata
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Tahir Atik
- Department of Pediatric Genetics, Ege University School of Medicine, İzmir, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology, Ege University School of Medicine, İzmir, Turkey
| | - Ferda Özkinay
- Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey ,Department of Pediatric Genetics, Ege University School of Medicine, İzmir, Turkey
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37
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Yılmaz Karapınar D, Patıroğlu T, Metin A, Çalışkan Ü, Celkan T, Yılmaz B, Karakaş Z, Karapınar TH, Akıncı B, Özkınay F, Onay H, Yeşilipek MA, Akar HH, Tüysüz G, Tokgöz H, Özdemir GN, Aslan Kıykım A, Karaman S, Kılınç Y, Oymak Y, Küpesiz A, Olcay L, Keskin Yıldırım Z, Aydoğan G, Gökçe M, İleri T, Aral YZ, Bay A, Atabay B, Kaya Z, Söker M, Özdemir Karadaş N, Özbek U, Özsait Selçuk B, Özdemir HH, Uygun V, Tezcan Karasu G, Yılmaz Ş. Homozygous c.130-131 ins A (pW44X) mutation in the HAX1 gene as the most common cause of congenital neutropenia in Turkey: Report from the Turkish Severe Congenital Neutropenia Registry. Pediatr Blood Cancer 2019; 66:e27923. [PMID: 31321910 DOI: 10.1002/pbc.27923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/13/2018] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Severe congenital neutropenia is a rare disease, and autosomal dominantly inherited ELANE mutation is the most frequently observed genetic defect in the registries from North America and Western Europe. However, in eastern countries where consanguineous marriages are common, autosomal recessive forms might be more frequent. METHOD Two hundred and sixteen patients with severe congenital neutropenia from 28 different pediatric centers in Turkey were registered. RESULTS The most frequently observed mutation was HAX1 mutation (n = 78, 36.1%). A heterozygous ELANE mutation was detected in 29 patients (13.4%) in our cohort. Biallelic mutations of G6PC3 (n = 9, 4.3%), CSF3R (n = 6, 2.9%), and JAGN1 (n = 2, 1%) were also observed. Granulocyte colony-stimulating factor treatment was given to 174 patients (80.6%). Two patients died with infectious complications, and five patients developed myelodysplastic syndrome/acute myeloblastic leukemia. The mean (± mean standard error) follow-up period was 129.7 ± 76.3 months, and overall survival was 96.8% (CI, 94.4-99.1%) at the age of 15 years. In Turkey, severe congenital neutropenia mostly resulted from the p W44X mutation in the HAX1 gene. CONCLUSION In Turkey, mutation analysis should be started with HAX1, and if this is negative, ELANE and G6PC3 should be checked. Because of the very high percentage of consanguineous marriage, rare mutations should be tested in patients with a negative mutation screen.
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Affiliation(s)
| | - Türkan Patıroğlu
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Metin
- Department of Pediatric Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ümran Çalışkan
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Barış Yılmaz
- Department of Pediatric Hematology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Karakaş
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tuba H Karapınar
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Burcu Akıncı
- Department of Pediatric Hematology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ferda Özkınay
- Department of Pediatric Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Akif Yeşilipek
- Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Himmet Haluk Akar
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Gülen Tüysüz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Hüseyin Tokgöz
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gül Nihal Özdemir
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Ayça Aslan Kıykım
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Serap Karaman
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yurdanur Kılınç
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Lale Olcay
- Department of Pediatric Hematology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Zuhal Keskin Yıldırım
- Department of Pediatric Hematology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Gönül Aydoğan
- Department of Pediatric Hematology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Müge Gökçe
- Department of Pediatric Bone marrow Transplantation Unit, Yeni Yüzyıl Üniversitesi, Gaziosmanpaşa Hastanesi, Istanbul, Turkey
| | - Talia İleri
- Department of Pediatric Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yusuf Ziya Aral
- Department of Pediatric Hematology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Bay
- Department of Pediatric Hematology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Berna Atabay
- Department of Pediatric Hematology, Tepecik Teaching and Research Hospital, İzmir, Turkey
| | - Zuhre Kaya
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Söker
- Department of Pediatric Hematology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | | | - Uğur Özbek
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Bilge Özsait Selçuk
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hamiyet Hekimci Özdemir
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Vedat Uygun
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Gülsün Tezcan Karasu
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Şebnem Yılmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Karasoy H, Tuncel R, Ekmekci O, Yuceyar A, Bademkiran F, Onay H. P.55Sensory ataxic neuropathy with dysarthria and ophthalmoparesis: seven case reports. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.084] [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: 10/25/2022]
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Rashnonejad A, Amini Chermahini G, Gündüz C, Onay H, Aykut A, Durmaz B, Baka M, Su Q, Gao G, Özkınay F. Fetal Gene Therapy Using a Single Injection of Recombinant AAV9 Rescued SMA Phenotype in Mice. Mol Ther 2019; 27:2123-2133. [PMID: 31543414 DOI: 10.1016/j.ymthe.2019.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/28/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022] Open
Abstract
Symptoms of spinal muscular atrophy (SMA) disease typically begin in the late prenatal or the early postnatal period of life. The intrauterine (IU) correction of gene expression, fetal gene therapy, could offer effective gene therapy approach for early onset diseases. Hence, the overall goal of this study was to investigate the efficacy of human survival motor neuron (hSMN) gene expression after IU delivery in SMA mouse embryos. First, we found that IU-intracerebroventricular (i.c.v.) injection of adeno-associated virus serotype-9 (AAV9)-EGFP led to extensive expression of EGFP protein in different parts of the CNS with a great number of transduced neural stem cells. Then, to implement the fetal gene therapy, mouse fetuses received a single i.c.v. injection of a single-stranded (ss) or self-complementary (sc) AAV9-SMN vector that led to a lifespan of 93 (median of 63) or 171 (median 105) days for SMA mice. The muscle pathology and number of the motor neurons also improved in both study groups, with slightly better results coming from scAAV treatment. Consequently, fetal gene therapy may provide an alternative therapeutic approach for treating inherited diseases such as SMA that lead to prenatal death or lifelong irreversible damage.
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Affiliation(s)
| | | | - Cumhur Gündüz
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Ayça Aykut
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Burak Durmaz
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Meral Baka
- Department of Histology and Embryology, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Qin Su
- The Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Guangping Gao
- The Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Ferda Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir 35100, Turkey
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Kırlı U, Binbay T, Drukker M, Elbi H, Kayahan B, Keskin Gökçelli D, Özkınay F, Onay H, Alptekin K, van Os J. DSM outcomes of psychotic experiences and associated risk factors: 6-year follow-up study in a community-based sample. Psychol Med 2019; 49:1346-1356. [PMID: 30101737 DOI: 10.1017/s0033291718001964] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators. METHODS Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis. RESULTS In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness. CONCLUSION The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.
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Affiliation(s)
- Umut Kırlı
- Education and Research Hospital,Van,Turkey
| | - Tolga Binbay
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Marjan Drukker
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
| | - Hayriye Elbi
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | - Bülent Kayahan
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | | | - Ferda Özkınay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Hüseyin Onay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Köksal Alptekin
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
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Abstract
OBJECTIVE Children with ADHD show substantial deficits in social cognitive abilities. Oxytocin, mediated through its specific receptor (OXTR), is involved in the regulation of social behavior and social cognition. METHOD The entire coding sequence of the human OXT and OXTR genes were sequenced to identify mutations and single nucleotide polymorphisms (SNPs) in 151 children with ADHD (ADHD-combined, n = 51; inattentive subtype, n = 50; ADHD-C plus conduct disorder [CD], n = 50; 11-18 years) and 100 healthy controls. RESULTS We examined the association of three detected SNPs of OXTR with social cognition deficits. A significant association was shown between the children with ADHD and children with CT/TT genotypes of rs4686302 (χ2 = 3.695; p = .037). ADHD children with CT/TT genotype for the OXTR rs4686302 performed significantly lower on the facial emotion recognition task than those with CC genotype. CONCLUSION OXTR rs4686302 polymorphism was shown to be a genetic marker in social cognition deficits in ADHD children.
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Kirli U, Binbay T, Drukker M, Elbi H, Kayahan B, Gökçelli DK, Özkınay F, Onay H, Alptekin K, van Os J. Is BDNF-Val66Met polymorphism associated with psychotic experiences and psychotic disorder outcome? Evidence from a 6 years prospective population-based cohort study. Am J Med Genet B Neuropsychiatr Genet 2019; 180:113-121. [PMID: 29785763 DOI: 10.1002/ajmg.b.32641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/27/2018] [Revised: 04/05/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022]
Abstract
There is little research on genetic risk for the extended psychosis phenotype ranging from psychotic experiences (PEs) to psychotic disorders (PDs). In this general population-based prospective cohort study, the longitudinal associations between BDNF-Val66Met polymorphism and the different levels of the extended psychosis phenotype were investigated. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighborhoods at baseline (n = 4011). A nested case-control study (n = 366) recruited individuals with PEs and PDs as well as individuals with no psychotic symptoms. In this subgroup, blood sampling for genetic analysis and assessment of environmental exposures were carried out, followed by clinical re-appraisal at follow-up 6 years later (n = 254). The BDNF-Val66Met polymorphism was significantly associated with the extended psychosis phenotype. The pattern of the association was that the BDNF-Val66Met polymorphism impacted in a dose-response but extra-linear fashion, with stronger impact at the PD end of the extended psychosis phenotype. Associations were still significant after adjusting for sociodemographic factors and environmental exposures including life events, childhood adversity, socioeconomic status, urbanicity, and cannabis use. The BDNF-Val66Met polymorphism may index susceptibility to expression of psychosis along a spectrum.
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Affiliation(s)
- Umut Kirli
- Department of Psychiatry, Van Education and Research Hospital, Van, Turkey.,School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tolga Binbay
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Marjan Drukker
- School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hayriye Elbi
- Faculty of Medicine, Department of Psychiatry, Ege University, Izmir, Turkey
| | - Bülent Kayahan
- Faculty of Medicine, Department of Psychiatry, Ege University, Izmir, Turkey
| | | | - Ferda Özkınay
- Faculty of Medicine, Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Hüseyin Onay
- Faculty of Medicine, Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Köksal Alptekin
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Jim van Os
- School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College, King's Health Partners, London, United Kingdom.,Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
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43
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Kırlı U, Binbay T, Elbi H, Drukker M, Kayahan B, Özkınay F, Onay H, Alptekin K, van Os J. Izmir Mental Health Cohort for Gene-Environment Interaction in Psychosis (TürkSch): Assessment of the Extended and Transdiagnostic Psychosis Phenotype and Analysis of Attrition in a 6-Year Follow-Up of a Community-Based Sample. Front Psychiatry 2019; 10:554. [PMID: 31447712 PMCID: PMC6692632 DOI: 10.3389/fpsyt.2019.00554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: TürkSch is a prospective, longitudinal study in a representative community sample (İzmir, Turkey), consisting of several data collection stages, to screen and follow-up mental health outcomes, with a special focus on the extended and transdiagnostic psychosis phenotype. The aim of the present paper is to describe the research methodology, data collection results, and associations with noncontact and refusal in the longitudinal arm. Methods: Households were contacted in a multistage clustered probability sampling frame, covering 11 districts and 302 neighborhoods at baseline (n = 4,011) and at 6-year follow-up (n = 2,185). Both at baseline and at follow-up, participants were interviewed with the Composite International Diagnostic Interview. Participants with probable psychotic disorder were reinterviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID)-I either at the hospital or at the participant's residence. Relevant neighborhood-level measures were assessed in a separate sample (n = 5,124) in addition to individual-level measures. Candidate gene-by-environment interactions were investigated using two nested case-control studies. Results: Individuals with a mental health problem had lower refusal rates. Older and lower educated individuals had a lower probability of noncontact. Discussion: The TürkSch study has an advanced design to meet the challenges of evaluating the multidimensional etiological and phenomenological nature of the extended and transdiagnostic psychosis phenotype.
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Affiliation(s)
- Umut Kırlı
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey.,Maastricht University Medical Centre, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht, Netherlands
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hayriye Elbi
- Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Marjan Drukker
- Maastricht University Medical Centre, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht, Netherlands
| | - Bülent Kayahan
- Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Jim van Os
- Maastricht University Medical Centre, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College, King's Health Partners, London, United Kingdom.,Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands
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Abstract
Persistent Müllerian Duct syndrome (PMDS) develops due to deficiency of anti-Müllerian hormone (AMH) or insensitivity of target organs to AMH in individuals with 46,XY karyotype. PMDS is characterized by normal male phenotype of external genitals, associated with persistence of Müllerian structures. This report includes the presentation of a 2.5 year old male patient due to bilateral undescended testis. His karyotype was 46,XY. The increase in testosterone following human chorionic gonadotropin stimulation test was normal. The patient was referred to our clinic after uterine, fallopian tube and vaginal remnants were recognized during the orchiopexy surgery. The family reported that the eight year old elder brother of the patient was operated on for right inguinal hernia and left undescended testis at the age of one year. A right transverse testicular ectopia was found in the elder brother. Both cases had normal AMH levels. AMHR2 gene was analyzed and a homozygous NM_020547.3:c.233-1G>A mutation was found that was not identified previously. In conclusion, we determined a novel mutation in the AMHR2 gene that was identified for the first time. This presented with different phenotypes in two siblings.
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Affiliation(s)
- Edip Unal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey,* Address for Correspondence: Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey Phone: +90 412 248 80 01 E-mail:
| | - Ruken Yıldırım
- Diyarbakır Children’s Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Suat Tekin
- Dicle University Faculty of Medicine, Department of Pediatrics, Diyarbakır, Turkey
| | | | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Yusuf Kenan Haspolat
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
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45
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Abstract
Aromatase deficiency is a rare autosomal recessive genetic disorder with an unknown incidence. Aromatase converts androgens into estrogen in the gonadal and extra-gonadal tissues. Aromatase deficiency causes ambiguous genitalia in the female fetus and maternal virilization (hirsutism, acne, cliteromegaly, deep voice) during pregnancy due to increased concentration of androgens. A 19 months old girl patient was assessed due to presence of ambiguous genitalia. There were findings of maternal virilization during pregnancy. The karyotype was 46,XX. Congenital adrenal hyperplasia was not considered since adrenocorticotropic hormone, cortisol, and 17-hydroxyprogesterone levels were within normal ranges. At age two months, follicle-stimulating hormone and total testosterone levels were elevated and estradiol level was low. Based on these findings, aromatase deficiency was suspected. A novel homozygous mutation IVS7-2A>G (c.744-2A>G) was identified in the CYP19A1 gene. Pelvic ultrasound showed hypoplasic ovaries rather than large and cystic ovaries. We identified a novel mutation in the CYP19A1 gene in a patient who presented with ambiguous genitalia and maternal virilization during pregnancy. Presence of large and cystic ovaries is not essential in aromatase deficiency.
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Affiliation(s)
- Edip Unal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey,* Address for Correspondence: Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey Phone: +90 412 248 80 01 E-mail:
| | - Ruken Yıldırım
- Diyarbakır Children’s Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Funda Feryal Taş
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | | | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Yusuf Kenan Haspolat
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
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Mete Gökmen N, Gülbahar O, Onay H, Peker Koc Z, Özgül S, Köse T, Gelincik A, Büyüköztürk S, Sin AZ. Deletions in SERPING1 Lead to Lower C1 Inhibitor Function: Lower C1 Inhibitor Function Can Predict Disease Severity. Int Arch Allergy Immunol 2018; 178:50-59. [PMID: 30278448 DOI: 10.1159/000492583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/30/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND How genotype affects phenotype in hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) has not been totally clarified. In this study, we investigated the relationship between different types of mutations and various phenotypic characteristics. METHODS Clinical data from 81 patients from 47 families were recorded. Complement proteins were analyzed from 61 untreated patients. The coding exons and the exon-intron boundaries of the SERPING1 gene were sequenced, and deletion/duplication analysis with multiple ligation dependent probe amplification was performed. The relationship of complement protein with the mutation type was analyzed by using generalized estimating equations. RESULTS Thirty-five different mutations (15 novel and 2/15 homozygous) were identified. There was no causative mutation in 6 patients (7.4%). Patients with deletion and large deletion had the lowest (5.05%, 0-18.7; 5.8%, 0-16.5%, respectively), and the none mutation group had the highest C1 inhibitor function (23.3%, 11-78%, p < 0.001). C1 inhibitor function levels decreased as the age of the disease progressed (r = -0.352, p = 0.005). Lower C1 inhibitor function levels caused severer disease (r = -0.404, p = 0.001) and more frequent annual attacks (r = -0.289, p = 0.024). In the off-attack period, C1q levels were lower than normal in 9.8% of the patients. CONCLUSION Deletion mutations may represent the most unfavorable effect on C1 inhibitor function. The earlier disease onset age could be a sign for lower C1 inhibitor function levels in adult life. C1q levels could also be low in C1-INH-HAE patients, as in acquired angioedema. Lower C1 inhibitor function can predict disease severity and may have negative impacts on the course of C1-INH-HAE.
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Affiliation(s)
- Nihal Mete Gökmen
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir,
| | - Okan Gülbahar
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Zeynep Peker Koc
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
| | - Semiha Özgül
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Timur Köse
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aslı Gelincik
- Division of Allergy, Department of Internal Medicine, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Suna Büyüköztürk
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aytül Zerrin Sin
- Division of Allergy and Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
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Olcay L, Ünal Ş, Onay H, Erdemli E, Öztürk A, Billur D, Metin A, Okur H, Yıldırmak Y, Büyükaşık Y, İkincioğulları A, Falay M, Özet G, Yetgin S. Both Granulocytic and Non-Granulocytic Blood Cells Are Affected in Patients with Severe Congenital Neutropenia and Their Non-Neutropenic Family Members: An Evaluation of Morphology, Function, and Cell Death. Turk J Haematol 2018; 35:229-259. [PMID: 30040071 PMCID: PMC6256814 DOI: 10.4274/tjh.2017.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 01/26/2023] Open
Abstract
Objective: To examine granulocytic and non-granulocytic cells in children with severe congenital neutropenia (SCN) and their non-neutropenic parents. Materials and Methods: Fifteen patients with SCN and 21 non-neutropenic parents were evaluated for a) CD95, CD95 ligand, annexin V, propidium iodide, cell cycle, and lymphocyte subsets by flow cytometry; b) rapid cell senescence (of leukocytes) by senescence-associated β-galactosidase stain; c) aggregation tests by aggregometer; d) in vitro bleeding time by PFA-100 instrument; e) mepacrine-labeled dense granule number of thrombocytes by fluorescence microscope; and f) hematomorphology by light and electron microscope. HAX1, ELANE, G6PC3, CSF3R, and JAGN1 mutations associated with SCN were studied in patients and several parents. Results: Significant increase in apoptosis and secondary necrosis in monocytes, lymphocytes, and granulocytes of the patients and parents was detected, irrespective of the mutation type. CD95 and CD95 ligand results implied that apoptosis was non-CD95-mediated. Leukocytes of 25%, 12.5%, and 0% of patients, parents, and controls showed rapid cell senescence. The cell cycle analysis testable in four cases showed G1 arrest and apoptosis in lymphocytes of three. The patients had HAX1 (n=6), ELANE (n=2), G6PC3 (n=2), and unidentified (n=5) mutations. The CD3, CD4, and NK lymphocytes were below normal levels in 16.6%, 8.3%, and 36.4% of the patients and in 0%, 0%, and 15.4% of the parents (controls: 0%, 0%, 5.6%). The thrombocytes aggregated at low rates, dense granule number/thrombocyte ratio was low, and in vitro bleeding time was prolonged in 37.5%-66.6% of patients and 33.3%-63.2% of parents (vs. 0% in controls). Under electron and/or light microscope, the neutrophils, monocytes, lymphocytes, and thrombocytes in the peripheral blood of both patients and parents were dysplastic and the bone marrow of patients revealed increased phagocytic activity, dysmegakaryopoiesis, and necrotic and apoptotic cells. Ultrastructurally, thrombocyte adhesion, aggregation, and release were inadequate. Conclusion: In cases of SCN, patients’ pluripotent hematopoietic stem cells and their non-neutropenic parents are both affected irrespective of the genetic defect.
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Affiliation(s)
- Lale Olcay
- Ankara Oncology Training and Research Hospital, Clinic of Pediatric Hematology, Ankara, Turkey
| | - Şule Ünal
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children’s Hospital, Clinic of Pediatric Hematology, Ankara, Turkey
| | - Hüseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Esra Erdemli
- Ankara University Faculty of Medicine, Department of Histology Embryology, Ankara, Turkey
| | - Ayşenur Öztürk
- Ankara University Faculty of Medicine, Department of Pediatric Molecular Genetics, Ankara, Turkey
| | - Deniz Billur
- Ankara University Faculty of Medicine, Department of Histology Embryology, Ankara, Turkey
| | - Ayşe Metin
- Ankara Children’s Hematology Oncology Training and Research Hospital, Clinic of Pediatric Immunology, Ankara, Turkey
| | - Hamza Okur
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children’s Hospital, Clinic of Pediatric Hematology, Ankara, Turkey
| | - Yıldız Yıldırmak
- Şişli Etfal Children’s Training and Research Hospital, Clinic of Pediatric Hematology, İstanbul, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Unit of Hematology, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University Faculty of Medicine, Department of Pediatric Immunology and Allergy and Pediatric Molecular Genetics, Ankara, Turkey
| | - Mesude Falay
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey,Yıldırım Beyazıt University Faculty of Medicine, Department of Internal Medicine, Clinic of Hematology, Ankara, Turkey
| | - Sevgi Yetgin
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children’s Hospital, Clinic of Pediatric Hematology, Ankara, Turkey
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48
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Altay C, Seçil M, Demir T, Atik T, Akıncı G, Özdemir Kutbay N, Keskin Temeloğlu E, Yıldırım Şimşir I, Özışık S, Demir L, Eren E, Tuna EB, Aytaç H, Onay H, Akıncı B. Determining residual adipose tissue characteristics with MRI in patients with various subtypes of lipodystrophy. Diagn Interv Radiol 2018; 23:428-434. [PMID: 29044029 DOI: 10.5152/dir.2017.17019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate residual adipose tissue with whole-body magnetic resonance imaging to differentiate between subtypes of lipodystrophy. METHODS A total of 32 patients (12 with congenital generalized lipodystrophy [CGL], 1 with acquired generalized lipodystrophy [AGL], 12 with familial partial lipodystrophy [FPLD], and 7 with acquired partial lipodystrophy [APL]) were included. RESULTS Despite generalized loss of metabolically active adipose tissue, patients with CGL1 caused by AGPAT2 mutations had a significant amount of residual adipose tissue in the scalp, earlobes, retro-orbital region, and palms and soles. No residual adipose tissue was noted particularly in the head and neck, palms and soles in CGL2 caused by BSCL2 mutations. CGL4 caused by mutations in the PTRF gene was characterized with well-preserved retro-orbital and bone marrow fat in the absence of any visible residual adipose tissue in other areas. No residual adipose tissue was observed in AGL. Despite loss of subcutaneous fat, periarticular adipose tissue was preserved in the lower limbs of patients with FPLD. Retro-orbital adipose tissue was surprisingly preserved in APL, although they lacked head and neck fat. CONCLUSION Lipodystrophies are a heterogeneous group of disorders characterized by generalized or partial loss of adipose tissue, which can be congenital or acquired. Our results suggest that residual adipose tissue characteristics can help distinguish different subtypes of lipodystrophy.
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Affiliation(s)
- Canan Altay
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
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Palamar M, Onay H, Atik T, Güven Yilmaz S, Özkınay F. Akondroplazi olgularında ön segment ve kornea biyomekaniği. Ege Tıp Dergisi 2018. [DOI: 10.19161/etd.414705] [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: 11/23/2022] Open
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Çakır AD, Turan H, Onay H, Emir H, Emre S, Comunoglu N, Ercan O, Evliyaoglu O. A Novel Mutation of AMHR2 In Two Siblings with Persistent Müllerian Duct Syndrome. Sex Dev 2018; 11:289-292. [PMID: 29332065 DOI: 10.1159/000485882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
Persistent müllerian duct syndrome (PMDS) is characterized by the presence of müllerian duct derivatives in otherwise phenotypically normal males. It is caused in approximately 85% of the cases by mutations in the AMH gene or its type II receptor (AMHR2). We report on 2 brothers with normal external genitalia but high serum AMH levels. Sequence analysis of the AMHR2 gene in the 2 siblings revealed a novel homozygous missense mutation in exon 10 (p.V458L, c.1372G>T). PMDS is a rare condition, but it has to be considered in differential diagnosis of cryptorchidism with normal male genitalia.
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Affiliation(s)
- Aydilek D Çakır
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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