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Li D, Wang Q, Bayat A, Battig MR, Zhou Y, Bosch DG, van Haaften G, Granger L, Petersen AK, Pérez-Jurado LA, Aznar-Laín G, Aneja A, Hancarova M, Bendova S, Schwarz M, Kremlikova Pourova R, Sedlacek Z, Keena BA, March ME, Hou C, O’Connor N, Bhoj EJ, Harr MH, Lemire G, Boycott KM, Towne M, Li M, Tarnopolsky M, Brady L, Parker MJ, Faghfoury H, Parsley LK, Agolini E, Dentici ML, Novelli A, Wright M, Palmquist R, Lai K, Scala M, Striano P, Iacomino M, Zara F, Cooper A, Maarup TJ, Byler M, Lebel RR, Balci TB, Louie R, Lyons M, Douglas J, Nowak C, Afenjar A, Hoyer J, Keren B, Maas SM, Motazacker MM, Martinez-Agosto JA, Rabani AM, McCormick EM, Falk MJ, Ruggiero SM, Helbig I, Møller RS, Tessarollo L, Tomassoni Ardori F, Palko ME, Hsieh TC, Krawitz PM, Ganapathi M, Gelb BD, Jobanputra V, Wilson A, Greally J, Jacquemont S, Jizi K, Bruel AL, Quelin C, Misra VK, Chick E, Romano C, Greco D, Arena A, Morleo M, Nigro V, Seyama R, Uchiyama Y, Matsumoto N, Taira R, Tashiro K, Sakai Y, Yigit G, Wollnik B, Wagner M, Kutsche B, Hurst AC, Thompson ML, Schmidt R, Randolph L, Spillmann RC, Shashi V, Higginbotham EJ, Cordeiro D, Carnevale A, Costain G, Khan T, Funalot B, Tran Mau-Them F, Fernandez Garcia Moya L, García-Miñaúr S, Osmond M, Chad L, Quercia N, Carrasco D, Li C, Sanchez-Valle A, Kelley M, Nizon M, Jensson BO, Sulem P, Stefansson K, Gorokhova S, Busa T, Rio M, Hadj Habdallah H, Lesieur-Sebellin M, Amiel J, Pingault V, Mercier S, Vincent M, Philippe C, Fatus-Fauconnier C, Friend K, Halligan RK, Biswas S, Rosser J, Shoubridge C, Corbett M, Barnett C, Gecz J, Leppig K, Slavotinek A, Marcelis C, Pfundt R, de Vries BB, van Slegtenhorst MA, Brooks AS, Cogne B, Rambaud T, Tümer Z, Zackai EH, Akizu N, Song Y, Hakonarson H. Spliceosome malfunction causes neurodevelopmental disorders with overlapping features. J Clin Invest 2024; 134:e171235. [PMID: 37962958 PMCID: PMC10760965 DOI: 10.1172/jci171235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
Pre-mRNA splicing is a highly coordinated process. While its dysregulation has been linked to neurological deficits, our understanding of the underlying molecular and cellular mechanisms remains limited. We implicated pathogenic variants in U2AF2 and PRPF19, encoding spliceosome subunits in neurodevelopmental disorders (NDDs), by identifying 46 unrelated individuals with 23 de novo U2AF2 missense variants (including 7 recurrent variants in 30 individuals) and 6 individuals with de novo PRPF19 variants. Eight U2AF2 variants dysregulated splicing of a model substrate. Neuritogenesis was reduced in human neurons differentiated from human pluripotent stem cells carrying two U2AF2 hyper-recurrent variants. Neural loss of function (LoF) of the Drosophila orthologs U2af50 and Prp19 led to lethality, abnormal mushroom body (MB) patterning, and social deficits, which were differentially rescued by wild-type and mutant U2AF2 or PRPF19. Transcriptome profiling revealed splicing substrates or effectors (including Rbfox1, a third splicing factor), which rescued MB defects in U2af50-deficient flies. Upon reanalysis of negative clinical exomes followed by data sharing, we further identified 6 patients with NDD who carried RBFOX1 missense variants which, by in vitro testing, showed LoF. Our study implicates 3 splicing factors as NDD-causative genes and establishes a genetic network with hierarchy underlying human brain development and function.
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Affiliation(s)
- Dong Li
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Qin Wang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allan Bayat
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Yijing Zhou
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniëlle G.M. Bosch
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gijs van Haaften
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leslie Granger
- Department of Genetics and Metabolism, Randall Children’s Hospital at Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - Andrea K. Petersen
- Department of Genetics and Metabolism, Randall Children’s Hospital at Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - Luis A. Pérez-Jurado
- Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
- Genetic Service, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Gemma Aznar-Laín
- Universitat Pompeu Fabra, Barcelona, Spain
- Pediatric Neurology, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Anushree Aneja
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Miroslava Hancarova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Sarka Bendova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Martin Schwarz
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Radka Kremlikova Pourova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Zdenek Sedlacek
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Beth A. Keena
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Elizabeth J. Bhoj
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Gabrielle Lemire
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kym M. Boycott
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Megan Li
- Invitae, San Francisco, California, USA
| | - Mark Tarnopolsky
- Division of Neuromuscular and Neurometabolic Disorders, Department of Paediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Lauren Brady
- Division of Neuromuscular and Neurometabolic Disorders, Department of Paediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Michael J. Parker
- Department of Clinical Genetics, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | | | - Lea Kristin Parsley
- University of Illinois College of Medicine, Mercy Health Systems, Rockford, Illinois, USA
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit, Academic Department of Pediatrics, IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Meredith Wright
- Rady Children’s Institute for Genomic Medicine, San Diego, California, USA
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Khanh Lai
- Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, and
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, and
| | - Michele Iacomino
- Medical Genetics Unit, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Federico Zara
- Medical Genetics Unit, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Annina Cooper
- Department of Genetics, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, California, USA
| | - Timothy J. Maarup
- Department of Genetics, Kaiser Permanente, Los Angeles, California, USA
| | - Melissa Byler
- Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Robert Roger Lebel
- Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Tugce B. Balci
- Division of Genetics, Department of Paediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Raymond Louie
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Michael Lyons
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Jessica Douglas
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Catherine Nowak
- Division of Genetics and Metabolism, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Alexandra Afenjar
- APHP. SU, Reference Center for Intellectual Disabilities Caused by Rare Causes, Department of Genetics and Medical Embryology, Hôpital Trousseau, Paris, France
| | - Juliane Hoyer
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Boris Keren
- Department of Genetics, Hospital Pitié-Salpêtrière, Paris, France
| | - Saskia M. Maas
- Department of Human Genetics, Academic Medical Center, and
| | - Mahdi M. Motazacker
- Laboratory of Genome Diagnostics, Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ahna M. Rabani
- Division of Medical Genetics, Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Elizabeth M. McCormick
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics
| | - Marni J. Falk
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics
| | - Sarah M. Ruggiero
- Division of Neurology, and
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, and
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rikke S. Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Lino Tessarollo
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Francesco Tomassoni Ardori
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Mary Ellen Palko
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Peter M. Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Mythily Ganapathi
- New York Genome Center, New York, New York, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and the Departments of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine, New York, New York, USA
| | - Vaidehi Jobanputra
- New York Genome Center, New York, New York, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - John Greally
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sébastien Jacquemont
- Division of Genetics and Genomics, CHU Ste-Justine Hospital and CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Khadijé Jizi
- Division of Genetics and Genomics, CHU Ste-Justine Hospital and CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Ange-Line Bruel
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
- FHU-TRANSLAD, Fédération Hospitalo-Universitaire Translational Medicine in Developmental Anomalies, CHU Dijon Bourgogne, Dijon, France
| | - Chloé Quelin
- Medical Genetics Department, Centre de Référence Maladies Rares CLAD-Ouest, CHU Hôpital Sud, Rennes, France
| | - Vinod K. Misra
- Division of Genetic, Genomic, and Metabolic Disorders, Children’s Hospital of Michigan, Detroit, Michigan, USA
- Central Michigan University College of Medicine, Discipline of Pediatrics, Mount Pleasant, Michigan, USA
| | - Erika Chick
- Division of Genetic, Genomic, and Metabolic Disorders, Children’s Hospital of Michigan, Detroit, Michigan, USA
| | - Corrado Romano
- Research Unit of Rare Diseases and Neurodevelopmental Disorders, Oasi Research Institute-IRCCS, Troina, Italy
- Medical Genetics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | - Manuela Morleo
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Nigro
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Rie Seyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Yuri Uchiyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryoji Taira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Tashiro
- Department of Pediatrics, Karatsu Red Cross Hospital, Saga, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gökhan Yigit
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Michael Wagner
- Kinderzentrum Oldenburg, Sozialpädiatrisches Zentrum, Diakonisches Werk Oldenburg, Oldenburg, Germany
| | - Barbara Kutsche
- Kinderzentrum Oldenburg, Sozialpädiatrisches Zentrum, Diakonisches Werk Oldenburg, Oldenburg, Germany
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ryan Schmidt
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Linda Randolph
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Division of Medical Genetics, Children’s Hospital Los Angeles, California, USA
| | - Rebecca C. Spillmann
- Department of Pediatrics–Medical Genetics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vandana Shashi
- Department of Pediatrics–Medical Genetics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Dawn Cordeiro
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Carnevale
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tayyaba Khan
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Benoît Funalot
- Department of Genetics, Hôpital Henri-Mondor APHP and CHI Creteil, University Paris Est Creteil, IMRB, Inserm U.955, Creteil, France
| | - Frederic Tran Mau-Them
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | | | - Sixto García-Miñaúr
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Matthew Osmond
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren Chad
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nada Quercia
- Department of Genetic Counselling, Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Ottawa, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Diana Carrasco
- Department of Clinical Genetics, Cook Children’s Hospital, Fort Worth, Texas, USA
| | - Chumei Li
- Division of Genetics, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Amarilis Sanchez-Valle
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Meghan Kelley
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Mathilde Nizon
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | | | | | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Svetlana Gorokhova
- Aix Marseille University, Inserm, U1251-MMG, Marseille Medical Genetics, Marseille, France
- Department of Medical Genetics, Timone Hospital, APHM, Marseille, France
| | - Tiffany Busa
- Department of Medical Genetics, Timone Hospital, APHM, Marseille, France
| | - Marlène Rio
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Hamza Hadj Habdallah
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Marion Lesieur-Sebellin
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jeanne Amiel
- Rare Disease Genetics Department, APHP, Hôpital Necker, Paris, France
- Université Paris Cité, Inserm, Institut Imagine, Embryology and Genetics of Malformations Laboratory, Paris, France
| | - Véronique Pingault
- Rare Disease Genetics Department, APHP, Hôpital Necker, Paris, France
- Université Paris Cité, Inserm, Institut Imagine, Embryology and Genetics of Malformations Laboratory, Paris, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Sandra Mercier
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - Marie Vincent
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - Christophe Philippe
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
| | | | - Kathryn Friend
- Genetics and Molecular Pathology, SA Pathology, Adelaide, South Australia, Australia
| | | | | | - Jane Rosser
- Department of General Medicine, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - Cheryl Shoubridge
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Mark Corbett
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Christopher Barnett
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
- Pediatric and Reproductive Genetics Unit, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Jozef Gecz
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kathleen Leppig
- Genetic Services, Kaiser Permenante of Washington, Seattle, Washington, USA
| | - Anne Slavotinek
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carlo Marcelis
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert B.A. de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alice S. Brooks
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Benjamin Cogne
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Thomas Rambaud
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elaine H. Zackai
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Naiara Akizu
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuanquan Song
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Morgan G, Casalino S, Chowdhary S, Frangione E, Fung CYJ, Haller S, Lapadula E, Scott M, Wolday D, Young J, Arnoldo S, Aujla N, Bearss E, Binnie A, Bombard Y, Borgundvaag B, Briollais L, Dagher M, Devine L, Faghfoury H, Friedman SM, Gingras AC, Goneau LW, Khan Z, Mazzulli T, McLeod SL, Nomigolzar R, Noor A, Pugh TJ, Richardson D, Satnam Singh HK, Simpson J, Stern S, Strug L, Taher A, Lerner-Ellis J, Taher J. Characterizing Risk Factors for Hospitalization and Clinical Characteristics in a Cohort of COVID-19 Patients Enrolled in the GENCOV Study. Viruses 2023; 15:1764. [PMID: 37632107 PMCID: PMC10457914 DOI: 10.3390/v15081764] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The GENCOV study aims to identify patient factors which affect COVID-19 severity and outcomes. Here, we aimed to evaluate patient characteristics, acute symptoms and their persistence, and associations with hospitalization. Participants were recruited at hospital sites across the Greater Toronto Area in Ontario, Canada. Patient-reported demographics, medical history, and COVID-19 symptoms and complications were collected through an intake survey. Regression analyses were performed to identify associations with outcomes including hospitalization and COVID-19 symptoms. In total, 966 responses were obtained from 1106 eligible participants (87% response rate) between November 2020 and May 2022. Increasing continuous age (aOR: 1.05 [95%CI: 1.01-1.08]) and BMI (aOR: 1.17 [95%CI: 1.10-1.24]), non-White/European ethnicity (aOR: 2.72 [95%CI: 1.22-6.05]), hypertension (aOR: 2.78 [95%CI: 1.22-6.34]), and infection by viral variants (aOR: 5.43 [95%CI: 1.45-20.34]) were identified as risk factors for hospitalization. Several symptoms including shortness of breath and fever were found to be more common among inpatients and tended to persist for longer durations following acute illness. Sex, age, ethnicity, BMI, vaccination status, viral strain, and underlying health conditions were associated with developing and having persistent symptoms. By improving our understanding of risk factors for severe COVID-19, our findings may guide COVID-19 patient management strategies by enabling more efficient clinical decision making.
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Affiliation(s)
- Gregory Morgan
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Selina Casalino
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Sunakshi Chowdhary
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Erika Frangione
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Chun Yiu Jordan Fung
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Simona Haller
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Elisa Lapadula
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Mackenzie Scott
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Dawit Wolday
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Juliet Young
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- William Osler Health System, Brampton, ON L6R 3J7, Canada
| | - Navneet Aujla
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Alexandra Binnie
- Department of Critical Care, William Osler Health System, Etobicoke, ON M9V 1R8, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON M5G 2A2, Canada
| | | | - Marc Dagher
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Luke Devine
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Hanna Faghfoury
- Fred A Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada
| | - Steven M. Friedman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Emergency Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lee W. Goneau
- Dynacare Medical Laboratories, Brampton, ON L6T 5V1, Canada
| | - Zeeshan Khan
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Microbiology, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada
| | - Shelley L. McLeod
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON M5G 2A2, Canada
| | | | - Abdul Noor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Trevor J. Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | | | - Harpreet Kaur Satnam Singh
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Jared Simpson
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada
| | - Seth Stern
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
| | - Lisa Strug
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, ON M5G 1Z5, Canada
| | - Ahmed Taher
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jennifer Taher
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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Bhandari V, Kim R, Faghfoury H, Silver J, Chan RH, Ding Q, Schwartz MLB, Bril V. Congenital Myopathy Due to Pathogenic Missense Variant in the MYBPC1 Gene. Can J Neurol Sci 2023:1-3. [PMID: 37577974 DOI: 10.1017/cjn.2023.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Vinaya Bhandari
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raymond Kim
- Division of Clinical and Metabolic Genetics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Josh Silver
- Department of Molecular Genetics, University of Toronto & Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Raymond H Chan
- University health Network, University of Toronto, Toronto, ON, Canada
| | - Qiliang Ding
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marci L B Schwartz
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
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4
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Faghfoury H, Guerin A. Accélérer l’obtention d’un diagnostic génétique chez l’adulte. CMAJ 2023; 195:E802-E803. [PMID: 37277127 DOI: 10.1503/cmaj.221652-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Hanna Faghfoury
- Département de médecine (Faghfoury), Hôpital du Mont Sinaï et Réseau universitaire de santé, Université de Toronto, Toronto, Ont.; Division de génétique médicale (Guerin), Département de pédiatrie, Université Queen's, Kingston, Ont
| | - Andrea Guerin
- Département de médecine (Faghfoury), Hôpital du Mont Sinaï et Réseau universitaire de santé, Université de Toronto, Toronto, Ont.; Division de génétique médicale (Guerin), Département de pédiatrie, Université Queen's, Kingston, Ont.
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5
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Faghfoury H, Guerin A. Ensuring timely genetic diagnosis in adults. CMAJ 2023; 195:E413-E414. [PMID: 37072235 PMCID: PMC10120577 DOI: 10.1503/cmaj.221652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
- Hanna Faghfoury
- Department of Medicine (Faghfoury), Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ont.; Division of Medical Genetics (Guerin), Department of Pediatrics, Queen's University, Kingston, Ont
| | - Andrea Guerin
- Department of Medicine (Faghfoury), Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ont.; Division of Medical Genetics (Guerin), Department of Pediatrics, Queen's University, Kingston, Ont.
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6
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Hartley T, Soubry É, Acker M, Osmond M, Couse M, Gillespie MK, Ito Y, Marshall AE, Lemire G, Huang L, Chisholm C, Eaton AJ, Price EM, Dowling JJ, Ramani AK, Mendoza-Londono R, Costain G, Axford MM, Szuto A, McNiven V, Damseh N, Jobling R, de Kock L, Mojarad BA, Young T, Shao Z, Hayeems RZ, Graham ID, Tarnopolsky M, Brady L, Armour CM, Geraghty M, Richer J, Sawyer S, Lines M, Mercimek-Andrews S, Carter MT, Graham G, Kannu P, Lazier J, Li C, Aul RB, Balci TB, Dlamini N, Badalato L, Guerin A, Walia J, Chitayat D, Cohn R, Faghfoury H, Forster-Gibson C, Gonorazky H, Grunebaum E, Inbar-Feigenberg M, Karp N, Morel C, Rusnak A, Sondheimer N, Warman-Chardon J, Bhola PT, Bourque DK, Chacon IJ, Chad L, Chakraborty P, Chong K, Doja A, Goh ESY, Saleh M, Potter BK, Marshall CR, Dyment DA, Kernohan K, Boycott KM. Bridging clinical care and research in Ontario, Canada: Maximizing diagnoses from reanalysis of clinical exome sequencing data. Clin Genet 2023; 103:288-300. [PMID: 36353900 DOI: 10.1111/cge.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
We examined the utility of clinical and research processes in the reanalysis of publicly-funded clinical exome sequencing data in Ontario, Canada. In partnership with eight sites, we recruited 287 families with suspected rare genetic diseases tested between 2014 and 2020. Data from seven laboratories was reanalyzed with the referring clinicians. Reanalysis of clinically relevant genes identified diagnoses in 4% (13/287); four were missed by clinical testing. Translational research methods, including analysis of novel candidate genes, identified candidates in 21% (61/287). Of these, 24 families have additional evidence through data sharing to support likely diagnoses (8% of cohort). This study indicates few diagnoses are missed by clinical laboratories, the incremental gain from reanalysis of clinically-relevant genes is modest, and the highest yield comes from validation of novel disease-gene associations. Future implementation of translational research methods, including continued reporting of compelling genes of uncertain significance by clinical laboratories, should be considered to maximize diagnoses.
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Affiliation(s)
- Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Élisabeth Soubry
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Meryl Acker
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Yoko Ito
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Aren E Marshall
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Gabrielle Lemire
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Lijia Huang
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Alison J Eaton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- University of Alberta, Edmonton, Canada
| | - E Magda Price
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - James J Dowling
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Gregory Costain
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Michelle M Axford
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Anna Szuto
- Hospital for Sick Children, Toronto, Canada
| | - Vanda McNiven
- Hospital for Sick Children, Toronto, Canada
- University Health Network, Toronto, Canada
| | | | | | - Leanne de Kock
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Ted Young
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Zhuo Shao
- University of Toronto, Toronto, Canada
- North York General Hospital, Toronto, Canada
| | | | - Ian D Graham
- University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Christine M Armour
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Julie Richer
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sarah Sawyer
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Matthew Lines
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Melissa T Carter
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Gail Graham
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Peter Kannu
- Hospital for Sick Children, Toronto, Canada
- University of Alberta, Edmonton, Canada
| | - Joanna Lazier
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Chumei Li
- McMaster Children's Hospital, Hamilton, Canada
| | - Ritu B Aul
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Tugce B Balci
- London Health Sciences Center, Western University, London, Canada
| | | | - Lauren Badalato
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Andrea Guerin
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Jagdeep Walia
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - David Chitayat
- Hospital for Sick Children, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | | | | | | | | | | | | | - Natalya Karp
- London Health Sciences Center, Western University, London, Canada
| | | | - Alison Rusnak
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | | | - Jodi Warman-Chardon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
| | - Priya T Bhola
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Danielle K Bourque
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Lauren Chad
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Asif Doja
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Maha Saleh
- London Health Sciences Center, Western University, London, Canada
| | | | - Beth K Potter
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Christian R Marshall
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - David A Dyment
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin Kernohan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
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7
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Frangione E, Chung M, Casalino S, MacDonald G, Chowdhary S, Mighton C, Faghfoury H, Bombard Y, Strug L, Pugh T, Simpson J, Hao L, Lebo M, Lane WJ, Taher J, Lerner‐Ellis J. Genome Reporting for Healthy Populations-Pipeline for Genomic Screening from the GENCOV COVID-19 Study. Curr Protoc 2022; 2:e534. [PMID: 36205462 PMCID: PMC9874607 DOI: 10.1002/cpz1.534] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Genome sequencing holds the promise for great public health benefits. It is currently being used in the context of rare disease diagnosis and novel gene identification, but also has the potential to identify genetic disease risk factors in healthy individuals. Genome sequencing technologies are currently being used to identify genetic factors that may influence variability in symptom severity and immune response among patients infected by SARS-CoV-2. The GENCOV study aims to look at the relationship between genetic, serological, and biochemical factors and variability of SARS-CoV-2 symptom severity, and to evaluate the utility of returning genome screening results to study participants. Study participants select which results they wish to receive with a decision aid. Medically actionable information for diagnosis, disease risk estimation, disease prevention, and patient management are provided in a comprehensive genome report. Using a combination of bioinformatics software and custom tools, this article describes a pipeline for the analysis and reporting of genetic results to individuals with COVID-19, including HLA genotyping, large-scale continental ancestry estimation, and pharmacogenomic analysis to determine metabolizer status and drug response. In addition, this pipeline includes reporting of medically actionable conditions from comprehensive gene panels for Cardiology, Neurology, Metabolism, Hereditary Cancer, and Hereditary Kidney, and carrier screening for reproductive planning. Incorporated into the genome report are polygenic risk scores for six diseases-coronary artery disease; atrial fibrillation; type-2 diabetes; and breast, prostate, and colon cancer-as well as blood group genotyping analysis for ABO and Rh blood types and genotyping for other antigens of clinical relevance. The genome report summarizes the findings of these analyses in a way that extensively communicates clinically relevant results to patients and their physicians. © 2022 Wiley Periodicals LLC. Basic Protocol 1: HLA genotyping and disease association Basic Protocol 2: Large-scale continental ancestry estimation Basic Protocol 3: Dosage recommendations for pharmacogenomic gene variants associated with drug response Support Protocol: System setup.
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Affiliation(s)
- Erika Frangione
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada
| | - Monica Chung
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada
| | - Selina Casalino
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada
| | - Georgia MacDonald
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada
| | - Sunakshi Chowdhary
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada
| | - Chloe Mighton
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada,University of TorontoTorontoOntarioCanada,Unity Health TorontoTorontoOntarioCanada
| | | | - Yvonne Bombard
- University of TorontoTorontoOntarioCanada,Unity Health TorontoTorontoOntarioCanada
| | - Lisa Strug
- The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Trevor Pugh
- University Health NetworkTorontoOntarioCanada,Ontario Institute for Cancer ResearchTorontoOntarioCanada
| | - Jared Simpson
- Ontario Institute for Cancer ResearchTorontoOntarioCanada
| | - Limin Hao
- Laboratory of Molecular MedicinePartners Personalized MedicineBostonMassachusetts
| | - Matthew Lebo
- Laboratory of Molecular MedicinePartners Personalized MedicineBostonMassachusetts,Harvard Medical School & Brigham and Women's HospitalBostonMassachusetts
| | - William J. Lane
- Harvard Medical School & Brigham and Women's HospitalBostonMassachusetts
| | - Jennifer Taher
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Jordan Lerner‐Ellis
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada,Lunenfeld‐Tanenbaum Research InstituteSinai HealthTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
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8
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Shickh S, Hirjikaka D, Clausen M, Kodida R, Mighton C, Reble E, Sam J, Panchal S, Aronson M, Graham T, Armel SR, Glogowski E, Elser C, Eisen A, Carroll JC, Shuman C, Seto E, Baxter NN, Scheer A, Shastri-Estrada S, Feldman G, Thorpe KE, Schrader KA, Lerner-Ellis J, Kim RH, Faghfoury H, Bombard Y. Genetics Adviser: a protocol for a mixed-methods randomised controlled trial evaluating a digital platform for genetics service delivery. BMJ Open 2022; 12:e060899. [PMID: 35487723 PMCID: PMC9058789 DOI: 10.1136/bmjopen-2022-060899] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The high demand for genetic tests and limited supply of genetics professionals has created a need for alternative service delivery models. Digital tools are increasingly being used to support multiple points in the genetic testing journey; however, none are transferable across multiple clinical specialties and settings nor do they encompass the entire trajectory of the journey. We aim to evaluate the effectiveness of the Genetics Adviser, an interactive, patient-facing, online digital health tool that delivers pre-test counselling, provides support during the waiting period for results, and returns results with post-test counselling, encompassing the entire patient genetic testing journey. METHODS AND ANALYSIS We will compare the Genetics Adviser paired with a brief genetic counselling session to genetic counselling alone in a randomised controlled trial. One hundred and forty patients who previously received uninformative genetic test results for their personal and family history of cancer will be recruited from familial cancer clinics in Toronto and offered all clinically significant results from genomic sequencing. Participants randomised into the intervention arm will use the Genetics Adviser to learn about genomic sequencing, receive pre-test counselling, support during the waiting period and results, supplemented with brief counselling from a genetic counsellor. Participants in the control arm will receive standard pre-test and post-test counselling for genomic sequencing from a genetic counsellor. Our primary outcome is decisional conflict following pre-test counselling from the Genetics Adviser+genetic counsellor or counsellor alone. Secondary outcomes include: knowledge, satisfaction with decision-making, anxiety, quality of life, psychological impact of results, empowerment, acceptability and economic impact for patients and the health system. A subset of patients will be interviewed to assess user experience. ETHICS AND DISSEMINATION This study has been approved by Clinical Trials Ontario Streamlined Research Ethics Review System (REB#20-035). Results will be shared through stakeholder workshops, national and international conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04725565.
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Affiliation(s)
- Salma Shickh
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Daena Hirjikaka
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Marc Clausen
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rita Kodida
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Emma Reble
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jordan Sam
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Seema Panchal
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tracy Graham
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Randall Armel
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Christine Elser
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Eisen
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - June C Carroll
- Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adena Scheer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Geoff Feldman
- Ontario Disability Coalition, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kasmintan A Schrader
- BC Cancer, Vancouver, British Columbia, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan Lerner-Ellis
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond H Kim
- The Hospital for Sick Children, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Fred A Litwin and Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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9
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Hirjikaka D, Kodida R, Clausen M, Shickh S, Reble E, Mighton C, Sam J, Krishnapillai S, Adi-Wauran E, Feldman G, Glogowski E, Shastri-Estrada S, Scheer A, Seto E, Shuman C, Baxter NN, Eisen A, Elser C, Kim R, Lerner-Ellis J, Carroll J, Schrader K, Faghfoury H, Bombard Y. eP299: Genetics adviser: The development and usability testing of a new patient-centered digital health application to support clinical genomic testing. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.335] [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: 11/29/2022] Open
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10
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Casalino S, Mighton C, Clausen M, Frangione E, Chowdhary S, Chung M, Jordan Fung CY, Morgan G, MacDonald G, Lapadula E, Faghfoury H, Arnoldo S, Bearss E, Binnie A, Borgundvaag B, Chertkow H, Devine L, Friedmen SM, Gingras AC, Khan Z, Mazzulli T, McGeer A, McLeod S, Pugh T, Richardson D, Simpson J, Stern S, Strug L, Taher A, Wong I, Zarei N, Kaushik D, Goneau L, Dagher M, Noor A, Greenfeld E, Bombard Y, Taher J, Lerner-Ellis J. eP294: Return of genome sequencing results in ostensibly healthy COVID-19 positive individuals: GENCOV Study Canada. Genet Med 2022. [PMCID: PMC8935071 DOI: 10.1016/j.gim.2022.01.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Frangione E, Chung M, Mighton C, Casalino S, Chowdhary S, Satnam Singh HK, Xu L, Di Iorio D, Jain A, Kidwai A, Wong Q, Aujla N, Li JM, Quraishi M, Morgan G, Clausen M, Jordan Fung CY, MacDonald G, Lapadula E, Arnoldo S, Bearss E, Binnie A, Borgundvaag B, Chertkow H, Devine L, Friedmen SM, Gingras AC, Khan Z, Mazzulli T, McGeer A, McLeod S, Pugh T, Richardson D, Simpson J, Stern S, Strug L, Taher A, Wong I, Zarei N, Kaushik D, Goneau L, Dagher M, Greenfeld E, Faghfoury H, Bombard Y, Noor A, Taher J, Lerner-Ellis J. eP325: Medically actionable DNA variation from the GENCOV COVID-19 Genome Sequencing Study. Genet Med 2022. [PMCID: PMC8935062 DOI: 10.1016/j.gim.2022.01.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Taher J, Mighton C, Chowdhary S, Casalino S, Frangione E, Arnoldo S, Bearss E, Binnie A, Bombard Y, Borgundvaag B, Chertkow H, Clausen M, Devine L, Faghfoury H, Friedman SM, Gingras AC, Khan Z, Mazzulli T, McGeer A, McLeod SL, Pugh TJ, Richardson D, Simpson J, Stern S, Strug L, Taher A, Lerner-Ellis J. Implementation of serological and molecular tools to inform COVID-19 patient management: protocol for the GENCOV prospective cohort study. BMJ Open 2021; 11:e052842. [PMID: 34593505 PMCID: PMC8487020 DOI: 10.1136/bmjopen-2021-052842] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is considerable variability in symptoms and severity of COVID-19 among patients infected by the SARS-CoV-2 virus. Linking host and virus genome sequence information to antibody response and biological information may identify patient or viral characteristics associated with poor and favourable outcomes. This study aims to (1) identify characteristics of the antibody response that result in maintained immune response and better outcomes, (2) determine the impact of genetic differences on infection severity and immune response, (3) determine the impact of viral lineage on antibody response and patient outcomes and (4) evaluate patient-reported outcomes of receiving host genome, antibody and viral lineage results. METHODS AND ANALYSIS A prospective, observational cohort study is being conducted among adult patients with COVID-19 in the Greater Toronto Area. Blood samples are collected at baseline (during infection) and 1, 6 and 12 months after diagnosis. Serial antibody titres, isotype, antigen target and viral neutralisation will be assessed. Clinical data will be collected from chart reviews and patient surveys. Host genomes and T-cell and B-cell receptors will be sequenced. Viral genomes will be sequenced to identify viral lineage. Regression models will be used to test associations between antibody response, physiological response, genetic markers and patient outcomes. Pathogenic genomic variants related to disease severity, or negative outcomes will be identified and genome wide association will be conducted. Immune repertoire diversity during infection will be correlated with severity of COVID-19 symptoms and human leucocyte antigen-type associated with SARS-CoV-2 infection. Participants can learn their genome sequencing, antibody and viral sequencing results; patient-reported outcomes of receiving this information will be assessed through surveys and qualitative interviews. ETHICS AND DISSEMINATION This study was approved by Clinical Trials Ontario Streamlined Ethics Review System (CTO Project ID: 3302) and the research ethics boards at participating hospitals. Study findings will be disseminated through peer-reviewed publications, conference presentations and end-users.
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Affiliation(s)
- Jennifer Taher
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Chloe Mighton
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sunakshi Chowdhary
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Selina Casalino
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Erika Frangione
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- William Osler Health System, Brampton, Ontario, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bjug Borgundvaag
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | | | - Marc Clausen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Luke Devine
- Division of General Internal Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Fred A Litwin and Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Steven Marc Friedman
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Zeeshan Khan
- Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Shelley L McLeod
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Jared Simpson
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Seth Stern
- Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Lisa Strug
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Taher
- Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Mackenzie Health, Richmond Hill, Ontario, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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13
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Modin L, Ng V, Gissen P, Raiman J, Pfister ED, Das A, Santer R, Faghfoury H, Santra S, Baumann U. A Case Series on Genotype and Outcome of Liver Transplantation in Children with Niemann-Pick Disease Type C. Children (Basel) 2021; 8:children8090819. [PMID: 34572251 PMCID: PMC8470073 DOI: 10.3390/children8090819] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND To report on clinical presentation and outcomes of children who underwent liver transplantation (LTx) and were subsequently diagnosed to have Niemann-Pick type C (NPC). METHODS Retrospective, descriptive, multi-centre review of children diagnosed with NPC who underwent LTx (2003-2018). Diagnosis was made by filipin skin test or genetic testing. RESULTS Nine children were identified (six centres). Neonatal acute liver failure was the most common indication for LTx (seven children). Median age at first presentation: 7 days (range: 0-37). The most prevalent presenting symptoms: jaundice (8/9), hepatosplenomegaly (8/9) and ascites (6/9). 8/9 children had a LTx before the diagnosis of NPC. Genetic testing revealed mutations in NPC1 correlating with a severe biochemical phenotype in 5 patients. All 9 children survived beyond early infancy. Seven children are still alive (median follow-up time of 9 (range: 6-13) years). Neurological symptoms developed in 4/7 (57%) patients at median 9 (range: 5-13) years following LTx. CONCLUSION Early diagnosis of NPC continues to be a challenge and a definitive diagnosis is often made only after LTx. Neurological disease is not prevented in the majority of patients. Genotype does not appear to predict neurological outcome after LTx. LTx still remains controversial in NPC.
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Affiliation(s)
- Line Modin
- Department of Gastroenterology, Hans Christian Andersen Children’s Hospital, DK-5000 Odense, Denmark;
- Liver Department, Birmingham Children’s Hospital, Steelhouse Ln, Birmingham B4 6NH, UK;
| | - Vicky Ng
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (V.N.); (J.R.); (H.F.)
| | - Paul Gissen
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London WC1N 1EH, UK;
| | - Julian Raiman
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (V.N.); (J.R.); (H.F.)
| | - Eva Doreen Pfister
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (E.D.P.); (A.D.)
| | - Anibh Das
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (E.D.P.); (A.D.)
| | - René Santer
- Department of Pediatrics, "KiNDER-UKE", University Medical Center Eppendorf, Martini Str. 52 (O45), 20246 Hamburg, Germany;
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (V.N.); (J.R.); (H.F.)
| | - Saikat Santra
- Liver Department, Birmingham Children’s Hospital, Steelhouse Ln, Birmingham B4 6NH, UK;
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
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14
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Heikoop D, Brick L, Chitayat D, Colaiacovo S, Dupuis L, Faghfoury H, Goobie S, Mendoza R, Napier M, Nowaczyk M, Oh R, Silver J, Prasad C, Saleh M. The phenotypic spectrum of AMER1-related osteopathia striata with cranial sclerosis: The first Canadian cohort. Am J Med Genet A 2021; 185:3793-3803. [PMID: 34414661 DOI: 10.1002/ajmg.a.62452] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
Osteopathia striata with cranial sclerosis (OSCS; OMIM# 300373) is a rare X-linked disorder caused by mutations of the AMER1 gene. OSCS is traditionally considered a skeletal dysplasia, characterized by cranial sclerosis and longitudinal striations in the long bone metaphyses. However, OSCS affects many body systems and varies significantly in phenotypic severity between individuals. This case series focuses on the phenotypic presentation and development of individuals with OSCS. We provide an account of 12 patients with OSCS, ranging from 5 months to 38 years of age. These patients were diagnosed with OSCS after genetic testing confirmed pathogenic mutations in AMER1. Patient consent was obtained for photos and participation. Data were collected regarding perinatal history, dysmorphic features, and review of systems. This case series documents common facial dysmorphology, as well as rare extraskeletal features of OSCS, including two patients with intestinal malrotation and two patients with pyloric stenosis. We share four apparently nonmosaic males with OSCS (one de novo and three maternal variants). We also provide a clinical update on a patient who was previously published by Chénier et al. (2012). American Journal of Medical Genetics Part A, 158, 2946-2952. More research is needed to investigate the links between genotype and phenotype and assess the long-term comorbidities and overall quality of life of individuals with OSCS.
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Affiliation(s)
- David Heikoop
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lauren Brick
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Colaiacovo
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sharan Goobie
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, IWK Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roberto Mendoza
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Margaret Nowaczyk
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Oh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Josh Silver
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Prasad
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Maha Saleh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
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15
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Mittal N, Mina DS, McGillis L, Weinrib A, Slepian PM, Rachinsky M, Buryk-Iggers S, Laflamme C, Lopez-Hernandez L, Hussey L, Katz J, McLean L, Rozenberg D, Liu L, Tse Y, Parker C, Adler A, Charames G, Bleakney R, Veillette C, Nielson CJ, Tavares S, Varriano S, Guzman J, Faghfoury H, Clarke H. The GoodHope Ehlers Danlos Syndrome Clinic: development and implementation of the first interdisciplinary program for multi-system issues in connective tissue disorders at the Toronto General Hospital. Orphanet J Rare Dis 2021; 16:357. [PMID: 34376220 PMCID: PMC8353438 DOI: 10.1186/s13023-021-01962-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 09/03/2020] [Accepted: 07/18/2021] [Indexed: 11/22/2022] Open
Abstract
Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward—from lack of awareness, diagnosis, and treatment—to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.
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Affiliation(s)
- Nimish Mittal
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Temerty Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada. .,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada. .,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada.
| | - Daniel Santa Mina
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada
| | - Laura McGillis
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Aliza Weinrib
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
| | - P Maxwell Slepian
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Psychology, York University, Toronto, ON, Canada
| | - Maxim Rachinsky
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada
| | - Stephanie Buryk-Iggers
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Camille Laflamme
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Laura Lopez-Hernandez
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Laura Hussey
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Joel Katz
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Lianne McLean
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Dmitry Rozenberg
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Temerty Faculty of Medicine, Division of Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, UHN, University of Toronto, Toronto, ON, Canada
| | - Louis Liu
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Division to Temerty Faculty of Medicine, Division of Gastroenterology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yvonne Tse
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Division to Temerty Faculty of Medicine, Division of Gastroenterology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Colleen Parker
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Division to Temerty Faculty of Medicine, Division of Gastroenterology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Arnon Adler
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - George Charames
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Robert Bleakney
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Department of Surgery, Division of Orthopedics, University of Toronto, Toronto, ON, Canada
| | - Christopher J Nielson
- Department of Surgery, Division of Orthopedics, University of Toronto, Toronto, ON, Canada
| | - Sandra Tavares
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Stephanie Varriano
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Juan Guzman
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hanna Faghfoury
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Temerty Faculty of Medicine, Division of Medical Genetics, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- GoodHope Ehlers Danlos Syndrome Program, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anaesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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16
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Abstract
Male congenital hypogonadotropic hypogonadism (CHH) is a heterogenous group of genetic disorders that cause impairment in the production or action of gonadotropin releasing hormone (GnRH). These defects result in dysfunction of the hypothalamic-pituitary-gonadal hormone axis, leading to low testosterone levels and impaired fertility. Genetic testing techniques have expanded our knowledge of the underlying mechanisms contributing to CHH including over 30 genes to date implicated in the development of CHH. In some cases, non-reproductive signs or symptoms can give clues as to the putative genetic etiology, but many cases remain undiagnosed with less than 50% identified with a specific gene defect. This leads to many patients labelled as “idiopathic hypogonadotropic hypogonadism”. Medical and family history as well as physical exam and laboratory features can aid in the identification of hypogonadotropic hypogonadism (HH) that is associated with specific medical syndromes or associated with other pituitary hormonal deficiencies. Genetic testing strategies are moving away from the classic practice of testing for only a few of the most commonly affected genes and instead utilizing next generation sequencing techniques that allow testing of numerous potential gene targets simultaneously. Treatment of CHH is dependent on the individual’s desire to preserve fertility and commonly include human chorionic gonadotropin (hCG) and recombinant follicle stimulating hormone (rFSH) to stimulate testosterone production and spermatogenesis. In situations where fertility is not desired, testosterone replacement therapies are widely offered in order to maintain virilization and sexual function.
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Affiliation(s)
- Adam C Millar
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Endocrinology, Mount Sinai Hospital and Toronto General Hospital, Toronto, ON, Canada
| | - Hanna Faghfoury
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Fred A Litwin and Family Centre in Genetic Medicine, Mount Sinai Hospital and Toronto General Hospital, Toronto, ON, Canada
| | - Jared M Bieniek
- Tallwood Urology & Kidney Institute, Hartford HealthCare, Hartford, CT, USA
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17
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So J, Sriretnakumar V, Suddaby J, Barsanti-Innes B, Faghfoury H, Gofine T. High Rates of Genetic Diagnosis in Psychiatric Patients with and without Neurodevelopmental Disorders: Toward Improved Genetic Diagnosis in Psychiatric Populations. Can J Psychiatry 2020; 65:865-873. [PMID: 32495635 PMCID: PMC7658423 DOI: 10.1177/0706743720931234] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a paucity of literature on genetic diagnosis in psychiatric populations, particularly the vulnerable population of patients with concomitant neurodevelopmental disorder (NDD). In this cross-sectional study, we investigated the genetic diagnostic rate in 151 adult psychiatric patients from two centers in Ontario, Canada, including a large subset (73.5%) with concurrent NDD, and performed phenotypic analysis to determine the strongest predictors for the presence of a genetic diagnosis. METHOD Patients 16 years of age or older and affected with a psychiatric disorder plus at least one of NDD, neurological disorder, congenital anomaly, dysmorphic features, or family history of NDD were recruited through the genetics clinics between 2012 and 2016. Patients underwent genetic assessment and testing according to clinical standards. Chi-squared test was used for phenotypic comparisons. Multivariate logistic regression analysis was performed to determine which phenotypic features were predictive of genetic diagnosis types. RESULTS Overall, 45.7% of patients in the total cohort were diagnosed with genetic disorders with the vast majority of diagnoses (89.9%) comprising single gene and chromosomal disorders. There were management and treatment implications for almost two-thirds (63.8%) of diagnosed patients. Presence of a single gene disorder or chromosomal diagnosis was predicted by differing combinations of neurological, NDD, and psychiatric phenotypes. CONCLUSION The results of this study highlight the frequency and impact of genetic diagnosis in psychiatric populations, particularly those with concomitant NDD. Genetic assessment should be considered in psychiatric patients, particularly those with multiple brain phenotypes (psychiatric, neurodevelopmental, neurological).
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Affiliation(s)
- Joyce So
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Venuja Sriretnakumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Jessica Suddaby
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Hanna Faghfoury
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Timothy Gofine
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
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18
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Shickh S, Gutierrez Salazar M, Zakoor KR, Lázaro C, Gu J, Goltz J, Kleinman D, Noor A, Khalouei S, Mighton C, Reble E, Kodida R, Bombard Y, DiTroia S, Baxter S, Watkins N, Care M, Adler A, Horsburgh S, Morar O, Murphy J, Nevay DL, Szybowska M, Aronson M, Panchal S, Godoy R, Holter S, Randall Armel S, Semotiuk K, Elser C, Kim RH, Chitayat D, So J, Faghfoury H, Silver J, Morel CF, Lerner-Ellis J. Exome and genome sequencing in adults with undiagnosed disease: a prospective cohort study. J Med Genet 2020; 58:275-283. [PMID: 32581083 DOI: 10.1136/jmedgenet-2020-106936] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/21/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exome and genome sequencing have been demonstrated to increase diagnostic yield in paediatric populations, improving treatment options and providing risk information for relatives. There are limited studies examining the clinical utility of these tests in adults, who currently have limited access to this technology. METHODS Patients from adult and cancer genetics clinics across Toronto, Ontario, Canada were recruited into a prospective cohort study evaluating the diagnostic utility of exome and genome sequencing in adults. Eligible patients were ≥18 years of age and suspected of having a hereditary disorder but had received previous uninformative genetic test results. In total, we examined the diagnostic utility of exome and genome sequencing in 47 probands and 34 of their relatives who consented to participate and underwent exome or genome sequencing. RESULTS Overall, 17% (8/47) of probands had a pathogenic or likely pathogenic variant identified in a gene associated with their primary indication for testing. The diagnostic yield for patients with a cancer history was similar to the yield for patients with a non-cancer history (4/18 (22%) vs 4/29 (14%)). An additional 24 probands (51%) had an inconclusive result. Secondary findings were identified in 10 patients (21%); three had medically actionable results. CONCLUSIONS This study lends evidence to the diagnostic utility of exome or genome sequencing in an undiagnosed adult population. The significant increase in diagnostic yield warrants the use of this technology. The identification and communication of secondary findings may provide added value when using this testing modality as a first-line test.
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Affiliation(s)
- Salma Shickh
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mariana Gutierrez Salazar
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kathleen-Rose Zakoor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Conxi Lázaro
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Hereditary Cancer Program, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet, Barcelona, Spain.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jessica Gu
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Genetics, Medcan Clinic, Toronto, Ontario, Canada
| | - Jamie Goltz
- University of Guelph, Guelph, Ontario, Canada
| | - Dakota Kleinman
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Abdul Noor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Sam Khalouei
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Chloe Mighton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reble
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rita Kodida
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie DiTroia
- Center for Mendelian Genomics, Broad Institute, Cambridge, Massachusetts, USA
| | - Samantha Baxter
- Center for Mendelian Genomics, Broad Institute, Cambridge, Massachusetts, USA
| | - Nicholas Watkins
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Arnon Adler
- Department of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheri Horsburgh
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Oana Morar
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Jillian Murphy
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Dayna-Lynn Nevay
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marta Szybowska
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Seema Panchal
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Ruth Godoy
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Lifelabs, Toronto, Ontario, Canada
| | - Spring Holter
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Susan Randall Armel
- Familial Breast and Ovarian Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Christine Elser
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond H Kim
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Joyce So
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josh Silver
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Chantal F Morel
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
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19
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Vuong V, Mosabbir A, Paneduro D, Picard L, Faghfoury H, Evans M, Gordon A, Bartel L. Effects of Rhythmic Sensory Stimulation on Ehlers-Danlos Syndrome: A Pilot Study. Pain Res Manag 2020; 2020:3586767. [PMID: 32399126 PMCID: PMC7204284 DOI: 10.1155/2020/3586767] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility and skin extensibility and is often accompanied by chronic pain. Rhythmic sensory stimulation (RSS) can be defined as the stimulation of the senses in a periodic manner within a range of low frequencies. Music plus sound delivered through a vibroacoustic device is a form of RSS and has demonstrated utility in managing pain. In this current study, we conducted an open-label pilot study of 15 patients with hypermobile EDS using RSS as the intervention. Posttreatment improvements were seen in 11 of the 15 patients (73%), whereas 3 of the 15 patients (20%) experienced worse outcomes. Of the 14 patients that completed the experiment, 6 participants (43%) were classified as "responders" to the device while 8 participants (57%) were classified as "nonresponders." Responders demonstrated significant improvements in pain interference (51.5 ± 16 preintervention vs. 43.5 ± 16.4 postintervention BPI score) and depression symptoms (34.0 ± 15.9 preintervention vs. 26.8 ± 12.1 postintervention CESD score). Poststudy interviews confirm the improvements of pain interference, mood, and bowel symptoms. Furthermore, analysis of medical conditions within the responder group indicates that the presence of depression, anxiety, irritable bowel syndrome, and fibromyalgia may indicate a greater likelihood for patients to benefit with vibroacoustic applications. These results indicate a possible potential for RSS, delivered using a vibroacoustic device, in managing pain-related symptoms. Further research is necessary to elucidate the exact mechanism behind the physiological benefits of RSS.
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Affiliation(s)
- Veronica Vuong
- Faculty of Music, University of Toronto, Toronto, Ontario, Canada
| | | | - Denise Paneduro
- Wasser Pain Management Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Larry Picard
- Wasser Pain Management Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Division of Medical Oncology and Hematology, Sinai Health System, Toronto, Ontario, Canada
| | - Michael Evans
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Allan Gordon
- Wasser Pain Management Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Lee Bartel
- Faculty of Music, University of Toronto, Toronto, Ontario, Canada
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20
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Verbeeten KC, Lamhonwah AM, Bulman D, Faghfoury H, Chakraborty P, Tein I, Geraghty MT. Carnitine uptake defect due to a 5'UTR mutation in a pedigree with false positives and false negatives on Newborn screening. Mol Genet Metab 2020; 129:213-218. [PMID: 31864849 DOI: 10.1016/j.ymgme.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/12/2019] [Revised: 10/23/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
Abstract
Carnitine Uptake Defect (CUD) is an autosomal recessive disorder due to mutations in the SLC22A5 gene. Classically patients present in infancy with profound muscle weakness and cardiomyopathy with characteristic EKG findings. Later presentations include recurrent hypoketotic hypoglycemia, proximal limb girdle myopathy,and/or recurrent muscle pain. Newborn screening detects most of these clinical variants but in addition has identified maternal CUD often in asymptomatic women. We describe a family ascertained through 3 newborn screening (NBS) positive infants found to be unaffected themselves but in whom the mothers (sisters) were affected. There were also two affected children born to an affected male and his heterozygous wife who were false negatives on NBS but had increased fractional excretion of free carnitine in the urine. Analysis on a Next Generation Sequencing panel specifically designed to fully cover newborn screening disease targets showed a homozygous change in the five probands (SLC22A5; NM_003060:c.-149G > A; p.?). The mutation segregates with the CUD within the family. It is in the 5' UTR and has a frequency within the gnomAd database of 0.001198. Plasma carnitine was decreased and fractional excretion of free carnitine was increased in all affected individuals. Functional carnitine uptake studies in cultured skin fibroblasts of one proband showed carnitine uptake at the 5 μM concentration to be 6% of controls. Relative expression of OCTN2 mRNA to beta-actin mRNA by qRT-PCR was increased in a proband relative to controls by a factor of 465-fold. Western blotting revealed a 120 kDa protein band, as well as a weaker 240 kDa band in the proband, the significance of which is unknown at this time.
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Affiliation(s)
| | - Anne-Marie Lamhonwah
- University of Toronto, Toronto, ON, Canada; Dept. of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Canada; Genetics and Genome Biology Program, Hospital for Sick Children, University of Toronto, Canada
| | - Dennis Bulman
- University of Ottawa, Ottawa, ON, Canada; Newborn Screening Ontario, Canada; Children's Hospital of Eastern Ontario, Canada
| | | | - P Chakraborty
- University of Ottawa, Ottawa, ON, Canada; Newborn Screening Ontario, Canada; Children's Hospital of Eastern Ontario, Canada
| | - Ingrid Tein
- University of Toronto, Toronto, ON, Canada; Dept. of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Canada; Genetics and Genome Biology Program, Hospital for Sick Children, University of Toronto, Canada
| | - Michael T Geraghty
- University of Ottawa, Ottawa, ON, Canada; Newborn Screening Ontario, Canada; Children's Hospital of Eastern Ontario, Canada.
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21
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Khalaf D, Bell H, Dale D, Gupta V, Faghfoury H, Morel CF, Tierens A, Weinstein DA, Yan J, Thyagu S, Maze D. A case of secondary acute myeloid leukemia on a background of glycogen storage disease with chronic neutropenia treated with granulocyte colony stimulating factor. JIMD Rep 2019; 49:37-42. [PMID: 31788408 PMCID: PMC6875697 DOI: 10.1002/jmd2.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/18/2019] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
Congenital neutropenias due to mutations in ELANE, SBDS or HAX1 or in the setting of glycogen storage disease (GSD) which is caused by SLC37A4 mutation, often require prolonged granulocyte colony stimulating factor (G-CSF) therapy to prevent recurrent infections and hospital admission. There has been emerging evidence that prolonged exposure to G-CSF in cases with congenital neutropenia other than GSD is associated with transformation to myelodysplastic syndrome/acute myeloid leukemia.
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Affiliation(s)
- Dina Khalaf
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Heather Bell
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - David Dale
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Vikas Gupta
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Hanna Faghfoury
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - Chantal F. Morel
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - Anne Tierens
- Department of Pathology, Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
| | - David A. Weinstein
- Glycogen Storage Disease ProgramUniversity of Connecticut and Connecticut Children's Medical CenterHartfordConnecticut
| | - Jiong Yan
- Department of Pathology, Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Santhosh Thyagu
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Dawn Maze
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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22
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Tran C, Patel J, Stacy H, Mamak EG, Faghfoury H, Raiman J, Clarke JTR, Blaser S, Mercimek-Mahmutoglu S. Long-term outcome of patients with X-linked adrenoleukodystrophy: A retrospective cohort study. Eur J Paediatr Neurol 2017; 21:600-609. [PMID: 28274546 DOI: 10.1016/j.ejpn.2017.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/25/2016] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is a peroxisomal disorder associated with leukodystrophy, myeloneuropathy and adrenocortical insufficiency. We performed a retrospective cohort study to evaluate long-term outcome of patients with X-ALD. METHOD All patients with X-ALD diagnosed between 1989 and 2012 were included. Electronic patient charts were reviewed for clinical features, biochemical investigations, molecular genetic testing, neuroimaging, long-term outcome and treatment. RESULTS Forty-eight patients from 18 unrelated families were included (15 females; 33 males). Seventeen patients were symptomatic at the time of the biochemical diagnosis including 14 with neurocognitive dysfunction and 3 with Addison disease only. Thirty-one asymptomatic individuals were identified by positive family history of X-ALD. During follow-up, eight individuals developed childhood cerebral X-ALD (CCALD), one individual developed adrenomyeloneuropathy (AMN), six individuals developed Addison disease only, and five individuals remained asymptomatic. Direct sequencing of ABCD1 confirmed the genetic diagnosis in 29 individuals. Seven patients with CCALD underwent hematopoietic stem cell transplantation (HSCT). Nine patients lost the follow-up. There was no correlation between clinical severity score, Loes score and elevated degree of elevated very long chain fatty acid (VLCFA) levels in CCALD. CONCLUSION Our study reports forty-eight new patients with X-ALD and their long-term outcome. Only 35% of the patients presented with neurological features or Addison disease. The remaining individuals were identified due to positive family history. Close monitoring of asymptomatic males resulted in early HSCT to prevent progressive lethal neurodegenerative disease. Identification of patients with X-ALD is important to improve neurodevelopmental outcome of asymptomatic males.
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Affiliation(s)
- Christel Tran
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada; Division of Genetic Medicine, Center for Molecular Diseases, Lausanne University Hospital, Lausanne, Switzerland; Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
| | - Jaina Patel
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Hewson Stacy
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Eva G Mamak
- Department of Psychology, The Hospital for Sick Children, Canada
| | - Hanna Faghfoury
- The Fred A Litwin and Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Julian Raiman
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Joe T R Clarke
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Saadet Mercimek-Mahmutoglu
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada; Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada
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23
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Rezazadeh A, Borlot F, Faghfoury H, Andrade DM. Genetic generalized epilepsy in three siblings with 8q21.13-q22.2 duplication. Seizure 2017; 48:57-61. [DOI: 10.1016/j.seizure.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022] Open
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24
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Saleh M, Horsburgh S, Shago M, Faghfoury H. MG-109 A novel 0.34 MB microduplication of 9Q34.3 in a patient with congenital cardiac defects and learning disabilities. J Med Genet 2015. [DOI: 10.1136/jmedgenet-2015-103577.5] [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: 11/04/2022]
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25
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Huang L, Vanstone MR, Hartley T, Osmond M, Barrowman N, Allanson J, Baker L, Dabir TA, Dipple KM, Dobyns WB, Estrella J, Faghfoury H, Favaro FP, Goel H, Gregersen PA, Gripp KW, Grix A, Guion-Almeida ML, Harr MH, Hudson C, Hunter AGW, Johnson J, Joss SK, Kimball A, Kini U, Kline AD, Lauzon J, Lildballe DL, López-González V, Martinezmoles J, Meldrum C, Mirzaa GM, Morel CF, Morton JEV, Pyle LC, Quintero-Rivera F, Richer J, Scheuerle AE, Schönewolf-Greulich B, Shears DJ, Silver J, Smith AC, Temple IK, van de Kamp JM, van Dijk FS, Vandersteen AM, White SM, Zackai EH, Zou R, Bulman DE, Boycott KM, Lines MA. Mandibulofacial Dysostosis with Microcephaly: Mutation and Database Update. Hum Mutat 2015; 37:148-54. [PMID: 26507355 DOI: 10.1002/humu.22924] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 07/08/2015] [Accepted: 10/12/2015] [Indexed: 11/08/2022]
Abstract
Mandibulofacial dysostosis with microcephaly (MFDM) is a multiple malformation syndrome comprising microcephaly, craniofacial anomalies, hearing loss, dysmorphic features, and, in some cases, esophageal atresia. Haploinsufficiency of a spliceosomal GTPase, U5-116 kDa/EFTUD2, is responsible. Here, we review the molecular basis of MFDM in the 69 individuals described to date, and report mutations in 38 new individuals, bringing the total number of reported individuals to 107 individuals from 94 kindreds. Pathogenic EFTUD2 variants comprise 76 distinct mutations and seven microdeletions. Among point mutations, missense substitutions are infrequent (14 out of 76; 18%) relative to stop-gain (29 out of 76; 38%), and splicing (33 out of 76; 43%) mutations. Where known, mutation origin was de novo in 48 out of 64 individuals (75%), dominantly inherited in 12 out of 64 (19%), and due to proven germline mosaicism in four out of 64 (6%). Highly penetrant clinical features include, microcephaly, first and second arch craniofacial malformations, and hearing loss; esophageal atresia is present in an estimated ∼27%. Microcephaly is virtually universal in childhood, with some adults exhibiting late "catch-up" growth and normocephaly at maturity. Occasionally reported anomalies, include vestibular and ossicular malformations, reduced mouth opening, atrophy of cerebral white matter, structural brain malformations, and epibulbar dermoid. All reported EFTUD2 mutations can be found in the EFTUD2 mutation database (http://databases.lovd.nl/shared/genes/EFTUD2).
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Affiliation(s)
- Lijia Huang
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan R Vanstone
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Taila Hartley
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Osmond
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Barrowman
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Judith Allanson
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Laura Baker
- Division of Medical Genetics, A. I. duPont Hospital for Children, Wilmington, Delaware
| | - Tabib A Dabir
- Clinical Genetics Department, Belfast City Hospital, Belfast, UK
| | - Katrina M Dipple
- Department of Pediatrics and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California
| | - William B Dobyns
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Jane Estrella
- Department of Medical Genetics, Westmead Hospital, Sydney, Australia
| | - Hanna Faghfoury
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Francine P Favaro
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Himanshu Goel
- Hunter Genetics, Newcastle, Waratah, Australia.,University of Newcastle, Newcastle - School of Medicine and Public Health, Faculty of Health, Callaghan, Australia
| | | | - Karen W Gripp
- Division of Medical Genetics, A. I. duPont Hospital for Children, Wilmington, Delaware
| | - Art Grix
- Department of Genetics, Permanente Medical Group, Roseville, California
| | - Maria-Leine Guion-Almeida
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Margaret H Harr
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - John Johnson
- Shodair Children's Hospital, Helena, Montana.,Clinical Genetics and Metabolism, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Shelagh K Joss
- West of Scotland Clinical Genetics Service, South Glasgow University Hospital, Glasgow, UK
| | - Amy Kimball
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Usha Kini
- Department of Clinical Genetics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Antonie D Kline
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Julie Lauzon
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dorte L Lildballe
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Vanesa López-González
- Sección de Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.,Grupo Clínico Vinculado al Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | | | - Ghayda M Mirzaa
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Chantal F Morel
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jenny E V Morton
- West Midlands Regional Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - Louise C Pyle
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Fabiola Quintero-Rivera
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Julie Richer
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Angela E Scheuerle
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bitten Schönewolf-Greulich
- Genetic Counselling Clinic Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Deborah J Shears
- Oxford Regional Genetics Service, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Josh Silver
- The Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amanda C Smith
- Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - I Karen Temple
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Fleur S van Dijk
- Department of Clinical Genetics, VU Medical Center, Amsterdam, The Netherlands
| | | | - Sue M White
- Victoria Clinical Genetics Service, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ruobing Zou
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | -
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dennis E Bulman
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Newborn Screening Ontario, The Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kym M Boycott
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Matthew A Lines
- The Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Metabolics and Newborn Screening, Department of Pediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Canada
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26
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Hershenfeld SA, Wasim S, McNiven V, Parikh M, Majewski P, Faghfoury H, So J. Psychiatric disorders in Ehlers–Danlos syndrome are frequent, diverse and strongly associated with pain. Rheumatol Int 2015; 36:341-8. [DOI: 10.1007/s00296-015-3375-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/25/2015] [Indexed: 12/21/2022]
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Fung WLA, Butcher NJ, Costain G, Andrade DM, Boot E, Chow EW, Chung B, Cytrynbaum C, Faghfoury H, Fishman L, García-Miñaúr S, George S, Lang AE, Repetto G, Shugar A, Silversides C, Swillen A, van Amelsvoort T, McDonald-McGinn DM, Bassett AS. Practical guidelines for managing adults with 22q11.2 deletion syndrome. Genet Med 2015; 17:599-609. [PMID: 25569435 PMCID: PMC4526275 DOI: 10.1038/gim.2014.175] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 02/03/2023] Open
Abstract
22q11.2 Deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans, estimated to affect up to 1 in 2,000 live births. Major features of this multisystem condition include congenital anomalies, developmental delay, and an array of early- and later-onset medical and psychiatric disorders. Advances in pediatric care ensure a growing population of adults with 22q11.2DS. Informed by an international panel of multidisciplinary experts and a comprehensive review of the existing literature concerning adults, we present the first set of guidelines focused on managing the neuropsychiatric, endocrine, cardiovascular, reproductive, psychosocial, genetic counseling, and other issues that are the focus of attention in adults with 22q11.2DS. We propose practical strategies for the recognition, evaluation, surveillance, and management of the associated morbidities.Genet Med 17 8, 599-609.
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Affiliation(s)
- Wai Lun Alan Fung
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nancy J. Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Danielle M. Andrade
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, Krembil Neurosciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erik Boot
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Eva W.C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cheryl Cytrynbaum
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- The Fred A. Litwin and Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Leona Fishman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sixto García-Miñaúr
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain
| | - Susan George
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E. Lang
- Division of Neurology, Toronto Western Hospital, Krembil Neurosciences Centre, University of Toronto, Toronto, Ontario, Canada
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gabriela Repetto
- Center for Genetics and Genomics, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Andrea Shugar
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Candice Silversides
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Obstetric Medicine, Medical Disorders of Pregnancy Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ann Swillen
- Center for Human Genetics, University Hospital Gasthuisberg, Leuven, Flanders, Belgium
- Department of Human Genetics, University of Leuven (KU Leuven), Leuven, Flanders, Belgium
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Donna M. McDonald-McGinn
- Division of Human Genetics, 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Genetics Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne S. Bassett
- The Dalglish Family Hearts and Minds Clinic for 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Steriade C, Andrade DM, Faghfoury H, Tarnopolsky MA, Tai P. Reply from the authors. Pediatr Neurol 2014; 51:e5-6. [PMID: 25079585 DOI: 10.1016/j.pediatrneurol.2014.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Claude Steriade
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Canada.
| | - Danielle M Andrade
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | - Hanna Faghfoury
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | - Mark A Tarnopolsky
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | - Peter Tai
- Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Canada
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29
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Lowther C, Costain G, Stavropoulos DJ, Melvin R, Silversides CK, Andrade DM, So J, Faghfoury H, Lionel AC, Marshall CR, Scherer SW, Bassett AS. Delineating the 15q13.3 microdeletion phenotype: a case series and comprehensive review of the literature. Genet Med 2014; 17:149-57. [PMID: 25077648 DOI: 10.1038/gim.2014.83] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/06/2014] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Recurrent 15q13.3 deletions are enriched in multiple neurodevelopmental conditions including intellectual disability, autism, epilepsy, and schizophrenia. However, the 15q13.3 microdeletion syndrome remains ill-defined. METHODS We systematically compiled all cases of 15q13.3 deletion published before 2014. We also examined three locally available cohorts to identify new adults with 15q13.3 deletions. RESULTS We identified a total of 246 cases (133 children, 113 adults) with deletions overlapping or within the 15q13.3 (breakpoint (BP)4-BP5) region, including seven novel adult cases from local cohorts. No BP4-BP5 deletions were identified in 23,838 adult controls. Where known, 15q13.3 deletions were typically inherited (85.4%) and disproportionately of maternal origin (P < 0.0001). Overall, 198 cases (121 children, 77 adults; 80.5%) had at least one neuropsychiatric diagnosis. Accounting for ascertainment, developmental disability/intellectual disability was present in 57.7%, epilepsy/seizures in 28.0%, speech problems in 15.9%, autism spectrum disorder in 10.9%, schizophrenia in 10.2%, mood disorder in 10.2%, and attention deficit hyperactivity disorder in 6.5%. By contrast, major congenital malformations, including congenital heart disease (2.4%), were uncommon. Placenta previa occurred in the pregnancies of four cases. CONCLUSION The 15q13.3 microdeletion syndrome is predominantly characterized by neuropsychiatric expression. There are implications for pre- and postnatal detection, genetic counseling, and anticipatory care.
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Affiliation(s)
- Chelsea Lowther
- 1] Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada [2] Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Dimitri J Stavropoulos
- 1] Cytogenetics Laboratory, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada [2] Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Melvin
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Candice K Silversides
- 1] Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada [2] Division of Obstetric Medicine, Medical Disorders of Pregnancy Program, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Danielle M Andrade
- 1] Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada [2] Krembil Neurosciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joyce So
- 1] Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada [2] Department of Clinical Genetics, Lakeridge Health Oshawa, Oshawa, Ontario, Canada
| | - Hanna Faghfoury
- The Fred A. Litwin and Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anath C Lionel
- 1] The Centre for Applied Genomics and Program in Genomics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada [2] Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christian R Marshall
- 1] The Centre for Applied Genomics and Program in Genomics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada [2] Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Scherer
- 1] Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [2] The Centre for Applied Genomics and Program in Genomics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada [3] Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- 1] Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada [2] Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [3] Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada [4] Department of Psychiatry, University of Toronto and University Health Network, Toronto, Ontario, Canada
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30
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Steriade C, Andrade DM, Faghfoury H, Tarnopolsky MA, Tai P. Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) may respond to adjunctive ketogenic diet. Pediatr Neurol 2014; 50:498-502. [PMID: 24656211 DOI: 10.1016/j.pediatrneurol.2014.01.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 10/24/2013] [Revised: 12/21/2013] [Accepted: 01/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome can present management challenges. Refractory seizures and stroke-like episodes leading to disability are common. PATIENT We analyzed the clinical, electrophysiologic, and radiologic data of a 22-year-old woman with multiple episodes of generalized and focal status epilepticus and migratory cortical stroke-like lesions who underwent muscle biopsy for mitochondrial genome sequencing. RESULTS Although initial mitochondrial genetic testing was negative, muscle biopsy demonstrated a mitochondrial DNA disease-causing mutation (m.3260A > G). New antiepileptic medications were added with each episode of focal status epilepticus with only temporary improvement, until a modified ketogenic diet and magnesium were introduced, leading to seizure freedom despite development of a new stroke-like lesion, and subsequent decrease in frequency of stroke-like episodes. We propose a metabolic model in which the ketogenic diet may lead to improvement of the function of respiratory chain complexes. CONCLUSIONS The ketogenic diet may lead to improvement of mitochondrial dysfunction in MELAS, which in turn may promote better seizure control and less frequent stroke-like episodes.
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Affiliation(s)
- Claude Steriade
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Danielle M Andrade
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Tarnopolsky
- Department of Neuromuscular and Neurometabolic Disease, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Peter Tai
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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31
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Nascimento FA, Faghfoury H, Krings T, Ali A, Fridhandler JD, Lozano A, Wennberg R, Andrade DM. Deep brain stimulation for the management of seizures in MECP2 duplication syndrome. Seizure 2014; 23:405-7. [PMID: 24675111 DOI: 10.1016/j.seizure.2014.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Fabio A Nascimento
- Faculdade de Medicina, Universidade Federal do Parana, Curitiba, Brazil; Epilepsy Genetics Program, University of Toronto, Toronto, Canada
| | - Hanna Faghfoury
- Division of Clinical Genetics, University of Toronto, Toronto, Canada; Epilepsy Genetics Program, University of Toronto, Toronto, Canada
| | - Timo Krings
- Department of Radiology, University of Toronto, Toronto, Canada; Epilepsy Genetics Program, University of Toronto, Toronto, Canada
| | - Anfal Ali
- Epilepsy Genetics Program, University of Toronto, Toronto, Canada
| | - Jonathan D Fridhandler
- Faculty of Medicine, University of Toronto, Toronto, Canada; Epilepsy Genetics Program, University of Toronto, Toronto, Canada
| | - Andres Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | | | - Danielle M Andrade
- Division of Neurology, University of Toronto, Toronto, Canada; Epilepsy Genetics Program, University of Toronto, Toronto, Canada.
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32
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Girdea M, Dumitriu S, Fiume M, Bowdin S, Boycott KM, Chénier S, Chitayat D, Faghfoury H, Meyn MS, Ray PN, So J, Stavropoulos DJ, Brudno M. PhenoTips: Patient Phenotyping Software for Clinical and Research Use. Hum Mutat 2013; 34:1057-65. [DOI: 10.1002/humu.22347] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/18/2013] [Indexed: 12/23/2022]
Affiliation(s)
- Marta Girdea
- Department of Computer Science; University of Toronto; Ontario Canada
- Centre for Computational Medicine; Hospital for Sick Children; Toronto Ontario Canada
| | - Sergiu Dumitriu
- Department of Computer Science; University of Toronto; Ontario Canada
| | - Marc Fiume
- Department of Computer Science; University of Toronto; Ontario Canada
| | - Sarah Bowdin
- Department of Paediatrics; University of Toronto; Ontario Canada
- Division of Clinical and Metabolic Genetics; Hospital for Sick Children; Toronto Ontario Canada
| | - Kym M. Boycott
- Children's Hospital of Eastern Ontario Research Institute; University of Ottawa; Ottawa Ontario Canada
| | - Sébastien Chénier
- Molecular Genetics Laboratory; Hospital for Sick Children; Toronto Ontario Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics; Hospital for Sick Children; Toronto Ontario Canada
- The Prenatal Diagnosis and Medical Genetics Program; Department of Obstetrics and Gynecology; Mount Sinai Hospital; Toronto Ontario Canada
| | - Hanna Faghfoury
- Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
- University Health Network; University of Toronto; Toronto Ontario Canada
| | - M. Stephen Meyn
- Division of Clinical and Metabolic Genetics; Hospital for Sick Children; Toronto Ontario Canada
- Genetics and Genome Biology Program; Hospital for Sick Children; Toronto Ontario Canada
| | - Peter N. Ray
- Molecular Genetics Laboratory; Hospital for Sick Children; Toronto Ontario Canada
| | - Joyce So
- Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
- Centre for Addiction and Mental Health; Toronto Ontario Canada
| | | | - Michael Brudno
- Department of Computer Science; University of Toronto; Ontario Canada
- Centre for Computational Medicine; Hospital for Sick Children; Toronto Ontario Canada
- Genetics and Genome Biology Program; Hospital for Sick Children; Toronto Ontario Canada
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33
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Fernández-Irigoyen J, Santamaría E, Chien YH, Hwu WL, Korman SH, Faghfoury H, Schulze A, Hoganson GE, Stabler SP, Allen RH, Wagner C, Mudd SH, Corrales FJ. Enzymatic activity of methionine adenosyltransferase variants identified in patients with persistent hypermethioninemia. Mol Genet Metab 2010; 101:172-7. [PMID: 20675163 DOI: 10.1016/j.ymgme.2010.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 01/12/2023]
Abstract
Methionine adenosyltransferases (MAT's) are central enzymes in living organisms that have been conserved with a high degree of homology among species. In the liver, MAT I and III, tetrameric and dimeric isoforms of the same catalytic subunit encoded by the gene MAT1A, account for the predominant portion of total body synthesis of S-adenosylmethionine (SAM), a versatile sulfonium ion-containing molecule involved in a variety of vital metabolic reactions and in the control of hepatocyte proliferation and differentiation. During the past 15years 28 MAT1A mutations have been described in patients with elevated plasma methionines, total homocysteines at most only moderately elevated, and normal levels of tyrosine and other aminoacids. In this study we describe functional analyses that determine the MAT and tripolyphosphatase (PPPase) activities of 18 MAT1A variants, six of them novel, and none of them previously assayed for activity. With the exception of G69S and Y92H, all recombinant proteins showed impairment (usually severe) of MAT activity. Tripolyphosphate (PPPi) hydrolysis was decreased only in some mutant proteins but, when it was decreased MAT activity was always also impaired.
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Affiliation(s)
- Joaquín Fernández-Irigoyen
- Division of Hepatology and Gene Therapy, Proteomics Unit, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
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