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Arroja N, Binois O, Hesters L, Sonigo C, Monnot S, Steffann J, Frydman N, Mayeur A. PGT and deferred embryo transfer: Is blastocyst biopsy more effective than cleaved embryo biopsy? J Gynecol Obstet Hum Reprod 2024; 53:102718. [PMID: 38158043 DOI: 10.1016/j.jogoh.2023.102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Blastocyst biopsy has recently been implemented in our laboratory for PGT with a "freeze all" indication. The aim of this study is to compare PGT results between embryos biopsied at the cleaved and embryos biopsied at the blastocyst stage. STUDY DESIGN This is a retrospective cohort study conducted from January 2017 to December 2022 in France. All couples with a "freeze all" indication the day of hCG trigerring during the study period were included in the study. Patients were retrospectively assigned in one group of two groups based on the day of embryo biopsy: the cleavage group if a blastomere biopsy was performed on day 3/4 or the blastocyst group if a trophectoderm biopsy was performed on day 5/6. We evaluated and compared the results between the two groups for biological parameters and clinical outcomes. RESULTS In total, 325 PGT cycles (291 patients) were included in our study. Frozen-thawed embryo transfer was performed for 285 cycles, 122 in the blastocyst group and 163 in the cleavage group. The number of biopsied embryos per cycle is significantly higher in the cleavage group with a mean of 7.2 ± 4.1 embryos biopsied per cycle vs. 2.9 ± 2.8 embryos in the blastocyst group (p < 0.001). The rate of the useful embryos was similar between the two groups with 14.6 % of frozen healthy embryos among the 1352 cleaved embryos obtained in blastocyst group, compared to 17.1 % in the cleavage group. No significant differences in clinical pregnancy rate per transfer and implantation rate were observed between the blastocyst and cleavage groups (36.4% vs. 40.4 % and 33.1% vs. 33.2 % respectively). CONCLUSIONS For "freeze all" PGT cycles, the day of embryo biopsy (cleaved vs blastocyst biopsy) does not impact pregnancy outcomes. Knowing how to perform embryo biopsy at different stages helps to better organize daily laboratory activity and to rescue some undiagnosed embryos after day 3 biopsy.
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Affiliation(s)
- Nathalie Arroja
- Service de Biologie de la Reproduction-CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.
| | - Olivier Binois
- Service de Biologie de la Reproduction-CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | - Laetitia Hesters
- Service de Biologie de la Reproduction-CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | - Charlotte Sonigo
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France; Univ Paris Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Inserm U1185, Faculté de médecine Paris Sud, France
| | - Sophie Monnot
- Université de Paris, Institut Imagine et Service de Génétique Moléculaire, Hôpital Necker-Enfants Malades, Paris, France
| | - Julie Steffann
- Université de Paris, Institut Imagine et Service de Génétique Moléculaire, Hôpital Necker-Enfants Malades, Paris, France
| | - Nelly Frydman
- Service de Biologie de la Reproduction-CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France; Univ Paris Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Anne Mayeur
- Service de Biologie de la Reproduction-CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France; Univ Paris Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
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Mayeur A, Benaloun E, Benguigui J, Duperier C, Hesters L, Chatzovoulou K, Monnot S, Grynberg M, Steffann J, Frydman N, Sonigo C. Preimplantation genetic testing for mitochondrial DNA mutation: ovarian response to stimulation, outcomes and follow-up. Reprod Biomed Online 2023; 47:61-69. [PMID: 37202317 DOI: 10.1016/j.rbmo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
RESEARCH QUESTION How do carriers of pathogenic mitochondrial DNA (mtDNA) respond to ovarian stimulation? DESIGN A single-centre, retrospective study conducted between January 2006 and July 2021 in France. Ovarian reserve markers and ovarian stimulation cycle outcomes were compared for couples undergoing preimplantation genetic testing (PGT) for maternally inherited mtDNA disease (n = 18) (mtDNA-PGT group) with a matched-control group of patients undergoing PGT for male indications (n = 96). The PGT outcomes for the mtDNA-PGT group and the follow-up of these patients in case of unsuccessful PGT was also reported. RESULTS For carriers of pathogenic mtDNA, parameters of ovarian response to FSH and ovarian stimulation cycle outcomes were not different from those of matched-control ovarian stimulation cycles. The carriers of pathogenic mtDNA needed a longer ovarian stimulation and higher dose of gonadotrophins. Three patients (16.7%) obtained a live birth after the PGT process, and eight patients (44.4%) achieved parenthood through alternative methods: oocyte donation (n = 4), natural conception with prenatal diagnosis (n = 2) and adoption (n = 2). CONCLUSION To the best of our knowledge, this is the first study of women carrying a mtDNA variant who have undergone a PGT for monogenic (single gene defects) procedure. It is one of the possible options to obtain a healthy baby without observing an impairment in ovarian response to stimulation.
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Affiliation(s)
- Anne Mayeur
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France..
| | - Emmanuelle Benaloun
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | - Jonas Benguigui
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Constance Duperier
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Laetitia Hesters
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | | | - Sophie Monnot
- Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Michael Grynberg
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Julie Steffann
- Université de Paris, Institut Imagine, INSERM UMR1163, Paris, France.; Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Nelly Frydman
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Charlotte Sonigo
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France.; Inserm U1185, Faculté de médecine Paris Sud, France
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3
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Yamaguti PM, de La Dure-Molla M, Monnot S, Cardozo-Amaya YJ, Baujat G, Michot C, Fournier BPJ, Riou MC, Caldas Rosa ECC, Soares de Lima Y, Dos Santos PAC, Alcaraz G, Guerra ENS, Castro LC, de Oliveira SF, Pogue R, Berdal A, de Paula LM, Mazzeu JF, Cormier-Daire V, Acevedo AC. Unequal Impact of COL1A1 and COL1A2 Variants on Dentinogenesis Imperfecta. J Dent Res 2023; 102:616-625. [PMID: 36951356 DOI: 10.1177/00220345231154569] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Dentinogenesis imperfecta (DI) is the main orodental manifestation of osteogenesis imperfecta (OI) caused by COL1A1 or COL1A2 heterozygous pathogenic variants. Its prevalence varies according to the studied population. Here, we report the molecular analysis of 81 patients with OI followed at reference centers in Brazil and France presenting COL1A1 or COL1A2 variants. Patients were submitted to clinical and radiographic dental examinations to diagnose the presence of DI. In addition, a systematic literature search and a descriptive statistical analysis were performed to investigate OI/DI phenotype-genotype correlation in a worldwide sample. In our cohort, 50 patients had COL1A1 pathogenic variants, and 31 patients had COL1A2 variants. A total of 25 novel variants were identified. Overall, data from a total of 906 individuals with OI were assessed. Results show that DI was more frequent in severe and moderate OI cases. DI prevalence was also more often associated with COL1A2 (67.6%) than with COL1A1 variants (45.4%) because COL1A2 variants mainly lead to qualitative defects that predispose to DI more than quantitative defects. For the first time, 4 DI hotspots were identified. In addition, we showed that 1) glycine substitution by branched and charged amino acids in the α2(I) chain and 2) substitutions occurring in major ligand binding regions-MLRB2 in α1(I) and MLBR 3 in α2(I)-could significantly predict DI (P < 0.05). The accumulated variant data analysis in this study provides a further basis for increasing our comprehension to better predict the occurrence and severity of DI and appropriate OI patient management.
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Affiliation(s)
- P M Yamaguti
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Oral Care Center for Inherited Diseases, University Hospital of Brasília, Brasília, Brazil
| | - M de La Dure-Molla
- Reference Center of Oral Rare Diseases O-Rares, Rothschild Hospital, Public Assistance-Paris Hospitals, Paris, France
- Paris Cité University, Dental Faculty, Paris, France
- Paris Cité University, INSERM UMR 1163 IMAGINE Institute, Paris, France
| | - S Monnot
- Reference Center for Skeletal Dysplasia, Service de Médecine Génomique des Maladies Rares, Necker Enfants Malades Hospital, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
| | - Y J Cardozo-Amaya
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Oral Care Center for Inherited Diseases, University Hospital of Brasília, Brasília, Brazil
- Graduate Program of Health Sciences, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - G Baujat
- Reference Center for Skeletal Dysplasia, Service de Médecine Génomique des Maladies Rares, Necker Enfants Malades Hospital, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
| | - C Michot
- Reference Center for Skeletal Dysplasia, Service de Médecine Génomique des Maladies Rares, Necker Enfants Malades Hospital, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
| | - B P J Fournier
- Reference Center of Oral Rare Diseases O-Rares, Rothschild Hospital, Public Assistance-Paris Hospitals, Paris, France
- Paris Cité University, Dental Faculty, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne University, UMRS 1138 Inserm, Molecular Oral Physiopathology, Paris, France
| | - M C Riou
- Reference Center of Oral Rare Diseases O-Rares, Rothschild Hospital, Public Assistance-Paris Hospitals, Paris, France
- Paris Cité University, Dental Faculty, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne University, UMRS 1138 Inserm, Molecular Oral Physiopathology, Paris, France
| | - E C C Caldas Rosa
- Graduate Program of Health Sciences, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Y Soares de Lima
- University of Brasília, Institute of Biological Sciences, Brasília, Brazil
- Fundació de Recerca de l'Institut de Microcirurgia Ocular, Department of Genetics, Barcelona, Spain
| | | | - G Alcaraz
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - E N S Guerra
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - L C Castro
- University Hospital of the University of Brasília, Pediatric Endocrinology, College of Health Sciences, University of Brasília, Brasília, Brazil
| | - S F de Oliveira
- University of Brasília, Institute of Biological Sciences, Brasília, Brazil
- Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasília, Brazil
| | - R Pogue
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Brasília, Brazil
| | - A Berdal
- Reference Center of Oral Rare Diseases O-Rares, Rothschild Hospital, Public Assistance-Paris Hospitals, Paris, France
- Paris Cité University, Dental Faculty, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne University, UMRS 1138 Inserm, Molecular Oral Physiopathology, Paris, France
| | - L M de Paula
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Oral Care Center for Inherited Diseases, University Hospital of Brasília, Brasília, Brazil
| | - J F Mazzeu
- Laboratory of Clinical Genetics, Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - V Cormier-Daire
- Paris Cité University, INSERM UMR 1163 IMAGINE Institute, Paris, France
- Reference Center for Skeletal Dysplasia, Service de Médecine Génomique des Maladies Rares, Necker Enfants Malades Hospital, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
| | - A C Acevedo
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Oral Care Center for Inherited Diseases, University Hospital of Brasília, Brasília, Brazil
- Paris Cité University, Dental Faculty, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne University, UMRS 1138 Inserm, Molecular Oral Physiopathology, Paris, France
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4
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Chatzovoulou K, Mayeur A, Cagnard N, Zarhrate M, Bole C, Nitschke P, Jabot-Hanin F, Rötig A, Monnot S, Munnich A, Frydman N, Steffann J. A shared pattern of altered gene expression in human embryos affected by mitochondrial diseases. Hum Reprod 2023; 38:992-1002. [PMID: 36952633 DOI: 10.1093/humrep/dead052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/01/2023] [Indexed: 03/25/2023] Open
Abstract
STUDY QUESTION Does mitochondrial deficiency affect human embryonic preimplantation development? SUMMARY ANSWER The presence of a pathogenic mitochondrial variant triggers changes in the gene expression of preimplantation human embryos, compromising their development, cell differentiation, and survival. WHAT IS KNOWN ALREADY Quantitative and qualitative anomalies of mitochondrial DNA (mtDNA) are reportedly associated with impaired human embryonic development, but the underlying mechanisms remain unexplained. STUDY DESIGN, SIZE, DURATION Taking advantage of the preimplantation genetic testing for mitochondrial disorders in at-risk couples, we have compared gene expression of 9 human embryos carrying pathogenic variants in either mtDNA genes or nuclear genes encoding mitochondrial protein to 33 age-matched control embryos. PARTICIPANTS/MATERIALS, SETTING, METHODS Single-embryo transcriptomic analysis was performed on whole human blastocyst embryos donated to research. MAIN RESULTS AND THE ROLE OF CHANCE Specific pathogenic mitochondrial variants downregulate gene expression in preimplantation human embryos [566 genes in oxidative phosphorylation (OXPHOS)-deficient embryos], impacting transcriptional regulators, differentiation factors, and nuclear genes encoding mitochondrial proteins. These changes in gene expression primarily alter OXPHOS and cell survival pathways. LIMITATIONS, REASONS FOR CAUTION The number of OXPHOS-deficient embryos available for the study was limited owing to the rarity of this material. However, the molecular signature shared by all these embryos supports the relevance of the findings. WIDER IMPLICATIONS OF THE FINDINGS While identification of reliable markers of normal embryonic development is urgently needed in ART, our study prompts us to consider under-expression of the targeted genes reported here, as predictive biomarkers of mitochondrial dysfunction during preimplantation development. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the 'Association Française contre les Myopathies (AFM-Téléthon)' and the 'La Fondation Maladies Rares'. No competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kalliopi Chatzovoulou
- Paris-Cité University, Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163, Paris, France
| | - Anne Mayeur
- Reproductive Biology Department, CECOS, Paris-Saclay University, Antoine-Béclère Hospital, APHP, Clamart, France
| | - Nicolas Cagnard
- Bioinformatics Core Facility, Paris-Cité University-Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Mohammed Zarhrate
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 and INSERM US24/CNRS UAR3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Christine Bole
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 and INSERM US24/CNRS UAR3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Patrick Nitschke
- Bioinformatics Core Facility, Paris-Cité University-Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Fabienne Jabot-Hanin
- Bioinformatics Core Facility, Paris-Cité University-Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Agnès Rötig
- Paris-Cité University, Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163, Paris, France
| | - Sophie Monnot
- Genomic Medicine Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Arnold Munnich
- Paris-Cité University, Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163, Paris, France
- Genomic Medicine Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Nelly Frydman
- Reproductive Biology Department, CECOS, Paris-Saclay University, Antoine-Béclère Hospital, APHP, Clamart, France
| | - Julie Steffann
- Paris-Cité University, Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163, Paris, France
- Genomic Medicine Department, Necker-Enfants Malades Hospital, APHP, Paris, France
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5
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Chatzovoulou K, Mayeur A, Cagnard N, Mohammed Z, Bole C, Nitschke P, Jabot-Hanin F, Rötig A, Monnot S, Bonnefont J, Munnich A, Achour N, Steffann J. P-250 A shared gene expression signature in human blastocyst embryos affected by a mitochondrial disorder. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Do human blastocyst embryos affected by mitochondrial disorders have gene expression disruption?
Summary answer
A global transcriptional repression was found in embryos carrying mutations in mitochondrial genes, primarily affecting oxidative phosphorylation and cell survival pathways.
What is known already
Mitochondria are thought to play a critical role for embryo development by supplying adequate energy levels. Whether a metabolic rescue through mitochondrial metabolism modifications is taking place during the blastocyst stage, remained to be elucidated. For instance, abnormally elevated mtDNA levels were detected in human blastocyst embryos carrying the m.3243>G pathogenic variant, suggestive of a compensatory response, while this was not the case for embryos carrying another mtDNA mutation (m.8344A>G).
Study design, size, duration
To investigate if mitochondrial mutations affect gene expression of human blastocysts, transcriptome profiling between 33 control and 9 mitochondrial embryos was performed and analyzed by RNA-Sequencing.
Participants/materials, setting, methods
In total, 42 blastocyst embryos (Day-5/6/7) from 27 unrelated couples were collected after a preimplantation genetic testing analysis, concluding in an affected status. Among them, 33 were affected by a non-metabolic, non-mitochondrial genetic disorder (control group), and 9 were affected by a mitochondrial disorder (mitochondrial group). Transcriptomic analyses were performed on whole blastocyst embryos, by RNA-Sequencing.
Main results and the role of chance
Gene expression profiling of human blastocyst embryos revealed a global transcriptional repression in mitochondrial embryos, with a total of 566 genes being down-regulated, while only 52 genes were up-regulated (p ≤ 0.05; fold-change=2). A similar pattern was observed among all mitochondrial embryos, affecting a significant proportion of differentiation factors (such as KLF4, p = 1.88x10-2; OXT2, p = 3.32x10-3 and POU5F1, p = 8.03x10-3), as well as nuclear genes encoding mitochondrial proteins (n = 59). If oxidative phosphorylation was at the top of the most significant deregulated pathways (p = 6.32x10-14), cell survival (p = 2.19x10−10) and autophagy (p = 4.56x10-9) were found to be significantly decreased in these embryos, questioning their viability.
Limitations, reasons for caution
The number of mitochondrial embryos was limited due to the rarity of the material, however similar molecular profiles were detected among them. The control group included embryos affected by genetic disorders, although the resulting potential transcriptional biases were neutralized by selecting embryos affected by various and distinct genetic disorders.
Wider implications of the findings
The differentially expressed genes identified in this study represent biomarkers predictive of mitochondrial dysfunction, which will be useful for the establishment of therapeutic or mitochondrial replacement trials. Because of the role of mitochondria, they are also interesting to test in the context of in-vitro fertilization, as biomarkers of preimplantation development.
Trial registration number
Not applicable
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Affiliation(s)
| | - A Mayeur
- Antoine Beclere Hospital , Embryology, Clamart, France
| | - N Cagnard
- Imagine Institute , Bioinformatics, Paris, France
| | - Z Mohammed
- Imagine Institute , Genomics, Paris, France
| | - C Bole
- Imagine Institute , Genomics, Paris, France
| | - P Nitschke
- Imagine Institute , Bioinformatics, Paris, France
| | | | - A Rötig
- Imagine Institute , Genetics, Paris, France
| | - S Monnot
- Imagine Institute , Genetics, Paris, France
| | | | - A Munnich
- Imagine Institute , Genetics, Paris, France
| | - N Achour
- Antoine Beclere Hospital , Embryology, Clamart, France
| | - J Steffann
- Imagine Institute , Genetics, Paris, France
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6
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Sonigo C, Mayeur A, Sadoun M, Pinto M, Benguigui J, Frydman N, Monnot S, Benachi A, Steffann J, Grynberg M. What is the threshold of mature oocytes to obtain at least one healthy transferable cleavage-stage embryo after preimplantation genetic testing for fragile X syndrome? Hum Reprod 2021; 36:3003-3013. [PMID: 34568938 DOI: 10.1093/humrep/deab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/25/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY QUESTION What are the chances of obtaining a healthy transferable cleavage-stage embryo according to the number of mature oocytes in fragile X mental retardation 1 (FMR1)-mutated or premutated females undergoing preimplantation genetic testing (PGT)? SUMMARY ANSWER In our population, a cycle with seven or more mature oocytes has an 83% chance of obtaining one or more healthy embryos. WHAT IS KNOWN ALREADY PGT may be an option to achieve a pregnancy with a healthy baby for FMR1 mutation carriers. In addition, FMR1 premutation is associated with a higher risk of diminished ovarian reserve and premature ovarian failure. The number of metaphase II (MII) oocytes needed to allow the transfer of a healthy embryo following PGT has never been investigated. STUDY DESIGN, SIZE, DURATION The study is a monocentric retrospective observational study carried out from January 2006 to January 2020 that is associated with a case-control study and that analyzes 38 FMR1 mutation female carriers who are candidates for PGT; 16 carried the FMR1 premutation and 22 had the full FMR1 mutation. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 95 controlled ovarian stimulation (COS) cycles for PGT for fragile X syndrome were analyzed, 49 in premutated patients and 46 in fully mutated women. Only patients aged ≤38 years with anti-Müllerian hormone (AMH) >1 ng/ml and antral follicle count (AFC) >10 follicles were eligible for the PGT procedure. Each COS cycle of the FMR1-PGT group was matched with the COS cycles of partners of males carrying any type of translocation (ratio 1:3). Conditional logistic regression was performed to compare the COS outcomes. We then estimated the number of mature oocytes needed to obtain at least one healthy embryo after PGT using receiver operating characteristic curve analysis. MAIN RESULTS AND THE ROLE OF CHANCE Overall, in the FMR1-PGT group, the median number of retrieved and mature oocytes per cycle was 11 (interquartile range 7-15) and 9 (6-12), respectively. The COS outcomes of FMR1 premutation or full mutation female carriers were not altered compared with the matched COS cycles in partners of males carrying a balanced translocation in their karyotype. Among the 6 (4-10) Day 3 embryos obtained in the FMR1-PGT group, a median number of 3 (1-6) embryos were morphologically eligible for biopsy, leading to 1 (1-3) healthy embryo. A cutoff value of seven MII oocytes yielded a sensitivity of 82% and a specificity of 61% of having at least one healthy embryo, whereas a cutoff value of 10 MII oocytes led to a specificity of 85% and improved positive predictive value. LIMITATIONS, REASONS FOR CAUTION This study is retrospective, analyzing a limited number of cycles. Moreover, the patients who were included in a fresh PGT cycle were selected on ovarian reserve parameters and show high values in ovarian reserve tests. This information could influence our conclusion. WIDER IMPLICATIONS OF THE FINDINGS The results relate only to the target population of this study, with a correct ovarian reserve of AMH >1 and AFC >10. However, the information provided herein extends knowledge about the current state of COS for FMR1 mutation carriers in order to provide patients with proper counseling regarding the optimal number of oocytes needed to have a chance of transferring an unaffected embryo following PGT. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C Sonigo
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France.,Inserm, Physiologie et Physiopathologie Endocrinienne, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Mayeur
- Laboratoire d'Histologie-Embryologie-Cytogenetique CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Cedex, Clamart, France
| | - M Sadoun
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - M Pinto
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - J Benguigui
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - N Frydman
- Laboratoire d'Histologie-Embryologie-Cytogenetique CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Cedex, Clamart, France
| | - S Monnot
- Service de Génétique Moléculaire, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - A Benachi
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Gynécologie Obstétrique, Université Paris-Saclay, Clamart, France
| | - J Steffann
- Imagine Institute, Université de Paris-Sorbonne Paris Cité, INSERM UMR1163, Paris, France
| | - M Grynberg
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France.,BFA- Unité de Biologie Fonctionnelle et Adaptative, UMR 8251, CNRS, ERL U1133, Inserm, Université de Paris, Paris, France
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7
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Monnot S, Paul JF. Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR.
Purpose
To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR.
Methods
We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR.
Results
We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94).
Conclusion
We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.
Funding Acknowledgement
Type of funding sources: None. Quantification of MR using 4D Flow CMR
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Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - J L Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - S Monnot
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - J F Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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8
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Monnot S, Paul JF. Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR.
OBJECTIVES
To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR.
METHODS
We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016-2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR.
RESULTS
We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95%CI, 0.8-1) and 20% and 37% for RF (κ=0.90; 95%CI, 0.7-0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95%CI, 0.61-0.94).
CONCLUSION
We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.
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Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - JL Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - S Monnot
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - JF Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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Ribeyrolles S, Monin J, Rohnean A, Diakov C, Caussin C, Monnot S, Paul J. Grading mitral regurgitation using 4D-Flow CMR: Comparison to transthoracic echocardiography. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Léguillier T, Favier R, Harroche A, Lasne D, Bachelot-Loza C, Borgel D, Boussaroque A, Pascreau T, Lallemant-Dudek P, Gkalea V, Haguet MC, Cormier-Daire V, Beaudeux JL, Monnot S, Lapillonne H, Baujat G, Forin V, Nivet-Antoine V. Assessing bleeding risk in 18 children with Osteogenesis imperfecta. Br J Haematol 2021; 192:785-788. [PMID: 33475155 DOI: 10.1111/bjh.17303] [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: 11/29/2022]
Affiliation(s)
- Teddy Léguillier
- Department of Clinical Biochemistry, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1140, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - Rémi Favier
- Department of Haematology, Reference Centre for Platelet Disorders, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Annie Harroche
- Department of Haematology, Haemophilia Care Centre, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Dominique Lasne
- Department of Haematology, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1176, Paris-Sud University, Paris-Saclay University, le Kremlin-Bicêtre, France
| | | | - Delphine Borgel
- Department of Haematology, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1176, Paris-Sud University, Paris-Saclay University, le Kremlin-Bicêtre, France
| | - Agathe Boussaroque
- Department of Clinical Biochemistry, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1140, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - Tiffany Pascreau
- Department of Haematology, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1176, Paris-Sud University, Paris-Saclay University, le Kremlin-Bicêtre, France
| | - Pauline Lallemant-Dudek
- Department of Paediatric Physical Therapy and Rehabilitation, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Vasiliki Gkalea
- Department of Haematology, Reference Centre for Platelet Disorders, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Marie-Clotilde Haguet
- Department of Clinical Biochemistry, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Valérie Cormier-Daire
- Department of Medical Genetics, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Jean-Louis Beaudeux
- Department of Clinical Biochemistry, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1139, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - Sophie Monnot
- Department of Medical Genetics, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Hélène Lapillonne
- Department of Haematology, Reference Centre for Platelet Disorders, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Geneviève Baujat
- Department of Medical Genetics, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Véronique Forin
- Department of Paediatric Physical Therapy and Rehabilitation, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Valérie Nivet-Antoine
- Department of Clinical Biochemistry, Necker Enfants Malades Hospital, AP-HP, Paris, France.,INSERM UMR_S1140, Faculty of Pharmacy, Paris Descartes University, Paris, France
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Steffann J, Monnot S, Magen M, Assouline Z, Gigarel N, Ville Y, Salomon L, Bessiere B, Martinovic J, Rötig A, Bengoa J, Borghèse R, Munnich A, Barcia G, Bonnefont JP. A retrospective study on the efficacy of prenatal diagnosis for pregnancies at risk of mitochondrial DNA disorders. Genet Med 2020; 23:720-731. [PMID: 33303968 DOI: 10.1038/s41436-020-01043-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Prenatal diagnosis of mitochondrial DNA (mtDNA) disorders is challenging due to potential instability of fetal mutant loads and paucity of data connecting prenatal mutant loads to postnatal observations. Retrospective study of our prenatal cohort aims to examine the efficacy of prenatal diagnosis to improve counseling and reproductive options for those with pregnancies at risk of mtDNA disorders. METHODS We report on a retrospective review of 20 years of prenatal diagnosis of pathogenic mtDNA variants in 80 pregnant women and 120 fetuses. RESULTS Patients with undetectable pathogenic variants (n = 29) consistently had fetuses free of variants, while heteroplasmic women (n = 51) were very likely to transmit their variant (57/78 fetuses, 73%). In the latter case, 26 pregnancies were terminated because fetal mutant loads were >40%. Of the 84 children born, 27 were heteroplasmic (mutant load <65%). To date, no medical problems related to mitochondrial dysfunction have been reported. CONCLUSION Placental heterogeneity of mutant loads questioned the reliability of chorionic villous testing. Fetal mutant load stability, however, suggests the reliability of a single analysis of amniotic fluid at any stage of pregnancy for prenatal diagnosis of mtDNA disorders. Mutant loads under 40% reliably predict lack of symptoms in the progeny of heteroplasmic women.
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Affiliation(s)
- Julie Steffann
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France. .,Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France.
| | - Sophie Monnot
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Maryse Magen
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Zahra Assouline
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Nadine Gigarel
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Yves Ville
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France.,Service d'Obstétrique - Maternité, chirurgie médecine et imagerie fœtale, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Laurent Salomon
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France.,Service d'Obstétrique - Maternité, chirurgie médecine et imagerie fœtale, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Bettina Bessiere
- Service d'histo-embryologie et fœtopathologie, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Jelena Martinovic
- Unité de Foetopathologie, Hôpital Antoine Béclère, GHU Paris Saclay, AP-HP, Clamart, France
| | - Agnès Rötig
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France
| | - Joana Bengoa
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Roxana Borghèse
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Arnold Munnich
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France.,Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Giulia Barcia
- Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Jean-Paul Bonnefont
- Université de Paris-Sorbonne Paris Cité, Imagine Institute, INSERM UMR1163, Paris, France.,Service de Génétique Moléculaire, Groupe hospitalier Necker-Enfants Malades, AP-HP, Paris, France
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12
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Dubail J, Brunelle P, Baujat G, Huber C, Doyard M, Michot C, Chavassieux P, Khairouni A, Topouchian V, Monnot S, Koumakis E, Cormier-Daire V. Homozygous Loss-of-Function Mutations in CCDC134 Are Responsible for a Severe Form of Osteogenesis Imperfecta. J Bone Miner Res 2020; 35:1470-1480. [PMID: 32181939 DOI: 10.1002/jbmr.4011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022]
Abstract
Osteogenesis imperfecta (OI) is a primary bone fragility disorder with an estimated prevalence of 1 in 15,000 births. The majority of OI cases are inherited in an autosomal-dominant manner, while 5% to 10% have recessive or X-linked inheritance. Up to now, approximately 5% of OI cases remain without mutation demonstrated, supporting the involvement of other genes in the disease spectrum. By whole-exome sequencing, we identified a homozygous variant (c.2T>C) in CCDC134 gene in three patients from two unrelated families with severe bone fragility that did not respond to bisphosphonate treatment, short stature, and gracile long bones with pseudarthroses but no dentinogenesis imperfecta. CCDC134 encodes a secreted protein widely expressed and implicated in the regulation of some mitogen-activated protein kinases (MAPK) signaling pathway. Western blot and immunofluorescence analyses confirmed the absence of CCDC134 protein in patient cells compared with controls. Furthermore, we demonstrated that CCDC134 mutations are associated with increased Erk1/2 phosphorylation, decreased OPN mRNA and COL1A1 expression and reduced mineralization in patient osteoblasts compared with controls. These data support that CCDC134 is a new gene involved in severe progressive deforming recessive osteogenesis imperfecta (type III). © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Johanne Dubail
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Perrine Brunelle
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Geneviève Baujat
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Céline Huber
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Mathilde Doyard
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Caroline Michot
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | | | | | - Vicken Topouchian
- Pediatrics Orthopedics Department, Necker-Enfants Malade Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Monnot
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
| | - Eugénie Koumakis
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France.,Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-Constitutive Site, Paris, France
| | - Valérie Cormier-Daire
- Department of Clinical Genetics and Reference Centre for Constitutional Bone Diseases, INSERM U1163, Université de Paris, Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, F-75015, Paris, France
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Puy V, Mayeur A, Levy A, Hesters L, Raad J, Monnot S, Steffann J, Frydman N. CTG Expansion in the DMPK Gene: Semen Quality Assessment and Outcome of Preimplantation Genetic Diagnosis. J Clin Endocrinol Metab 2020; 105:5717685. [PMID: 31996899 DOI: 10.1210/clinem/dgaa041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/28/2020] [Indexed: 01/23/2023]
Abstract
CONTEXT Myotonic dystrophy (DM) is an autosomal dominant disorder characterized mainly by myotonia but also by primary hypogonadism. No study has reported on fertility management of patients affected by DM type 1 (DM1). OBJECTIVE This study investigates the impact of CTG repeats in the DMPK gene on semen quality and preimplantation genetic diagnosis (PGD) outcome. DESIGN This is a monocentric retrospective observational study conducted from January 2003 to January 2019. SETTING Antoine Béclère University Hospital, Clamart, France. PATIENTS Three groups were compared in this study: male DM1 patients (Group A, n = 18), unaffected partners of DM1 female patients (Group B, n = 30), and proven fertile men (Group C, n = 33). Reproductive outcomes after PGD were compared between groups A and B. RESULTS Sperm volume was reduced in group A (2.0 mL) when compared with groups B (3.0 mL; P < 0.01) and C (3.5 mL; P < 0.01). Progressive motility in raw sperm was also decreased in group A (30%) as compared to group C (40%; P < 0.01). The median number of progressive spermatozoa retrieved after sperm preparation was 2.7 million (M) in group A, which was significantly less than those of groups B (10.0 M; P < 0.01) and C (62.2 M; P < 0.01). Sperm motility was inversely correlated to the number of CTG repeats (Spearman r2 = 0.48, Pearson r2 = 0.35). Cumulative live birth rate per transfer was similar between groups, with 32.2% in group A versus 26.8% in group B. CONCLUSIONS As a precautionary measure, we advise physicians to perform regular monitoring of semen quality in affected males, which would allow sperm cryopreservation should semen parameters fall. PGD allows good reproductive outcomes without disease transmission.
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Affiliation(s)
- Vincent Puy
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
- Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Université de Paris, Université Paris-Saclay, CEA, Fontenay-aux-Roses, France
| | - Anne Mayeur
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
| | - Alexandre Levy
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
| | - Laetitia Hesters
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
| | - Jade Raad
- Department of Reproductive Medicine and Fertility Preservation, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
| | - Sophie Monnot
- Institut Imagine et Service de Génétique Moléculaire, Université de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Julie Steffann
- Institut Imagine et Service de Génétique Moléculaire, Université de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Nelly Frydman
- Reproductive Biology Unit CECOS, Paris-Saclay University, Antoine Béclère Hospital, APHP Clamart, France
- Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Université de Paris, Université Paris-Saclay, CEA, Fontenay-aux-Roses, France
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14
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Isorni M, Moisson L, Monnot S, Planche O, Sigal A, Guihaire J, Hascoët S. 4D flow magnetic resonance imaging in congenital heart diseases: Who can benefit? Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Isorni MA, Martins D, Ben Moussa N, Monnot S, Boddaert N, Bonnet D, Hascoet S, Raimondi F. 4D flow MRI versus conventional 2D for measuring pulmonary flow after Tetralogy of Fallot repair. Int J Cardiol 2019; 300:132-136. [PMID: 31676117 DOI: 10.1016/j.ijcard.2019.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND After tetralogy of Fallot (TOF) repair, pulmonary regurgitation and right ventricular function must be monitored. Conventional (2D) cardiac magnetic resonance (CMR) is currently the clinical reference method for measuring pulmonary regurgitation. However, 4DFlow CMR has been reported to provide a more comprehensive flow analysis than 2D CMR. We aimed to compare 4DFlow CMR to 2D CMR for assessing pulmonary regurgitation and flow, as well as aortic flow, in children and adults after surgical repair of TOF. METHODS Retrospective analysis of patients with repaired TOF admitted for cardiac MRI with 4DFlow acquisition from 2016 to 2018. Linear regression was used to assess correlations and Bland-Altman analyses were performed. RESULTS The 60 included patients had a mean age of 18.2 ± 10.4 years (range, 2-54 years). Significant correlations between the two techniques were found for pulmonary regurgitant fraction (R [2] = 0.6642, p < 0.0001), net pulmonary flow (R [2] = 0.6782, p < 0.0001), forward pulmonary flow (R [2] = 0.6185, p < 0.0001), backward pulmonary flow (R [2] = 0.8192, p < 0.0001), and aortic valve flow (R [2] = 0.6494, p < 0.0001). The Bland-Altman analysis showed no significant bias, narrow limits of agreement, and few scattered points. The correlation between pulmonary and aortic flow was better with 4DFlow CMR than with 2D CMR (R [2] = 0.8564, p < 0.0001 versus R [2] = 0.4393, p < 0,0001, respectively). Interobserver reliability was good. CONCLUSION These results establish the feasibility and reliability of 4DFlow CMR for assessing pulmonary flow in a large paediatric and adult population with repaired TOF. 4DFlow CMR may be more reliable than 2D MRI for pulmonary flow assessment after TOF repair.
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Affiliation(s)
- M A Isorni
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - D Martins
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France; Pediatric Cardiology Unit, Hospital de Santa Cruz, Lisboa, Portugal
| | - N Ben Moussa
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - S Monnot
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - N Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France
| | - D Bonnet
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France
| | - S Hascoet
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - F Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France; Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France.
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Isorni M, Martins D, Ben Moussa N, Monnot S, Boddaert N, Bonnet D, Hascoet S, Raimondi F. 4D Flow versus Conventional 2D MRI for Measuring Pulmonary Flow after Tetralogy of Fallot Repair. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Isorni MA, Moisson L, Guihaire J, Ouerd L, Monnot S, Sigal Cinqualbre A, Planche O, Hascoet S. Four-Dimensional flow magnetic resonance imaging in cardiovascular diseases: Who can benefit? Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.06.028] [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: 11/16/2022]
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Bizaoui V, Michot C, Baujat G, Amouroux C, Baron S, Capri Y, Cohen-Solal M, Collet C, Dieux A, Geneviève D, Isidor B, Monnot S, Rossi M, Rothenbuhler A, Schaefer E, Cormier-Daire V. Pycnodysostosis: Natural history and management guidelines from 27 French cases and a literature review. Clin Genet 2019; 96:309-316. [PMID: 31237352 DOI: 10.1111/cge.13591] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 01/25/2023]
Abstract
Pycnodysostosis is a lysosomal autosomal recessive skeletal dysplasia characterized by osteosclerosis, short stature, acro-osteolysis, facial features and an increased risk of fractures. The clinical heterogeneity of the disease and its rarity make it difficult to provide patients an accurate prognosis, as well as appropriate care and follow-up. French physicians from the OSCAR network have been asked to fill out questionnaires collecting molecular and clinical data for 27 patients issued from 17 unrelated families. All patients showed short stature (mean = -3.5 SD) which was more severe in females (P = .006). The mean fracture rate was moderate (0.21 per year), with four fractures in total average. About 75% underwent at least one surgery, with an average number of 2.1 interventions per patient. About 50% required non-invasive assisted ventilation due to sleep apnea (67%). About 29% showed psychomotor difficulties and 33% needed a school assistant or adapted schooling. No patient had any psychological evaluation or follow-up. Molecular data were available for 14 families. Growth hormone administration was efficient on linear growth in 40% of cases. We propose several axis of management, such as systematic cerebral MRI for Chiari malformation screening at diagnosis and regular psychological follow-up.
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Affiliation(s)
- Varoona Bizaoui
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Caroline Michot
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Geneviève Baujat
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Cyril Amouroux
- Department of Paediatric Endocrinology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Sabine Baron
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
| | - Yline Capri
- Genetics Department, AP-HP, Robert-Debré University Hospital, Paris, France
| | - Martine Cohen-Solal
- Department of Rheumatology, Lariboisière Hospital, INSERM U1132 and University Paris-Diderot, Paris, France
| | - Corinne Collet
- Department of Biochemistry, APHP, Saint-Louis Lariboisière Hospitals, Paris, France
| | - Anne Dieux
- Centre de Référence CLAD NdF, Service de Génétique Clinique, Hôpital Jeanne de Flandre, CHU Lille, France
| | - David Geneviève
- Service de Génétique Clinique et du Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Centre de Compétence Maladies Osseuses Constitutionnelles, Inserm U1183, Université Montpellier, Montpellier, France
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
| | - Sophie Monnot
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Massimiliano Rossi
- Hospices Civils de Lyon, Service de Génétique, Centre de Référence Anomalies du Développement, Bron, France.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS UMR5292, UCB Lyon 1, Lyon, France
| | - Anya Rothenbuhler
- Department of Paediatric Endocrinology, Bicêtre Hospital, Paris, France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Cormier-Daire
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
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Bacrot S, Monnot S, Haddad G, Barcia G, Rachid M, Boisson M, Pasquier N, Rondeau S, Munnich A, Steffann J, Bonnefont JP, Raynaud M. Prenatal diagnosis of fragile X syndrome: Small meiotic recombination events at the FMR1 locus. Prenat Diagn 2019; 39:388-393. [PMID: 30779209 DOI: 10.1002/pd.5439] [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] [Received: 10/29/2018] [Revised: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Séverine Bacrot
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Sophie Monnot
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Georges Haddad
- Service de gynécologie obstétrique, Centre hospitalier de Blois, Blois, France
| | - Giulia Barcia
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Myriam Rachid
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Marie Boisson
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Pasquier
- Service de Génétique, CHRU de Tours, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Sophie Rondeau
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Arnold Munnich
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Julie Steffann
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Jean-Paul Bonnefont
- Université Paris Descartes - Sorbonne Paris Cite, Institut Imagine UMR1163, Fédération de Génétique médicale, Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Martine Raynaud
- Service de Génétique, CHRU de Tours, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Doyard M, Bacrot S, Huber C, Di Rocco M, Goldenberg A, Aglan MS, Brunelle P, Temtamy S, Michot C, Otaify GA, Haudry C, Castanet M, Leroux J, Bonnefont JP, Munnich A, Baujat G, Lapunzina P, Monnot S, Ruiz-Perez VL, Cormier-Daire V. FAM46A mutations are responsible for autosomal recessive osteogenesis imperfecta. J Med Genet 2018; 55:278-284. [PMID: 29358272 DOI: 10.1136/jmedgenet-2017-104999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stüve-Wiedemann syndrome (SWS) is characterised by bowing of the lower limbs, respiratory distress and hyperthermia that are often responsible for early death. Survivors develop progressive scoliosis and spontaneous fractures. We previously identified LIFR mutations in most SWS cases, but absence of LIFR pathogenic changes in five patients led us to perform exome sequencing and to identify homozygosity for a FAM46A mutation in one case [p.Ser205Tyrfs*13]. The follow-up of this case supported a final diagnosis of osteogenesis imperfecta (OI), based on vertebral collapses and blue sclerae. METHODS AND RESULTS This prompted us to screen FAM46A in 25 OI patients with no known mutations.We identified a homozygous deleterious variant in FAM46A in two affected sibs with typical OI [p.His127Arg]. Another homozygous variant, [p.Asp231Gly], also classed as deleterious, was detected in a patient with type III OI of consanguineous parents using homozygosity mapping and exome sequencing.FAM46A is a member of the superfamily of nucleotidyltransferase fold proteins but its exact function is presently unknown. Nevertheless, there are lines of evidence pointing to a relevant role of FAM46A in bone development. By RT-PCR analysis, we detected specific expression of FAM46A in human osteoblasts andinterestingly, a nonsense mutation in Fam46a has been recently identified in an ENU-derived (N-ethyl-N-nitrosourea) mouse model characterised by decreased body length, limb, rib, pelvis, and skull deformities and reduced cortical thickness in long bones. CONCLUSION We conclude that FAM46A mutations are responsible for a severe form of OI with congenital bowing of the lower limbs and suggest screening this gene in unexplained OI forms.
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Affiliation(s)
- Mathilde Doyard
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Séverine Bacrot
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Céline Huber
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genova, Italy
| | - Alice Goldenberg
- Department of Genetics, Centre Normand de Génomique Médicale et Médecine Personnalisée, CHU de Rouen, Rouen, France
| | - Mona S Aglan
- Department of Clinical Genetics. Human Genetics and Genome Research Division, Centre of Excellence of Human Genetics, National Research Centre, Cairo, Egypt
| | - Perrine Brunelle
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Samia Temtamy
- Department of Clinical Genetics. Human Genetics and Genome Research Division, Centre of Excellence of Human Genetics, National Research Centre, Cairo, Egypt
| | - Caroline Michot
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Ghada A Otaify
- Department of Clinical Genetics. Human Genetics and Genome Research Division, Centre of Excellence of Human Genetics, National Research Centre, Cairo, Egypt
| | - Coralie Haudry
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Julien Leroux
- Department of Pediatric Surgery, CHU de Rouen, Rouen, France
| | - Jean-Paul Bonnefont
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Arnold Munnich
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Geneviève Baujat
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Pablo Lapunzina
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz-IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain.,CIBER de enfermedades Raras (CIBERER), Insitituto de Salud Carlos III, Madrid, Spain
| | - Sophie Monnot
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - Victor L Ruiz-Perez
- CIBER de enfermedades Raras (CIBERER), Insitituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigaciones Biomédicas de Madrid, Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid, Spain
| | - Valérie Cormier-Daire
- Department of Medical Genetics, INSERM U1163, Université Paris-Descartes, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
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Vachin P, Adda-Herzog E, Chalouhi G, Elie C, Rio M, Rondeau S, Gigarel N, Jabot Hanin F, Monnot S, Borghese R, Bengoa J, Ville Y, Rotig A, Munnich A, Bonnefont JP, Steffann J. Segregation of mitochondrial DNA mutations in the human placenta: implication for prenatal diagnosis of mtDNA disorders. J Med Genet 2017; 55:131-136. [DOI: 10.1136/jmedgenet-2017-104615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 11/03/2022]
Abstract
BackgroundMitochondrial DNA (mtDNA) disorders have a high clinical variability, mainly explained by variation of the mutant load across tissues. The high recurrence risk of these serious diseases commonly results in requests from at-risk couples for prenatal diagnosis (PND), based on determination of the mutant load on a chorionic villous sample (CVS). Such procedures are hampered by the lack of data regarding mtDNA segregation in the placenta.The objectives of this report were to determine whether mutant loads (1) are homogeneously distributed across the whole placentas, (2) correlate with those in amniocytes and cord blood cells and (3) correlate with the mtDNA copy number.MethodsWe collected 11 whole placentas carrying various mtDNA mutations (m.3243A>G, m.8344A>G, m.8993T>G, m.9185T>C and m.10197G>A) and, when possible, corresponding amniotic fluid samples (AFSs) and cord blood samples. We measured mutant loads in multiple samples from each placenta (n= 6–37), amniocytes and cord blood cells, as well as total mtDNA content in placenta samples.ResultsLoad distribution was homogeneous at the sample level when average mutant load was low (<20%) or high (>80%) at the whole placenta level. By contrast, a marked heterogeneity was observed (up to 43%) in the intermediate range (20%–80%), the closer it was to 40%–50% the mutant load, the wider the distribution. Mutant loads were found to be similar in amniocytes and cord blood cells, at variance with placenta samples. mtDNA content correlated to mutant load in m.3243A>G placentas only.ConclusionThese data indicate that (1) mutant load determined from CVS has to be interpreted with caution for PND of some mtDNA disorders and should be associated with/substituted by a mutant load measurement on amniocytes; (2) the m.3243A>G mutation behaves differently from other mtDNA mutations with respect to the impact on mtDNA copy number, as previously shown in human preimplantation embryogenesis.
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Nicol P, Ruhin B, Sourice S, Corre P, Monnot S, Baujat G, Khonsari RH. Re: Agarwal et al Stylomandibular fusion that complicates recurrent bilateral ankylosis of the temporomandibular joint. Br J Oral Maxillofac Surg 2016; 54:1057-1059. [PMID: 27131983 DOI: 10.1016/j.bjoms.2016.04.015] [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] [Received: 02/10/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- P Nicol
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillofaciale et Stomatologie, Paris, F-75013, France; UPMC Université Paris 06, F-75005, Paris, France
| | - B Ruhin
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillofaciale et Stomatologie, Paris, F-75013, France; UPMC Université Paris 06, F-75005, Paris, France
| | - S Sourice
- Inserm U791 - LIOAD, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - P Corre
- Service de Chirurgie Maxillofaciale et Stomatologie, Centre Hospitalo-Universitaire de Nantes; Université de Nantes, Nantes, France
| | - S Monnot
- Department of Genetics, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades (AP-HP), Paris, France
| | - G Baujat
- Department of Genetics, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades (AP-HP), Paris, France
| | - R H Khonsari
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillofaciale et Stomatologie, Paris, F-75013, France; UPMC Université Paris 06, F-75005, Paris, France.
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23
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Taillandier A, Domingues C, De Cazanove C, Porquet-Bordes V, Monnot S, Kiffer-Moreira T, Rothenbuhler A, Guggenbuhl P, Cormier C, Baujat G, Debiais F, Capri Y, Cohen-Solal M, Parent P, Chiesa J, Dieux A, Petit F, Roume J, Isnard M, Cormier-Daire V, Linglart A, Millán JL, Salles JP, Muti C, Simon-Bouy B, Mornet E. Molecular diagnosis of hypophosphatasia and differential diagnosis by targeted Next Generation Sequencing. Mol Genet Metab 2015; 116:215-20. [PMID: 26432670 PMCID: PMC5257278 DOI: 10.1016/j.ymgme.2015.09.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/26/2015] [Accepted: 09/26/2015] [Indexed: 11/24/2022]
Abstract
Hypophosphatasia (HPP) is a rare inherited skeletal dysplasia due to loss of function mutations in the ALPL gene. The disease is subject to an extremely high clinical heterogeneity ranging from a perinatal lethal form to odontohypophosphatasia affecting only teeth. Up to now genetic diagnosis of HPP is performed by sequencing the ALPL gene by Sanger methodology. Osteogenesis imperfecta (OI) and campomelic dysplasia (CD) are the main differential diagnoses of severe HPP, so that in case of negative result for ALPL mutations, OI and CD genes had often to be analyzed, lengthening the time before diagnosis. We report here our 18-month experience in testing 46 patients for HPP and differential diagnosis by targeted NGS and show that this strategy is efficient and useful. We used an array including ALPL gene, genes of differential diagnosis COL1A1 and COL1A2 that represent 90% of OI cases, SOX9, responsible for CD, and 8 potentially modifier genes of HPP. Seventeen patients were found to carry a mutation in one of these genes. Among them, only 10 out of 15 cases referred for HPP carried a mutation in ALPL and 5 carried a mutation in COL1A1 or COL1A2. Interestingly, three of these patients were adults with fractures and/or low BMD. Our results indicate that HPP and OI may be easily misdiagnosed in the prenatal stage but also in adults with mild symptoms for these diseases.
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Affiliation(s)
- Agnès Taillandier
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Christelle Domingues
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Clémence De Cazanove
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Valérie Porquet-Bordes
- Endocrinologie, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, CHU de Toulouse, Toulouse Cedex 9, France.
| | - Sophie Monnot
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France.
| | - Tina Kiffer-Moreira
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Agnès Rothenbuhler
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, Le Kremlin Bicêtre 94270, France; APHP, Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme D'expertise Paris Sud, Le Kremlin Bicêtre 94270, France.
| | - Pascal Guggenbuhl
- Service de Rhumatologie, Hôpital Sud, CHU de Rennes, 16, Boulevard de Bulgarie, BP90347, 35203 Rennes Cedex 2, France.
| | - Catherine Cormier
- Rheumatology Department, Cochin University Hospital, 75015 Paris, France.
| | - Geneviève Baujat
- Centres de Référence Maladies Osseuses Constitutionnelles (MOC), Hôpital Universitaire Necker-Enfants Malades et Institut Imagine (AP-HP), 75015 Paris, France.
| | - Françoise Debiais
- Service de rhumatologie, CHU de Poitiers, 86021 Poitiers Cedex, France.
| | - Yline Capri
- Department of Genetics, APHP-Robert Debré University Hospital, Paris, France.
| | - Martine Cohen-Solal
- Department of Rheumatology, INSERM UMR-1132, Lariboisière Hospital and University, Paris Diderot Sorbonne, Paris, France.
| | - Philippe Parent
- Service de Génétique Clinique, CHU Brest, Brest F-29200, France.
| | - Jean Chiesa
- Department of Genetics, University Hospital, Nîmes, France.
| | - Anne Dieux
- Service de Génétique Clinique, CHU, Lille, France.
| | | | - Joelle Roume
- Unité de Génétique Médicale, Centre Intercommunal Poissy-St-Germain en Laye, Poissy, France.
| | - Monica Isnard
- Gynécologie Obstétrique, Centre Hospitalier de Mulhouse, 68051 Mulhouse Cedex, France
| | - Valérie Cormier-Daire
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France.
| | - Agnès Linglart
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, Le Kremlin Bicêtre 94270, France; APHP, Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme D'expertise Paris Sud, Le Kremlin Bicêtre 94270, France.
| | - José Luis Millán
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Jean-Pierre Salles
- Endocrinologie, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, CHU de Toulouse, Toulouse Cedex 9, France.
| | - Christine Muti
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Brigitte Simon-Bouy
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Etienne Mornet
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
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Steffann J, Gigarel N, Samuels DC, Monnot S, Borghese R, Hesters L, Frydman N, Burlet P, Frydman R, Benachi A, Rotig A, Munnich A, Bonnefont JP. Data from artificial models of mitochondrial DNA disorders are not always applicable to humans. Cell Rep 2015; 7:933-4. [PMID: 24856293 DOI: 10.1016/j.celrep.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Julie Steffann
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France.
| | - Nadine Gigarel
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - David C Samuels
- Center for Human Genetics Research, Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, USA
| | - Sophie Monnot
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - Roxana Borghese
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - Laetitia Hesters
- Service de Biologie et Génétique de la Reproduction, Hôpital Antoine Béclère, 92141 Clamart cedex, France
| | - Nelly Frydman
- Service de Biologie et Génétique de la Reproduction, Hôpital Antoine Béclère, 92141 Clamart cedex, France
| | - Philippe Burlet
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - René Frydman
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Unité INSERM U782, Hôpital Antoine Béclère, 92141 Clamart cedex, France
| | - Agnes Rotig
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - Arnold Munnich
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
| | - Jean-Paul Bonnefont
- Université Paris-Descartes; Sorbonne Paris Cité, Institut IMAGINE and INSERM U781; Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris, Cedex 15, France
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Steffann J, Monnot S, Bonnefont JP. mtDNA mutations variously impact mtDNA maintenance throughout the human embryofetal development. Clin Genet 2015; 88:416-24. [PMID: 25523230 DOI: 10.1111/cge.12557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
Abstract
Mitochondria are the largest generator of ATP in the cell. It is therefore expected that energy-requiring processes such as oocyte maturation, early embryonic or fetal development, would be adversely impacted in case of mitochondrial deficiency. Human mitochondrial DNA (mtDNA) mutations constitute a spontaneous model of mitochondrial failure and offer the opportunity to study the consequences of energetic defects over fertility and embryofetal development. This review provides an update on the mtDNA metabolism in the early preimplantation embryo, and compiles data showing the impact of mtDNA mutations over mtDNA segregation. Despite convincing evidences about the essential role of mitochondria in oogenesis and preimplantation development, no correlation between the presence of a mtDNA mutation and fertilization failure, impaired oocyte quality, or embryofetal development arrest was found. In some cases, mutant cells might upregulate their mitochondrial content to overcome the bioenergetic defects induced by mtDNA mutations, and might escape negative selection. Finally we discuss some of the clinical consequences of these observations.
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Affiliation(s)
- J Steffann
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
| | - S Monnot
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
| | - J-P Bonnefont
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
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26
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Habarou F, Brassier A, Rio M, Chrétien D, Monnot S, Barbier V, Barouki R, Bonnefont JP, Boddaert N, Chadefaux-Vekemans B, Le Moyec L, Bastin J, Ottolenghi C, de Lonlay P. Pyruvate carboxylase deficiency: An underestimated cause of lactic acidosis. Mol Genet Metab Rep 2014. [PMID: 28649521 PMCID: PMC5471145 DOI: 10.1016/j.ymgmr.2014.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pyruvate carboxylase (PC) is a biotin-containing mitochondrial enzyme that catalyzes the conversion of pyruvate to oxaloacetate, thereby being involved in gluconeogenesis and in energy production through replenishment of the tricarboxylic acid (TCA) cycle with oxaloacetate. PC deficiency is a very rare metabolic disorder. We report on a new patient affected by the moderate form (the American type A). Diagnosis was nearly fortuitous, resulting from the revision of an initial diagnosis of mitochondrial complex IV (C IV) defect. The patient presented with severe lactic acidosis and pronounced ketonuria, associated with lethargy at age 23 months. Intellectual disability was noted at this time. Amino acids in plasma and organic acids in urine did not show patterns of interest for the diagnostic work-up. In skin fibroblasts PC showed no detectable activity whereas biotinidase activity was normal. We had previously reported another patient with the severe form of PC deficiency and we show that she also had secondary C IV deficiency in fibroblasts. Different anaplerotic treatments in vivo and in vitro were tested using fibroblasts of both patients with 2 different types of PC deficiency, type A (patient 1) and type B (patient 2). Neither clinical nor biological effects in vivo and in vitro were observed using citrate, aspartate, oxoglutarate and bezafibrate. In conclusion, this case report suggests that the moderate form of PC deficiency may be underdiagnosed and illustrates the challenges raised by energetic disorders in terms of diagnostic work-up and therapeutical strategy even in a moderate form.
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Affiliation(s)
- F Habarou
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,INSERM U1124, Université Paris Descartes, Paris, France.,Service de Biochimie Métabolomique et Protéomique, Hôpital Necker, APHP, Paris, France
| | - A Brassier
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,Université Paris Descartes, Paris, France
| | - M Rio
- Département de Génétique, Hôpital Necker, APHP, Paris, France
| | | | - S Monnot
- Département de Génétique, Hôpital Necker, APHP, Paris, France.,IHU Imagine, UMR1163, France
| | - V Barbier
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France
| | - R Barouki
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,INSERM U1124, Université Paris Descartes, Paris, France.,Service de Biochimie Métabolomique et Protéomique, Hôpital Necker, APHP, Paris, France
| | - J P Bonnefont
- Département de Génétique, Hôpital Necker, APHP, Paris, France.,INSERM U781, Paris, France
| | - N Boddaert
- Service de Radiologie Pédiatrique, Hôpital Necker, APHP, Paris, France
| | - B Chadefaux-Vekemans
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,INSERM U1124, Université Paris Descartes, Paris, France.,Service de Biochimie Métabolomique et Protéomique, Hôpital Necker, APHP, Paris, France
| | - L Le Moyec
- INSERM U902, Université d'Evry Val d'Essonne, INSERM UBIAE U902, Boulevard François Miterrand, 91025 Evry, France
| | - J Bastin
- INSERM U1124, Université Paris Descartes, Paris, France
| | - C Ottolenghi
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,INSERM U1124, Université Paris Descartes, Paris, France.,Service de Biochimie Métabolomique et Protéomique, Hôpital Necker, APHP, Paris, France
| | - P de Lonlay
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, APHP, Paris, France.,Université Paris Descartes, Paris, France.,INSERM U781, Paris, France
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Steffann J, Michot C, Borghese R, Baptista-Fernandes M, Monnot S, Bonnefont JP, Munnich A. Parental mosaicism is a pitfall in preimplantation genetic diagnosis of dominant disorders. Eur J Hum Genet 2014; 22:711-2. [PMID: 24022303 PMCID: PMC3992558 DOI: 10.1038/ejhg.2013.164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/03/2013] [Accepted: 06/25/2013] [Indexed: 01/26/2023] Open
Abstract
PCR amplification on single cells is prone to allele drop-out (PCR failure of one allele), a cause of misdiagnosis in preimplantation genetic diagnosis (PGD). Owing to this error risk, PGD usually relies on both direct and indirect genetic analyses. When the affected partner is the sporadic case of a dominant disorder, building haplotypes require spermatozoon or polar body testing prior to PGD, but these procedures are cost and time-consuming. A couple requested PGD because the male partner suffered from a dominant Cowden syndrome (CS). He was a sporadic case, but the couple had a first unaffected child and the non-mutated paternal haplotype was tentatively deduced. The couple had a second spontaneous pregnancy and the fetus was found to carry the at-risk haplotype but not the PTEN mutation. The mutation was present in blood from the affected father, but at low level, confirming the somatic mosaicism. Ignoring the possibility of mosaicism in the CS patient would have potentially led to selection of affected embryos. This observation emphasizes the risk of PGD in families at risk to transmit autosomal-dominant disorder when the affected partner is a sporadic case.
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Affiliation(s)
- Julie Steffann
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Caroline Michot
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Roxana Borghese
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marcia Baptista-Fernandes
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sophie Monnot
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Paul Bonnefont
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Arnold Munnich
- Unité Université Paris Descartes-Sorbonne Paris Cité, Institut imagine, INSERM-U781, Paris, France
- Service de génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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Monnot S, Samuels DC, Hesters L, Frydman N, Gigarel N, Burlet P, Kerbrat V, Lamazou F, Frydman R, Benachi A, Feingold J, Rotig A, Munnich A, Bonnefont JP, Steffann J. Mutation dependance of the mitochondrial DNA copy number in the first stages of human embryogenesis. Hum Mol Genet 2013; 22:1867-72. [DOI: 10.1093/hmg/ddt040] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Vuillaumier-Barrot S, Bouchet-Séraphin C, Chelbi M, Devisme L, Quentin S, Gazal S, Laquerrière A, Fallet-Bianco C, Loget P, Odent S, Carles D, Bazin A, Aziza J, Clemenson A, Guimiot F, Bonnière M, Monnot S, Bole-Feysot C, Bernard JP, Loeuillet L, Gonzales M, Socha K, Grandchamp B, Attié-Bitach T, Encha-Razavi F, Seta N. Identification of mutations in TMEM5 and ISPD as a cause of severe cobblestone lissencephaly. Am J Hum Genet 2012; 91:1135-43. [PMID: 23217329 DOI: 10.1016/j.ajhg.2012.10.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/27/2012] [Accepted: 10/05/2012] [Indexed: 02/04/2023] Open
Abstract
Cobblestone lissencephaly is a peculiar brain malformation with characteristic radiological anomalies. It is defined as cortical dysplasia that results when neuroglial overmigration into the arachnoid space forms an extracortical layer that produces agyria and/or a "cobblestone" brain surface and ventricular enlargement. Cobblestone lissencephaly is pathognomonic of a continuum of autosomal-recessive diseases characterized by cerebral, ocular, and muscular deficits. These include Walker-Warburg syndrome, muscle-eye-brain disease, and Fukuyama muscular dystrophy. Mutations in POMT1, POMT2, POMGNT1, LARGE, FKTN, and FKRP identified these diseases as alpha-dystroglycanopathies. Our exhaustive screening of these six genes, in a cohort of 90 fetal cases, led to the identification of a mutation in only 53% of the families, suggesting that other genes might also be involved. We therefore decided to perform a genome-wide study in two multiplex families. This allowed us to identify two additional genes: TMEM5 and ISPD. Because TMEM has a glycosyltransferase domain and ISPD has an isoprenoid synthase domain characteristic of nucleotide diP-sugar transferases, these two proteins are thought to be involved in the glycosylation of dystroglycan. Further screening of 40 families with cobblestone lissencephaly identified nonsense and frameshift mutations in another four unrelated cases for each gene, increasing the mutational rate to 64% in our cohort. All these cases displayed a severe phenotype of cobblestone lissencephaly A. TMEM5 mutations were frequently associated with gonadal dysgenesis and neural tube defects, and ISPD mutations were frequently associated with brain vascular anomalies.
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Monnot S, Gigarel N, Samuels DC, Burlet P, Hesters L, Frydman N, Frydman R, Kerbrat V, Funalot B, Martinovic J, Benachi A, Feingold J, Munnich A, Bonnefont JP, Steffann J. Segregation of mtDNA throughout human embryofetal development: m.3243A>G as a model system. Hum Mutat 2011; 32:116-25. [PMID: 21120938 PMCID: PMC3058134 DOI: 10.1002/humu.21417] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mitochondrial DNA (mtDNA) mutations cause a wide range of serious diseases with high transmission risk and maternal inheritance. Tissue heterogeneity of the heteroplasmy rate (“mutant load”) accounts for the wide phenotypic spectrum observed in carriers. Owing to the absence of therapy, couples at risk to transmit such disorders commonly ask for prenatal (PND) or preimplantation diagnosis (PGD). The lack of data regarding heteroplasmy distribution throughout intrauterine development, however, hampers the implementation of such procedures. We tracked the segregation of the m.3243A > G mutation (MT-TL1 gene) responsible for the MELAS syndrome in the developing embryo/fetus, using tissues and cells from eight carrier females, their 38 embryos and 12 fetuses. Mutant mtDNA segregation was found to be governed by random genetic drift, during oogenesis and somatic tissue development. The size of the bottleneck operating for m.3243A > G during oogenesis was shown to be individual-dependent. Comparison with data we achieved for the m.8993T > G mutation (MT-ATP6 gene), responsible for the NARP/Leigh syndrome, indicates that these mutations differentially influence mtDNA segregation during oogenesis, while their impact is similar in developing somatic tissues. These data have major consequences for PND and PGD procedures in mtDNA inherited disorders. Hum Mutat 32:116–125, 2011. © 2010 Wiley-Liss, Inc.
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Affiliation(s)
- Sophie Monnot
- Université Paris-Descartes, Unité INSERM U, Hopital Necker-Enfants Malades, France
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Gigarel N, Hesters L, Samuels DC, Monnot S, Burlet P, Kerbrat V, Lamazou F, Benachi A, Frydman R, Feingold J, Rotig A, Munnich A, Bonnefont JP, Frydman N, Steffann J. Poor correlations in the levels of pathogenic mitochondrial DNA mutations in polar bodies versus oocytes and blastomeres in humans. Am J Hum Genet 2011; 88:494-8. [PMID: 21473984 DOI: 10.1016/j.ajhg.2011.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 12/11/2022] Open
Abstract
Because the mtDNA amount remains stable in the early embryo until uterine implantation, early human development is completely dependent on the mtDNA pool of the mature oocyte. Both quantitative and qualitative mtDNA defects therefore may negatively impact oocyte competence or early embryonic development. However, nothing is known about segregation of mutant and wild-type mtDNA molecules during human meiosis. To investigate this point, we compared the mutant levels in 51 first polar bodies (PBs) and their counterpart (oocytes, blastomeres, or whole embryos), at risk of having (1) the "MELAS" m.3243A>G mutation in MT-TL1 (n = 30), (2) the "MERRF" m.8344A>G mutation in MT-TK (n = 15), and (3) the m.9185T>G mutation located in MT-ATP6 (n = 6). Seven out of 51 of the PBs were mutation free and had homoplasmic wild-type counterparts. In the heteroplasmic PBs, measurement of the mutant load was a rough estimate of the counterpart mutation level (R(2) = 0.52), and high mutant-load differentials between the two populations were occasionally observed (ranging from -34% to +34%). The mutant-load differentials between the PB and its counterpart were higher in highly mutated PBs, suggestive of a selection process acting against highly mutated cells during gametogenesis or early embryonic development. Finally, individual discrepancies in mutant loads between PBs and their counterparts make PB-based preconception diagnosis unreliable for the prevention of mtDNA disorder transmission. Such differences were not observed in animal models, and they emphasize the need to conduct thorough studies on mtDNA segregation in humans.
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Affiliation(s)
- Nadine Gigarel
- Université Paris-Descartes, Faculté de Médecine, Unité INSERM U781, Service de Génétique Médicale, Hôpital Necker-Enfants Malades (Assistance Publique-Hôpitaux de Paris), 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Steffann J, Monnot S, Rötig A, Munnich A, Bonnefont JP. [Nuclear transfer to prevent mitochondrial DNA diseases: myth or reality?]. Med Sci (Paris) 2010; 26:897-9. [PMID: 21106164 DOI: 10.1051/medsci/20102611897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Gigarel N, Hesters L, Monnot S, Burlet P, Kerbrat V, Lamazou F, Fanchin R, Bonnefont JP, Munnich A, Frydman R, Frydman N, Steffann J. P32 Pitfalls of preimplantation genetic diagnosis for mitochondrial DNA mutations by using polar body analysis. Reprod Biomed Online 2010. [DOI: 10.1016/s1472-6483(10)62348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Monnot S, Serre V, Chadefaux-Vekemans B, Aupetit J, Romano S, De Lonlay P, Rival JM, Munnich A, Steffann J, Bonnefont JP. Structural insights on pathogenic effects of novel mutations causing pyruvate carboxylase deficiency. Hum Mutat 2009; 30:734-40. [PMID: 19306334 DOI: 10.1002/humu.20908] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pyruvate carboxylase (PC), a key enzyme for gluconeogenesis and anaplerotic pathways, consists of four domains, namely, biotin carboxylase (BC), carboxyltransferase (CT), pyruvate carboxylase tetramerization (PT), and biotin carboxyl carrier protein (BCCP). PC deficiency is a rare metabolic disorder inherited in an autosomal recessive way. The most severe form (form B) is characterized by neonatal lethal lactic acidosis, whereas patients with form A suffer chronic lactic acidosis with psychomotor retardation. Diagnosis of PC deficiency relies on enzymatic assay and identification of the PC gene mutations. To date, six mutations of the PC gene have been identified. We report nine novel mutations of the PC gene, in five unrelated patients: three being affected with form B, and the others with form A. Three of them were frameshift mutations predicted to introduce a premature termination codon, the remaining ones being five nucleotide substitutions and one in frame deletion. Impact of these mutations on mRNA was assessed by RT-PCR. Evidence for a deleterious effect of the missense mutations was achieved using protein alignments and three-dimensional structural prediction, thanks to our modeling of the human PC structure. Altogether, our data and those previously reported indicate that form B is consistently associated with at least one truncating mutation, mostly lying in CT (C-terminal part) or BCCP domains, whereas form A always results from association of two missense mutations located in BC or CT (N-terminal part) domains. Finally, although most PC mutations are suggested to interfere with biotin metabolism, none of the PC-deficient patients was biotin-responsive.
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Affiliation(s)
- Sophie Monnot
- INSERM unit U781, Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France.
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Monnot S, Giuliano F, Massol C, Fossoud C, Cossée M, Lambert JC, Karmous-Benailly H. Partial Xp11.23-p11.4 duplication with random X inactivation: clinical report and molecular cytogenetic characterization. Am J Med Genet A 2008; 146A:1325-9. [PMID: 18412111 DOI: 10.1002/ajmg.a.32238] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Partial duplications of the short arm of the X chromosome are relatively rare and have been described in males and females. We describe a 4 10/12-year-old girl presenting with developmental delay, severe language retardation and minor anomalies with slightly elevated head circumference (+1.8 SD), prominent forehead, wide palpebral fissures and anteverted nares. No pigmentary dysplasia of the skin was present. The external genitalia were normal. The karyotype completed by cytogenetic analysis with the Whole Chromosome Painting probe of chromosome X revealed a de novo partial duplication of the short arm of an X chromosome. In order to further characterize the duplicated segment, we used a series of BAC probes extending from band Xp11.22 to Xp22.1. BACs from Xp11.23 to Xp11.4 were duplicated. The karyotype was finally defined as 46,X,dup(X)(p11p11).ish dup(X)(p11.23p11.4)(WCPX+,RP11-416I6++,RP11-386N14++,RP11-466C12++). The X-inactivation status was studied using the human androgen receptor (HUMARA) and the FRAXA locus methylation assay. Unexpectedly, the two X chromosomes were found to be randomly inactivated, in the proband. Indeed, usually, in women with structurally abnormal X chromosome, the abnormal X chromosome is preferentially inactivated and those patients share an apparent normal phenotype. So, we speculate that in the present case, the phenotype of the patient could be explained by a functional disomy of the genes present in the duplicated region. We will discuss the possible implication of these genes on the observed phenotype.
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Affiliation(s)
- Sophie Monnot
- Department of Medical Genetics, Hospital Archet 2, CHU Nice, France.
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Cano A, Rouzier C, Monnot S, Chabrol B, Conrath J, Lecomte P, Delobel B, Boileau P, Valero R, Procaccio V, Paquis-Flucklinger V, Vialettes B. Identification of novel mutations in WFS1 and genotype-phenotype correlation in Wolfram syndrome. Am J Med Genet A 2007; 143A:1605-12. [PMID: 17568405 DOI: 10.1002/ajmg.a.31809] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mutations in the WFS1 gene have been reported in Wolfram syndrome (WS), an autosomal recessive disorder defined by early onset of diabetes mellitus (DM) and progressive optic atrophy. Because of the low prevalence of this syndrome and the recent identification of the WFS1 gene, few data are available concerning the relationships between clinical and molecular aspects of the disease. Here, we describe 12 patients from 11 families with WS. We report on eight novel (A214fsX285, L293fsX303, P346L, I427S, V503fsX517, R558C, S605fsX711, P838L) and seven previously reported mutations. We also looked for genotype-phenotype correlation both in patients included in this study and 19 additional WS patients that were previously reported. Subsequently, we performed a systematic review and meta-analysis of five published clinical and molecular studies of WFS1 for genotype-phenotype correlation, combined with our current French patient group for a total of 96 patients. The presence of two inactivating mutations was shown to predispose to an earlier age of onset of both DM and optic atrophy. Moreover, the clinical expression of WS was more complete and occurred earlier in patients harboring no missense mutation.
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Affiliation(s)
- A Cano
- Department of Nutrition, Metabolic Diseases and Endocrinology, la Timone, Hospital, Marseille, France
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Fontaine D, Monnot S, Vandenbos F, Paquis P, Michiels JF, Bannwarth S, Paquis-Flucklinger V. DNA extraction by FTA? technology: application for rapid detection of 1p/19q deletions in gliomas. Neuropathol Appl Neurobiol 2007; 33:360-3. [PMID: 17493015 DOI: 10.1111/j.1365-2990.2007.00835.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bouchet C, Steffann J, Corcos J, Monnot S, Paquis V, Rötig A, Lebon S, Levy P, Royer G, Giurgea I, Gigarel N, Benachi A, Dumez Y, Munnich A, Bonnefont JP. Prenatal diagnosis of myopathy, encephalopathy, lactic acidosis, and stroke-like syndrome: contribution to understanding mitochondrial DNA segregation during human embryofetal development. J Med Genet 2006; 43:788-92. [PMID: 16690729 PMCID: PMC2563165 DOI: 10.1136/jmg.2005.034140] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Myopathy, encephalopathy, lactic acidosis, and stroke-like (MELAS) syndrome, a maternally inherited disorder that is among the most common mitochondrial DNA (mtDNA) diseases, is usually associated with the m.3242A>G mutation of the mitochondrial tRNA(leu) gene. Very few data are available with respect to prenatal diagnosis of this serious disease. The rate of mutant versus wild-type mtDNA (heteroplasmy) in fetal DNA is indeed considered to be a poor indicator of postnatal outcome. MATERIALS AND METHODS Taking advantage of a novel semi-quantitative polymerase chain reaction test for m.3243A>G mutant load assessment, we carried out nine prenatal diagnoses in five unrelated women, using two different fetal tissues (chorionic villi v amniocytes) sampled at two or three different stages of pregnancy. RESULTS Two of the five women, although not carrying m.3243A>G in blood or extra-blood tissues, were, however, considered at risk for transmission of the mutation, as they were closely related to MELAS-affected individuals. The absence of 3243A>G in the blood of first degree relatives was associated with no mutated mtDNA in the cardiovascular system (CVS) or amniocytes, and their three children are healthy, with a follow-up of 3 months-3 years. Among the six fetuses from the three carrier women, three were shown to be homoplasmic (0% mutant load), the remaining three being heteroplasmic, with a mutant load ranging from 23% to 63%. The fetal mutant load was fairly stable at two or three different stages of pregnancy in CVS and amniocytes. Although pregnancy was terminated in the case of the fetus with a 63% mutant load, all other children are healthy with a follow-up of 3 months-6 years. CONCLUSION These data suggest that a prenatal diagnosis for MELAS syndrome might be helpful for at-risk families.
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Affiliation(s)
- C Bouchet
- Department of Genetics, Hôpital Necker-Enfants Malades, Paris, France
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Monnot S, Chabrol B, Cano A, Pellissier JF, Collignon P, Montfort MF, Paquis-Flucklinger V. [Cytochrome c oxydase-deficient Leigh syndrome with homozygous mutation in SURF1 gene]. Arch Pediatr 2005; 12:568-71. [PMID: 15885549 DOI: 10.1016/j.arcped.2005.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 01/25/2005] [Indexed: 11/27/2022]
Abstract
Leigh syndrome is a heterogeneous disorder, usually due to a defect in oxidative metabolism. Mutations in SURF1 gene have been identified in patients with cytochrome c oxidase deficiency. We report a homozygous splice site deletion [516-2_516-1delAG] in a young girl presenting with cytochrome c oxidase-deficient Leigh syndrome. Identification of molecular defect is indispensable for genetic counselling and prenatal diagnosis.
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Affiliation(s)
- S Monnot
- Service de génétique médicale, hôpital Archet 2, 151, route de Saint-Antoine-de-Ginestière, 06202 Nice cedex 03, France
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Giuliano F, Bannwarth S, Monnot S, Cano A, Chabrol B, Vialettes B, Delobel B, Paquis-Flucklinger V. Wolfram syndrome in French population: Characterization of novel mutations and polymorphisms in theWFS1 gene. Hum Mutat 2004; 25:99-100. [PMID: 15605410 DOI: 10.1002/humu.9300] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Wolfram syndrome (WS), a rare autosomal recessive neurodegenerative disorder, results in most cases from mutations in the WFS1 gene. In this study, a total of 19 patients with Wolfram syndrome and 36 relatives from 17 families were screened for mutations in the WFS1 gene. WFS1 mutations were identified on both alleles in 16 of 19 patients and on 1 allele of 3 patients, showing that WFS1 is the major gene involved in WS in the french population. We identified 25 different mutations, twelve of which were novel. We found 6 frameshift mutations, 6 nonsense mutations, 6 missense mutations, 6 in-frame deletions, and one new homozygous mutation in the splice donor site of exon 7 (c.861+1G>A) resulting in a frameshift. Most patients were compound heterozygotes. No common founder mutation or mutational hot spot were found in the WFS1 gene. Although most mutations occurred in exon 8, in some cases molecular screening requires analysis of all exons, including the non-coding exon 1. We also identified 3 new polymorphisms. Furthermore, genotype-phenotype correlation suggests that the presence of inactivating mutations on both alleles may be associated with an early onset of diabetes mellitus.
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