[Early diagnosis of autism: Phenotype-endophenotype]

Autism Spectrum Disorders have for some time been the focus of intense interest for clinicians and researchers because of the high prevalence of the disorders among children in the community (approximately 1%), their severity and pervasiveness. Particular attention has been paid to the early diagnosis of the disorder and to the intensive therapeutic intervention. Currently the best prognosis for autism lays in the early diagnosis and intervention. Postponing the diagnosis and the intervention beyond infancy is considered loss of precious time. The diagnosis of autism, which begins early in life, was until recently considered that could be reliability made at the age of 3 years. Recent follow up studies however on children at risk for autism (children who had an older sibling with autism) have shown that the clinical signs of autism emerge at the end of the first year and become distinct by the end of the second year when the diagnosis can reliably be made. From a clinical perspective it is noted that the early clinical signs of risk for autism are related to social communication (e.g. limited or absent response when calling his/her name and to joint attention), stereotype behaviours and body movements or unusual handling of objects (e.g. intensive observation of objects and stereotype movements of hands and tapping or spinning), incongruent regulation of emotions (reduced positive and increased negative emotion). There is also delay in developmental characteristics such as the language (both receptive and expressive) and motor (particularly in postural control - characteristic is the drop of the head backwards when the infant is held in horizontal position). Studies on various aspects of the endophenotype of certain clinical signs among infants at risk for Autism Spectrum Disorders, such as avoidance of eye contact, delay in verbal communication and increase of the head circumference, may provide useful information and may assist the clinician on follow up in the early diagnosis. Compared to the progress made for an early diagnosis of autism there is relatively no equal progress in the early intervention. However, some methods such as the 'Early Start Denver Model' which focuses in the family, which is the natural environment of the child, may provide a useful framework for effective work with the child and the family.

Abstract 1572: Sensitive and robust targeted sequencing of pancreatic precancer and tumors using microfluidic single-molecule enrichment

Pancreatic ductal adenocarcinoma (PDAC) arises from two precursor lesions, pancreatic intraepithelial neoplasias and pancreatic cysts, such as intraductal papillary mucinous neoplasias (IPMNs). Since cyst lesions are readily detected on cross sectional imaging, early diagnosis of IPMN-associated PDAC and intervention may be feasible. However, clinical guidelines dictating which IPMNs are high-risk and require surgical resection are suboptimal. Recently, the genomic signature of IPMN-associated carcinomas has been described opening the possibility for targeted genomic analysis. Previous groups have sought to achieve this using conventional methods. However, since IPMN tissue and cyst fluid are limited in quantity and contain inhibitors of PCR, we developed a novel microfluidics-based approach to achieve sensitive and specific targeted amplification and Illumina library construction.

We have optimized a novel method to enrich targeted genomic regions for next generation sequencing (NGS) platforms featuring microfluidic partitioning of the sample into uniform picoliter volume droplets containing single molecules of target DNA. All droplets contain all of the primers and PCR reagents, ensuring that every target molecule from the sample is amplified, and after endpoint PCR results in a highly uniform yield that facilitates efficient use of the NGS platform. In addition, the primers contain ‘Illumina tails’ that enable easy sample indexing and loading directly onto a MiSeq without additional library preparation.

Here we detail the successful customization and use of the ThunderBolts Cancer Panel, which targets 230 commonly mutated regions in 50 cancer associated genes, with additional primers for commonly mutated genes in PDAC. Addition of the 37 PDAC-relevant primer pairs to the commercially available core panel was very straightforward and resulted in sequencing metrics similar to those of the core panel alone (100% coverage at 100x depth, mean read depth of 2500). Cyst fluid from 30 patients with IPMN resected under Sendai criteria were analyzed. We describe the mutational signature of cyst fluid and relate the presence and quantity of mutations in KRAS, GNAS and PIK3CA to the presence of invasive carcinoma and high grade dysplasia on pathology. Finally, unbiased and high resolution sequencing was obtained using this protocol with as little as 8ng of input DNA.

Using picodroplet PCR technology we were able to achieve unprecedented sequencing performance on ultra-low sample inputs. Given the ease of use and customization of the panel, the same platform may be readily adapted to other applications in which samples are limited or are difficult to amplify. Future studies will utilize this platform for an expanded analysis of pancreatic cyst fluid with additional primers.

Citation Format: Angelina I. Londoño-Joshi, Erica Pratt, Robert W. Cowan, Michael L. Samuels, Steve Kotsopoulos, Jeff Olson, Francis Long, Michelle A. Anderson, Diane Simeone, Andrew D. Rhim. Sensitive and robust targeted sequencing of pancreatic precancer and tumors using microfluidic single-molecule enrichment. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1572. doi:10.1158/1538-7445.AM2015-1572

Parents of mentally retarded adolescents evaluate the past and face the future of their child

This report deals with answers to a questionnaire given by 69 parents of retarded adolescents living in a community which, at the time of the study, offered little in terms of concrete services to mentally retarded persons. The inquiry concerned basically the parents' evaluation of the support they received from services or other sources and their concern about the child's future.

Abstract 4211: Detection and quantification of minoritary subclones of KRAS in metastatic colorectal cancers by digital microfluidics: therapeutic implications

KRAS mutations are associated with an absence of response to EGFR-targeting treatments in colorectal cancer. These therapies are restricted to patients with a KRAS wild type tumor but only 50% of these patients present an objective response. It has been recently demonstrated that secondary resistance was associated with appearance of a KRAS mutation. The presence of a low fraction of KRAS-mutated cells within tumors, not detectable by commonly used procedures, could explain these false negative and these secondary resistances.

To understand the importance of mutated subclones in the apparition of resistance to therapy targeting EGFR, a retrospective study including 95 patients with a metastatic colorectal cancer have been performed. All these patients, refractory to irinotecan were treated either with a combination of anti-EGFR and irinotecan or by anti-EGFR in monotherapy. These patients consisted of 54 men and 41 women with an average age of 62 years ± 11. Thirty-six patients were classified as responders according to RECIST criteria and 59 as non responders. Within this historitical serie, 27 patients were previously characterized as bearing a KRAS mutation by bulk Taqman analysis. DNA extracted from the tumors was analyzed by multiplex droplet-based microfluidics. This method, by segregating individual DNA molecules within million of aqueous microdroplets acting as independent microreactors, allows to perform precise quantitative experiments, for the 7 most frequent mutations of KRAS.

All tumors reported as bearing a mutated KRAS were detected as positives in droplets with proportions of mutated DNA from 10 to 64% (mean of 34,7% ± 17,9%). Two of them (KRAS G12D) were bearing additional subclones (KRAS G12V; KRAS G12S) detected only in droplets. With the 68 negative tumors, 18 were found positive in droplets with KRAS proportions from 0,013% to 86% (mean of 8.6% ± 20). Only 4 patients had a proportion of mutated DNA higher than 10% (86%, 24.5%, 12.7% and 10%), all presented low quantities of amplifiable DNA. We observed an inverse correlation between the proportion of mutated DNA and the frequency of anti-EGFR responses (P< 0.03). The percentage of mutated DNA was 11.6% and 28,4% for responders and non-responders respectively. Survival free progression of patients was significantly different depending on the level of mutated DNA within the tumor. The survival free progression of patients with tumor presenting less than 5% of mutated KRAS was identical to the one of non mutated patients with both technics. HRs were of 0.54±0.2 NS, 3.1±0.9, (P<0.001) 4.9±1.7 (P<0.001) for patients with tumor containing less than 5%, between 5 and 25% or more than 25% of mutated DNA respectively. This work highlights the importance of a quantitative approach for detection of mutation of the KRAS oncogene.

Citation Format: Deniz Pekin, Corinne Normand, Steve Kotsopoulos, Li Xinyu, Leonor Benhaim, O. Bouche, T. Lecomte, D. Le Corre, T. Hor, Z. El Harrak, P. Nizard, D. LINK, B. HUTCHISON, P. LAURENT-PUIG, Valerie Taly. Detection and quantification of minoritary subclones of KRAS in metastatic colorectal cancers by digital microfluidics: therapeutic implications. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4211. doi:10.1158/1538-7445.AM2013-4211

Application of microdroplet PCR for large-scale targeted bisulfite sequencing

Cytosine methylation of DNA CpG dinucleotides in gene promoters is an epigenetic modification that regulates gene transcription. While many methods exist to interrogate methylation states, few current methods offer large-scale, targeted, single CpG resolution. We report an approach combining bisulfite treatment followed by microdroplet PCR with next-generation sequencing to assay the methylation state of 50 genes in the regions 1 kb upstream of and downstream from their transcription start sites. This method yielded 96% coverage of the targeted CpGs and demonstrated high correlation between CpG island (CGI) DNA methylation and transcriptional regulation. The method was scaled to interrogate the methylation status of 77,674 CpGs in the promoter regions of 2100 genes in primary CD4 T cells. The 2100 gene library yielded 97% coverage of all targeted CpGs and 99% of the target amplicons.

Abstract 4826: Identification of low prevalence somatic mutations in heterogeneous tumor samples

High throughput sequencing enables the digital measurement of each allele in a DNA sample. This provides an ideal method to interrogate mutations present in heterogeneous samples such as solid tumors in which clonal selection or contamination with stroma can hinder the identification of important somatic mutations. We developed an ultra-deep targeted sequencing (UDT-Seq) assay to screen 46 cancer genes via microdroplet PCR (RainDance Technologies) and direct sequencing of the amplicons on the Illumina GA. This UDT-Seq library interrogates ∼86 kb of DNA located in cancer mutational hotspots (87% of all COSMIC mutations) and ∼29 kb located in exons sequenced in HapMap samples for the assay calibration and performance evaluation. We devised a statistical filtering of the mutations by using both experimental estimation and statistical modeling of the sequencing error rate. We measured the performance of our assay by processing 4 blends of 4 HapMap samples, interrogating 160 SNPs with known prevalence in each blend. The sensitivity and specificity of our method is >90% and >99% respectively for variants present at 5% prevalence or greater. We next interrogated 4 cancer samples (xenografts, 2 of which with matching primary samples) from 4 different tissues. We were able to detect low-prevalence somatic mutations in all samples of which some are well-known driver mutations. Interestingly, the mutational profile from primary to xenograft is conserved for one sample but different for another. Finally, we analyzed the robustness of the detection and prevalence measurement after performing whole-genome amplification on DNA extracted from fresh frozen and FFPE tissue using Single Primer Isothermal Amplification technology (SPIA® -NuGEN Technologies). Featuring a streamlined sample preparation to interrogate a large number of bases, this assay is well suited for clinical applications to study clonal selection in cancer progression or treatment with sub-optimal heterogeneous cancer samples.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4826. doi:10.1158/1538-7445.AM2011-4826

[The neurobiology of autism]

The research effort on autism has for several years been intensive. Recent progress in this field is due mainly to the development of increasingly sophisticated visualizing assessment methods of the brain. Most of the evidence reported in this review requires further replication and elaboration by ongoing research. Evidence from volumetric studies indicates that the brain of the child with autism deviates from normal paths at the early stages of development showing excessive growth during the first year and a half involving the hemispheres and the cerebellum. Post mortem studies have shown neuron abnormalities in the frontal and temporal cortex and the cerebellum. Studies using diffusion tensor imaging, an fMRI based method, have shown disruptions between white and grey matter in several areas of the hemispheres. Other studies investigating activation of the cortex showed lack of synchrony and coordination between anterior and posterior areas of the hemispheres. It has been suggested that the deviation in brain development in autism consists of excessive numbers of neurons which cause the cytoarchitectural deviation. A theory suggesting that the basic deficit in autism is due to dysfunction of the "mirror neuron system" requires further substantiation. The aetiology of autism is not known although risk factors have been identified. Predominant among them are genetic influences. The search is currently intensive for an understanding of the pathogenesis of the pathological deviation in the development of the brain in autism. Neurotrophic factors which determine the developmental steps of the brain are examined such as serotonin, brain-derived neurotrophic factor (BDNF), the neuropeptide reelin, neuroligines and others. There is evidence of some involvement of these factors with autism but it is still far from clear how they do interact with one another and how they lead to the pathological deviations observed in autism. The neurotrophic factors are evidently coded by genes which are being examined by geneticists. It has also been suggested that autoimmune responses while interacting with neurotrophic factors may be important for the autistic deviation in brain development. Limitations may exist in the interpretation of the study results on which the present review was based. These are probably due to inconsistencies among studies related to variability in the severity of the disorders and age among subjects, presence or not of mental retardation, differing assessment methods.

Psychosocial adaptation of immigrant Greek children from the former Soviet Union

BACKGROUND

The objective of this study was to assess psychiatric disorders in, and the psychosocial adaptation and academic performance of, children of immigrant families of Greek origin from countries of the former Soviet Union.

METHOD

At a preliminary stage, all immigrant children (276) aged 8-12 years attending 22 schools in a working-class suburb of Athens were assessed by their teachers in terms of behaviour and academic performance. They and their families had migrated to Greece within the previous three years. A matching control group of native children (251) attending the same schools and classes was also assessed. For an in-depth assessment of psychopathology and social adaptation, 65 immigrant and 41 native children were randomly selected from the two larger groups and were further assessed.

RESULTS

No statistically significant differences were observed between the immigrant and native children in terms of psychopathology and social adaptation, although a few differences were observed in subscales. However, there were significant differences between the groups in academic performance, that of the immigrant group being poorer, particularly in language-related areas (p < 0.01). In the light of these results, language enrichment classes are suggested for immigrant children who need them.

Intrusion and internalisation of the devil: popular saints vs. the Fathers of the Church

In early Christianity, and in the domain of Byzantium in particular, the devil's interference with man took two distinct forms which may be identified as "intrusion" and "internalisation". The intruding form of the devil was presented in the hagiographies of popular saints, while the internalisation form was presented and elaborated upon by the Fathers of the Church. Intrusion was the most striking and characteristic demonic interference with man. It was an invasion of the body by demons or impure spirits that took possession of the person and caused madness and other illnesses. The internalisation form of demonic interference was more subtle and sinister, and although it was not causing mental illness it was affecting the minds of people by inflaming passions and interfering with judgement, thus leading to erroneous actions, contrary to the commands of God. The two forms of demonic interference that were compatible one with the other and might coexist, emerged from the power of the devil. Intrusion was probably more appealing to and understood by the crowds of the peasants addressed by the popular saints while internalisation was better understood by the educated and the town people addressed by the Fathers of the Church. The two forms of demonic interference have had a lasting effect on religious and spiritual thought and practice till modern times.

Uncertainties in aetiology and treatment of infantile autism--assumptions and evidence

Uncertainty in the field of child psychiatry may at times lead to groundless assumptions about the aetiology and pathology of psychiatric disorders of childhood. Treatment based on non-validated assumptions may be ineffective and may cause more harm than good. The case is presented of infantile autism which was at first attributed by clinicians to a specific negative effect of parents on their children. Evidence grounded on research did subsequently refute the assumption implicating the parents in the aetiology of this disorder. An explanatory assumption can become evidence if it is tested and found valid. To avoid serious errors in the understanding and treatment of child psychiatric disorders, the clinician should always consider critically assumptions and opinion, provided in lieu of evidence.

Event-related potential correlates of primed and unprimed words in children co-morbid for disruptive behaviour disorders and academic delay

Children with disruptive behaviour disorders and academic delay (DD-AD) were compared to children with disruptive behaviour disorders only (DD) and normal control children with no psychiatric disturbance or academic delay (NO) with respect to scalp-recorded event-related electrical potentials (ERPs) elicited by semantically primed and unprimed words. Primed words were preceded by spoken words having a related meaning, while unprimed words were preceded by nonassociated spoken words. For normal controls, the unprimed words elicited greater N400 amplitudes at frontal-central recording sites than primed words. Primed vs. unprimed N400 differences were not evident at frontal sites in DD and the DD-AD group failed to exhibit differences in primed vs. unprimed N400 amplitudes at either frontal, central or parietal sites. These findings suggest that DD-AD children may represent a unique neuroelectric subgroup of learning disabilities.

A clinical and academic outcome study of children attending a day treatment program

OBJECTIVE

To assess the behavioural and academic improvement of children who attended a day treatment program during a defined period of time.

METHOD

Forty-six children admitted consecutively to the project were assessed on admission and discharge using behavioural and academic measures. They also had intelligence and language assessments. The subjects attended the program for one academic year, on the average. The large majority presented with disruptive behaviour disorders and low academic achievement levels.

RESULTS

There was a significant improvement reported by the parents in externalizing (P < 0.001) and internalizing (P < 0.05) behaviour. The subjects also gained one academic year, but their levels continued to be low in terms of percentiles. Measures of academic improvement showed significant associations with cognitive measures only (subscales of Wechsler Intelligence Scale for Children-Revised [WISC-R] and Clinical Evaluation of Language Fundamentals-Revised [CELF-R]).

CONCLUSION

A day treatment and school program is an effective modality for treatment and remediation of children with severe psychiatric disorders. The academic underachievement may be resistant to remediation within the limited period of attendance in such a program.

Reading and spelling deficits among children attending a psychiatric day treatment program

To investigate the specific behavioural and cognitive characteristics which may account for academic deficits in children with psychiatric disorders, 50 children admitted to a day treatment and school program were assessed using behaviour questionnaires for parents and teachers, and tests assessing intelligence (WISC-R), language (CELF-R) and academic performance (Kaufman Test of Educational Achievement). The academic measures Reading Decoding, Reading Comprehension and Spelling formed the dependent variables. Behaviour and cognitive measures which distinguished the sample from normative data constituted the independent variables. Hierarchical multiple regression analyses were performed in order to identify behaviour and cognitive measures accounting for the academic deficits. In the analyses, three measures (Digit Span, Sentence Assembly, Recalling Sentences), probably assessing overlapping cognitive/linguistic functions, accounted for a large proportion of variance for Reading Decoding (0.47), Reading Comprehension (0.63) and Spelling (0.29). None of the behaviour measures accounted for any variance of the academic variables. It is argued that linguistic dysfunction is a primary deficit which underlies problems in academic learning.

A psychiatric follow-up study of adoptees

This is a five year follow-up study of adopted children and adolescents. Thirty-five adoptees and 23 control subjects were assessed. Five years earlier, the initial sample consisted of 57 pairs of adoptees and controls. The study showed that both adopted and control subjects were improved at the follow-up assessment and that there were no significant differences in clinical diagnoses and social adaptation between the groups. Compared with the controls, the adoptees were scored higher on a behaviour scale (Revised Behavior Problem Checklist) by parents. Adoption by the sixth month of age was associated with better overall psychosocial functioning. Significantly more adoptees were not living with their adoptive families. Factors associated with outcome are discussed.

Pilot study of anxiety and depression in prepubertal children

Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.

Phenomenology of anxiety and depressive disorders in children and adolescents

In recent years, clinicians and researchers have demonstrated renewed interest in the study of anxiety and depression in children and adolescents. There is difficulty in determining the constituents' characteristics of, and distinguishing between, anxiety and depression. Further understanding of the phenomenology of these disorders may result from observation, by attending to the subjective experiences of the child and adolescent, and by studying the biologic factors associated with anxiety and depressive disorders. Despite the fact that much remains unknown concerning the disorders of anxiety and depression in children and adolescents, considerable progress has been made toward a better understanding of the phenomenology of depressive disorders in children and adolescents.

Parent satisfaction in a child psychiatric service

The development and use is reported of a client satisfaction questionnaire to be answered by parents of children and adolescents referred to an outpatient psychiatric program. The structure of the questionnaire and the results from a first application are reported. It is suggested that a client satisfaction questionnaire may become an important feedback instrument useful for service planning.

Extralinguistic speech characteristics of children with conduct and anxiety disorders

Nine children with conduct and nine with anxiety disorder participated in the study. The subjects were requested to respond to verbal tasks (counting, picture description, story telling). Disturbance of conduct was associated with short initial hesitation before speaking. It is suggested that the initial hesitation variables are measures of reflection and cognitive planning. Anxiety across subjects was associated with increased breath rate and lower output of speech per breath. It is suggested speech breath variables are reliable measures of anxiety. Implication for the diagnosis and management of child psychiatric disorders are discussed.

A profile of the child psychiatric population of Newfoundland

At all referrals during the year 1977 to the only child psychiatric facility in the Province of Newfoundland and Labrador were investigated on a number of variables. Two hundred and two children were referred. This was considered a very low rate of referrals. Distance of the child's residence beyond the range of 50 kilometres from the unit was negatively associated to referrals. Lack of parental employment was not associated with increased rate of referrals. Children from the outlying regions of the Province were unlikely to come from broken families. Academic failure was common among those referred. Few differences were observed in the clinical diagnoses between those referred from the Avalon Peninsula and the regions lying further away. As compared to another Canadian province, Ontario, (Ottawa-Carleton region) (2), fewer aggressive children were referred in Newfoundland. Some implications of these findings for the practice of child psychiatry in the Province were discussed.

Worries of parents regarding the future of their mentally retarded adolescent children

Responding to a questionnaire, a group of parents of mentally retarded adolescents, reported several worries regarding the future of their child. The welfare of the child in the event of the death of the parent seemed to preoccupy the majority of them. Several among them were embarked in an effort to secure financially the future of the child while others felt that could do very little about it. Two thirds expected assistance from community services while just over one third admitted of having received some assistance. It is held by the authors that the community has the duty to assist such parents.

Histidinemia and infantile autism

A 10-year-old boy first showed features of infantile autism at age 24 months. Histidinemia was also diagnosed, with histidine blood levels seven times higher than the upper normal values. If the coexistence of autism and histidinemia was not coincidental, histidinemia may have constituted a necessary but not sufficient factor leading to the clinical condition of autism. Other members of the patient's family had high blood levels of histidine, but did not show symptoms that have been related to histidinemia.

Infantile autism in dizygotic twins. A case report

This was a case study of a pair of dizygotic twins who both developed psychotic symptoms indicative of infantile autism at the age of 31--32 months. By the age of 5 years, when the children were evaluated, and over the 1 1/2 years they were followed, some improvement could be observed. Certain family events which took place just prior to the outbreak of the psychosis are reported, and the point is made that these may have had some causative relation with the disorder by acting as environmental stress factors. The possibility of a genetic factor also contributing to the appearance of the disorder could not be excluded in view of the existence of a first cousin with autistic symptoms.