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Scala M, Wortmann SB, Kaya N, Stellingwerff MD, Pistorio A, Glamuzina E, van Karnebeek CD, Skrypnyk C, Iwanicka‐Pronicka K, Piekutowska‐Abramczuk D, Ciara E, Tort F, Sheidley B, Poduri A, Jayakar P, Jayakar A, Upadia J, Walano N, Haack TB, Prokisch H, Aldhalaan H, Karimiani EG, Yildiz Y, Ceylan AC, Santiago‐Sim T, Dameron A, Yang H, Toosi MB, Ashrafzadeh F, Akhondian J, Imannezhad S, Mirzadeh HS, Maqbool S, Farid A, Al‐Muhaizea MA, Alshwameen MO, Aldowsari L, Alsagob M, Alyousef A, AlMass R, AlHargan A, Alwadei AH, AlRasheed MM, Colak D, Alqudairy H, Khan S, Lines MA, García Cazorla MÁ, Ribes A, Morava E, Bibi F, Haider S, Ferla MP, Taylor JC, Alsaif HS, Firdous A, Hashem M, Shashkin C, Koneev K, Kaiyrzhanov R, Efthymiou S, Genomics QS, Schmitt‐Mechelke T, Ziegler A, Issa MY, Elbendary HM, Striano P, Alkuraya FS, Zaki MS, Gleeson JG, Barakat TS, Bierau J, van der Knaap MS, Maroofian R, Houlden H. Clinico-radiological features, molecular spectrum, and identification of prognostic factors in developmental and epileptic encephalopathy due to inosine triphosphate pyrophosphatase (ITPase) deficiency. Hum Mutat 2022; 43:403-419. [PMID: 34989426 PMCID: PMC9152572 DOI: 10.1002/humu.24326] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022]
Abstract
Developmental and epileptic encephalopathy 35 (DEE 35) is a severe neurological condition caused by biallelic variants in ITPA, encoding inosine triphosphate pyrophosphatase, an essential enzyme in purine metabolism. We delineate the genotypic and phenotypic spectrum of DEE 35, analyzing possible predictors for adverse clinical outcomes. We investigated a cohort of 28 new patients and reviewed previously described cases, providing a comprehensive characterization of 40 subjects. Exome sequencing was performed to identify underlying ITPA pathogenic variants. Brain MRI (magnetic resonance imaging) scans were systematically analyzed to delineate the neuroradiological spectrum. Survival curves according to the Kaplan-Meier method and log-rank test were used to investigate outcome predictors in different subgroups of patients. We identified 18 distinct ITPA pathogenic variants, including 14 novel variants, and two deletions. All subjects showed profound developmental delay, microcephaly, and refractory epilepsy followed by neurodevelopmental regression. Brain MRI revision revealed a recurrent pattern of delayed myelination and restricted diffusion of early myelinating structures. Congenital microcephaly and cardiac involvement were statistically significant novel clinical predictors of adverse outcomes. We refined the molecular, clinical, and neuroradiological characterization of ITPase deficiency, and identified new clinical predictors which may have a potentially important impact on diagnosis, counseling, and follow-up of affected individuals.
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Affiliation(s)
- Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversità Degli Studi di GenovaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
- UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Saskia B. Wortmann
- Amalia Children's HospitalRadboud University NijmegenNijmegenThe Netherlands
- University Children's HospitalParacelsus Medical UniversitySalzburgAustria
| | - Namik Kaya
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- Department of Translational Genomics, Center for Genomics MedicineKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Menno D. Stellingwerff
- Department of Child Neurology, Emma Children's Hospital, Amsterdam Leukodystrophy Center, Amsterdam University Medical CentersVrije Universiteit and Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Angela Pistorio
- Clinical Epidemiology and Biostatistics UnitIRCCS Istituto Giannina GasliniGenoaItaly
| | - Emma Glamuzina
- Adult and Paediatric National Metabolic ServiceStarship Children's HospitalAucklandNew Zealand
| | - Clara D. van Karnebeek
- Departments of Pediatrics and Clinical GeneticsAcademic Medical CentreAmsterdamThe Netherlands
| | - Cristina Skrypnyk
- Department of Molecular Medicine, Al‐Jawhara Centre for Molecular MedicineArabian Gulf UniversityManamaKingdom of Bahrain
| | - Katarzyna Iwanicka‐Pronicka
- Department of Medical GeneticsThe Children's Memorial Health InstituteWarsawPoland
- Department of Audiology and PhoniatricsThe Children's Memorial Health InstituteWarsawPoland
| | | | - Elżbieta Ciara
- Department of Medical GeneticsThe Children's Memorial Health InstituteWarsawPoland
| | - Frederic Tort
- Secció d'Errors Congènits del Metabolisme‐IBC, Servei de Bioquímica iGenètica MolecularHospital Clínic, IDIBAPS, CIBERERBarcelonaSpain
| | - Beth Sheidley
- Department of NeurologyF.M. Kirby Neurobiology Center, Boston Children's HospitalBostonMassachusettesUSA
- Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics ProgramBoston Children's HospitalBostonMassachusettesUSA
| | - Annapurna Poduri
- Department of NeurologyF.M. Kirby Neurobiology Center, Boston Children's HospitalBostonMassachusettesUSA
- Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics ProgramBoston Children's HospitalBostonMassachusettesUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettesUSA
| | | | | | - Jariya Upadia
- Tulane University School of MedicineNew OrleansLouisianaUSA
| | | | - Tobias B. Haack
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Holger Prokisch
- Institute of Human GeneticsTechnische Universität MünchenMunichGermany
- Institute of Human GeneticsHelmholtz Zentrum MünchenNeuherbergGermany
| | - Hesham Aldhalaan
- Department of NeurosciencesKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Ehsan G. Karimiani
- Department of Medical GeneticsNext Generation Genetic PolyclinicMashhadIran
- Molecular and Clinical Sciences InstituteSt. George's University of London, Cranmer TerraceLondonUK
- Innovative Medical Research CenterIslamic Azad University, Mashhad BranchMashhadIran
| | - Yilmaz Yildiz
- Pediatric Metabolic Diseases ClinicDr. Sami Ulus Training and Research Hospital for Maternity and ChildrenAnkaraTurkey
| | - Ahmet C. Ceylan
- Department of Medical GeneticsAnkara City HospitalAnkaraTurkey
| | | | | | | | - Mehran B. Toosi
- Pediatric Neurology Department, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Farah Ashrafzadeh
- Department of PediatricsMashhad University of Medical SciencesMashhadIran
| | - Javad Akhondian
- Pediatric Neurology Department, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Shima Imannezhad
- Department of Pediatric DiseasesMashhad University of Medical SciencesMashhadIran
| | - Hanieh S. Mirzadeh
- Department of Pediatric DiseasesMashhad University of Medical SciencesMashhadIran
| | - Shazia Maqbool
- Development and Behavioral Pediatrics DepartmentInstitute of Child Health and The Children HospitalLahorePakistan
| | - Aisha Farid
- Development and Behavioral Pediatrics DepartmentInstitute of Child Health and The Children HospitalLahorePakistan
| | - Mohamed A. Al‐Muhaizea
- Department of NeurosciencesKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Meznah O. Alshwameen
- Department of NeurosciencesKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Lama Aldowsari
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Maysoon Alsagob
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Ashwaq Alyousef
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Rawan AlMass
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Aljouhra AlHargan
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Ali H. Alwadei
- Neurosciences DepartmentKing Fahad Medical CityRiyadhSaudi Arabia
| | - Maha M. AlRasheed
- Department of Clinical PharmacyKing Saud UniversityRiyadhSaudi Arabia
| | - Dilek Colak
- Department of Biostatistics, Epidemiology and Scientific ComputingKFSHRCRiyadhKingdom of Saudi Arabia
| | - Hanan Alqudairy
- Department of GeneticsKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Sameena Khan
- Department of NeurosciencesKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Matthew A. Lines
- Medical Genetics, Department of PediatricsAlberta Children's HospitalCalgaryCanada
| | | | - Antonia Ribes
- Secció d'Errors Congènits del Metabolisme‐IBC, Servei de Bioquímica iGenètica MolecularHospital Clínic, IDIBAPS, CIBERERBarcelonaSpain
| | - Eva Morava
- Department of Clinical Genomics, Laboratory of Medicine and PathologyCenter for Individualized Medicine, Mayo ClinicRochesterMinnesotaUSA
| | - Farah Bibi
- Institute of Biochemistry and BiotechnologyPir Mehar Ali Shah Arid Agriculture UniversityRawalpindiPakistan
| | - Shahzad Haider
- Izzat Ali Shah HospitalLalarukh Wah CanttRawalpindiPakistan
| | - Matteo P. Ferla
- NIHR Oxford BRC Genomic Medicine, Wellcome Centre for Human GeneticsUniversity of OxfordOxfordUK
| | - Jenny C. Taylor
- NIHR Oxford BRC Genomic Medicine, Wellcome Centre for Human GeneticsUniversity of OxfordOxfordUK
| | - Hessa S. Alsaif
- Department of Translational Genomics, Center for Genomics MedicineKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Abdulwahab Firdous
- Department of Translational Genomics, Center for Genomics MedicineKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Mais Hashem
- Department of Translational Genomics, Center for Genomics MedicineKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Chingiz Shashkin
- International University of Postgraduate EducationAlmatyKazakhstan
| | - Kairgali Koneev
- Department of Neurology and NeurosurgeryAsfendiyarov Kazakh National Medical UniversityAlmatyKazakhstan
| | - Rauan Kaiyrzhanov
- UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | | | | | | | - Andreas Ziegler
- Zentrum für Kinder und Jugendmedizin Heidelberg, Sektion Neuropädiatrie und StoffwechselmedizinUniversitätsklinikum HeidelbergHeidelbergGermany
| | - Mahmoud Y. Issa
- Clinical Genetics Department, Human Genetics and Genome Research DivisionNational Research CentreCairoEgypt
| | - Hasnaa M. Elbendary
- Clinical Genetics Department, Human Genetics and Genome Research DivisionNational Research CentreCairoEgypt
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversità Degli Studi di GenovaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
| | - Fowzan S. Alkuraya
- Department of Translational Genomics, Center for Genomics MedicineKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- Department of Anatomy and Cell BiologyAlfaisal UniversityRiyadhSaudi Arabia
| | - Maha S. Zaki
- Clinical Genetics Department, Human Genetics and Genome Research DivisionNational Research CentreCairoEgypt
| | - Joseph G. Gleeson
- Department of Neuroscience, Rady Children's Institute for Genomic Medicine, Howard Hughes Medical InstituteUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Jorgen Bierau
- Laboratory of Biochemical Genetics, Department of Clinical GeneticsMaastricht University HospitalMaastrichtThe Netherlands
| | - Marjo S. van der Knaap
- Department of Child Neurology, Emma Children's Hospital, Amsterdam Leukodystrophy Center, Amsterdam University Medical CentersVrije Universiteit and Amsterdam NeuroscienceAmsterdamThe Netherlands
- Department of Functional Genomics, Center for Neurogenomics and Cognitive ResearchVU UniversityAmsterdamThe Netherlands
| | - Reza Maroofian
- UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Henry Houlden
- UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
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