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Barillari MR, Karali M, Di Iorio V, Contaldo M, Piccolo V, Esposito M, Costa G, Argenziano G, Serpico R, Carotenuto M, Cappuccio G, Banfi S, Melillo P, Simonelli F. Mild form of Zellweger Spectrum Disorders (ZSD) due to variants in PEX1: Detailed clinical investigation in a 9-years-old female. Mol Genet Metab Rep 2020; 24:100615. [PMID: 32596134 PMCID: PMC7306489 DOI: 10.1016/j.ymgmr.2020.100615] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/27/2022] Open
Abstract
Peroxisomal biogenesis disorders (PBD) are rare autosomal recessive disorders with various degrees of severity caused by hypomorphic mutations in 13 different peroxin (PEX) genes. In this study, we report the clinical and molecular characterization of a 9-years-old female presenting an apparently isolated pre-lingual sensorineural hearing loss (SNHL) and early onset Retinitis Pigmentosa (RP) that may clinically overlap with Usher syndrome. Genetic testing by clinical exome sequencing identified two variants in PEX1: the missense variant c.274G > C; p.(Val92Leu) that was already reported in a PBD patient, and the variant c.2140_2145dup; p.(Ser714_Gln715dup) which is a novel, non-frameshift variant, absent in control databases. On the basis of the molecular analysis, a thorough clinical examination revealed nail and dental abnormalities, a mild cognitive impairment, learning disabilities and poor feeding, apart from the retinal and audiological features initially identified. The clinical and molecular findings led us to the diagnosis of a mild form of PBD. This study further emphasizes that mild forms of PBD can be a differential diagnosis of Usher syndrome and suggests that patients with mild cognitive impairment associated to visual and hearing loss should perform a comprehensive mutation screening that includes PEX genes.
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Key Words
- ABR, Auditory Brainstem Responses
- BCVA, Best Corrected Visual Acuity
- CDI, Children’s Depression Inventory
- ERG, full-field electroretinogram
- Enamel defects
- FAF, color fundus and fundus autofluorescence
- GVF, Goldmann Visual Field
- HS, Heimler syndrome
- Mild Zellweger syndrome
- OCT, optical coherence tomography
- PBD, Peroxisomal biogenesis disorders
- PEX genes
- PEX, peroxin
- PTA, Pure Tone Average
- Peroxisomal biogenesis disorders
- RP, retinitis pigmentosa
- Retinitis pigmentosa
- SNHL, sensorineural hearing loss
- Sensorineural hearing loss
- TEOAE, Transient-Evoked Otoacustic Emission
- VLCFA, Very Long Chain Fatty Acid
- WISC-IV, Wechsler Intelligence Scale for Children (4th Edition)
- ZS, Zellweger Syndrome
- ZSD, Zellweger spectrum disorder
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Affiliation(s)
- Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138 Naples, Italy
| | - Marianthi Karali
- Telethon Institute of Genetics and Medicine, Pozzuoli, Via Campi Flegrei 34, 80078 Pozzuoli, Italy
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via Pansini 5, 80131 Naples, Italy
| | - Maria Contaldo
- Dental Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 6, 80138 Naples, Italy
| | - Vincenzo Piccolo
- Pediatric Dermatology, Dermatology Unit, University of Campania Luigi Vanvitelli, Via Pansini 5, 80131 Naples, Italy
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131 Naples, Italy
| | - Giuseppe Costa
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138 Naples, Italy
| | - Giuseppe Argenziano
- Pediatric Dermatology, Dermatology Unit, University of Campania Luigi Vanvitelli, Via Pansini 5, 80131 Naples, Italy
| | - Rosario Serpico
- Dental Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 6, 80138 Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131 Naples, Italy
| | - Gerarda Cappuccio
- Telethon Institute of Genetics and Medicine, Pozzuoli, Via Campi Flegrei 34, 80078 Pozzuoli, Italy
- Department of Translational Medicine, Section of Paediatrics, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Sandro Banfi
- Telethon Institute of Genetics and Medicine, Pozzuoli, Via Campi Flegrei 34, 80078 Pozzuoli, Italy
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Naples, Italy
| | - Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via Pansini 5, 80131 Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via Pansini 5, 80131 Naples, Italy
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