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Lee KY, Bremner R, Hartley J, Protheroe S, Haller W, Johnson T, Whyte L. Long term outcomes in children with trichohepatoenteric syndrome. Am J Med Genet A 2024; 194:141-149. [PMID: 37753667 DOI: 10.1002/ajmg.a.63409] [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: 07/12/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder caused by mutations in either TTC37 or SKIV2L, usually leading to congenital diarrhea as part of a multisystem disease. Here, we report on the natural history of the disease for the largest UK cohort of patients with THES from 1996 to 2020. We systematically reviewed the clinical records and pathological specimens of patients diagnosed with THES managed in a single tertiary pediatric gastroenterology unit. Between 1996 and 2020, 13 patients (7 female and 6 male) were diagnosed with THES either by mutation analysis or by clinical phenotype. Two patients died from complications of infection. All patients received parenteral nutrition (PN) of which six patients were weaned off PN. All patients had gastrointestinal tract inflammation on endoscopy. Almost half of the cohort were diagnosed with monogenic inflammatory bowel disease (IBD) by the age of 11 years, confirmed by endoscopic and histological findings. Protracted diarrhea causing intestinal failure improves with time in all patients with THES, but monogenic IBD develops in later childhood that is refractory to conventional IBD treatments. Respiratory issues contribute to significant morbidity and mortality, and good respiratory care is crucial to prevent comorbidity.
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Affiliation(s)
- Kwang Yang Lee
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
- Department of Paediatric Gastroenterology and Nutrition, Bristol Royal Hospital for Children, Bristol, UK
| | - Ronald Bremner
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Jane Hartley
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Sue Protheroe
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Wolfram Haller
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tracey Johnson
- Department of Nutrition and Dietetics, Birmingham Children's Hospital, Birmingham, UK
| | - Lisa Whyte
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
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2
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Gao J, Hu X, Hu W, Sun X, Chen L. Novel TTC37 mutations in a patient with Trichohepatoenteric syndrome: a case report and literature review. Transl Pediatr 2022; 11:1050-1057. [PMID: 35800280 PMCID: PMC9253954 DOI: 10.21037/tp-21-574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Trichohepatoenteric syndrome (THES) is a rare autosomal recessive genetic disease caused by pathogenic mutations in TTC37 or SKIV2L gene. The presentation is variable, including intractable diarrhea, woolly hair abnormality, immune dysfunction, intrauterine growth restriction (IUGR), facial dysmorphism, and sometimes liver and skin abnormalities. Although four Chinese children affected with THES syndrome 1 have been described in Singapore, Taiwan (China) and Malaysia, to our knowledge, this is the first report of a patient with THES in Mainland China, harboring classical platelets features, clinical course, and novel mutations in TTC37 gene. CASE DESCRIPTION The male infant had symmetrical IUGR, and was born at 37+1 weeks with a birth weight of 1,480 g. He presented with feeding difficulties and vomiting from the 12th day after birth during the stay in neonatal intensive care unit, and had excessive diarrhea from the 21st day after birth. From the 35th day after birth, even slightly hypotonic oral rehydration solution caused watery stools. The blood glucose level was lower than 3.3 mmol/L even when the glucose infusion rate was up to 14 mg/kg/min on the parenteral alone, which has not been reported in previous literature. Normal α-granules were observed occasionally in THES platelets. Whole-exome sequencing analysis identified compound heterozygous mutations (c.4130C > G: p.S1377X) and (Exon11-13 del) in the TTC37 gene, which had been inherited from his father and mother, respectively. To our knowledge, the above mutations have not been described in any database or previous literature. Total parenteral nutrition was employed as mainstay of therapy, and hydrocortisone (1 mg/kg/dose, every 4 hours) was used to maintain blood glucose levels. The patient's final prognosis was poor after discharged from the hospital. CONCLUSIONS This case presented with mild platelet abnormality and intractable hypoglycemia, which extends the known mutation and phenotype of THES. The clinical features of Chinese patient are consistent with other ethnicity. Molecular diagnosis is useful for patients with unexplained intractable diarrhea, which puts an end to a long diagnostic odyssey.
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Affiliation(s)
- Jinzhi Gao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Hu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Hu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Sun
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Goulet O, Pigneur B, Charbit-Henrion F. Congenital enteropathies involving defects in enterocyte structure or differentiation. Best Pract Res Clin Gastroenterol 2022; 56-57:101784. [PMID: 35331396 DOI: 10.1016/j.bpg.2021.101784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/02/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Abstract
Congenital enteropathies (CE) are a group of rare inherited diseases with a typical onset early in life. They involve defects in enterocyte structure or differentiation. They can cause a severe condition of intestinal failure (IF). The diagnostic approach is based first on clinical presentation (consanguinity, prenatal expression, polyhydramnios, early neonatal onset, aspect of stools, persistence at bowel rest, associated extra-digestive manifestations….) and histo-pathological analyses. These rare intestinal diseases cause protracted diarrhea that might resolve, for a few, with a dietetic approach. However, protracted or permanent IF may require long term parenteral nutrition and, in limited cases, intestinal transplantation. With the progresses in both clinical nutrition and genetics, many of these CE are nowadays associated with recognized gene mutations. It improved our knowledge and the understanding in the patho-physiology of these diseases, thus, leading potentially to therapeutic perspectives. These review cover most of the early onset CE and excludes the immune related diarrhea.
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Affiliation(s)
- Olivier Goulet
- Division of Paediatric Gastroenterology Hepatology and Nutrition, University Paris-Centre, Hôpital Necker-Enfants Malades, 149, Rue de Sèvres, 75743, PARIS Cedex 15, France.
| | - Bénédicte Pigneur
- Division of Paediatric Gastroenterology Hepatology and Nutrition, University Paris-Centre, Hôpital Necker-Enfants Malades, 149, Rue de Sèvres, 75743, PARIS Cedex 15, France
| | - Fabienne Charbit-Henrion
- Department of Genetics, Hôpital Necker-Enfants Malades, 149, Rue de Sèvres, 75743, PARIS Cedex 15, France
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Rahmani F, Rayzan E, Rahmani MR, Shahkarami S, Zoghi S, Rezaei A, Aryan Z, Najafi M, Rohlfs M, Jeske T, Aflatoonian M, Chavoshzadeh Z, Farahmand F, Motamed F, Rohani P, Alimadadi H, Mahdaviani A, Mansouri M, Tavakol M, Vanderberg M, Kotlarz D, Klein C, Rezaei N. Clinical and Mutation Description of the First Iranian Cohort of Infantile Inflammatory Bowel Disease: The Iranian Primary Immunodeficiency Registry (IPIDR). Immunol Invest 2020; 50:445-459. [PMID: 32633164 DOI: 10.1080/08820139.2020.1776725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe a cohort of 25 Iranian patients with infantile inflammatory bowel disease (IBD), 14 (56%) of whom had monogenic defects. After proper screening, patients were referred for whole exome sequencing (WES). Four patients had missense mutations in the IL10 RA, and one had a large deletion in the IL10 RB. Four patients had mutations in genes implicated in host:microbiome homeostasis, including TTC7A deficiency, and two patients with novel mutations in the TTC37 and NOX1. We found a novel homozygous mutation in the SRP54 in a deceased patient and the heterozygous variant in his sibling with a milder phenotype. Three patients had combined immunodeficiency: one with ZAP-70 deficiency (T+B+NK-), and two with atypical SCID due to mutations in RAG1 and LIG4. One patient had a G6PC3 mutation without neutropenia. Eleven of the 14 patients with monogenic defects were results of consanguinity and only 4 of them were alive to this date.
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Affiliation(s)
- Farzaneh Rahmani
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri, USA.,Student's Scientific Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Elham Rayzan
- International Hematology/Oncology of Pediatrics' Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Rahmani
- Department of Immunology & Hematology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sepideh Shahkarami
- Medical Genetics Network (Megene), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Samaneh Zoghi
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Arezoo Rezaei
- Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aryan
- Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Najafi
- Department of Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meino Rohlfs
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Tim Jeske
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Majid Aflatoonian
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Chavoshzadeh
- Pediatric Infectious Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Farahmand
- Department of Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Motamed
- Department of Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Rohani
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Alimadadi
- Department of Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mahdaviani
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mansouri
- Immunology and Allergy Department, Mofid Children Hospital, Shahid Behehshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Tavakol
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mirjam Vanderberg
- Laboratory for Immunology, Dept. Of Pediatrics, Leiden University Medical Center, Netherlands
| | - Daniel Kotlarz
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Nima Rezaei
- Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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5
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Vély F, Barlogis V, Marinier E, Coste ME, Dubern B, Dugelay E, Lemale J, Martinez-Vinson C, Peretti N, Perry A, Bourgeois P, Badens C, Goulet O, Hugot JP, Farnarier C, Fabre A. Combined Immunodeficiency in Patients With Trichohepatoenteric Syndrome. Front Immunol 2018; 9:1036. [PMID: 29868001 PMCID: PMC5958188 DOI: 10.3389/fimmu.2018.01036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/01/2017] [Accepted: 04/25/2018] [Indexed: 11/13/2022] Open
Abstract
The syndromic diarrhea/trichohepatoenteric syndrome (SD/THE) is a rare and multi-system genetic disorder caused by mutation in SKIV2L or in TTC37, two genes encoding subunits of the putative human SKI complex involved in RNA degradation. The main features are intractable diarrhea of infancy, hair abnormalities, facial dysmorphism, and intrauterine growth restriction. Immunologically this syndrome is associated with a hypogammaglobulinemia leading to an immunoglobulin supplementation. Our immune evaluation of a large French cohort of SD/THE patient revealed several immunological defects. First, switched memory B lymphocytes count is very low. Second, IFN-γ production by T and NK cells is impaired and associated with a reduced degranulation of NK cells. Third, T cell proliferation was abnormal in 3/6 TTC37-mutated patients. These three patients present with severe EBV infection and a transient hemophagocytosis which may be related to these immunological defects. Moreover, an immunological screening of patients with clinical features of SD/THE could facilitate both diagnosis and therapeutic management of these patients.
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Affiliation(s)
- Frédéric Vély
- Aix Marseille Univ, CNRS, INSERM, CIML, Marseille, France.,APHM, Hôpital de la Timone, Service d'Immunologie, Marseille-Immunopôle, Marseille, France
| | - Vincent Barlogis
- APHM, Hôpital de la Timone, Service d'Hématologie et Oncologie Pédiatrique, Marseille, France
| | - Evelyne Marinier
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Marie-Edith Coste
- APHM, Hôpital de la Timone Enfant, Service de Pédiatrie Multidisciplinaire, Marseille, France
| | - Béatrice Dubern
- Nutrition et Gastroentérologie Pédiatriques, Hôpital Armand-Trousseau, UMR-S U1166 Nutriomics, UPMC, Sorbonne University, Paris, France
| | - Emmanuelle Dugelay
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Julie Lemale
- Nutrition et Gastroentérologie Pédiatriques, Hôpital Armand-Trousseau, UMR-S U1166 Nutriomics, UPMC, Sorbonne University, Paris, France
| | - Christine Martinez-Vinson
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Noël Peretti
- Department of Pediatric Nutrition, University Pediatric Hospital of Lyon, Hospices Civils de Lyon HCL, INSERM U1060, CarMeN Laboratory, University Claude Bernard Univ Lyon-1, Lyon, France
| | - Ariane Perry
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Centre de référence des maladies héréditaires du métabolisme hépatique, Clamart, France
| | - Patrice Bourgeois
- APHM, Hôpital de la Timone Enfant, Service de biologie moléculaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Catherine Badens
- APHM, Hôpital de la Timone Enfant, Service de biologie moléculaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Olivier Goulet
- APHP, Necker-Enfants Malades Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris-Descartes University, Intestinal Failure Rehabilitation Center, National Reference Centre for Rare Digestive Diseases, Paris, France
| | - Jean-Pierre Hugot
- APHP, Hôpital Robert Debré, Paris, France.,UMR 1149, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Labex Inflamex, Université Paris-Diderot Sorbonne Paris-Cité, Paris, France
| | - Catherine Farnarier
- APHM, Hôpital de la Timone, Service d'Immunologie, Marseille-Immunopôle, Marseille, France
| | - Alexandre Fabre
- APHM, Hôpital de la Timone Enfant, Service de Pédiatrie Multidisciplinaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
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6
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Bourgeois P, Esteve C, Chaix C, Béroud C, Lévy N, Fabre A, Badens C. Tricho-Hepato-Enteric Syndrome mutation update: Mutations spectrum of TTC37 and SKIV2L, clinical analysis and future prospects. Hum Mutat 2018. [PMID: 29527791 DOI: 10.1002/humu.23418] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tricho-Hepato-Enteric syndrome (THES) is a very rare autosomal recessive syndromic enteropathy caused by mutations of either TTC37 or SKIV2L genes. Very little is known of these two gene products in mammals nor of the pathophysiology of the disease. Since the identification of the genes, we have set up the molecular diagnostic of THES in routine, gathering a large cohort with clinical and molecular data. Here, we report the phenotype and genotype analysis of this cohort together with an extensive literature review of THES cases worldwide, that is, 96 individuals harboring mutations in one gene or the other. We set up locus-specific databases for both genes and reviewed the type of mutation as well as their localization in the proteins. No hot spot is evidenced for any type of mutation. The phenotypic analysis was first made on the whole cohort but is limited due to heterogeneity in clinical descriptions. We then examined the lab diagnostic cohort in detail for clinical manifestations. For the first time, we are able to suggest that patients lacking SKIV2L seem more severely affected than those lacking TTC37, in terms of liver damage and prenatal growth impairment.
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Affiliation(s)
- Patrice Bourgeois
- Molecular genetics Laboratory, Medical genetics and Cell biology Department, La Timone children's hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France.,GMGF, Aix Marseille Univ, Marseille, France
| | | | - Charlène Chaix
- Molecular genetics Laboratory, Medical genetics and Cell biology Department, La Timone children's hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France
| | - Christophe Béroud
- Molecular genetics Laboratory, Medical genetics and Cell biology Department, La Timone children's hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France.,GMGF, Aix Marseille Univ, Marseille, France
| | - Nicolas Lévy
- Molecular genetics Laboratory, Medical genetics and Cell biology Department, La Timone children's hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France.,GMGF, Aix Marseille Univ, Marseille, France
| | | | - Alexandre Fabre
- GMGF, Aix Marseille Univ, Marseille, France.,Multidisciplinary Pediatric Service - La Timone Children's Hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France
| | - Catherine Badens
- Molecular genetics Laboratory, Medical genetics and Cell biology Department, La Timone children's hospital, Assistance-Publique des Hôpitaux de Marseille (APHM), Marseille, France.,GMGF, Aix Marseille Univ, Marseille, France
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7
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Abstract
The RNA exosome is an evolutionarily conserved, ribonuclease complex that is critical for both processing and degradation of a variety of RNAs. Cofactors that associate with the RNA exosome likely dictate substrate specificity for this complex. Recently, mutations in genes encoding both structural subunits of the RNA exosome and its cofactors have been linked to human disease. Mutations in the RNA exosome genes EXOSC3 and EXOSC8 cause pontocerebellar hypoplasia type 1b (PCH1b) and type 1c (PCH1c), respectively, which are similar autosomal-recessive, neurodegenerative diseases. Mutations in the RNA exosome gene EXOSC2 cause a distinct syndrome with various tissue-specific phenotypes including retinitis pigmentosa and mild intellectual disability. Mutations in genes that encode RNA exosome cofactors also cause tissue-specific diseases with complex phenotypes. How mutations in these genes give rise to distinct, tissue-specific diseases is not clear. In this review, we discuss the role of the RNA exosome complex and its cofactors in human disease, consider the amino acid changes that have been implicated in disease, and speculate on the mechanisms by which exosome gene mutations could underlie dysfunction and disease.
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Affiliation(s)
- Derrick J Morton
- Department of Biology, Emory University, NE, Atlanta, Georgia 30322, USA
| | - Emily G Kuiper
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Stephanie K Jones
- Department of Biology, Emory University, NE, Atlanta, Georgia 30322, USA
- Genetics and Molecular Biology Graduate Program, Emory University, NE, Atlanta, Georgia 30322, USA
| | - Sara W Leung
- Department of Biology, Emory University, NE, Atlanta, Georgia 30322, USA
| | - Anita H Corbett
- Department of Biology, Emory University, NE, Atlanta, Georgia 30322, USA
| | - Milo B Fasken
- Department of Biology, Emory University, NE, Atlanta, Georgia 30322, USA
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8
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Neves JF, Afonso I, Borrego L, Martins C, Cordeiro AI, Neves C, Lacoste C, Badens C, Fabre A. Missense mutation of TTC7A mimicking tricho-hepato-enteric (SD/THE) syndrome in a patient with very-early onset inflammatory bowel disease. Eur J Med Genet 2017; 61:185-188. [PMID: 29174094 DOI: 10.1016/j.ejmg.2017.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/04/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
Tricho-hepato-enteric syndrome (SD/THE) and Multiple intestinal atresia with combined immune deficiency (MIA-CID) are autosomal recessive disorders that present immunological and gastrointestinal features. There are two different phenotypes of patients with TTC7A mutations: the severe form, caused by null mutations and leading to the classical MIA-CID; and the mild form, caused by missense mutations and leading to predominant features of VEO-IBD, less severe immunological involvement and hair abnormalities. We expand the knowledge about TTC7A deficiency, describing a patient with the mild phenotype of TTC7A deficiency but presenting overlapping features of SD/THE and MIA-CID: intestinal atresia and inflammatory bowel disease evocative of MIA-CID, but also dental abnormalities, huge forehead, liver abnormalities, autoimmune thyroiditis and hypogammaglobulinemia, evocative of SD/THE.
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Affiliation(s)
- João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal.
| | - Isabel Afonso
- Gastroenterology Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Luis Borrego
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal; Immunoallergy Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - Catarina Martins
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Caroline Lacoste
- Laboratoire de Génétique Moléculaire, Hôpital d'enfants de la Timone, APHM, Marseille, France
| | - Catherine Badens
- Laboratoire de Génétique Moléculaire, Hôpital d'enfants de la Timone, APHM, Marseille, France; Faculté de Médecine, Inserm UMRS 910, Aix-Marseille Université, Marseille, France
| | - Alexandre Fabre
- Faculté de Médecine, Inserm UMRS 910, Aix-Marseille Université, Marseille, France; Service de Pédiatrie Multidisciplinaire, Hôpital d'enfants de la Timone, 264 rue Saint Pierre, APHM, 13005 Marseille, France
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9
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Fabre A, Bourgeois P, Coste ME, Roman C, Barlogis V, Badens C. Management of syndromic diarrhea/tricho-hepato-enteric syndrome: A review of the literature. Intractable Rare Dis Res 2017; 6:152-157. [PMID: 28944135 PMCID: PMC5608923 DOI: 10.5582/irdr.2017.01040] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) is a rare disease linked to the loss of function of either TTC37 or SKIV2L, two components of the SKI complex. It is characterized by a combination of 9 signs (intractable diarrhea, hair abnormalities, facial dysmorphism, immune abnormalities, IUGR/SGA, liver abnormalities, skin abnormalities, congenital heart defect and platelet abnormalities). We present a comprehensive review of the management of SD/THE and tested therapeutic regimens. A review of the literature was conducted in May 2017: 29 articles and 2 abstracts were included describing a total of 80 patients, of which 40 presented with mutations of TTC37, 14 of SKIV2L. Parenteral nutrition was used in the management of 83% of the patients and weaned in 44% (mean duration of 14.97 months). Immunoglobulins were used in 33 patients, but data on efficacy was reported for 6 patients with a diminution of infection (n = 3) or diarrhea reduction (n = 2). Antibiotics (n = 11) provided no efficacy. Steroids (n = 17) and immunosuppressant drugs (n = 13) were used with little efficacy and mostly in patients with IBD-like SD/THE. Hematopoietic stem cell transplantation (HSCT) was performed in 4 patients: 2 died, for one it corrected the immune defects but not the other features and for the last one, it provided only a partial improvement. Finally, no specific diet was effective except for some contradictory reports for elemental formula. In conclusion, the management of SD/THE mainly involves parenteral nutrition and immunoglobulin supplementation. Antibiotics, steroids, immunosuppressants, and HSCT are not recommended as principle treatments since there is no evidence of efficacy.
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Affiliation(s)
- Alexandre Fabre
- Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone, APHM, Marseille, France
- Aix Marseille Université, INSERM, Génétique Médicale et Génomique Fonctionnelle (GMGF), UMRS 910, Marseille, France
- Address correspondence to: Dr. Alexandre Fabre, Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone Enfant, 264 Rue Saint Pierre, Marseille 13005, France. E-mail:
| | - Patrice Bourgeois
- Aix Marseille Université, INSERM, Génétique Médicale et Génomique Fonctionnelle (GMGF), UMRS 910, Marseille, France
- Service de génétique moléculaire, Hôpital de la Timone Enfant, APHM, Marseille, France
| | - Marie-Edith Coste
- Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone, APHM, Marseille, France
| | - Céline Roman
- Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone, APHM, Marseille, France
| | - Vincent Barlogis
- Service d'hématologie pédiatrique, Hôpital de la Timone, APHM, Marseille, France
| | - Catherine Badens
- Aix Marseille Université, INSERM, Génétique Médicale et Génomique Fonctionnelle (GMGF), UMRS 910, Marseille, France
- Service de génétique moléculaire, Hôpital de la Timone Enfant, APHM, Marseille, France
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Lee WS, Teo KM, Ng RT, Chong SY, Kee BP, Chua KH. Novel mutations in SKIV2L and TTC37 genes in Malaysian children with trichohepatoenteric syndrome. Gene 2016; 586:1-6. [PMID: 27050310 DOI: 10.1016/j.gene.2016.03.049] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder that is classically associated with intractable diarrhea with an onset within the first few months of life. Herein, we investigated and reported novel mutations in two causal genes in 3 Malaysian cases. Genomic DNA was extracted from peripheral blood obtained from patients in two Malaysian Chinese families. The exons of SKIV2L and TTC37 genes were amplified and sequenced by bi-directional sequencing to identify the point mutations within the coding sequence. Three Chinese boys from two families with characteristic features and clinical course were diagnosed with THES. In family-1, two point mutations were identified in the SKIV2L gene (c.1891G>A and c.3187C>T). In family-2, a single-nucleotide duplication (c.3426dupA) was found in the TTC37 gene. These mutations cause the production of abnormal non-functional gene product leading to the clinical manifestations in the patients. We reported three point mutations, which have not been previously described in other patients with THES in SKIV2L and TTC37 genes, including one nonsense, one frameshift, and one missense mutations.
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Affiliation(s)
- Way Seah Lee
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia; University Malaya Paediatric and Child Health Research Group, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Kai Ming Teo
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ruey Terng Ng
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Sze Yee Chong
- Department of Paediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Boon Pin Kee
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Chong JH, Jamuar SS, Ong C, Thoon KC, Tan ES, Lai A, Aan MKJ, Tan WLW, Foo R, Tan EC, Lau YL, Liew WK. Tricho-hepato-enteric syndrome (THE-S): two cases and review of the literature. Eur J Pediatr 2015; 174:1405-11. [PMID: 25976726 DOI: 10.1007/s00431-015-2563-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/03/2015] [Accepted: 05/06/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Tricho-hepato-enteric syndrome (THE-S) is characterized by severe infantile diarrhea, failure to thrive, dysmorphism, woolly hair, and immune or hepatic dysfunction. We report two cases of East Asian descent with THE-S who had remained undiagnosed despite extensive investigations but were diagnosed on whole exome sequencing (WES). Both cases presented with chronic diarrhea, failure to thrive, and recurrent infections. Case 1 had posteriorly rotated low set ears, mild retrognathia, and fine curly hypopigmented hair. She was managed with prolonged total parenteral nutrition and intravenous immunoglobulin infusions. Case 2 had sparse coarse brown hair as well as multiple lentigines and café-au-lait macules. She was managed with amino acid-based formula. For both cases, routine investigations were inconclusive. WES in both cases showed biallelic truncating mutations in TTC37 (c.3507T>G;p.Y1169X and c.3601C>T;p.R1201X in case 1 and c.3507T>G;p.Y1169X and c.154G>T;p.E52X in case 2), suggesting a diagnosis of THE-S. CONCLUSION We present novel mutations in the TTC37 gene in two individuals of East Asian descent with the rare THE-S, detected by WES. Future identification of patients with THE-S and establishing genotype-phenotype correlations will aid in counseling the patients and their families. WHAT IS KNOWN • Tricho-Hepato-Enteric syndrome (THE-S) is characterized by severe infantile diarrhea, failure to thrive, dysmorphism, woolly hair, and immune or hepatic dysfunction. • Complex patients with diagnostic dilemmas undergo extensive investigations. What is New: • This is a report of novel mutations in TTC37 in individuals of East Asian descent. • Whole exome sequencing (WES) can be useful in certain complex cases with diagnostic dilemmas.
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Affiliation(s)
- Jin Ho Chong
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Christina Ong
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Koh Cheng Thoon
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Ee Shien Tan
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Angeline Lai
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Mark Koh Jean Aan
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore.
| | | | - Roger Foo
- Genome Institute of Singapore, Singapore, Singapore.
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
| | - Woei Kang Liew
- Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
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12
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Fabre A, Badens C. Human Mendelian diseases related to abnormalities of the RNA exosome or its cofactors. Intractable Rare Dis Res 2014; 3:8-11. [PMID: 25343120 PMCID: PMC4204543 DOI: 10.5582/irdr.3.8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 02/01/2014] [Revised: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 01/03/2023] Open
Abstract
The RNA exosome has a key role in RNA decays and RNA quality control. In 2012, two human Mendelian diseases: syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) and Ponto-cerebellar hypoplasia type 1(PCH1) were linked to the RNA exosome or its cofactor's defect. SD/THE's main features are an intractable diarrhea of infancy associated with hair abnormalities, facial dysmorphism, intra uterine growth restriction and immune deficiency. SD/THE is caused by a defect of the SKI complex (TTC37 and SKIV2L), the cytoplasmic co-factor of the RNA exosome for mRNA degradation. PCH1's main features are atrophy of the pons and of the cerebellum, a progressive microcephaly with developmental delay and muscle atrophy secondary to spinal anterior horn cell loss. In 30-40% of patients, PCH1 is caused by a defect in EXOSC3 which encodes RRP40, a protein of the cap of the RNA exosome. Thanks to knowledge about other forms of PCH it could be assumed that the altered substrates are probably transfer RNA However, as there exists no patient with two null mutations, residual RNA exosome functionality is probably required to preserve viability. Thus, to date two very different human Mendelian diseases have been related to the dysfunctioning of the RNA exosome. It illustrates the versatility of the RNA exosome function and substrate.
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Affiliation(s)
- Alexandre Fabre
- Service de pédiatrie Multidisciplinaire, Hôpital des Enfants de la Timone, APHM, Marseille, France
- UMR_S 910, Aix-Marseille Université, Marseille, France
- Address correspondence to: Dr. Alexandre Fabre, Service de pédiatrie Multidisciplinaire, Hôpital des Enfants de la Timone, APHM, Marseille, France. E-mail:
| | - Catherine Badens
- UMR_S 910, Aix-Marseille Université, Marseille, France
- Service de Génétique Moléculaire, Hôpital des Enfants de la Timone, APHM, Marseille, France
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