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Chen B, Wang L, Xie D, Wang Y. Bioinformatics-based discovery of biomarkers and immunoinflammatory targets in children with cerebral palsy: An observational study. Medicine (Baltimore) 2024; 103:e37828. [PMID: 38640267 PMCID: PMC11029991 DOI: 10.1097/md.0000000000037828] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/21/2024] Open
Abstract
Cerebral palsy (CP) is the most common disabling disease in children, and motor dysfunction is the core symptom of CP. Although relevant risk factors have been found to be closely associated with CP: congenital malformations, multiple gestation, prematurity, intrauterine inflammation and infection, birth asphyxia, thrombophilia, and perinatal stroke. Its important pathophysiological mechanism is amniotic fluid infection and intraamniotic inflammation leading to fetal developing brain damage, which may last for many years. However, the molecular mechanism of CP is still not well explained. This study aimed to use bioinformatics to identify key biomarker-related signaling pathways in CP. The expression profile of children with CP was selected from the Gene Expression Comprehensive Database, and the CP disease gene data set was obtained from GeneCards. A protein-protein interaction network was established and functional enrichment analysis was performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases. A total of 144 differential key intersection genes and 10 hub genes were identified through molecular biology. Gene Ontology functional enrichment analysis results show that differentially expressed genes are mainly concentrated in biological processes, such as immune response and neurogenesis. The cellular components involved mainly include axons, postsynaptic membranes, etc, and their molecular functions mainly involve proteoglycan binding, collagen binding, etc. Kyoto Encyclopedia of Genes and Genomes analysis shows that the intersection genes are mainly in signaling pathways related to the immune system, inflammatory response, and nervous system, such as Th17 cell differentiation, Toll-like receptor signaling pathway, tumor necrosis factor signaling pathway, NF-κB signaling pathway, axon guidance, PI3K-Akt signaling pathway, HIF-1 signaling pathway, gap junction, etc. Jak-STAT signaling pathway, mTOR signaling pathway, and related hub genes regulate immune cells and inflammatory factors and play an important role in the development and progression of CP.
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Affiliation(s)
- Bo Chen
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
- Department of Rehabilitation Science, Hong Kong Polytechnic University, Hong Kong, China
| | - Ling Wang
- Department of Operating Room, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Dongke Xie
- Pediatric Surgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Yuanhui Wang
- Pediatric Surgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
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Fehlings DL, Zarrei M, Engchuan W, Sondheimer N, Thiruvahindrapuram B, MacDonald JR, Higginbotham EJ, Thapa R, Behlim T, Aimola S, Switzer L, Ng P, Wei J, Danthi PS, Pellecchia G, Lamoureux S, Ho K, Pereira SL, de Rijke J, Sung WWL, Mowjoodi A, Howe JL, Nalpathamkalam T, Manshaei R, Ghaffari S, Whitney J, Patel RV, Hamdan O, Shaath R, Trost B, Knights S, Samdup D, McCormick A, Hunt C, Kirton A, Kawamura A, Mesterman R, Gorter JW, Dlamini N, Merico D, Hilali M, Hirschfeld K, Grover K, Bautista NX, Han K, Marshall CR, Yuen RKC, Subbarao P, Azad MB, Turvey SE, Mandhane P, Moraes TJ, Simons E, Maxwell G, Shevell M, Costain G, Michaud JL, Hamdan FF, Gauthier J, Uguen K, Stavropoulos DJ, Wintle RF, Oskoui M, Scherer SW. Comprehensive whole-genome sequence analyses provide insights into the genomic architecture of cerebral palsy. Nat Genet 2024; 56:585-594. [PMID: 38553553 DOI: 10.1038/s41588-024-01686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/13/2024] [Indexed: 04/17/2024]
Abstract
We performed whole-genome sequencing (WGS) in 327 children with cerebral palsy (CP) and their biological parents. We classified 37 of 327 (11.3%) children as having pathogenic/likely pathogenic (P/LP) variants and 58 of 327 (17.7%) as having variants of uncertain significance. Multiple classes of P/LP variants included single-nucleotide variants (SNVs)/indels (6.7%), copy number variations (3.4%) and mitochondrial mutations (1.5%). The COL4A1 gene had the most P/LP SNVs. We also analyzed two pediatric control cohorts (n = 203 trios and n = 89 sib-pair families) to provide a baseline for de novo mutation rates and genetic burden analyses, the latter of which demonstrated associations between de novo deleterious variants and genes related to the nervous system. An enrichment analysis revealed previously undescribed plausible candidate CP genes (SMOC1, KDM5B, BCL11A and CYP51A1). A multifactorial CP risk profile and substantial presence of P/LP variants combine to support WGS in the diagnostic work-up across all CP and related phenotypes.
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Affiliation(s)
- Darcy L Fehlings
- Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mehdi Zarrei
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Worrawat Engchuan
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Neal Sondheimer
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | | | - Jeffrey R MacDonald
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Edward J Higginbotham
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ritesh Thapa
- Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Tarannum Behlim
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sabrina Aimola
- Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lauren Switzer
- Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Pamela Ng
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - John Wei
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakroothi S Danthi
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Pellecchia
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sylvia Lamoureux
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Ho
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sergio L Pereira
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill de Rijke
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wilson W L Sung
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alireza Mowjoodi
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Howe
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Nalpathamkalam
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roozbeh Manshaei
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Siavash Ghaffari
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph Whitney
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rohan V Patel
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Omar Hamdan
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan Shaath
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brett Trost
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shannon Knights
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Grandview Children's Centre, Oshawa, Ontario, Canada
| | - Dawa Samdup
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Carolyn Hunt
- Grandview Children's Centre, Oshawa, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics, Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Anne Kawamura
- Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ronit Mesterman
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nomazulu Dlamini
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniele Merico
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Deep Genomics Inc., Toronto, Ontario, Canada
- Vevo Therapeutics Inc., San Francisco, CA, USA
| | - Murto Hilali
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyle Hirschfeld
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kritika Grover
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nelson X Bautista
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kara Han
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christian R Marshall
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan K C Yuen
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piush Mandhane
- Faculty of Medicine & Dentistry, Pediatrics Department, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Translation Medicine & Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - George Maxwell
- Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Michael Shevell
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Departments of Pediatrics and Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Gregory Costain
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacques L Michaud
- Departments of Pediatrics and Neurosciences, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Azrieli Research Center, Montréal, Québec, Canada
| | - Fadi F Hamdan
- CHU Sainte-Justine Azrieli Research Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Julie Gauthier
- CHU Sainte-Justine Azrieli Research Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Kevin Uguen
- CHU Sainte-Justine Azrieli Research Center, Montréal, Québec, Canada
| | - Dimitri J Stavropoulos
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Richard F Wintle
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maryam Oskoui
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Departments of Pediatrics and Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada.
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Zhang J, Zhang Y, Shang Q, Cheng Y, Su Y, Zhang J, Wang T, Ding J, Li Y, Xie Y, Xing Q. Gain-of-Function KIDINS220 Variants Disrupt Neuronal Development and Cause Cerebral Palsy. Mov Disord 2024; 39:498-509. [PMID: 38148610 DOI: 10.1002/mds.29694] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Kinase D-interacting substrate of 220 kDa (KIDINS220) is a multifunctional scaffolding protein essential for neuronal development. It has been implicated in neurological diseases with either autosomal dominant (AD) or autosomal recessive (AR) inheritance patterns. The molecular mechanisms underlying the AR/AD dual nature of KIDINS220 remain elusive, posing challenges to genetic interpretation and clinical interventions. Moreover, increased KIDINS220 exhibited neurotoxicity, but its role in neurodevelopment remains unclear. OBJECTIVE The aim was to investigate the genotype-phenotype correlations of KIDINS220 and elucidate its pathophysiological role in neuronal development. METHODS Whole-exome sequencing was performed in a four-generation family with cerebral palsy. CRISPR/Cas9 was used to generate KIDINS220 mutant cell lines. In utero electroporation was employed to investigate the effect of KIDINS220 variants on neurogenesis in vivo. RESULTS We identified in KIDINS220 a pathogenic nonsense variant (c.4177C > T, p.Q1393*) that associated with AD cerebral palsy. We demonstrated that the nonsense variants located in the terminal exon of KIDINS220 are gain-of-function (GoF) variants, which enable the mRNA to escape nonsense-mediated decay and produce a truncated yet functional KIDINS220 protein. The truncated protein exhibited significant resistance to calpain and consequently accumulated within cells, resulting in the hyperactivation of Rac1 and defects in neuronal development. CONCLUSIONS Our findings demonstrate that the location of variants within KIDINS220 plays a crucial role in determining inheritance patterns and corresponding clinical outcomes. The proposed interaction between Rac1 and KIDINS220 provides new insights into the pathogenesis of cerebral palsy, implying potential therapeutic perspectives. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jin Zhang
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Yandong Zhang
- Department of Anesthesia, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qing Shang
- Department of Pediatric Rehabilitation Medicine, Children's Hospital of Zhengzhou University and Henan Children's Hospital, Zhengzhou, China
| | - Ye Cheng
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Yu Su
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Junjie Zhang
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Ting Wang
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Jian Ding
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Yunqian Li
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Yunli Xie
- Department of Anesthesia, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qinghe Xing
- Children's Hospital of Fudan University and Institutes of Biomedical Sciences of Fudan University, Shanghai, China
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Cheng Y, Xu Y, Li H, Qiao Y, Wang Y, Su Y, Zhang J, Wang X, Song L, Ding J, Wang D, Zhu C, Xing Q. Genetic variants in the HLA region contribute to the risk of cerebral palsy. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167008. [PMID: 38163449 DOI: 10.1016/j.bbadis.2023.167008] [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: 09/26/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Cerebral palsy (CP) is the most common physical disability in childhood, and genetic factors play an important role in its pathogenesis. However, the genetic contributions remain incompletely elucidated. Here, we conducted a two-stage association study between 1090 CP cases and 1100 healthy controls after whole exome sequencing. The human leukocyte antigen (HLA) allelic predispositions were further analyzed in overall CP and subgroups using multivariate logistic regression. We found a strong signal in the HLA region on chromosome 6, where rs3131787 harbored the most significant association with CP (P = 2.05 × 10-14, OR = 2.22). In comparison to controls, the carrier frequencies of HLA-B*13:02 were significantly higher in children with CP (9.82 % in control vs 19.27 % in CP, P = 1.03 × 10-4, OR = 2.17). Furthermore, the effect of HLA-B*13:02 on increasing the risk of CP mainly existed in cryptogenic CP without exposure to premature birth, low birth weight, birth asphyxia, or periventricular leukomalacia. This study indicated a strong association of HLA variants with CP, which implied that immune dysregulation resulting from immunogenetic variants might underlie the pathogenesis of CP. Our findings provide genetic evidence that an immunomodulator may serve as a promising therapeutic intervention for patients with CP by reinstating the neuroinflammation hemostasis.
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Affiliation(s)
- Ye Cheng
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China; Shanghai Center for Women and Children's Health, Shanghai 200062, China
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, The Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou 450052, China
| | - Hongwei Li
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, The Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou 450052, China
| | - Yimeng Qiao
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, The Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou 450052, China
| | - Yangong Wang
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Yu Su
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Jin Zhang
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, The Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou 450052, China; Centre of Perinatal Medicine and Health, Institute of Clinical Science, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Lili Song
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Jian Ding
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Dan Wang
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, The Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou 450052, China; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg 40530, Sweden.
| | - Qinghe Xing
- Children's Hospital of Fudan University, and Institutes of Biomedical Sciences of Fudan University, Shanghai 201102, China; Shanghai Center for Women and Children's Health, Shanghai 200062, China.
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Horber V, Andersen GL, Arnaud C, De La Cruz J, Dakovic I, Greitane A, Hensey O, Himmelmann K, Hollody K, Horridge K, Künzle CT, Marcelli M, Ortibus E, Papavasiliou A, Perra O, Platt MJ, Rackauskaite G, Sigurdardottir S, Troha Gergeli A, Virella D, Krägeloh-Mann I, Sellier E. Prevalence, Clinical Features, Neuroimaging, and Genetic Findings in Children With Ataxic Cerebral Palsy in Europe. Neurology 2023; 101:e2509-e2521. [PMID: 37857495 PMCID: PMC10791054 DOI: 10.1212/wnl.0000000000207851] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 05/30/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To report on prevalence, associated impairments, severity, and neuroimaging findings in children with ataxic cerebral palsy (CP). METHODS In children coded as having ataxic CP in the Central database of Joint Research Center-Surveillance of Cerebral Palsy in Europe (JRC-SCPE) and born during 1980-2010, birth characteristics, severity profiles including associated impairments, neuroimaging patterns, and the presence of syndromes were analyzed. Definitions were according to validated SCPE guidelines. Prevalence over time was estimated using Poisson regression. RESULTS In total, 679 children with ataxic CP were identified in 20 European CP registers. The proportion with ataxic CP was 3.8% and varied from 0% to 12.9%. Prevalence over time showed no significant trend. Approximately 70% of children with ataxic CP were able to walk, and 40% had severe intellectual impairment and a high impairment index. Children with ataxic CP were mostly born at term (79%) and with normal birth weight (77%). Neuroimaging patterns revealed normal findings in 29%, brain maldevelopments in 28.5%, miscellaneous findings in 23.5%, and brain injuries in 19%, according to the SCPE classification. Genetic syndromes were described in 9%. DISCUSSION This register-based multicenter study on children with ataxic CP provides a large sample size for the analysis of prevalence, severity, and origin of this rare CP subtype. Even with strict inclusion and classification criteria, there is variation between registers on how to deal with this subtype, and diagnosis of ataxic CP remains a challenge. Ataxic cerebral palsy differs from other CP subtypes: children with ataxic CP have a disability profile that is more pronounced in terms of cognitive than gross motor dysfunction. They are mostly term born and the origin rarely suggests acquired injuries. In addition to neuroimaging, a comprehensive genetic workup is particularly recommended for children with this CP type.
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Affiliation(s)
- Veronka Horber
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Guro L Andersen
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Catherine Arnaud
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Javier De La Cruz
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Ivana Dakovic
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Andra Greitane
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Owen Hensey
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Kate Himmelmann
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Katalin Hollody
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Karen Horridge
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Christoph T Künzle
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Marco Marcelli
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Els Ortibus
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Antigone Papavasiliou
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Oliver Perra
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Mary J Platt
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Gija Rackauskaite
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Solveig Sigurdardottir
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Anja Troha Gergeli
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Daniel Virella
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Ingeborg Krägeloh-Mann
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
| | - Elodie Sellier
- From the Department of Paediatric Neurology (V.H., I.K.-M.), University Children's Hospital Tübingen, Germany; Norwegian Quality and Surveillance Registry for Cerebral Palsy (G.L.A.), Vestfold Hospital Trust, Tønsberg, Norway; CERPOP (C.A.), UMR 1295 Toulouse University, Inserm, Paul Sabatier University, Toulouse; Clinical Epidemiology Unit (C.A.), University Hospital of Toulouse, France; Imas12 (J.D.L.C.), Hospital Universitario 12 de Octubre, RedSAMID, Madrid Spain; Department of Pediatrics (I.D.), Children's Hospital, University of Zagreb Croatia; Association Rehabilitation Center (A.G.), Riga, Latvia; The Central Remedial Clinic (O.H.), Dublin, Ireland; Department of Pediatrics (K. Himmelmann), Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Regional Rehabilitation Centre (K. Himmelmann), Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatrics (K. Hollody), Faculty of Medicine, University of Pecs, Hungary; Childhood Disability and Development (K. Horridge), University of Sunderland, UK; Zentrum für Kinderneurologie (C.T.K.), Entwicklung und Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland; Developmental Age Mental Health and Rehabilitation Unit (M.M.), ASL (local Health Institution Viterbo), Viterbo, Italy; Department of Development and Regeneration (E.O.), KU Leuven, Belgium; Iaso Children's Hospital (A.P.), Athens, Greece; Queen's University Belfast (O.P.), UK; Norwich Medical School (M.J.P.), University of East Anglia, Norwich, UK; Department of Pediatrics and Adolescent Medicine (G.R.), Aarhus University Hospital, Denmark; Counselling and Diagnostic Centre (S.S.), Iceland Department of Child and Adolescent & Developmental Neurology (A.T.G.), Children´s Hospital, University Medical Centre Ljubljana, Slovenia; PVNPC (D.V.), Programa de Vigilância Nacional da Paralisia Cerebral, Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Grenoble Alpes University (E.S.), CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG; and Registre des Handicaps de l'Enfant et Observatoire Périnatal (E.S.), Grenoble, France
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6
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Sundaramurthi JC, Bagley AM, Blau H, Carmody L, Crandall A, Danis D, Gargano MA, Gustafson AG, Raney EM, Shingle M, Davids JR, Robinson PN. De novo TRPM3 missense variant associated with neurodevelopmental delay and manifestations of cerebral palsy. Cold Spring Harb Mol Case Stud 2023; 9:a006293. [PMID: 37684057 PMCID: PMC10815282 DOI: 10.1101/mcs.a006293] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
We identified a de novo heterozygous transient receptor potential cation channel subfamily M (melastatin) member 3 (TRPM3) missense variant, p.(Asn1126Asp), in a patient with developmental delay and manifestations of cerebral palsy (CP) using phenotype-driven prioritization analysis of whole-genome sequencing data with Exomiser. The variant is localized in the functionally important ion transport domain of the TRPM3 protein and predicted to impact the protein structure. Our report adds TRPM3 to the list of Mendelian disease-associated genes that can be associated with CP and provides further evidence for the pathogenicity of the variant p.(Asn1126Asp).
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Affiliation(s)
| | - Anita M Bagley
- Shriners Children's Northern California, Sacramento, California 95817, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Leigh Carmody
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Amy Crandall
- Shriners Children's, Portland, Oregon 97239, USA
| | - Daniel Danis
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Michael A Gargano
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | | | | | - Mallory Shingle
- Shriners Children's Northern California, Sacramento, California 95817, USA
| | - Jon R Davids
- Shriners Children's Northern California, Sacramento, California 95817, USA
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, California 95817, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA;
- Institute for Systems Genomics, University of Connecticut, Farmington, Connecticut 06032, USA
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7
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Eskandar M, Tochen L, Shin MR, Lavenstein B, Meltzer M, Gropman A, Sen K. Limitations of Multigene Next-Generation Sequencing Panel for "Cerebral Palsy" Phenotype and Other Complex Movement Disorders. Pediatr Neurol 2023; 149:15-18. [PMID: 37757660 DOI: 10.1016/j.pediatrneurol.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
In the past couple of decades, literature in pediatric neurology and clinical genetics has identified hundreds of monogenic disorders that can masquerade as infantile cerebral palsy (CP). Accurate and prompt diagnosis in such cases may be challenging due to several reasons. There are commercial multigene CP panels, but their diagnostic yield is often limited compared with exome sequencing because of diverse etiologies that may mimic CP. We report one such case where a patient with spastic hemiplegia underwent a long diagnostic journey before genetic diagnosis was established with exome sequencing and appropriate management was started. TTC19-related mitochondrial complex III deficiency is an ultrarare disorder of energy metabolism that presents with bilateral lesions in the basal ganglia and a degenerative neuropsychiatric phenotype.
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Affiliation(s)
- Marina Eskandar
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Laura Tochen
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Mi Ran Shin
- Rehabilitation Medicine, Children's National Hospital, Washington, District of Columbia
| | - Bennett Lavenstein
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Meira Meltzer
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Andrea Gropman
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Kuntal Sen
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia.
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8
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van Eyk CL, Fahey MC, Gecz J. Redefining cerebral palsies as a diverse group of neurodevelopmental disorders with genetic aetiology. Nat Rev Neurol 2023; 19:542-555. [PMID: 37537278 DOI: 10.1038/s41582-023-00847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
Cerebral palsy is a clinical descriptor covering a diverse group of permanent, non-degenerative disorders of motor function. Around one-third of cases have now been shown to have an underlying genetic aetiology, with the genetic landscape overlapping with those of neurodevelopmental disorders including intellectual disability, epilepsy, speech and language disorders and autism. Here we review the current state of genomic testing in cerebral palsy, highlighting the benefits for personalized medicine and the imperative to consider aetiology during clinical diagnosis. With earlier clinical diagnosis now possible, we emphasize the opportunity for comprehensive and early genomic testing as a crucial component of the routine diagnostic work-up in people with cerebral palsy.
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Affiliation(s)
- Clare L van Eyk
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
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9
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Gur S, Gurbuz G, Tozkir H. Radiological and Genetic Evaluation in Hypotonic Infants. J Coll Physicians Surg Pak 2023; 33:1028-1034. [PMID: 37691366 DOI: 10.29271/jcpsp.2023.09.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/11/2022] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To investigate the importance and diagnostic yield of genetic and radiological evaluations in children with hypotonia. STUDY DESIGN Comparative observational study. Place and Duration of the Study: Department of Pediatrics Neurology, Namik Kemal University, Tekirdag, Turkey, between 2019 and 2022. METHODOLOGY Patients' medical histories, laboratory results, radiological examinations, and genetic tests, if any, were obtained retrospectively from the patients' clinic files. Children with hypotonia detected since the infantile period and who were on regular follow-up were included in the study. Patients who lost the follow-up were excluded. RESULTS Out of one hundred and seventy patients, 61.8% (n=105) were boys and 38.2% (n=65) were girls. The admission age of the patients ranged from 1 to 121 months; the mean age at presentation was 13.52±17.35 months. Hypotonia was central in 85.3% (n=145), peripheral in 12.4% (n=21), and mixed in 2.3% (n=4). Cerebral palsy was the predominant, non-genetic clinical cause of hypotonia (n=66, 39%). Brain magnetic resonance imaging (MRI) was normal in 48.2% (n=82). The most common MRI abnormality was periventricular leukomalacia in 15.9% (n=27). Sixty-five (38.2%) patients were diagnosed genetically. More than half of the patients with a genetic diagnosis were diagnosed by whole exome sequencing (WES). CONCLUSION Brain MRI is the first choice for the patients with central hypotonia. Patients who cannot be diagnosed with clinical findings and brain MRI should undergo WES. This is helpful for the long-term prognosis and management. KEY WORDS Hypotonia, Whole exome sequencing, Magnetic resonance, Spinal muscular atrophy, Cerebral palsy.
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Affiliation(s)
- Selen Gur
- Department of Pediatrics, Namik Kemal University, Tekirdag, Turkey
| | - Gurkan Gurbuz
- Department of Pediatrics Neurology, Namik Kemal University, Tekirdag, Turkey
| | - Hilmi Tozkir
- Department of Medical Genetics, Namik Kemal University, Tekirdag, Turkey
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10
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Affiliation(s)
- Mark I Evans
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David W Britt
- Fetal Medicine Foundation of America, New York, New York
| | - Lawrence D Devoe
- Department of Obstetrics and Gynecology Medical College of Georgia at Augusta University, Augusta
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11
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Affiliation(s)
- Ting Zhang
- Department of Rehabilitation, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Tingsong Li
- Department of Rehabilitation, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China
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12
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Myers SM, Martin CL, Moreno-De-Luca A. Implications of Genetic Variants in Cerebral Palsy-Reply. JAMA Pediatr 2023; 177:872-873. [PMID: 37358842 DOI: 10.1001/jamapediatrics.2023.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Scott M Myers
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
| | - Christa L Martin
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
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13
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Yu Y, Jia X, Yin H, Jiang H, Du Y, Yang F, Yang Z, Li H. A novel variant in BCL11B in an individual with neurodevelopmental delay: A case report. Mol Genet Genomic Med 2023; 11:e2132. [PMID: 36683525 PMCID: PMC10094078 DOI: 10.1002/mgg3.2132] [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: 10/09/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND B-Cell CLL/Lymphoma 11B (BCL11B) is a C2 H2 zinc finger transcription factor that has broad biological functions and is essential for the development of the immune system, neural system, cardiovascular system, dermis, and dentition. Variants of BCL11B have been found in patients with neurodevelopmental disorders and immunodeficiency. MATERIALS AND METHODS Whole-exome sequencing (WES) and clinical examinations were performed to identify the etiology of our patient. A variant in the BCL11B gene, NM_138576.4: c.1206delG (p.Phe403Serfs*2) was found and led to frameshift truncation. RESULTS We reported a male patient with developmental delay and cerebral palsy who carried the BCL11B variant. The detailed clinical features, such as brain structure and immune detection, were described and reviewed in comparison to previous patients. CONCLUSIONS The BCL11B-related neurodevelopmental disorders are rare, and only 17 variants in 25 patients have been found to date. Our report expands the variants spectrum of BCL11B and increases the case of neurodevelopmental abnormalities.
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Affiliation(s)
- Yonglin Yu
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Xiaoyi Jia
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Hongwei Yin
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Hongfang Jiang
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Yu Du
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | | | | | - Haifeng Li
- Department of Rehabilitation, the Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
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14
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Cif L, Demailly D, Gehin C, Chan Seng E, Dornadic M, Huby S, Poulen G, Roubertie A, Villessot M, Roujeau T, Coubes P. Deep brain stimulation effect in genetic dyskinetic cerebral palsy: The case of ADCY5- related disease. Mol Genet Metab 2023; 138:106970. [PMID: 36610259 DOI: 10.1016/j.ymgme.2022.106970] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/06/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cerebral Palsy (CP) represents a frequent cause of disability in childhood. Early in life, genetic disorders may present with motor dysfunction and diagnosed as CP. Establishing the primary, genetic etiology allows more accurate prognosis, genetic counselling, and planning for symptomatic interventions in homogeneous etiological groups. Deep brain stimulation (DBS) is recommended in refractory movement disorders, including isolated pediatric dystonias. For dystonia evolving in more complex associations in genetic CP, the effect of DBS is still understudied and currently only sporadically described. OBJECTIVES To report the effect of DBS applied to the globus pallidus pars interna (GPi) in children with complex movement disorders caused by pathogenic ADCY5 variants, diagnosed as dyskinetic CP previous to genetic diagnostic. METHODS We conducted a retrospective study on evolution of treatment with DBS in ADCY5-related disease. A standardized proforma including the different type of movement disorders and associated neurological signs was completed at each follow-up time, based on video recordings, as well as functional assessments used in children with CP. RESULTS Four children (mean of age, 13 ± 2.9 years) received GPi-DBS. The same de novo pathogenic missense variant (c.1252C > T, p.R418W) was identified in three out of four and a splice site variant (c.2088 + 2G > T) in one subject. Developmental delay and overlapping features including axial hypotonia, chorea, dystonic attacks, myoclonus, and cranial dyskinesia were present. The median age at DBS was 9 years and follow-up with DBS, 2.6 years. We identified a pattern of clinical response with early suppression of dystonic attacks, followed by improvement of myoclonus and facial dyskinesia. Effect on chorea was delayed and more limited. Two patients gained notable functional benefit related to sitting, standing, gait, use of upper limbs and speech. CONCLUSION ADCY5-related disease may benefit from GPi-DBS. The most significant clinical response relates to the early and sustained benefit on dystonic attacks and a variable but still positive response on the other hyperkinetic features. Genetic etiology of CP will contribute to further elucidate genotype-phenotype correlations and to refine DBS indication as network-related symptomatic interventions.
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Affiliation(s)
- Laura Cif
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France.
| | - Diane Demailly
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Claire Gehin
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Emilie Chan Seng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Morgan Dornadic
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sophie Huby
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Gaetan Poulen
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Agathe Roubertie
- Department of Neuropaediatrics, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Matthieu Villessot
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Thomas Roujeau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Philippe Coubes
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
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Abstract
Genome-wide sequencing (exome and whole genome) has transformed our ability to diagnose patients with suspected genetic disorders. Cerebral palsy (CP), although historically thought to be due to birth injury (perinatal hypoxia), represents a clinical spectrum of disorders, many of which have been attributed to a genetic cause. GWS has elucidated the underlying single gene cause for many patients with CP and has important implications for the customization of treatment, management, and genetic counseling. International guidelines recommend genetic counseling for all families considering genome-wide sequencing. Genetic counselors educate and support families and help them to make testing decisions based on their values. They can help families adapt to, and understand the implications of a genomic diagnosis. Here, we review advances in sequencing for CP, clinical features suggestive of a genetic etiology of CP, practice guidelines for GWS, and a practical approach to the genetic counseling of these families. This includes: the content to be addressed in pre-test and post-test genetic counseling sessions, the benefits of a establishing a genetic cause and importantly, the need for ongoing support.
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Affiliation(s)
- Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada.
| | - Colleen Guimond
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Srivastava S, Lewis SA, Kruer MC, Poduri A. Underrepresentation of the term cerebral palsy in clinical genetics databases. Am J Med Genet A 2022; 188:3555-3557. [PMID: 35959765 PMCID: PMC9939051 DOI: 10.1002/ajmg.a.62930] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Siddharth Srivastava
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara A. Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Cellular & Molecular Medicine, and Neurology, and Program in Genetics, University of Arizona College of Medicine – Phoenix
| | - Michael C. Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital; Departments of Child Health, Cellular & Molecular Medicine, and Neurology, and Program in Genetics, University of Arizona College of Medicine – Phoenix
| | - Annapurna Poduri
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Al Zahrani H, Siriwardena K, Young D, Lehman A, Horvath GA, Goez H. Genomics in Cerebral Palsy phenotype across the lifespan: Comparison of diagnostic yield between children and adult population. Mol Genet Metab 2022; 137:420-427. [PMID: 34364746 DOI: 10.1016/j.ymgme.2021.07.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The presentation and underlying etiology of Cerebral Palsy (CP) in general are heterogenous. Clinical features present differently in pediatric versus adult patient populations. Many metabolic and genetic conditions present with clinical symptoms suggestive of CP. Precision medicine practices are currently a standard of care, and Next-Generation-Sequencing (NGS) tools are used for the purpose of diagnosis and management. We describe the diagnostic yield and impact on management of NGS comparing a cohort of 102 children and 37 adults with CP, referred to two tertiary care centres between 2015 and 2020 (adult cohort) and 2017-2020 (pediatric cohort) respectively. PRINCIPAL RESULTS In the adult cohort, 28 patients had a positive genetic diagnosis, giving a yield of 75.6%. Their age varied between 18 and 59 years, with a median of 28 years. Out of the positive diagnoses, 12 were consistent with an inborn error of metabolism and in 9 patients (32.1%) some form of treatment or management guideline was recommended. In the pediatric cohort 21 patients had a positive genetic diagnosis and 22 results are still pending, giving a yield of 32.8%. Age at diagnosis ranged between 18 months and 12 years. In 15 patients (71.4%) there was some form of management recommendation. All families benefited from genetic counseling. MAJOR CONCLUSIONS Given the combined high yield of positive genetic diagnosis in pediatric and adult cases presenting with symptoms of Cerebral Palsy, and the more readily available Next Generation Sequencing testing in major academic centres, we recommend that either a referral to a pediatric or adult neurometabolic centre to be made, or genetic testing to be initiated where this is available.
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Affiliation(s)
- Haifa Al Zahrani
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Canada
| | - Dana Young
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Anna Lehman
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Gabriella A Horvath
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, Canada.
| | - Helly Goez
- Pediatric Neurometabolic Clinic, Glenrose Rehabilitation Hospital, Stollery Children's Hospital, Edmonton, Alberta, Canada
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18
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Srivastava S, Lewis SA, Cohen JS, Zhang B, Aravamuthan BR, Chopra M, Sahin M, Kruer MC, Poduri A. Molecular Diagnostic Yield of Exome Sequencing and Chromosomal Microarray in Cerebral Palsy: A Systematic Review and Meta-analysis. JAMA Neurol 2022; 79:1287-1295. [PMID: 36279113 PMCID: PMC9593320 DOI: 10.1001/jamaneurol.2022.3549] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023]
Abstract
Importance There are many known acquired risk factors for cerebral palsy (CP), but in some cases, CP is evident without risk factors (cryptogenic CP). Early CP cohort studies report a wide range of diagnostic yields for sequence variants assessed by exome sequencing (ES) and copy number variants (CNVs) assessed by chromosomal microarray (CMA). Objective To synthesize the emerging CP genetics literature and address the question of what percentage of individuals with CP have a genetic disorder via ES and CMA. Data Sources Searched articles were indexed by PubMed with relevant queries pertaining to CP and ES/CMA (query date, March 15, 2022). Study Selection Inclusion criteria were as follows: primary research study, case series with 10 or more nonrelated individuals, CP diagnosis, and ES and/or CMA data used for genetic evaluation. Nonblinded review was performed. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for assessing data quality and validity. Data were extracted by a single observer. Main Outcomes and Measures A separate meta-analysis was performed for each modality (ES, CMA). The primary outcome was proportion/molecular diagnostic yield (number of patients with a discovered genetic disorder divided by the total number of patients in the cohort), evaluated via meta-analysis of single proportions using random-effects logistic regression. A subgroup meta-analysis was conducted, using risk factor classification as a subgroup. A forest plot was used to display diagnostic yields of individual studies. Results In the meta-analysis of ES yield in CP, the overall diagnostic yield of ES among the cohorts (15 study cohorts comprising 2419 individuals from 11 articles) was 23% (95% CI, 15%-34%). The diagnostic yield across cryptogenic CP cohorts was 35% (95% CI, 27%-45%), compared with 7% (95% CI, 4%-12%) across cohorts with known risk factors (noncryptogenic CP). In the meta-analysis of CMA yield in CP, the diagnostic yield of CMA among the cohorts (5 study cohorts comprising 294 individuals from 5 articles) was 5% (95% CI, 2%-12%). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that for individuals with cryptogenic CP, ES followed by CMA to identify molecular disorders may be warranted.
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Affiliation(s)
- Siddharth Srivastava
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Sara A. Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, Arizona
- Department of Child Health, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Neurology, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Cellular & Molecular Medicine, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Program in Genetics, University of Arizona College of Medicine, Phoenix
| | - Julie S. Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Zhang
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Maya Chopra
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Michael C. Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, Arizona
- Department of Child Health, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Neurology, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Cellular & Molecular Medicine, Program in Genetics, University of Arizona College of Medicine, Phoenix
- Department of Program in Genetics, University of Arizona College of Medicine, Phoenix
| | - Annapurna Poduri
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Epilepsy, Boston Children’s Hospital, Boston, Massachusetts
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19
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Friedman JM, van Essen P, van Karnebeek CDM. Cerebral palsy and related neuromotor disorders: Overview of genetic and genomic studies. Mol Genet Metab 2022; 137:399-419. [PMID: 34872807 DOI: 10.1016/j.ymgme.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/22/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Cerebral palsy (CP) is a debilitating condition characterized by abnormal movement or posture, beginning early in development. Early family and twin studies and more recent genomic investigations clearly demonstrate that genetic factors of major effect contribute to the etiology of CP. Most copy number variants and small alterations of nucleotide sequence that cause CP arise as a result of de novo mutations, so studies that estimate heritability on basis of recurrence frequency within families substantially underestimate genetic contributions to the etiology. At least 4% of patients with typical CP have disease-causing CNVs, and at least 14% have disease-causing single nucleotide variants or indels. The rate of pathogenic genomic lesions is probably more than twice as high among patients who have atypical CP, i.e., neuromotor dysfunction with additional neurodevelopmental abnormalities or malformations, or with MRI findings and medical history that are not characteristic of a perinatal insult. Mutations of many different genetic loci can produce a CP-like phenotype. The importance of genetic variants of minor effect and of epigenetic modifications in producing a multifactorial predisposition to CP is less clear. Recognizing the specific cause of CP in an affected individual is essential to providing optimal clinical management. An etiological diagnosis provides families an "enhanced compass" that improves overall well-being, facilitates access to educational and social services, permits accurate genetic counseling, and, for a subset of patients such as those with underlying inherited metabolic disorders, may make precision therapy that targets the pathophysiology available. Trio exome sequencing with assessment of copy number or trio genome sequencing with bioinformatics analysis for single nucleotide variants, indels, and copy number variants is clinically indicated in the initial workup of CP patients, especially those with additional malformations or neurodevelopmental abnormalities.
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Affiliation(s)
- Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Peter van Essen
- Department of Pediatrics, Amalia Children's Hospital, Radboud Centre for Mitochondrial Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatrics, Amalia Children's Hospital, Radboud Centre for Mitochondrial Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Departments of Human Genetics and Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada.
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20
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Shevell M. The evolution of our understanding of the conceptualization and genetics of cerebral palsy: Implications for genetic testing. Mol Genet Metab 2022; 137:449-453. [PMID: 33423928 DOI: 10.1016/j.ymgme.2020.12.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Michael Shevell
- Department of Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Room B.RC. 6354, 1001 Decarie Blvd, Montreal, Quebec H4A 3J1, Canada.
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21
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Takahashi T, Mercan S, Sassa T, Akçapınar GB, Yararbaş K, Süsgün S, İşeri SAU, Kihara A, Akçakaya NH. Hypomyelinating spastic dyskinesia and ichthyosis caused by a homozygous splice site mutation leading to exon skipping in ELOVL1. Brain Dev 2022; 44:391-400. [PMID: 35379526 DOI: 10.1016/j.braindev.2022.03.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Next generation sequencing technologies allow detection of very rare pathogenic gene variants and uncover cerebral palsy. Herein, we describe two siblings with cerebral palsy due to ELOVL1 splice site mutation in autosomal recessive manner. ELOVL1 catalyzes fatty acid elongation to produce very long-chain fatty acids (VLCFAs; ≥C21), most of which are components of sphingolipids such as ceramides and sphingomyelins. Ichthyotic keratoderma, spasticity, hypomyelination, and dysmorphic facies (MIM: 618527) stem from ELOVL1 gene deficiency in human. METHODS We have studied a consanguineous family with whole exome sequencing (WES) and performed in depth analysis of cryptic splicing on the molecular level using RNA. Comprehensive analysis of ceramides in the skin stratum corneum of patients using liquid chromatography-tandem mass spectrometry (LC-MS/MS). ELOVL1 protein structure was computationally modelled. RESULTS The novel c.376-2A > G (ENST00000372458.8) homozygous variant in the affected siblings causes exon skipping. Comprehensive analysis of ceramides in the skin stratum corneum of patients using LC-MS/MS demonstrated significant shortening of fatty acid moieties and severe reduction in the levels of acylceramides. DISCUSSION It has recently been shown that disease associated variants of ELOVL1 segregate in an autosomal dominant manner. However, our study for the first time demonstrates an alternative autosomal recessive inheritance model for ELOVL1. In conclusion, we suggest that in ultra-rare diseases, being able to identify the inheritance patterns of the disease-associated gene or genes can be an important guide to identifying the molecular mechanism of genetic cerebral palsy.
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Affiliation(s)
- Taiko Takahashi
- Hokkaido University, Faculty of Pharmaceutical Sciences, Laboratory of Biochemistry, Sapporo, Japan
| | - Sevcan Mercan
- Kafkas University, Faculty of Engineering and Architecture, Department of Bioengineering, Kars, Turkey
| | - Takayuki Sassa
- Hokkaido University, Faculty of Pharmaceutical Sciences, Laboratory of Biochemistry, Sapporo, Japan
| | - Günseli Bayram Akçapınar
- Acibadem MAA University, Institute of Health Sciences, Department of Medical Biotechnology, Istanbul, Turkey
| | - Kanay Yararbaş
- Demiroglu Bilim University, Faculty of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | - Seda Süsgün
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey; Istanbul University, Graduate School of Health Sciences, Istanbul, Turkey; Bezmialem Vakif University, Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Sibel Aylin Uğur İşeri
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey
| | - Akio Kihara
- Hokkaido University, Faculty of Pharmaceutical Sciences, Laboratory of Biochemistry, Sapporo, Japan
| | - Nihan Hande Akçakaya
- Demiroglu Bilim University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Spastic Children's Foundation of Turkey, Cerebral Palsy Turkey, Istanbul, Turkey.
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22
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Bagrowski B, Czapracka M, Kraśny J, Prendecki M, Dorszewska J, Jóźwiak M. Assessment of the relationship between Val66Met BDNF polymorphism and the effectiveness of gait rehabilitation in children and adolescents with cerebral palsy. Acta Neurobiol Exp (Wars) 2022; 82:1-11. [PMID: 35451419 DOI: 10.55782/ane-2022-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/09/2022]
Abstract
Cerebral palsy (CP) is associated with the non‑progressive damage of upper motor neurons, which is manifested by a variety of symptoms, particularly motor and functional deficits. During the rehabilitation of patients with CP, attention is paid to improving mobility which can have a significant impact on the child's development. The effectiveness of rehabilitation depends on the plasticity of the nervous system, which may be genetically determined. Of importance are the various polymorphisms of the brain derived neurotrophic factor (BDNF) gene. It has been shown that the Val/Val genotype may predispose children to greater improvements in function and its maintenance. However, subjects with the Met allele showed a reduced tendency to improve their motor functions but had significantly better results on indirect tests assessing gait function. Fifty subjects with CP participated in this study. They were divided into two groups by genotype and examined on their rehabilitation progress in terms of improved gait function. The results correlated with other studies describing the relationship between the BDNF genotype and learning motor functions in CP, and with numerous studies on the relationship between BDNF genotype and neuroplasticity in stroke patients. This research provides a basis for the identification of genetic biomarkers in patients with CP which can be used to predict the effects of rehabilitation therapy and help with the development of personalized treatments.
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Affiliation(s)
- Bartosz Bagrowski
- Orthopedic and Rehabilitation Clinical Hospital No. 4 of Poznan University of Medical Sciences, Clinic of Pediatric Orthopedics and Traumatology, Poznan, Poland;
| | - Marta Czapracka
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Kraśny
- Department of Pediatrics Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Prendecki
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jolanta Dorszewska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jóźwiak
- Department of Pediatrics Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
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Hale AT, Akinnusotu O, He J, Wang J, Hibshman N, Shannon CN, Naftel RP. Genome-Wide Association Study Identifies Genetic Risk Factors for Spastic Cerebral Palsy. Neurosurgery 2021; 89:435-442. [PMID: 34098570 PMCID: PMC8364821 DOI: 10.1093/neuros/nyab184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many clinical risk factors of spastic cerebral palsy (CP) have been identified, the genetic basis of spastic CP is largely unknown. Here, using whole-genome genetic information linked to a deidentified electronic health record (BioVU) with replication in the UK Biobank and FinnGen, we perform the first genome-wide association study (GWAS) for spastic CP. OBJECTIVE To define the genetic basis of spastic CP. METHODS Whole-genome data were obtained using the multi-ethnic genotyping array (MEGA) genotyping array capturing single-nucleotide polymorphisms (SNPs), minor allele frequency (MAF) > 0.01, and imputation quality score (r2) > 0.3, imputed based on the 1000 genomes phase 3 reference panel. Threshold for genome-wide significance was defined after Bonferroni correction for the total number of SNPs tested (P < 5.0 × 10-8). Replication analysis (defined as P < .05) was performed in the UK Biobank and FinnGen. RESULTS We identify 1 SNP (rs78686911) reaching genome-wide significance with spastic CP. Expression quantitative trait loci (eQTL) analysis suggests that rs78686911 decreases expression of GRIK4, a gene that encodes a high-affinity kainate glutamatergic receptor of largely unknown function. Replication analysis in the UK Biobank and FinnGen reveals additional SNPs in the GRIK4 loci associated with CP. CONCLUSION To our knowledge, we perform the first GWAS of spastic CP. Our study indicates that genetic variation contributes to CP risk.
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Affiliation(s)
- Andrew T Hale
- Vanderbilt University School of Medicine, Medical Scientist Training Program, Nashville, Tennessee, USA
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Oluwatoyin Akinnusotu
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Jing He
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Janey Wang
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie Hibshman
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
| | - Robert P Naftel
- Surgical Outcomes Center for Kids, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee, USA
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Genetic Variants Account for About 14% of Cerebral Palsy Cases. Am J Med Genet A 2021; 185:9-10. [PMID: 33331116 DOI: 10.1002/ajmg.a.61646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Moreno-De-Luca A, Millan F, Pesacreta DR, Elloumi HZ, Oetjens MT, Teigen C, Wain KE, Scuffins J, Myers SM, Torene RI, Gainullin VG, Arvai K, Kirchner HL, Ledbetter DH, Retterer K, Martin CL. Molecular Diagnostic Yield of Exome Sequencing in Patients With Cerebral Palsy. JAMA 2021; 325:467-475. [PMID: 33528536 PMCID: PMC7856544 DOI: 10.1001/jama.2020.26148] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Cerebral palsy is a common neurodevelopmental disorder affecting movement and posture that often co-occurs with other neurodevelopmental disorders. Individual cases of cerebral palsy are often attributed to birth asphyxia; however, recent studies indicate that asphyxia accounts for less than 10% of cerebral palsy cases. OBJECTIVE To determine the molecular diagnostic yield of exome sequencing (prevalence of pathogenic and likely pathogenic variants) in individuals with cerebral palsy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of patients with cerebral palsy that included a clinical laboratory referral cohort with data accrued between 2012 and 2018 and a health care-based cohort with data accrued between 2007 and 2017. EXPOSURES Exome sequencing with copy number variant detection. MAIN OUTCOMES AND MEASURES The primary outcome was the molecular diagnostic yield of exome sequencing. RESULTS Among 1345 patients from the clinical laboratory referral cohort, the median age was 8.8 years (interquartile range, 4.4-14.7 years; range, 0.1-66 years) and 601 (45%) were female. Among 181 patients in the health care-based cohort, the median age was 41.9 years (interquartile range, 28.0-59.6 years; range, 4.8-89 years) and 96 (53%) were female. The molecular diagnostic yield of exome sequencing was 32.7% (95% CI, 30.2%-35.2%) in the clinical laboratory referral cohort and 10.5% (95% CI, 6.0%-15.0%) in the health care-based cohort. The molecular diagnostic yield ranged from 11.2% (95% CI, 6.4%-16.2%) for patients without intellectual disability, epilepsy, or autism spectrum disorder to 32.9% (95% CI, 25.7%-40.1%) for patients with all 3 comorbidities. Pathogenic and likely pathogenic variants were identified in 229 genes (29.5% of 1526 patients); 86 genes were mutated in 2 or more patients (20.1% of 1526 patients) and 10 genes with mutations were independently identified in both cohorts (2.9% of 1526 patients). CONCLUSIONS AND RELEVANCE Among 2 cohorts of patients with cerebral palsy who underwent exome sequencing, the prevalence of pathogenic and likely pathogenic variants was 32.7% in a cohort that predominantly consisted of pediatric patients and 10.5% in a cohort that predominantly consisted of adult patients. Further research is needed to understand the clinical implications of these findings.
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Affiliation(s)
- Andrés Moreno-De-Luca
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Department of Radiology, Geisinger, Danville, Pennsylvania
- Diagnostic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Denis R. Pesacreta
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Matthew T. Oetjens
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Karen E. Wain
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Scott M. Myers
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | - H. Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - David H. Ledbetter
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Christa L. Martin
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
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Kukec E, Goričar K, Dolžan V, Rener-Primec Z. HIF1A polymorphisms do not modify the risk of epilepsy nor cerebral palsy after neonatal hypoxic-ischemic encephalopathy. Brain Res 2021; 1757:147281. [PMID: 33515534 DOI: 10.1016/j.brainres.2021.147281] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Hypoxic-ischemic encephalopathy (HIE) remains the major cause of cerebral palsy and epilepsy in developed countries. Hypoxia-inducible factor 1 alpha (HIF-1α) is the key mediator of oxygen homoeostasis. The aim of this study was to investigate whether hypoxia-inducible factor 1 subunit alpha (HIF1A) functional polymorphisms are associated with the risk of epilepsy, drug-resistant epilepsy, and cerebral palsy after neonatal HIE. METHODS The study included 139 healthy controls and 229 patients with epilepsy and/or cerebral palsy, of which 95 had perinatal HIE. Genomic DNA isolated from buccal swabs or peripheral blood were genotyped for HIF1A rs11549465 and rs11549467 using PCR based methods. RESULTS The investigated HIF1A polymorphisms did not influence the risk of epilepsy and its drug-resistance nor cerebral palsy after neonatal HIE (all p > 0.05). Clinical characteristics of patients were significantly associated with neurological deficits after HIE. CONCLUSION This study found no statistically significant association of HIF1A rs11549465 and rs11549467 with the development of epilepsy and its drug-resistance, as well as cerebral palsy, after neonatal HIE.
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Affiliation(s)
- Eva Kukec
- Department of Child, Adolescent, and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Katja Goričar
- Faculty of Medicine, University of Ljubljana, Slovenia; Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Vita Dolžan
- Faculty of Medicine, University of Ljubljana, Slovenia; Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Zvonka Rener-Primec
- Department of Child, Adolescent, and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
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Sun Y, Ma L, Jin M, Zheng Y, Wang D, Ni H. Effects of Melatonin on Neurobehavior and Cognition in a Cerebral Palsy Model of plppr5-/- Mice. Front Endocrinol (Lausanne) 2021; 12:598788. [PMID: 33692754 PMCID: PMC7937640 DOI: 10.3389/fendo.2021.598788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022] Open
Abstract
Cerebral palsy (CP), a group of clinical syndromes caused by non-progressive brain damage in the developing fetus or infant, is one of the most common causes of lifelong physical disability in children in most countries. At present, many researchers believe that perinatal cerebral hypoxic ischemic injury or inflammatory injury are the main causes of cerebral palsy. Previous studies including our works confirmed that melatonin has a protective effect against convulsive brain damage during development and that it affects the expression of various molecules involved in processes such as metabolism, plasticity and signaling in the brain. Integral membrane protein plppr5 is a new member of the plasticity-related protein family, which is specifically expressed in brain and spinal cord, and induces filopodia formation as well as neurite growth. It is highly expressed in the brain, especially in areas of high plasticity, such as the hippocampus. The signals are slightly lower in the cortex, the cerebellum, and in striatum. Noteworthy, during development plppr5 mRNA is expressed in the spinal cord, i.e., in neuron rich regions such as in medial motor nuclei, suggesting that plppr5 plays an important role in the regulation of neurons. However, the existing literature only states that plppr5 is involved in the occurrence and stability of dendritic spines, and research on its possible involvement in neonatal ischemic hypoxic encephalopathy has not been previously reported. We used plppr5 knockout (plppr5-/-) mice and their wild-type littermates to establish a model of hypoxicischemic brain injury (HI) to further explore the effects of melatonin on brain injury and the role of plppr5 in this treatment in an HI model, which mainly focuses on cognition, exercise, learning, and memory. All the tests were performed at 3-4 weeks after HI. As for melatonin treatment, which was performed 5 min after HI injury and followed by every 24h. In these experiments, we found that there was a significant interaction between genotype and treatment in novel object recognition tests, surface righting reflex tests and forelimb suspension reflex tests, which represent learning and memory, motor function and coordination, and the forelimb grip of the mice, respectively. However, a significant main effect of genotype and treatment on performance in all behavioral tests were observed. Specifically, wild-type mice with HI injury performed better than plppr5-/- mice, regardless of treatment with melatonin or vehicle. Moreover, treatment with melatonin could improve behavior in the tests for wild-type mice with HI injury, but not for plppr5-/- mice. This study showed that plppr5 knockout aggravated HI damage and partially weakened the neuroprotection of melatonin in some aspects (such as novel object recognition test and partial nerve reflexes), which deserves further study.
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Abdel Hamid OI, Khayal EESH, Tolba SAR, Orabi EE. Maternal Δ-aminolevulinic acid dehydratase 1-2 genotype enhances fetal lead exposure and increases the susceptibility to the development of cerebral palsy. Environ Sci Pollut Res Int 2020; 27:44709-44723. [PMID: 32710353 DOI: 10.1007/s11356-020-10182-8] [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] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
Limited epidemiologic studies questioned the association between pre- and postnatal lead exposure and the development of cerebral palsy (CP). Moreover, the genotypes of δ-aminolevulinic acid dehydratase (δ-ALAD) in CP patients and their mothers and their association to the blood lead levels (BLLs) were not previously studied. This study aimed to evaluate the association between δ-ALAD gene polymorphism and BLL in cases of CP and their mothers. A case control study was carried out on 23 CP cases and equal number of healthy matched controls. The mothers of the included children were asked to answer a questionnaire involving the baseline clinical and demographic characteristics. Also, questionnaires were done to detect the sources of environmental lead exposure and screen lead exposure during the pregnancy period. BLL, δ-ALAD enzyme activity, and genetic analysis for ALAD G177C were done for each child and his mother. There was significant (p < 0.001) elevation of BLL in CP cases and their mothers that was positively correlated (r = 0.436, p < 0.05). There were progressive decreases in δ-ALAD activity with increasing BLL in both children and mothers (p < 0.05). There were non-significant (p > 0.05) differences between CP and the control group regarding frequency of ALAD G177C genotypes, while there was a significant (p = 0.04) increase in the frequency of ALAD 1-2 (GC) genotype in the mothers of the CP group associated with high BLL and significant decrease in δ-ALAD activity (p < 0.001). The study can indicate the significance of δ-ALAD gene polymorphism in the prenatal exposure to lead and the affection of the developing brain, pointing to the importance of controlling lead in pregnant women especially those with ALAD 1-2 genotype.
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Affiliation(s)
- Omaima Ibrahim Abdel Hamid
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | | | - Eman Elshahat Orabi
- Public Health & Community Medicine Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Rea G, Tirupathi S, Williams J, Clouston P, Morrison PJ. Infantile Onset of Spinocerebellar Ataxia Type 5 (SCA-5) in a 6 Month Old with Ataxic Cerebral Palsy. Cerebellum 2020; 19:161-163. [PMID: 31721007 PMCID: PMC6978426 DOI: 10.1007/s12311-019-01085-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia type 5 (SCA-5) is a predominantly slowly progressive adult onset ataxia. We describe a child with a presentation of ataxic cerebral palsy (CP) and developmental delay at 6 months of age. Genetic testing confirmed a c.812C>T p.(Thr271Ile) mutation within the SPTBN2 gene. Seven previous cases of infantile onset SCA-5 are reported in the literature, four of which had a CP presentation. Early onset of SCA-5 presents with ataxic CP and is a rare cause of cerebral palsy.
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Affiliation(s)
- Gillian Rea
- Departments of Genetic Medicine, Regional Genetics Centre, Belfast Health and Social Care Trust, A Floor, Belfast HSC Trust, Belfast, BT9 7AB, UK
| | - Sandya Tirupathi
- Paediatric Neurology, Belfast Health and Social Care Trust, Belfast, BT9 7AB, UK
| | - Jonathan Williams
- Oxford Regional Genetics Laboratories, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Penny Clouston
- Oxford Regional Genetics Laboratories, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Patrick J Morrison
- Departments of Genetic Medicine, Regional Genetics Centre, Belfast Health and Social Care Trust, A Floor, Belfast HSC Trust, Belfast, BT9 7AB, UK.
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, BT9 7AE, UK.
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Abstract
Pediatric movement disorders (PMDs) consist of a heterogeneous group of signs and symptoms caused by numerous neurological diseases. Different neurological disorders in children also share overlapping movement disorders making a diagnosis of the underlying cause of the movement disorder challenging. The similarity of the symptoms across multiple disease types suggests that there may be a final common motor pathway causing the overlapping movement disorders. There are numerous disorders in children associated with disturbances in tone and involuntary movements. This chapter will focus primarily on those disorders that involve abnormalities of tone and other important considerations of pediatric movement disorders. This chapter will address rating scales and goals for treatment and will include a review of symptomatic treatment and, where possible, the treatment of the underlying disease processes. The chapter will review representative disorders, including an inborn error of metabolism, an autoimmune disorder, and a group of neurodegenerative disorders. These examples demonstrate how the disorder's underlying pathophysiology results in a specific approach to the underlying disease and the associated conditions of tone and involuntary movements. Finally, the multiple treatment options for cerebral palsy and considerations of cerebral palsy mimics will be discussed.
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Affiliation(s)
- Stephen R Deputy
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Ann H Tilton
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA.
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Abstract
Objective Selective dorsal rhizotomy (SDR) is most commonly applied in the context of the treatment of the spastic diplegic variant of cerebral palsy (CP). Its role in the treatment of spasticity associated with other conditions is not well-established. We sought to review outcomes following SDR for the treatment of functionally limiting spasticity in the setting of a genetic etiology. Methods A systematic literature review was performed using the databases Ovid Medline, Embase, Cochrane Library, and PubMed based on the PRISMA guidelines. Articles were included if they described the application of SDR for spasticity of genetic etiology. Reported outcomes pertaining to spasticity and gross motor function following SDR were summarized. Results Five articles reporting on 16 patients (10 males, 6 females) met the inclusion criteria, of which four reported on SDR for hereditary spastic paraplegia (HSP) and four on syndromic patients or other inherited diseases, with an overall follow-up ranging from 11 to 252 months. These individuals were found to have several genetic mutations including ALS2, SPG4, and SPG3A. The mean age at the time of surgery was 14.9 years (median 10 years, range 3-37 years). Conclusions Although all patients experienced a reduction in spasticity, the long-term gross motor functional outcomes objectively assessed at last follow-up were heterogeneous. There may be a role for SDR in the context of static genetic disorders causing spasticity. Further evidence is required prior to the widespread adoption of SDR for such disorders as, based on the collective observations of this review, spasticity is consistently reduced but the long-term effect on gross motor function remains unclear.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave, Suite 1503, Toronto, Ontario, M5G 1X8, Canada.
| | - Ian Coulter
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave, Suite 1503, Toronto, Ontario, M5G 1X8, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave, Suite 1503, Toronto, Ontario, M5G 1X8, Canada
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Liu X, Dou LX, Han J, Zhang ZC. The Renpenning syndrome-associated protein PQBP1 facilitates the nuclear import of splicing factor TXNL4A through the karyopherin β2 receptor. J Biol Chem 2020; 295:4093-4100. [PMID: 32041777 PMCID: PMC7105315 DOI: 10.1074/jbc.ra119.012214] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/05/2020] [Indexed: 11/06/2022] Open
Abstract
Renpenning syndrome belongs to a group of X-linked intellectual disability disorders. The Renpenning syndrome-associated protein PQBP1 (polyglutamine-binding protein 1) is intrinsically disordered, associates with several splicing factors, and is involved in pre-mRNA splicing. PQBP1 uses its C-terminal YxxPxxVL motif for binding to the splicing factor TXNL4A (thioredoxin like 4A), but the biological function of this interaction has yet to be elucidated. In this study, using recombinant protein expression, in vitro binding assays, and immunofluorescence microscopy in HeLa cells, we found that a recently reported X-linked intellectual disability-associated missense mutation, resulting in the PQBP1-P244L variant, disrupts the interaction with TXNL4A. We further show that this interaction is critical for the subcellular location of TXNL4A. In combination with other PQBP1 variants lacking a functional nuclear localization signal required for recognition by the nuclear import receptor karyopherin β2, we demonstrate that PQBP1 facilitates the nuclear import of TXNL4A via a piggyback mechanism. These findings expand our understanding of the molecular basis of the PQBP1-TXNL4A interaction and of the etiology and pathogenesis of Renpenning syndrome and related disorders.
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Affiliation(s)
- Xian Liu
- School of Life Science and Technology, the Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu 210096, China
| | - Lin-Xia Dou
- School of Life Science and Technology, the Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu 210096, China
| | - Junhai Han
- School of Life Science and Technology, the Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu 210096, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, China
| | - Zi Chao Zhang
- School of Life Science and Technology, the Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu 210096, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, China.
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Varner MW, Costantine MM, Jablonski KA, Rouse DJ, Mercer BM, Leveno KJ, Reddy UM, Buhimschi C, Wapner RJ, Sorokin Y, Thorp JM, Ramin SM, Malone FD, Carpenter M, O’sullivan MJ, Peaceman AM, Dudley DJ, Caritis SN. Sex-Specific Genetic Susceptibility to Adverse Neurodevelopmental Outcome in Offspring of Pregnancies at Risk of Early Preterm Delivery. Am J Perinatol 2020; 37:281-290. [PMID: 30731481 PMCID: PMC6685763 DOI: 10.1055/s-0039-1678535] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate sex-specific genetic susceptibility to adverse neurodevelopmental outcome (ANO, defined as cerebral palsy [CP], mental, or psychomotor delay) at risk for early preterm birth (EPTB, < 32 weeks). STUDY DESIGN Secondary case-control analysis of a trial of magnesium sulfate (MgSO4) before anticipated EPTB for CP prevention. Cases are infants who died by the age of 1 year or developed ANO. Controls, matched by maternal race and infant sex, were neurodevelopmentally normal survivors. Neonatal DNA was evaluated for 80 polymorphisms in inflammation, coagulation, vasoregulation, excitotoxicity, and oxidative stress pathways using Taqman assays. The primary outcome for this analysis was sex-specific ANO susceptibility. Conditional logistic regression estimated each polymorphism's odds ratio (OR) by sex stratum, adjusting for gestational age, maternal education, and MgSO4-corticosteroid exposures. Holm-Bonferroni corrections, adjusting for multiple comparisons (p < 7.3 × 10-4), accounted for linkage disequilibrium between markers. RESULTS Analysis included 211 cases (134 males; 77 females) and 213 controls (130 males; 83 females). An interleukin-6 (IL6) polymorphism (rs2069840) was associated with ANO in females (OR: 2.6, 95% confidence interval [CI]: 1.5-4.7; p = 0.001), but not in males (OR: 0.8, 95% CI: 0.5-1.2; p = 0.33). The sex-specific effect difference was significant (p = 7.0 × 10-4) and was unaffected by MgSO4 exposure. No other gene-sex associations were significant. CONCLUSION An IL6 gene locus may confer susceptibility to ANO in females, but not males, after EPTB.
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Affiliation(s)
- Michael W. Varner
- Department of Obstetrics and Gynecology, University of
Utah, Salt Lake City, Utah
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, Galveston, Texas
| | - Kathleen A. Jablonski
- Department of Epidemiology and Biostatistics, George
Washington University Biostatistics Center, Washington, Disctrict of Columbia
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, University of
Alabama at Birmingham, Birmingham, Alabama
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, MetroHealth
Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth J. Leveno
- Department of Obstetrics and Gynecology, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State
University, Columbus, Ohio
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Thomas Jefferson
University, Philadelphia, Pennsylvania
- Department of Obstetrics and Gynecology, Drexel
University, Philadelphia, Pennsylvania
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State
University, Detroit, Michigan
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan M. Ramin
- Department of Obstetrics and Gynecology, University of
Texas Health Science Center at Houston, Houston, Texas
| | - Fergal D. Malone
- Department of Obstetrics and Gynecology, Columbia
University, New York, New York
| | - Marshall Carpenter
- Department of Obstetrics and Gynecology, Brown
University, Providence, Rhode Island
| | - Mary J. O’sullivan
- Department of Obstetrics and Gynecology, University of
Miami, Miami, Florida
| | - Alan M. Peaceman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
| | - Donald J. Dudley
- Department of Obstetrics and Gynecology, University of
Texas Health Science Center, San Antonio, Texas
| | - Steve N. Caritis
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
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Jennions E, Hedberg-Oldfors C, Berglund AK, Kollberg G, Törnhage CJ, Eklund EA, Oldfors A, Verloo P, Vanlander AV, De Meirleir L, Seneca S, Sterky FH, Darin N. TANGO2 deficiency as a cause of neurodevelopmental delay with indirect effects on mitochondrial energy metabolism. J Inherit Metab Dis 2019; 42:898-908. [PMID: 31276219 DOI: 10.1002/jimd.12149] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 12/18/2018] [Revised: 06/15/2019] [Accepted: 07/03/2019] [Indexed: 12/28/2022]
Abstract
Exome sequencing has recently identified mutations in the gene TANGO2 (transport and Golgi organization 2) as a cause of developmental delay associated with recurrent crises involving rhabdomyolysis, cardiac arrhythmias, and metabolic derangements. The disease is not well understood, in part as the cellular function and subcellular localization of the TANGO2 protein remain unknown. Furthermore, the clinical syndrome with its heterogeneity of symptoms, signs, and laboratory findings is still being defined. Here, we describe 11 new cases of TANGO2-related disease, confirming and further expanding the previously described clinical phenotype. Patients were homozygous or compound heterozygous for previously described exonic deletions or new frameshift, splice site, and missense mutations. All patients showed developmental delay with ataxia, dysarthria, intellectual disability, or signs of spastic diplegia. Of importance, we identify two subjects (aged 12 and 17 years) who have never experienced any overt episode of the catabolism-induced metabolic crises typical for the disease. Mitochondrial complex II activity was mildly reduced in patients investigated in association with crises but normal in other patients. In one deceased patient, post-mortem autopsy revealed heterotopic neurons in the cerebral white matter, indicating a possible role for TANGO2 in neuronal migration. Furthermore, we have addressed the subcellular localization of several alternative isoforms of TANGO2, none of which were mitochondrial but instead appeared to have a primarily cytoplasmic localization. Previously described aberrations in Golgi morphology were not observed in cultured skin fibroblasts.
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Affiliation(s)
- Elizabeth Jennions
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carola Hedberg-Oldfors
- Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Karin Berglund
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gittan Kollberg
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Johan Törnhage
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, Skaraborg hospital, Skövde, Sweden
| | - Erik A Eklund
- Department of Clinical Sciences, Section for Paediatrics, Lund University, Lund, Sweden
| | - Anders Oldfors
- Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Patrick Verloo
- Department of Internal Medicine and Paediatrics, Division of Paediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Arnaud V Vanlander
- Department of Internal Medicine and Paediatrics, Division of Paediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Linda De Meirleir
- Department of Paediatric Neurology and Metabolic Diseases, UZ Brussel, Brussels, Belgium
| | - Sara Seneca
- Center for Medical Genetics, University Hospital Brussels and Research Unit Genetics and Fertility, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fredrik H Sterky
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Darin
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Rahman SK, Okazawa H, Chen YW. Frameshift PQBP-1 mutants K192S fs*7 and R153S fs*41 implicated in X-linked intellectual disability form stable dimers. J Struct Biol 2019; 206:305-313. [PMID: 30951824 DOI: 10.1016/j.jsb.2019.04.003] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022]
Abstract
Polyglutamine tract-binding protein-1 (PQBP-1) is a nuclear intrinsically disordered protein playing important roles in transcriptional regulation and RNA splicing during embryonic and postembryonic development. In human, its mutations lead to severe cognitive impairment known as the Renpenning syndrome, a form of X-linked intellectual disability (XLID). Here, we report a combined biophysical study of two PQBP-1 frameshift mutants, K192Sfs*7 and R153Sfs*41. Both mutants are dimeric in solution, in contrast to the monomeric wild-type protein. These mutants contain more folded contents and have increased thermal stabilities. Using small-angle X-ray scattering data, we generated three-dimensional envelopes which revealed their overall flat shapes. We also described each mutant using an ensemble model based on a native-like initial pool with a dimeric structural core. PQBP-1 is known to repress transcription by way of interacting with the C-terminal domain of RNA polymerase II, which consists of 52 repeats of a consensus heptapeptide sequence YSPTSPS. We studied the binding of PQBP-1 variants to the labelled peptide which is phosphorylated at positions 2 and 5 (YpSPTpSPS) and found that this interaction is significantly weakened in the two mutants.
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Affiliation(s)
- Shah Kamranur Rahman
- Randall Centre for Cell and Molecular Biophysics, King's College London, Guy's Campus, London SE1 1UL, United Kingdom.
| | - Hitoshi Okazawa
- Department of Neuropathology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yu Wai Chen
- Randall Centre for Cell and Molecular Biophysics, King's College London, Guy's Campus, London SE1 1UL, United Kingdom.
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Zhu Q, Ni Y, Wang J, Yin H, Zhang Q, Bian W, Zhang L, Lin M, Liu J, Zhou J, Sha C, Zhou X. [Genetic analysis of 10 children with cerebral palsy]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2019; 36:229-233. [PMID: 30835352 DOI: 10.3760/cma.j.issn.1003-9406.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the genetic basis of cerebral palsy (CP). METHODS A pair of twins with cerebral palsy and different phenotypes were subjected to whole genome sequencing, and other 8 children with CP were subjected to whole exome sequencing. Genetic variations were screened by a self-designed filtration process in order to explore the CP-related biological pathways and genes. RESULTS Three biological pathways related to CP were identified, which included axon guiding, transmission across chemical synapses and protein-protein interactions at synapses, and 25 susceptibility genes for CP were identified. CONCLUSION The molecular mechanism of CP has been explored, which may provide clues for development of new treatment for CP.
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Affiliation(s)
- Qingwen Zhu
- Nantong Maternal and Child Health Care Hospital, Nantong, Jiangsu 210036, China.
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Abstract
More than 50% of infants with cerebral palsy (CP) are born at or near term, with the vast majority having pre- or perinatally acquired CP. While some have a clinical history predictive of CP, such as neonatal encephalopathy or neonatal stroke, others have no readily identifiable risk factors. Paediatricians are often required to discriminate generalised motor delay from a variety of other diagnoses, including CP. This paper outlines known causal pathways to CP in term-born infants with a focus on differential diagnosis. Early and accurate diagnosis is important as it allows prompt access to early intervention during the critical periods of brain development. A combination of clinical history taking, standard clinical examination, neuroimaging and genetic testing should be started at the time of referral. Attention to the investigation of common comorbidities of CP, including feeding and sleep difficulties, and referral to early intervention are recommended.
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Affiliation(s)
- Catherine Morgan
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance, School of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Bithi Roy
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
- Special Care Nursery, Mater Hospital Sydney, Sydney, New South Wales, Australia
| | - Iona Novak
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance, School of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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38
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Sun L, Xia L, Wang M, Zhu D, Wang Y, Bi D, Song J, Ma C, Gao C, Zhang X, Sun Y, Wang X, Zhu C, Xing Q. Variants of the OLIG2 Gene are Associated with Cerebral Palsy in Chinese Han Infants with Hypoxic-Ischemic Encephalopathy. Neuromolecular Med 2018; 21:75-84. [PMID: 30178266 DOI: 10.1007/s12017-018-8510-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/30/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
Cerebral palsy (CP) is a leading cause of neurological disability among young children. Congenial and adverse perinatal clinical conditions, such as genetic factors, perinatal infection, and asphyxia, are risk factors for CP. Oligodendrocyte transcription factor (OLIG2) is a protein that is expressed in brain oligodendrocyte cells and is involved in neuron repair after brain injury. In this study, we employed a Chinese Han cohort of 763 CP infants and 738 healthy controls to study the association of OLIG2 gene polymorphisms with CP. We found marginal association of the SNP rs6517135 with CP (p = 0.044) at the genotype level, and the association was greatly strengthened when we focused on the subgroup of CP infants who suffered from hypoxic-ischemic encephalopathy (HIE) after birth, with p = 0.003 (OR = 0.558) at the allele level and p = 0.007 at the genotype level, indicating a risk-associated role of the T allele of the SNP rs6517135 under HIE conditions. The haplotype CTTG for rs6517135-rs1005573-rs6517137-rs9653711 in OLIG2 was also significantly associated with the occurrence of CP in infants with HIE (p = 0.01, OR = 0.521). Our results indicate that in the Han Chinese population, the polymorphisms of OLIG2 were associated with CP, especially in patients who had suffered HIE injury. This finding could be used to develop personalized care for infants with high susceptibility to CP.
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MESH Headings
- Alleles
- Asian People/genetics
- Asphyxia Neonatorum/complications
- Case-Control Studies
- Cerebral Palsy/etiology
- Cerebral Palsy/genetics
- Child
- Child, Preschool
- Female
- Fetal Growth Retardation/epidemiology
- Genetic Predisposition to Disease
- Genotype
- Haplotypes/genetics
- Humans
- Hypoxia-Ischemia, Brain/complications
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/genetics
- Male
- Oligodendrocyte Transcription Factor 2/deficiency
- Oligodendrocyte Transcription Factor 2/genetics
- Oligodendrocyte Transcription Factor 2/physiology
- Oligodendroglia/metabolism
- Polymorphism, Single Nucleotide
- Pregnancy
- Pregnancy Complications/epidemiology
- Risk
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Affiliation(s)
- Liya Sun
- Institute of Biomedical Science and Children's Hospital, Fudan University, Shanghai, 201102, China
- Shanghai Center for Women and Children's Health, Shanghai, 200062, China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Lei Xia
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Mingtai Wang
- Nursing School, Sias International University, Zhengzhou, 451150, China
| | - Dengna Zhu
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Child Rehabilitation Center, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yangong Wang
- Institute of Biomedical Science and Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Dan Bi
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Juan Song
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Caiyun Ma
- Department of Pediatrics, Children's Hospital of Zhengzhou University and Henan Children's Hospital, Zhengzhou, 450053, China
| | - Chao Gao
- Department of Pediatrics, Children's Hospital of Zhengzhou University and Henan Children's Hospital, Zhengzhou, 450053, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanyan Sun
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The 3rd Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, Sweden.
- Henan Key Laboratory of Child Brain Injury, Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, China.
| | - Qinghe Xing
- Institute of Biomedical Science and Children's Hospital, Fudan University, Shanghai, 201102, China.
- Shanghai Center for Women and Children's Health, Shanghai, 200062, China.
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Jeong HI, Yang A, Kim J, Jang JH, Cho SY, Jin DK. First Korean Case of Renpenning Syndrome with Novel Mutation in PQBP1 Diagnosed by Targeted Exome Sequencing, and Literature Review. Ann Clin Lab Sci 2018; 48:522-527. [PMID: 30143497] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Renpenning syndrome is a rare X-linked disorder characterized by mental retardation, leanness, microcephaly, facial dysmorphism, short stature, and small testes. This disease is caused by PQBP1 mutations. Herein, we present a literature review and describe the clinical and molecular findings in a Korean boy with Renpenning syndrome. A 23-month-old boy presented with mental retardation, narrow face, bulbous nose, and cardiac anomaly. Interestingly, targeted exome sequencing identified a novel mutation c.559delT (p.Tyr187llefs*8) in the PQBP1 gene, and he was diagnosed as having Renpenning syndrome. In line with previously reported studies, our case suggests that men with mental retardation, short stature, and microcephaly should include Renpenning syndrome as a differential diagnosis.
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Affiliation(s)
- Hye-In Jeong
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Aram Yang
- Department of Pediatrics, Inha University College of Medicine, Incheon
| | - Jinsup Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul
| | | | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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40
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Pingel J, Suhr F. Are mechanically sensitive regulators involved in the function and (patho)physiology of cerebral palsy-related contractures? J Muscle Res Cell Motil 2017; 38:317-330. [PMID: 29190010 DOI: 10.1007/s10974-017-9489-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
Skeletal muscle tissue is mechanosensitive, as it is able to sense mechanical impacts and to translate these into biochemical signals making the tissue adapt. Among its mechanosensitive nature, skeletal muscle tissue is the largest metabolic organ of the human body. Disturbances in skeletal muscle mechanosensing and metabolism cause and contribute to many diseases, i.e. muscular dystrophies/myopathies, cardiovascular diseases, COPD or diabetes mellitus type 2. A less commonly focused muscle-related disorder is clinically known as muscle contractures that derive from cerebral palsy (CP) conditions in young and adults. Muscle contractures are characterized by gradually increasing passive muscle stiffness resulting in complete fixation of joints. Different mechanisms have been identified in CP-related contractures, i.e. altered calcium handling, altered metabolism or altered titin regulation. The muscle-related extracellular matrix (ECM), specifically collagens, plays a role in CP-related contractures. Herein, we focus on mechanically sensitive complexes, known as costameres (Cstms), and discuss their potential role in CP-related contractures. We extend our discussion to the ECM due to the limited knowledge of its role in CP-related contractures. The aims of this review are (1) to summarize CP-related contracture mechanisms, (2) to raise novel hypotheses on the genesis of contractures with a focus on Cstms, and (3) to stimulate novel approaches to study CP-related contractures.
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Affiliation(s)
- Jessica Pingel
- Motor Control Lab, Department of Neuroscience and Pharmacology, University of Copenhagen, Blegdamsvej 3b, 2200, Copenhagen N, Denmark.
| | - Frank Suhr
- Exercise Physiology Research Group, Department of Movement Sciences, Biomedical Sciences Group, KU Leuven, Tervuursevest 101, box 1500, 3001, Leuven, Belgium.
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41
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Vasquez-Vivar J, Shi Z, Luo K, Thirugnanam K, Tan S. Tetrahydrobiopterin in antenatal brain hypoxia-ischemia-induced motor impairments and cerebral palsy. Redox Biol 2017; 13:594-599. [PMID: 28803128 PMCID: PMC5554922 DOI: 10.1016/j.redox.2017.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 07/14/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 12/24/2022] Open
Abstract
Antenatal brain hypoxia-ischemia, which occurs in cerebral palsy, is considered a significant cause of motor impairments in children. The mechanisms by which antenatal hypoxia-ischemia causes brain injury and motor deficits still need to be elucidated. Tetrahydrobiopterin is an important enzyme cofactor that is necessary to produce neurotransmitters and to maintain the redox status of the brain. A genetic deficiency of this cofactor from mutations of biosynthetic or recycling enzymes is a well-recognized factor in the development of childhood neurological disorders characterized by motor impairments, developmental delay, and encephalopathy. Experimental hypoxia-ischemia causes a decline in the availability of tetrahydrobiopterin in the immature brain. This decline coincides with the loss of brain function, suggesting this occurrence contributes to neuronal dysfunction and motor impairments. One possible mechanism linking tetrahydrobiopterin deficiency, hypoxia-ischemia, and neuronal injury is oxidative injury. Evidence of the central role of the developmental biology of tetrahydrobiopterin in response to hypoxic ischemic brain injury, especially the development of motor deficits, is discussed.
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Affiliation(s)
- Jeannette Vasquez-Vivar
- Department of Biophysics and Redox Biology Program, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Zhongjie Shi
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA
| | - Kehuan Luo
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA
| | - Karthikeyan Thirugnanam
- Department of Biophysics and Redox Biology Program, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Sidhartha Tan
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA.
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42
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Wang FF, Luo R, Qu Y, Mu DZ. [Advances in genetic research of cerebral palsy]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:1022-1026. [PMID: 28899476 PMCID: PMC7403069 DOI: 10.7499/j.issn.1008-8830.2017.09.018] [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] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/14/2017] [Indexed: 06/07/2023]
Abstract
Cerebral palsy is a group of syndromes caused by non-progressive brain injury in the fetus or infant and can cause disabilities in childhood. Etiology of cerebral palsy has always been a hot topic for clinical scientists. More and more studies have shown that genetic factors are closely associated with the development of cerebral palsy. With the development and application of various molecular and biological techniques such as chromosome microarray analysis, genome-wide association study, and whole exome sequencing, new achievements have been made in the genetic research of cerebral palsy. Chromosome abnormalities, copy number variations, susceptibility genes, and single gene mutation associated with the development of cerebral palsy have been identified, which provides new opportunities for the research on the pathogenesis of cerebral palsy. This article reviews the advances in the genetic research on cerebral palsy in recent years.
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Affiliation(s)
- Fang-Fang Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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43
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McLaughlin MJ, He Y, Brunstrom-Hernandez J, Thio LL, Carleton BC, Ross CJD, Gaedigk A, Lewandowski A, Dai H, Jusko WJ, Leeder JS. Pharmacogenomic Variability of Oral Baclofen Clearance and Clinical Response in Children With Cerebral Palsy. PM R 2017; 10:235-243. [PMID: 28867665 DOI: 10.1016/j.pmrj.2017.08.441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/14/2017] [Accepted: 08/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacogenomic variability can contribute to differences in pharmacokinetics and clinical responses. Pediatric patients with cerebral palsy with genetic variations have not been studied for these potential differences. OBJECTIVE To determine the genetic sources of variation in oral baclofen clearance and clinical responses. DESIGN Pharmacogenomic add-on study to determine variability in oral baclofen clearance and clinical responses. SETTING Multicenter study based in academic pediatric cerebral palsy clinics. PARTICIPANTS A total of 49 patients with cerebral palsy who had participated in an oral baclofen pharmacokinetic/pharmacodynamic study. METHODS OR INTERVENTIONS Of 53 participants in a pharmacokinetic/pharmacodynamic trial, 49 underwent genetic analysis of 307 key genes and 4535 single-nucleotide polymorphisms involved in drug absorption, distribution, metabolism, and excretion. Associations between genotypes and phenotypes of baclofen disposition (weight-corrected and allometrically scaled clearance) and clinical endpoints (improvement from baseline in mean hamstring Modified Tardieu Scale scores from baseline for improvement of R1 spastic catch) were determined by univariate analysis with correction for multiple testing by false discovery rate. MAIN OUTCOME MEASUREMENTS Primary outcome measures were the genotypic and phenotypic variability of oral baclofen in allometrically scaled clearance and change in the Modified Tardieu Scale angle compared to baseline. RESULTS After univariate analysis of the data, the SNP of ABCC9 (rs11046232, heterozygous AT versus the reference TT genotype) was associated with a 2-fold increase in oral baclofen clearance (mean 0.51 ± standard deviation 0.05 L/h/kg for the AT genotype versus 0.25 ± 0.07 L/h/kg for the TT genotype, adjusted P < .001). Clinical responses were associated with decreased spasticity by Modified Tardieu Scale in allelic variants with SNPs ABCC12, SLC28A1, and PPARD. CONCLUSIONS Genetic variation in ABCC9 affecting oral baclofen clearance highlights the need for continued studies of genetic polymorphisms to better characterize variable drug response in children with cerebral palsy. Single-nucleotide polymorphisms in ABCC12, SLC28A1, and PPARD were associated with varied responses, which warrants further investigation to determine their effect on spasticity. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthew J McLaughlin
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Yang He
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Janice Brunstrom-Hernandez
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Liu Lin Thio
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Bruce C Carleton
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Colin J D Ross
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Andrea Gaedigk
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Andrew Lewandowski
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Hongying Dai
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - William J Jusko
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - J Steven Leeder
- Division of Rehabilitation Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108; Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, NY
- 1 CP Place, PLLC, Plano, TX; Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Pediatric Neurology Cerebral Palsy Center and Departments of Neurology and Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Canadian Pharmacogenomics Network for Drug Safety, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
- The EMMES Corporation, Rockville, MD
- Department of Pediatrics, Children's Mercy, Kansas City, MO
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Yuan Y. Study of global DNA methylation in monozygotic twins with cerebral palsy. Pak J Pharm Sci 2017; 30:1467-1473. [PMID: 29043999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this paper is to study the global DNA Methylation in monozygotic (MZ) twins with cerebral palsy. Two pairs of twins (a cerebral palsy children, a normal child) admitted to the First Affiliated Hospital of Zhengzhou University were selected as subjects. The phenol-chloroform method was used to extract DNA from venous blood and micro satellite DNA genotyping technique was used to identify the eggs of the twins. DNA methylation fragments were enriched by MBD affinity column chromatography, followed by Solexa sequencing and bioinformatics analysis. In this study, we found that there were different DNA hypermethylation regions between each pair of twins and normal children through global DNA methylation analysis technique by analyzing the blood cells of two pairs of monozygotic twins with cerebral palsy and normal infants. The results revealed the region of DNA methylation and the protein coding genes of promoter region of common methylation of cerebral palsy were both higher than normal children. These common promoter hypermethylation genes in cerebral palsy are involved in a variety of biological processes such as membrane protein transport, neuronal development, apoptosis, and metabolism. Moreover, DNA methylation plays an important role in gene expression. We hypothesized that the onset of cerebral palsy in twins is associated with hypermethylation of the promoter which inhibiting the expression of hypermethylation genes in children with cerebral palsy. The current research provided a basis for further study of the large sample of twins and sporadic cerebral palsy.
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Affiliation(s)
- Yuxiao Yuan
- Department of Pediatrics, Women & Infants Hospital of Zhengzhou, Zhengzhou, China
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Rajatileka S, Odd D, Robinson MT, Spittle AC, Dwomoh L, Williams M, Harding D, Wagstaff M, Owen M, Crosby C, Ching J, Molnár E, Luyt K, Váradi A. Variants of the EAAT2 Glutamate Transporter Gene Promoter Are Associated with Cerebral Palsy in Preterm Infants. Mol Neurobiol 2017; 55:2013-2024. [PMID: 28271401 PMCID: PMC5840247 DOI: 10.1007/s12035-017-0462-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 07/08/2016] [Accepted: 02/16/2017] [Indexed: 11/26/2022]
Abstract
Preterm delivery is associated with neurodevelopmental impairment caused by environmental and genetic factors. Dysfunction of the excitatory amino acid transporter 2 (EAAT2) and the resultant impaired glutamate uptake can lead to neurological disorders. In this study, we investigated the role of single nucleotide polymorphisms (SNPs; g.-200C>A and g.-181A>C) in the EAAT2 promoter in susceptibility to brain injury and neurodisability in very preterm infants born at or before 32-week gestation. DNA isolated from newborns’ dried blood spots were used for pyrosequencing to detect both SNPs. Association between EAAT2 genotypes and cerebral palsy, cystic periventricular leukomalacia and a low developmental score was then assessed. The two SNPs were concordant in 89.4% of infants resulting in three common genotypes all carrying two C and two A alleles in different combinations. However, in 10.6% of cases, non-concordance was found, generating six additional rare genotypes. The A alleles at both loci appeared to be detrimental and consequently, the risk of developing cerebral palsy increased four- and sixfold for each additional detrimental allele at -200 and -181 bp, respectively. The two SNPs altered the regulation of the EAAT2 promoter activity and glutamate homeostasis. This study highlights the significance of glutamate in the pathogenesis of preterm brain injury and subsequent development of cerebral palsy and neurodevelopmental disabilities. Furthermore, the described EAAT2 SNPs may be an early biomarker of vulnerability to neurodisability and may aid the development of targeted treatment strategies.
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Affiliation(s)
- Shavanthi Rajatileka
- Centre for Research in Biosciences, Department of Applied Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
| | - David Odd
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK
- Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Matthew T Robinson
- College of Life & Environmental Sciences, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Alexandra C Spittle
- Centre for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Louis Dwomoh
- Centre for Research in Biosciences, Department of Applied Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
| | - Maggie Williams
- Bristol Genetics Laboratory, Pathology Sciences, Blood Sciences and Bristol Genetics, Southmead Hospital, Bristol, BS10 5NB, UK
| | - David Harding
- Regional Neonatal Intensive Care Unit, St Michael's Hospital, University Hospital NHS Trust, Bristol, BS2 8EG, UK
| | - Miles Wagstaff
- Neonatal Intensive Care Unit, Gloucestershire Royal Hospital, Gloucestershire NHS Trust, Gloucester, GL1 3NN, UK
| | - Marie Owen
- Neonatal Intensive Care Unit, Gloucestershire Royal Hospital, Gloucestershire NHS Trust, Gloucester, GL1 3NN, UK
| | - Charlene Crosby
- Bristol Genetics Laboratory, Pathology Sciences, Blood Sciences and Bristol Genetics, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Jared Ching
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK
| | - Elek Molnár
- Centre for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Karen Luyt
- Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK
- Regional Neonatal Intensive Care Unit, St Michael's Hospital, University Hospital NHS Trust, Bristol, BS2 8EG, UK
| | - Anikó Váradi
- Centre for Research in Biosciences, Department of Applied Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
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Pucheta-Martinez E, D’Amelio N, Lelli M, Martinez-Torrecuadrada JL, Sudol M, Saladino G, Gervasio FL. Changes in the folding landscape of the WW domain provide a molecular mechanism for an inherited genetic syndrome. Sci Rep 2016; 6:30293. [PMID: 27456546 PMCID: PMC4960638 DOI: 10.1038/srep30293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/01/2016] [Indexed: 10/25/2022] Open
Abstract
WW domains are small domains present in many human proteins with a wide array of functions and acting through the recognition of proline-rich sequences. The WW domain belonging to polyglutamine tract-binding protein 1 (PQBP1) is of particular interest due to its direct involvement in several X chromosome-linked intellectual disabilities, including Golabi-Ito-Hall (GIH) syndrome, where a single point mutation (Y65C) correlates with the development of the disease. The mutant cannot bind to its natural ligand WBP11, which regulates mRNA processing. In this work we use high-field high-resolution NMR and enhanced sampling molecular dynamics simulations to gain insight into the molecular causes the disease. We find that the wild type protein is partially unfolded exchanging among multiple beta-strand-like conformations in solution. The Y65C mutation further destabilizes the residual fold and primes the protein for the formation of a disulphide bridge, which could be at the origin of the loss of function.
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Affiliation(s)
| | - Nicola D’Amelio
- Research Institute of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Moreno Lelli
- University of Florence, Department of Chemistry, Magnetic Resonance Center (CERM), 50019 Sesto Fiorentino (FI), Italy
| | - Jorge L. Martinez-Torrecuadrada
- Crystallography and Protein Engineering Unit, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernandez Almagro 3, 28029, Madrid, Spain
| | - Marius Sudol
- Institute of Molecular and Cell Biology A*STAR, 61 Biopolis, Singapore 138673, Republic of Singapore
- Mechanobiology Institute, 5A Engineering Drive 1, Singapore 117411, Republic of Singapore
- National University of Singapore, Department of Physiology, The Yong Loo Li School of Medicine, 2 Medical Drive, Singapore 117597, Republic of Singapore
| | - Giorgio Saladino
- Department of Chemistry, University College London, London WC1E 6BT, United Kingdom
- Research Institute of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
| | - Francesco Luigi Gervasio
- Department of Chemistry, University College London, London WC1E 6BT, United Kingdom
- Research Institute of Structural and Molecular Biology, University College London, London WC1E 6BT, United Kingdom
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Genetic factors may underlie many cerebral palsy cases: New research implicates genetic variations, not lack of oxygen at birth, in disorder. Am J Med Genet A 2015; 167A:vii-viii. [PMID: 26288074 DOI: 10.1002/ajmg.a.37283] [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: 11/08/2022]
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Kapitanović Vidak H, Catela Ivković T, Vidak Z, Kapitanović S. COX-1 and COX-2 polymorphisms in susceptibility to cerebral palsy in very preterm infants. Mol Neurobiol 2016; 54:930-938. [PMID: 26781425 DOI: 10.1007/s12035-016-9713-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 06/05/2015] [Accepted: 01/11/2016] [Indexed: 12/21/2022]
Abstract
Cerebral palsy (CP) is a nonprogressive motor disorder caused by white matter damage in the developing brain. Recent epidemiological and clinical data suggest intrauterine infection/inflammation as the most common cause of preterm delivery and neonatal complications, including CP. Cyclooxygenases are key enzymes in the conversion of arachidonic acid to prostaglandins. The COX family consists of two isoforms, COX-1 and COX-2. In the brain, COX-2 is constitutively expressed at high levels on pyramidal neurons, while COX-1 is predominantly expressed by microglia and can be upregulated in pathological conditions, such as infection, ischemia and traumatic brain injury. Single nucleotide polymorphisms in the COX-1 and COX-2 gene could have profound effects on COX-1 and COX-2 expression and, directly or indirectly, influence the pathogenesis, development and severity of CP. In this study we investigated the association between single nucleotide polymorphisms of the COX-1 and COX-2 gene and susceptibility to cerebral palsy in very preterm infants. The results of our study showed the association between COX-1 high expression genotype (-842 AA) and COX-1 high expression allele -842A and risk of CP in infants with cystic periventricular leucomalacia (cPVL). Our results support an important role of COX-1 enzyme on microglial activation during neuroinflammation resulting in huge neuroinflammatory response and the proinflammatory mediator overproduction, with the serious white matter damage and CP development as a consequence.
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Affiliation(s)
- Helena Kapitanović Vidak
- Special Hospital for Children with Neurodevelopmental and Motor Difficulties, Goljak 2, Zagreb, Croatia.
| | - Tina Catela Ivković
- Laboratory for Personalized Medicine, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička c. 54, Zagreb, Croatia
| | - Zoran Vidak
- Department of Obstetrics and Gynecology, Division of Neonatology, Clinical Hospital Merkur, Ivana Zajca 19, Zagreb, Croatia
| | - Sanja Kapitanović
- Laboratory for Personalized Medicine, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička c. 54, Zagreb, Croatia
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50
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Rosa RFM, Enk F, Camargo K, Travi GM, Freitas A, Rosa RCM, Graziadio C, de Mattos VF, Zen PRG. Microcephaly-chorioretinopathy syndrome, autosomal recessive form. A case report. SAO PAULO MED J 2015; 133:377-80. [PMID: 25337662 PMCID: PMC10876356 DOI: 10.1590/1516-3180.2013.7930003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/08/2013] [Revised: 11/08/2013] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT The autosomal recessive form of microcephaly-chorioretinopathy syndrome is a rare genetic condition that is considered to be an important differential diagnosis with congenital toxoplasmosis. CASE REPORT Our patient was a seven-year-old white boy who was initially diagnosed with congenital toxoplasmosis. However, his serological tests for congenital infections, including toxoplasmosis, were negative. He was the first child of young, healthy and consanguineous parents (fourth-degree relatives). The parents had normal head circumferences and intelligence. The patient presented microcephaly and specific abnormalities of the retina, with multiple diffuse oval areas of pigmentation and patches of chorioretinal atrophy associated with diffuse pigmentation of the fundus. Ophthalmological evaluations on the parents were normal. A computed tomography scan of the child's head showed slight dilation of lateral ventricles and basal cisterns without evidence of calcifications. We did not find any lymphedema in his hands and feet. He had postnatal growth retardation, severe mental retardation and cerebral palsy. CONCLUSIONS The finding of chorioretinal lesions in a child with microcephaly should raise suspicions of the autosomal recessive form of microcephaly-chorioretinopathy syndrome, especially in cases with an atypical pattern of eye fundus and consanguinity. A specific diagnosis is essential for an appropriate clinical evaluation and for genetic counseling for the patients and their families.
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Affiliation(s)
- Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Flávia Enk
- Undergraduate Medical Student, Universidade Luterana do Brasil (ULBRA), Canoas, Rio Grande do Sul, Brazil.
| | - Korine Camargo
- Undergraduate Medical Student, Universidade Luterana do Brasil (ULBRA), Canoas, Rio Grande do Sul, Brazil.
| | - Giovanni Marco Travi
- MD. Ophthalmologist, Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - André Freitas
- MD. Ophthalmologist, Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Carla Graziadio
- MD. Assistant Professor of Clinical Genetics and Student in the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Vinicius Freitas de Mattos
- MD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Ricardo Gazzola Zen
- PhD. Adjunct Professor of Clinical Genetics and of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
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