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Szlepák T, Kossev AP, Csabán D, Illés A, Udvari S, Balicza P, Borsos B, Takáts A, Klivényi P, Molnár MJ. GBA-associated Parkinson's disease in Hungary: clinical features and genetic insights. Neurol Sci 2024; 45:2671-2679. [PMID: 38153678 PMCID: PMC11082009 DOI: 10.1007/s10072-023-07213-w] [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: 07/23/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) has a complex genetic background involving both rare and common genetic variants. Although a small percentage of cases show a clear Mendelian inheritance pattern, it is much more relevant to identify patients who present with a complex genetic profile of risk variants with different severity. The ß-glucocerebrosidase coding gene (GBA1) is recognized as the most frequent genetic risk factor for PD and Lewy body dementia, irrespective of reduction of the enzyme activity due to genetic variants. METHODS In a selected cohort of 190 Hungarian patients with clinical signs of PD and suspected genetic risk, we performed the genetic testing of the GBA1 gene. As other genetic hits can modify clinical features, we also screened for additional rare variants in other neurodegenerative genes and assessed the APOE-ε genotype of the patients. RESULTS In our cohort, we identified 29 GBA1 rare variant (RV) carriers. Out of the six different detected RVs, the highly debated E365K and T408M variants are composed of the majority of them (22 out of 32). Three patients carried two GBA1 variants, and an additional three patients carried rare variants in other neurodegenerative genes (SMPD1, SPG11, and SNCA). We did not observe differences in age at onset or other clinical features of the patients carrying two GBA1 variants or patients carrying heterozygous APOE-ε4 allele. CONCLUSION We need further studies to better understand the drivers of clinical differences in these patients, as this could have important therapeutic implications.
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Affiliation(s)
- Tamás Szlepák
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- HUN-REN, Multiomic Neurodegeneration Research Group, Budapest, Hungary
| | - Annabel P Kossev
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Dóra Csabán
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Anett Illés
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Udvari
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Péter Balicza
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- HUN-REN, Multiomic Neurodegeneration Research Group, Budapest, Hungary
| | - Beáta Borsos
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Annamária Takáts
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Mária J Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary.
- HUN-REN, Multiomic Neurodegeneration Research Group, Budapest, Hungary.
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Molnár E, Kovács G, Varga L, Tasnády S, Bors A, Tankó L, Csabán D, Kapócs K, Nemes-Nagy Z, Andrikovics H. Nem malignus, nem infectiosus lymphoproliferatio: kihívások az autoimmun lymphoproliferativ szindróma diagnosztikájában és kezelésében. Orv Hetil 2022; 163:123-131. [DOI: 10.1556/650.2022.32353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Az autoimmun lymphoproliferativ szindróma egy ritka,
immundeficientiával járó genetikai betegség. Hátterében az extrinszik
apoptotikus útvonal génjeinek örökletes vagy szerzett mutációi és a
következményesen kialakuló, aktivált lymphocyták negatív szelekciójának a
defektusa áll. Az autoimmun lymphoproliferativ szindróma klinikai megjelenésére
jellemző a jóindulatú lymphocytaburjánzás következtében kialakuló
lymphadenopathia és lépmegnagyobbodás. Gyakran társul olyan autoimmun
kórképekkel, mint az autoimmun haemolyticus anaemia vagy az autoimmun
thrombocytopenia. A betegségben jellemző laboratóriumi eltérések a következők:
az αβ+ CD4–/CD8– kettős negatív T-sejtek
szaporulata, a szolúbilis Fas-ligand, az interleukin-10 és interleukin-18,
valamint a B12-vitamin szérumszintjének emelkedése. A kórkép
diagnózisához hozzátartozik az in vitro Fas-mediált apoptózis
funkciójának vizsgálata, valamint a genetikai vizsgálat.
Differenciáldiagnosztikai szempontból fontos elkülöníteni a lymphomáktól,
valamint az autoimmun lymphoproliferativ szindrómaszerű betegségektől. A kezelés
alapja a társuló autoimmun kórképek tüneteinek csökkentése immunszuppresszív
terápiával. Orv Hetil. 2022; 163(4): 123–131.
Summary. The autoimmune lymphoproliferative syndrome is a rare
genetic disorder causing immunodeficiency. In the background of the disease,
germline or somatic mutations of genes participating in the extrinsic apoptotic
pathway and the consequential defect in the negative selection of activated
lymphocytes were discovered. The clinical appearance of autoimmune
lymphoproliferative syndrome consists of non-malignant lymphoproliferation,
lymphadenopathy and splenomegaly, it is frequently accompanied by autoimmune
disorders such as autoimmune haemolytic anaemia or autoimmune thrombocytopenia.
The main diagnostic laboratory findings of this disease are the following: an
elevation in αβ+, CD4–/CD8– double-negative T
cell count, elevated serum levels of soluble Fas-ligand, interleukin-10,
interleukin-18 and vitamin B12. Other useful laboratory tests are the
in vitro Fas-mediated apoptotic functional assay and the
genetic screening for gene mutations. Differential diagnosis should exclude
malignant lymphoproliferation in lymphomas and non-malignant autoimmune
lymphoprolipherative syndrome-like diseases. The main aim of the treatment is
the amelioration of the accompanying autoimmune disease with immunosuppressive
therapy. Orv Hetil. 2022; 163(4): 123–131.
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Affiliation(s)
- Emese Molnár
- Országos Vérellátó Szolgálat, Közép-magyarországi Regionális Vérellátó Központ Budapest, Karolina út 19–21., 1113
- Semmelweis Egyetem, Általános Orvostudományi Kar, Transzfuziológiai Tanszék Budapest
| | - Gábor Kovács
- Semmelweis Egyetem, Általános Orvostudományi Kar, Transzfuziológiai Tanszék Budapest
- Semmelweis Egyetem, Általános Orvostudományi Kar, Élettani Intézet Budapest
| | - Lívia Varga
- Országos Vérellátó Szolgálat, Közép-magyarországi Regionális Vérellátó Központ Budapest, Karolina út 19–21., 1113
- Semmelweis Egyetem, Általános Orvostudományi Kar, Transzfuziológiai Tanszék Budapest
| | - Szabolcs Tasnády
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Központi Laboratórium Budapest
| | - András Bors
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Molekuláris Genetikai Laboratórium Budapest
| | - Lenke Tankó
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Molekuláris Genetikai Laboratórium Budapest
| | - Dóra Csabán
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Molekuláris Genetikai Laboratórium Budapest
| | - Katalin Kapócs
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Molekuláris Genetikai Laboratórium Budapest
| | - Zsuzsanna Nemes-Nagy
- Országos Vérellátó Szolgálat, Közép-magyarországi Regionális Vérellátó Központ Budapest, Karolina út 19–21., 1113
| | - Hajnalka Andrikovics
- Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Molekuláris Genetikai Laboratórium Budapest
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Melicher D, Illés A, Littvay L, Tárnoki ÁD, Tárnoki DL, Bikov A, Kunos L, Csabán D, Buzás EI, Molnár MJ, Falus A. Positive association and future perspectives of mitochondrial DNA copy number and telomere length - a pilot twin study. Arch Med Sci 2021; 17:1191-1199. [PMID: 34522248 PMCID: PMC8425227 DOI: 10.5114/aoms.2019.83173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/31/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent experimental and population studies have highlighted the existence of telomere-mitochondria interplay. Besides studies revealing the molecular mechanisms underlying the associations of telomere defects and mitochondrial functions, investigations of mitochondrial DNA copy number (mtDNAcn) and telomere length (TL) in healthy and disease phenotypes have likewise begun, with the aim of gaining more insights about their relationship in humans. MATERIAL AND METHODS A total of 142 asymptomatic adult twins, comprising 96 monozygotic (MZ) and 46 dizygotic (DZ) twins (mean age: 50.54 ±15.43 years), members of the Hungarian Twin Registry, were included in the analysis. Applying the qPCR standard curve method, we investigated the relationship of mtDNA copy number, telomere length and clinical data, besides assessing co-twin similarities of MZ and DZ twins for their mtDNAcn and TL measures. RESULTS We found that twins were similar in their intraclass correlation coefficients irrespective of zygosity, suggesting a possibly more important role of common (shared) environmental factors compared to non-shared (unique) environmental and to a smaller degree also individual genetic influences. We confirmed a significant positive association between mtDNAcn and TL (r = 0.28, p < 0.01) in age- and sex-corrected analysis. Following bivariate estimates and correction with significant predictors, the independent positive associations were further verified. CONCLUSIONS Our results extend the until now modest number of studies investigating mtDNAcn and TL simultaneously in humans. In addition, we are the first to examine the relationship between mtDNAcn and telomere length in MZ and DZ twin subjects.
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Affiliation(s)
- Dóra Melicher
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
- MTA-SE Immunproteogenomics Extracellular Vesicle Research Group
- Hungarian Twin Registry, Budapest, Hungary
| | - Anett Illés
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Levente Littvay
- Hungarian Twin Registry, Budapest, Hungary
- Central European University, Budapest, Hungary
| | - Ádám Domonkos Tárnoki
- Hungarian Twin Registry, Budapest, Hungary
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Dávid László Tárnoki
- Hungarian Twin Registry, Budapest, Hungary
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Dóra Csabán
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Edit Irén Buzás
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
- MTA-SE Immunproteogenomics Extracellular Vesicle Research Group
| | - Mária Judit Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - András Falus
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
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Stengl R, Bors A, Ágg B, Pólos M, Matyas G, Molnár MJ, Fekete B, Csabán D, Andrikovics H, Merkely B, Radovits T, Szabolcs Z, Benke K. Optimising the mutation screening strategy in Marfan syndrome and identifying genotypes with more severe aortic involvement. Orphanet J Rare Dis 2020; 15:290. [PMID: 33059708 PMCID: PMC7558671 DOI: 10.1186/s13023-020-01569-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Marfan syndrome (MFS) is a systemic connective tissue disorder with life-threatening manifestations affecting the ascending aorta. MFS is caused by dominant negative (DN) and haploinsufficient (HI) mutations of the FBN1 gene. Our aim was to identify mutations of MFS patients with high detection rate and to investigate the use of a gene panel for patients with Marfanoid habitus. We also aimed to examine correlations between genotype and cardiovascular manifestations to predict “malignant” mutations.
Methods 136 individuals were enrolled. In the first phase, next-generation sequencing (NGS) and Sanger sequencing were performed for 57 patients to screen the FBN1 gene, followed by multiplex ligation-dependent probe amplification (MLPA) in negative cases. For repeated negative results, NGS gene panel involving 9 genes was used. In the second phase, 79 patients were tested primarily with the same gene panel, negative samples were tested by MLPA. Results 84 pathogenic mutations were detected, out of which 78 affected FBN1, 6 non-FBN1 mutations (2 TGFB2, 1 TGFBR2, 2 TGFBR1, 1 SMAD3) are associated with Loeys-Dietz syndrome (LDS). LDS patients had lower systemic score and they were younger, but their aortic involvement did not differ. MLPA detected 4 multi-exon deletions of FBN1 gene, which could not be identified by our first-step screening method. Aortic involvement (aortic dissection and/or dilation) did not differ significantly among HI and DN mutations (p = 0.061). Combined group of HI and DN mutations eliminating a disulphide-bonding cysteine (DN Cys) had significantly higher aortic involvement rate than DN mutations not eliminating a disulphide-bonding cysteine (DN non-Cys) (p < 0.001). Patients with DN Cys required significantly more aortic surgeries than HI and DN non-Cys mutations (p = 0.042 and p = 0.015, respectively). Conclusions Due to the relevant number of mutations affecting genes other than FBN1, preferred approach for testing individuals with Marfanoid habitus is using a gene panel rather than single-gene analysis, followed by MLPA for negative samples. DN Cys and HI mutations should be considered as risk factors for aortic involvement. Genetic testing for patients with Marfanoid features and a systemic score under 7 is recommended, as LDS patients may have lower scores, but they may have severe cardiovascular manifestations.
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Affiliation(s)
- Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary. .,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary. .,Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary.
| | - András Bors
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gabor Matyas
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People With Rare Diseases, Wagistrasse 25, 8952, Schlieren, Zurich, Switzerland
| | - Mária Judit Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Bálint Fekete
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Dóra Csabán
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, Budapest, 1083, Hungary
| | - Hajnalka Andrikovics
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Albert Flórián út 5-7, Budapest, 1097, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
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Illés A, Balicza P, Gál A, Pentelényi K, Csabán D, Gézsi A, Molnár V, Molnár MJ. Hereditary Parkinson’s disease as a new clinical manifestation of the damaged POLG gene. Orv Hetil 2020; 161:821-828. [PMID: 32364361 DOI: 10.1556/650.2020.31724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The protein product of the nuclear-encoded POLG gene plays a key role in the maintenance of mitochondrial DNA replication, and its failure causes multi-system diseases with varying severity. The clinical spectrum is extremely wide, and the most common symptoms include ptosis, myoclonus, epilepsy, myopathy, sensory ataxia, parkinsonism, cognitive decline and infertility. Now, it is known that mitochondrial dysfunction in Parkinson's disease plays a key role in the loss of dopaminergic neurons in the substantia nigra. Therefore, changes in the POLG gene may influence the development of various hereditary neurodegenerative diseases, including monogenic parkinsonism. However, only limited information is available on the relationship between Parkinson's disease and POLG gene and until now, there are no available data about the Hungarian population. In our study, we performed a next-generation sequencing study of 67 Hungarian patients with parkinsonism and analyzed the potentially damaging alterations in the POLG gene. 3 patients have been identified with a potential pathogen variant. In this study, we would like to call attention to the fact that during the differential diagnosis of parkinsonism, the possible involvement of POLG gene should be kept in mind. Especially in the presence of additional symptoms, such as ophthalmoparesis, non-vascular white matter lesions, psychiatric comorbidity, and relatively early age of onset, the POLG gene should be taken into consideration. Based on previous data from the literature and our own experience, we have summarized a possible diagnostic approach for POLG-associated parkinsonism. Orv Hetil. 2020; 161(20): 821-828.
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Affiliation(s)
- Anett Illés
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Péter Balicza
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Anikó Gál
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Klára Pentelényi
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Dóra Csabán
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - András Gézsi
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Viktor Molnár
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
| | - Mária Judit Molnár
- Általános Orvostudományi Kar, Genomikai Medicina és Ritka Betegségek Intézete,Semmelweis Egyetem Budapest, Üllői út 78., 1083
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Andrikovics H, Kövy P, Bors A, Csabán D, Meggyesi N, Õrfi Z, Borsy A, Kozma A, Dolgos J, Harasztdombi J, Mikala G, Reményi P, Vályi-Nagy I. [Importance of next generation sequencing in precision oncology approach of acute myeloid leukemia]. Magy Onkol 2019; 63:282-287. [PMID: 31821383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
In contrast to solid tumours, the genetic background of acute myeloid leukemia (AML) is characterized by a relatively low number of alterations per sample (average 3-5 mutations similarly to paediatric malignancies). Although the mutational background is rather heterogeneous, the detection of genetic alterations has diagnostic, prognostic and therapeutic relevance. We investigated cytogenetic and most commonly occurring molecular genetic alterations, and their co-occurrence in 830 AML patients diagnosed and treated in our institute between 2001 and 2019. Results from the recently introduced next generation sequencing for seven AML patients are also presented. Both methods (previously performed standard PCR-based tests and NGS) achieved the same results for commonly occurring mutations, but NGS technique was capable to identify further, rarely occurring mutations which bear diagnostic and prognostic importance according to the recent European LeukemiaNet recommendations. The introduction of NGS techniques to routine laboratory diagnostic applications is a required step following international expertise.
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Affiliation(s)
- Hajnalka Andrikovics
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Petra Kövy
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - András Bors
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Dóra Csabán
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Nóra Meggyesi
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Zoltán Õrfi
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - Adrienn Borsy
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - András Kozma
- Molekuláris Genetikai Laboratórium, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary.
| | - János Dolgos
- Hematológiai és Õssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - József Harasztdombi
- Hematológiai és Õssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Gábor Mikala
- Hematológiai és Õssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Péter Reményi
- Hematológiai és Õssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - István Vályi-Nagy
- Hematológiai és Õssejt-transzplantációs Osztály, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
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7
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Illés A, Csabán D, Grosz Z, Balicza P, Gézsi A, Molnár V, Bencsik R, Gál A, Klivényi P, Molnar MJ. The Role of Genetic Testing in the Clinical Practice and Research of Early-Onset Parkinsonian Disorders in a Hungarian Cohort: Increasing Challenge in Genetic Counselling, Improving Chances in Stratification for Clinical Trials. Front Genet 2019; 10:1061. [PMID: 31737044 PMCID: PMC6837163 DOI: 10.3389/fgene.2019.01061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022] Open
Abstract
The genetic analysis of early-onset Parkinsonian disorder (EOPD) is part of the clinical diagnostics. Several genes have been implicated in the genetic background of Parkinsonism, which is clinically indistinguishable from idiopathic Parkinson's disease. The identification of patient's genotype could support clinical decision-making process and also track and analyse outcomes in a comprehensive fashion. The aim of our study was to analyse the genetic background of EOPD in a Hungarian cohort and to evaluate the clinical usefulness of different genetic investigations. The age of onset was between 25 and 50 years. To identify genetic alterations, multiplex ligation-dependent probe amplification (n = 142), Sanger sequencing of the most common PD-associated genes (n = 142), and next-generation sequencing (n = 54) of 127 genes which were previously associated to neurodegenerative disorders were carried out. The genetic analysis identified several heterozygous damaging substitutions in PD-associated genes (C19orf12, DNAJC6, DNAJC13, EIF4G1, LRRK2, PRKN, PINK1, PLA2G6, SYNJ1). CNVs in PRKN and SNCA genes were found in five patients. In our cohort, nine previously published genetic risk factors were detected in three genes (GBA, LRRK2, and PINK1). In nine cases, two or three coexisting pathogenic mutations and risk variants were identified. Advances of sequencing technologies make it possible to aid diagnostics of PD by widening the scope of analysis to genes which were previously linked to other neurodegenerative disorders. Our data suggested that rare damaging variants are enriched versus neutral variants, among PD patients in the Hungarian population, which raise the possibility of an oligogenic effect. Heterozygous mutations of multiple recessive genes involved in the same pathway may perturb the molecular process linked to PD pathogenesis. Comprehensive genetic assessment of individual patients can rarely reveal monogenic cause in EOPD, although it may identify the involvement of multiple PD-associated genes in the background of the disease and may facilitate the better understanding of clinically distinct phenocopies. Due to the genetic complexity of the disease, genetic counselling and management is getting more challenging. Clinical geneticist should be prepared for counselling of patients with coexisting disease-causing mutations and susceptibility factors. At the same time, genomic-based stratification has increasing importance in future clinical trials.
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Affiliation(s)
- Anett Illés
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Dóra Csabán
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Zoltán Grosz
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Péter Balicza
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Viktor Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Renáta Bencsik
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Anikó Gál
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
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