Hereditary Hyperekplexia in Saudi Arabia

BACKGROUND

Hyperekplexia is a rare disorder characterized by exaggerated startle responses to unexpected sensory stimuli, recurrent apneas, and stiffness. Only few studies have been published on this disorder in populations with high rates of consanguinity.

METHODS

We retrospectively reviewed Saudi patients with genetically confirmed hereditary hyperekplexia using a standard questionnaire that was sent to nine major referral hospitals in Saudi Arabia.

RESULTS

A total of 22 Saudi patients (11 males, 11 females) from 20 unrelated families who had hereditary hyperekplexia were included. Based on molecular studies, they were classified into different subtypes: SLC6A5 variant (12 patients, 54.5%), GLRB variant (seven patients, 31.8%), and GLRA1 variant (three patients, 13.7%). All patients were homozygous for the respective causal variant. The combined carrier frequency of hereditary hyperekplexia for the encountered founder mutations in the Saudi population is 10.9 per 10,000, which translates to a minimum disease burden of 13 patients per 1,000,000.

CONCLUSION

Our study provides comprehensive epidemiologic information, prevalence figures, and clinical characteristics of a large cohort of patients with hereditary hyperekplexia.

Phosphorylation of Serine 157 Protects the Rat Glycine Transporter GlyT2 from Calpain Cleavage

The N-terminal region of the rat glycine transporter 2 (rGlyT2, SLC6A5) is cleaved by calpain protease in vitro, which raises the question of its protection against calpain in vivo. Here, we used a phosphomimetic and orthogonal phosphoserine translation approach to investigate the possible role of phosphorylation in the protection of two calpain cleavage sites, M156/S157 and G164/T165, previously identified in the N-terminus region of the rat GlyT2. Replacement of serine 157 with phosphomimetic aspartate or with orthogonal phosphoserine blocked both calpain cleavage sites and caused an electrophoretic mobility shift of rGlyT2N fusion proteins. Both effects can be reversed by dephosphorylation, suggesting that phosphorylation might induce structural changes in the rGlyT2 N-terminus, preventing the accessibility of the M156/S157 and G164/T165 cleavage sites to calpain in vivo. In comparison with the wild type, the phosphomimetic mutation S157D increased the total immunoreactivity of the transporter expressed in neuroblastoma cells, suggesting that serine 157 phosphorylation or phosphorylation-regulated calpain cleavage might contribute to the turnover of the glycine transporter GlyT2.

Risk factors for vitamin D deficiency in sickle cell disease

Vitamin D deficiency (VDD), 25-OHD levels <20 ng/ml, is prevalent among patients with sickle cell disease (SCD) and is linked to acute and chronic pain and bone fracture in this population. There is limited literature regarding VDD-associated risk factors for SCD. We examined potential clinical and genomic parameters associated with VDD in 335 adults with SCD in a cross-sectional study. VDD was present in 65% of adult SCD patients, and 25-OHD levels independently and positively correlated with older age (P < 0·001) and vitamin D supplementation (P < 0·001). 25-OHD levels were higher in SCD patients over 40 years of age compared to the general African-American population. Both lower 25-OHD levels and increased pain frequency were associated with increased expression of SLC6A5 encoding glycine transporter-2 (GlyT2), a protein involved in neuronal pain pathways. Lower 25-OHD levels were also associated with increased expression of CYP3A4, and with decreased expression of GC (also termed DBP) and VDR, three genes involved in vitamin D metabolism. We conclude that vitamin D supplementation should be an almost universal feature of the care of young adults with SCD, and that further research is warranted into genomic factors that regulate vitamin D metabolism in SCD.