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BACKGROUND: Familial association of atrial fibrillation (AF) can involve single gene variants related to known arrhythmogenic mechanisms; however, genome-wide association studies often disclose complex genetic variants in familial and nonfamilial AF, making it difficult to relate to known pathogenetic mechanisms. METHODS: The finding of 4 siblings with AF led to studying 47 members of a family. Long-term Holter monitoring (average 298 hours) ruled out silent AF. Whole-exome sequencing was performed, and variants shared by the index cases were filtered and prioritised according to current recommendations. HCN4 currents (IHCN4) were recorded in Chinese hamster ovary cells expressing human p.P1163H or native HCN4 channels with the use of the patch-clamp technique, and topologically associating domain analyses of GATA5 variant were performed. RESULTS: The clinical study diagnosed 2 more AF cases. Five family members carried the heterozygous p.P1163H HCN4 variant, 14 carried the intronic 20,61040536,G,A GATA5 rare variant, and 9 carried both variants (HCN4+GATA5). Five of the 6 AF cases (onset age ranging from 33 to 70 years) carried both variants and 1 carried the GATA5 variant alone. Multivariate analysis showed that the presence of HCN4+GATA5 variants significantly increased AF risk (odds ratio 32.7, 95% confidence interval 1.8-591.4) independently from age, hypertension, and overweight. Functional testing showed that IHCN4 generated by heterozygous p.P1163H were normal. Topologically associating domain analysis suggested that GATA5 could affect the expression of many genes, including those encoding microRNA-1. CONCLUSION: The coincidence of 2 rare gene variants was independently associated with AF, but functional studies do not allow the postulation of the arrhythmogenic mechanisms involved.
Asunto(s)
Fibrilación Atrial , Factor de Transcripción GATA5 , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización , Linaje , Humanos , Fibrilación Atrial/genética , Fibrilación Atrial/diagnóstico , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización/genética , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Adulto , Factor de Transcripción GATA5/genética , Anciano , España/epidemiología , Canales de Potasio/genética , Secuenciación del Exoma/métodos , Animales , Predisposición Genética a la Enfermedad , Electrocardiografía Ambulatoria/métodos , Variación Genética , Proteínas MuscularesRESUMEN
BACKGROUND: KBG syndrome is a highly variable neurodevelopmental disorder and clinical diagnostic criteria have changed as new patients have been reported. Both loss-of-function sequence variants and large deletions (copy number variations, CNVs) involving ANKRD11 cause KBG syndrome, but no genotype-phenotype correlation has been reported. METHODS: 67 patients with KBG syndrome were assessed using a custom phenotypical questionnaire. Manifestations present in >50% of the patients and a 'phenotypical score' were used to perform a genotype-phenotype correlation in 340 patients from our cohort and the literature. RESULTS: Neurodevelopmental delay, macrodontia, triangular face, characteristic ears, nose and eyebrows were the most prevalentf (eatures. 82.8% of the patients had at least one of seven main comorbidities: hearing loss and/or otitis media, visual problems, cryptorchidism, cardiopathy, feeding difficulties and/or seizures. Associations found included a higher phenotypical score in patients with sequence variants compared with CNVs and a higher frequency of triangular face (71.1% vs 42.5% in CNVs). Short stature was more frequent in patients with exon 9 variants (62.5% inside vs 27.8% outside exon 9), and the prevalence of intellectual disability/attention deficit hyperactivity disorder/autism spectrum disorder was lower in patients with the c.1903_1907del variant (70.4% vs 89.4% other variants). Presence of macrodontia and comorbidities were associated with larger deletion sizes and hand anomalies with smaller deletions. CONCLUSION: We present a detailed phenotypical description of KBG syndrome in the largest series reported to date of 67 patients, provide evidence of a genotype-phenotype correlation between some KBG features and specific ANKRD11 variants in 340 patients, and propose updated clinical diagnostic criteria based on our findings.
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Anomalías Múltiples , Trastorno del Espectro Autista , Enfermedades del Desarrollo Óseo , Discapacidad Intelectual , Anomalías Dentarias , Masculino , Humanos , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/epidemiología , Discapacidad Intelectual/genética , Anomalías Múltiples/diagnóstico , Enfermedades del Desarrollo Óseo/genética , Anomalías Dentarias/genética , Facies , Trastorno del Espectro Autista/genética , Variaciones en el Número de Copia de ADN , Proteínas Represoras/genética , Deleción Cromosómica , Fenotipo , Factores de Transcripción/genéticaRESUMEN
Neuromuscular diseases are genetically highly heterogeneous, and differential diagnosis can be challenging. Over a 3-year period, we prospectively analyzed 268 pediatric and adult patients with a suspected diagnosis of inherited neuromuscular disorder (INMD) using comprehensive gene-panel analysis and next-generation sequencing. The rate of diagnosis increased exponentially with the addition of genes to successive versions of the INMD panel, from 31% for the first iteration (278 genes) to 40% for the last (324 genes). The global mean diagnostic rate was 36% (97/268 patients), with a diagnostic turnaround time of 4-6 weeks. Most diagnoses corresponded to muscular dystrophies/myopathies (68.37%) and peripheral nerve diseases (22.45%). The most common causative genes, TTN, RYR1, and ANO5, accounted for almost 30% of the diagnosed cases. Finally, we evaluated the utility of the differential diagnosis tool Phenomizer, which established a correlation between the phenotype and molecular findings in 21% of the diagnosed patients. In summary, comprehensive gene-panel analysis of all genes implicated in neuromuscular diseases facilitates a rapid diagnosis and provides a high diagnostic yield.
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In the last few years, the SORL1 gene has been strongly implicated in the development of Alzheimer's disease (AD). We performed whole-exome sequencing on 37 patients with early-onset dementia or family history suggestive of autosomal dominant dementia. Data analysis was based on a custom panel that included 46 genes related to AD and dementia. SORL1 variants were present in a high proportion of patients with candidate variants (15%, 3/20). We expand the clinical manifestations associated with the SORL1 gene by reporting detailed clinical and neuroimaging findings of six unrelated patients with AD and SORL1 mutations. We also present for the first time a patient with the homozygous truncating variant c.364C>T (p.R122*) in SORL1, who also had severe cerebral amyloid angiopathy. Furthermore, we report neuropathological findings and immunochemistry assays from one patient with the splicing variant c.4519+5G>A in the SORL1 gene, in which AD was confirmed by neuropathological examination. Our results highlight the heterogeneity of clinical presentation and familial dementia background of SORL1-associated AD and suggest that SORL1 might be contributing to AD development as a risk factor gene rather than as a major autosomal dominant gene.
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Enfermedad de Alzheimer , Demencia , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/patología , Predisposición Genética a la Enfermedad , Humanos , Proteínas Relacionadas con Receptor de LDL/genética , Proteínas de Transporte de Membrana/genética , NeuroimagenRESUMEN
Autism spectrum disorder (ASD) is a prevalent and extremely heterogeneous neurodevelopmental disorder (NDD) with a strong genetic component. In recent years, the clinical relevance of de novo mutations to the aetiology of ASD has been demonstrated. Current guidelines recommend chromosomal microarray (CMA) and a FMR1 testing as first-tier tests, but there is increasing evidence that support the use of NGS for the diagnosis of NDDs. Specifically in ASD, it has not been extensively evaluated and, thus, we performed and compared the clinical utility of CMA, FMR1 testing, and/or whole exome sequencing (WES) in a cohort of 343 ASD patients. We achieved a global diagnostic rate of 12.8% (44/343), the majority of them being characterised by WES (33/44; 75%) compared to CMA (9/44; 20.4%) or FMR1 testing (2/44; 4.5%). Taking into account the age at which genetic testing was carried out, we identified a causal genetic alteration in 22.5% (37/164) of patients over 5 years old, but only in 3.9% (7/179) of patients under this age. Our data evidence the higher diagnostic power of WES compared to CMA in the study of ASD and support the implementation of WES as a first-tier test for the genetic diagnosis of this disorder, when there is no suspicion of fragile X syndrome.
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Trastorno del Espectro Autista/diagnóstico , Secuenciación del Exoma/métodos , Proteína de la Discapacidad Intelectual del Síndrome del Cromosoma X Frágil/genética , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Adolescente , Adulto , Factores de Edad , Algoritmos , Trastorno del Espectro Autista/genética , Niño , Preescolar , Cromosomas Humanos/genética , Diagnóstico Precoz , Femenino , Pruebas Genéticas , Humanos , Lactante , Masculino , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVE: Up to 50% of patients with hypertrophic cardiomyopathy (HCM) show no disease-causing variants in genetic studies. TRIM63 has been suggested as a candidate gene for the development of cardiomyopathies, although evidence for a causative role in HCM is limited. We sought to investigate the relationship between rare variants in TRIM63 and the development of HCM. METHODS: TRIM63 was sequenced by next generation sequencing in 4867 index cases with a clinical diagnosis of HCM and in 3628 probands with other cardiomyopathies. Additionally, 3136 index cases with familial cardiovascular diseases other than cardiomyopathy (mainly channelopathies and aortic diseases) were used as controls. RESULTS: Sixteen index cases with rare homozygous or compound heterozygous variants in TRIM63 (15 HCM and one restrictive cardiomyopathy) were included. No homozygous or compound heterozygous were identified in the control population. Familial evaluation showed that only homozygous and compound heterozygous had signs of disease, whereas all heterozygous family members were healthy. The mean age at diagnosis was 35 years (range 15-69). Fifty per cent of patients had concentric left ventricular hypertrophy (LVH) and 45% were asymptomatic at the moment of the first examination. Significant degrees of late gadolinium enhancement were detected in 80% of affected individuals, and 20% of patients had left ventricular (LV) systolic dysfunction. Fifty per cent had non-sustained ventricular tachycardia. Twenty per cent of patients suffered an adverse cerebrovascular event (20%). CONCLUSION: TRIM63 appears to be an uncommon cause of HCM inherited in an autosomal-recessive manner and associated with concentric LVH and a high rate of LV dysfunction.
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Cardiomiopatía Hipertrófica/genética , Hipertrofia Ventricular Izquierda/genética , Proteínas Musculares/genética , Mutación , Proteínas de Motivos Tripartitos/genética , Ubiquitina-Proteína Ligasas/genética , Disfunción Ventricular Izquierda/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/fisiopatología , Estudios de Casos y Controles , Niño , Análisis Mutacional de ADN , Europa (Continente) , Femenino , Predisposición Genética a la Enfermedad , Herencia , Heterocigoto , Secuenciación de Nucleótidos de Alto Rendimiento , Homocigoto , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Linaje , Fenotipo , Medición de Riesgo , Factores de Riesgo , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Remodelación Ventricular , Adulto JovenRESUMEN
Carey-Fineman-Ziter syndrome is a congenital myopathy associated with mutations in the MYMK gene. It is clinically defined by the combination of hypotonia, Moebius-Robin sequence, facial anomalies and motor delay. Historically it was considered a brainstem dysgenesis syndrome. We provide detailed information of a Spanish boy with compound heterozygous variants in MYMK gene. A muscle biopsy performed as a toddler only disclosed minimal changes, but muscle MRI showed severe fatty infiltration of gluteus muscles and to a lesser extent in adductors magnus, sartorius and soleus muscles. Clinical course is fairly static, but the identification of new well characterized genetic cases will help to delineate the complete phenotype.
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Proteínas de la Membrana/genética , Síndrome de Mobius/diagnóstico , Síndrome de Mobius/genética , Síndrome de Mobius/patología , Proteínas Musculares/genética , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/genética , Enfermedades Musculares/patología , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/genética , Síndrome de Pierre Robin/patología , Encefalopatías/diagnóstico , Tronco Encefálico/anomalías , Niño , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
No disponible
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Humanos , Masculino , Femenino , Adulto Joven , Persona de Mediana Edad , Osteogénesis Imperfecta/genética , Reproducción/fisiología , Difosfonatos/uso terapéutico , Asesoramiento Genético , Fertilización In VitroAsunto(s)
Colágeno Tipo I/genética , Mutación Missense , Osteogénesis Imperfecta/genética , Mutación Puntual , Técnicas Reproductivas Asistidas , Sustitución de Aminoácidos , Cadena alfa 1 del Colágeno Tipo I , Femenino , Genes Dominantes , Asesoramiento Genético , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Linaje , Adulto JovenRESUMEN
Cystinuria is a genetic cause of kidney stones with a prevalence of 1 in 7000 births. So far, two genes have been described responsible for this disorder (SLC3A1 and SLC7A9). We report a patient with an SLC7A9 gene mutation located in 19q13.1 on one allele and with a 19q12q13 region deletion on the other allele. The characteristic clinical features of the 19q13.1 microdeletion syndrome include facial dysmorphism, signs of ectodermal dysplasia, growth retardation, neurologic features and genitourinary anomalies. Cystinuria has not yet been described as part of this syndrome, although one of its responsible genes (SLC7A9) is in the same genomic location. The index case is a 6-year-old male presented with distinctive facial features, cutis aplasia of the scalp, rudimentary teeth, microcephaly, intrauterine and postnatal growth retardation, psychomotor developmental delay, speech delay, epilepsy, inguinal hernias and cystinuria. An array-CGH analysis was performed, finding a large deletion of the 19q12q13.11 cytobands, which affects 19 genes. Two of them are involved in the 19q13.11 deletion syndrome and another affected gene is SLC7A9, responsible for type B cystinuria. Sanger sequencing was performed as well, detecting a heterozygous mutation of the SLC7A9 gene, located in 19q13.1. As far as we know, this is the first described case of cystinuria in a patient with SLC7A9 gene mutation located in 19q13.1 on one allele and with 19q12q13 region deletion on the other allele. Although this patient can be classified as a type B heterozygote and, therefore, his renal prognosis is not severe, the occasional nephrolithiasis found in such patients justifies a close follow-up with regular testing of urinary cystine excretion. We suggest that the recessive behavior of this case, explains the clinical features regarding cystinuria. We propose that in the face of patients affected of a phenotype matchable with 19q13.11 syndrome and cystinuria, a mutational or sequencing study of the SLC7A9 gene should be performed to allow an early onset of diagnosis and treatment.
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No disponible
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Adulto , Femenino , Humanos , Rabdomiólisis/complicaciones , Rabdomiólisis/genética , Rabdomiólisis/cirugía , Miositis/complicaciones , Miositis/genética , Mialgia/complicaciones , Mialgia/genética , Mialgia/terapia , Biopsia/métodos , Mutagénesis/fisiología , Ejercicio Físico , Electromiografía/métodos , Electromiografía/tendencias , Microscopía Electrónica/instrumentación , Microscopía Electrónica/métodosAsunto(s)
Lipasa/genética , Mutación Missense , Mutación Puntual , Rabdomiólisis/genética , Enfermedad Aguda , Adulto , Sustitución de Aminoácidos , Dieta Baja en Carbohidratos/efectos adversos , Dieta Reductora/efectos adversos , Ejercicio Físico , Exones/genética , Femenino , Heterocigoto , Humanos , Lípidos/análisis , Músculo Esquelético/patología , Recurrencia , Rabdomiólisis/etiología , Rabdomiólisis/patología , Vacuolas/ultraestructuraRESUMEN
No disponible
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Humanos , Sarcoglicanos/genética , Distrofias Musculares/genética , Mutación/genéticaRESUMEN
TITLE: Nueva mutacion en el gen del alfa-sarcoglicano en una familia espanola con distrofia muscular.
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Mutación Missense , Mutación Puntual , Sarcoglicanopatías/genética , Sarcoglicanos/genética , Adulto , Femenino , Pérdida Auditiva Sensorineural/genética , Heterocigoto , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Sarcoglicanopatías/diagnóstico , EspañaRESUMEN
Objetivos. Revisar los principios de los microarrays (en concreto array-CGH [a-CGH]), sus beneficios para el diagnóstico prenatal y los desafíos asociados, a través de los trabajos actualmente publicados y aquellos derivados de nuestra experiencia práctica en los dos últimos años. Métodos. Revisión de la literatura y comparación con estudios prospectivos y retrospectivos con array-CGH en casos de gestaciones con elevado riesgo (preferentemente con alteraciones ecográficas). Resultados. La tasa de detección de alteraciones genómicas por a-CGH en nuestros casos con alteraciones ecográficas fue de entre el 13,3 y el 15%. Conclusión. La combinación de la mayor capacidad de los microarrays en el cribado del genoma humano para la detección de cambios en números de copias, dentro de un único ensayo experimental, así como su mayor resolución técnica en casos de gestaciones de elevado riesgo, podría convertir a los array-CGH, en la próxima década, en una alternativa muy interesante para reemplazar al cariotipo convencional como test diagnóstico de primera línea, en estos casos(AU)
Objectives. Review the principles of microarrays (in particular array-CGH), their benefits for prenatal diagnosis and the associated challenges, through the currently published works and those derived from our practical experience over the past two years. Methods. A literature review was carried out, as well as comparisons with prospective and retrospective studies with array-CGH in cases of pregnancies at high risk (preferably with ultrasound anomalies). Results. The detection rate of genomic alterations by array-CGH in our cases with ultrasound anomalies was between 13.3-15%. Conclusion. The combination of the increased capacity of microarrays in screening of the human genome to detect changes in copy numbers variations, within a single experimental assay, as well as their greater technical resolution in cases of high-risk pregnancies, could lead to array-CGH to be a very interesting diagnostic approach in the next decade to replace the karyotype as a gold standard in such prenatal studies(AU)
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Humanos , Femenino , Embarazo , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal , Hibridación Genética/genética , Grupos de Riesgo , Gonadotropina Coriónica , Diagnóstico Prenatal/tendencias , Estudios Prospectivos , Estudios Retrospectivos , Tamizaje Masivo/métodosRESUMEN
BACKGROUND: Alport syndrome is a primary basement membrane disorder arising from mutations in genes encoding the type IV collagen protein family. It is a genetically heterogeneous disease with different mutations and forms of inheritance that presents with renal affection, hearing loss and eye defects. Several new mutations related to X-linked forms have been previously determined. METHODS: We report the case of a 12 years old male and his family diagnosed with Alport syndrome after genetic analysis was performed. RESULT: A new mutation determining a nucleotide change c.3614G > T (p.Gly1205Val) in hemizygosis in the COL4A5 gene was found. This molecular defect has not been previously described. CONCLUSION: Molecular biology has helped us to comprehend the mechanisms of pathophysiology in Alport syndrome. Genetic analysis provides the only conclusive diagnosis of the disorder at the moment. Our contribution with a new mutation further supports the need of more sophisticated molecular methods to increase the mutation detection rates with lower costs and less time.
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Familial hypocalciuric hypercalcemia is an uncommon cause of hypercalcemia that arises from mutations in the calcium-sensing receptor gene. Inactivation of this receptor leads to a decreased receptor sensitivity to calcium, determining that higher concentrations of calcium are needed to inhibit the release of parathormone in the parathyroid glands. Patients usually are asymptomatic. Diagnosis is usually made casually after a routine blood analysis. The syndrome is characterized by mild or moderate hypercalcemia, hypocalciuria, and normal or slightly increased levels of parathormone. The degree of hypercalcemia depends on the type of mutation. The accurate diagnosis is important since it is a benign disorder that does not require medical or surgical treatment. We report a 9-year-old female with persistent hypercalcemia in several routine blood analyses, who was diagnosed with familial hypocalciuric hypercalcemia after genetic studies were performed. A new mutation determining a nucleotide change c.2089G>A in the calcium-sensing receptor gene (exon 7) was detected. This mutation was also found in the patient's mother and brother.
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Hipercalcemia/genética , Mutación Puntual , Receptores Sensibles al Calcio/genética , Niño , Femenino , Humanos , Hipercalcemia/diagnóstico , Análisis de Secuencia de ADNRESUMEN
The SRY gene, located on the short arm of the Y chromosome, is responsible for differentiation of the testis from the undifferentiated gonad. We report a 4-year-old patient with male phenotype and female karyotype (46,XX) with cryptorchidism as the only presenting clinical abnormality. Fluorescent in situ hybridization analysis, using Y- and X-specific (whole chromosome painting WCP Y WCP X) DNA and SRY probes, detected a small Y chromosome fragment, including the SRY gene, transferred to the short arm of the X chromosome.