2,839 research outputs found
Is cyber security being taught correctly?
No full textStudents, academia and businesses all want different things from security. Dr Nigel Houlden, Dr Victoria Jackson and Dr Moustafa Haj Youssef ask whether trying to meet all of these demands is the right approach
Is cyber security being taught correctly?
No full textStudents, academia and businesses all want different things from security. Dr Nigel Houlden, Dr Victoria Jackson and Dr Moustafa Haj Youssef ask whether trying to meet all of these demands is the right approach
PRUNE1: a disease-causing gene for secondary microcephaly
No full textIn their Letter to the Editor, Karakaya et al. (2017) present
an interesting case report describing the clinical course
involving secondary microcephaly of a 3-year-old Turkish
boy found to be homozygous for a frameshift mutation in
PRUNE1 identified through whole exome sequencing. The
child presented with congenital hypotonia, contractures and
global developmental delay with respiratory insufficiency
and seizures developing in the first year of life. The authors
note that the affected child’s head circumference plotted on
the 75th centile at birth, and that by 38 months of age he
had developed microcephaly. Neuroimaging at 14 months
revealed cerebral and cerebellar atrophy consistent with
other patients described with Prune syndrome (Karaca
et al., 2015; Costain et al., 2017; Zollo et al., 2017).
Although the child had abnormal neurology from birth,
there was a period of early developmental regression.
Peripheral spasticity in the lower extremities and optic atrophy
were not documented until 38 months. In addition to
the PRUNE1 variant, Karakaya et al. also identified a
second homozygous variant in the CCDC14 gene in the
Turkish child’s whole exome sequencing data that, while
listed to have an allele count of 108 in the current Genome
Aggregation Database (gnomAD) release, is notably absent
in homozygous fashion (Lek et al., 2016). CCDC14 is
known to be expressed in human brain, reported to negatively
regulate centriole duplication and interact with proteins
previously associated with primary microcephaly
(Firat-Karalar et al., 2014). Thus, while it seems likely
that the homozygous PRUNE1 variant is primarily responsible
for the clinical presentation in the Turkish child, it is
impossible to determine whether there may be any phenotypical
contribution from this additional homozygous
sequence variant.
Recently, Costain et al. (2017) described a homozygous
consensus splice site variant in PRUNE1 (c.521-2A4G;
NM_021222.1) in a 2-year-old Oji-Cre male who presented
with congenital hypotonia and talipes, whose head circumference
was large at birth ( +3 standard deviations), but by
2 years and 2 months plotted on the 50th centile, with a
weight and height on the 95th and 75th centiles, respectively.
However, it should be noted that the child’s father
is macrocephalic ( +4 standard deviations), the published
clinical photographs at 2 years 5 months of age illustrate
bitemporal narrowing, a sloping forehead and large ears,
consistent with a developing microcephaly, and neuroimaging revealed cortical and cerebellar atrophy. He
developed respiratory insufficiency shortly after birth, and
infantile spasms in the first year of life (Costain et al., 2017).
It remains to be determined how the phenotypical outcomes
stemming from proposed loss-of-function mutations
defined by Karakaya et al. and Costain et al., relate to
missense mutations published by Karaca et al. and also
Zollo et al., which are likely to involve at least partial
gain-of-function outcomes in PRUNE1 activity. However,
as more cases are investigated and published, the phenotype
associated with autosomal recessive Prune neurodevelopmental
disorder, and the functional outcomes of
PRUNE1 mutation, are becoming clearer. It is now apparent
that while some patients have a small head at birth and
others a head circumference in the normal range, the key
component of the microcephaly is that it is progressive, and
associated with characteristic neuroimaging findings with a
thin or hypoplastic corpus callosum and cortical and cerebellar
atrophy developing in early childhood. Although all
patients with Prune syndrome described to date are neurologically
impaired from birth, there also appears to be a
neurodegenerative component with progression of the disorder.
In our manuscript, we described clinical overlap of
Prune syndrome with the neurodegenerative condition associated
with homozygous mutations in TBCD (Zollo et al.,
2017). TBCD encodes one of the five tubulin-specific chaperones
that are required for a/b-tubulin de novo heterodimer
formation and the disorder is characterized by
developmental regression, seizures, optic atrophy and secondary
microcephaly, cortical atrophy with delayed myelination,
cerebellar atrophy and thinned corpus callosum
(Edvardson et al., 2016; Flex et al., 2016; Miyake et al.,
2016; Pode-Shakked et al., 2017). The neurodegenerative
phenotype documented in the Turkish child by Karakaya
et al. further demonstrates the similarities with the TBCD
disorder and Prune syndrome, and confirms optic atrophy
to be a feature of Prune syndrome. Interestingly, it is also
becoming clear that respiratory insufficiency is a common
feature of Prune syndrome, having been documented by
Karakaya et al. and in the Oji-Cre child, as well as the
youngest affected Omani child described in our manuscript
How to approach a neurogenetics diagnosis in different European countries: The European Academy of Neurology Neurogenetics Panel survey
No full textBackground and purpose: Seven thousand rare diseases have been identified; most of them are of genetic origin. The diagnosis of a neurogenetic disease is difficult, and management and training programs are not well defined through Europe. To capture and assess care needs, the Neurogenetics Panel of the European Academy of Neurology (EAN) has performed an explorative survey. Methods: The survey covering multiple topics of neurogenetics was sent to all neurologists and neuropediatricians affiliated with the EAN practicing in Europe. Results: We collected answers from 239 members based in 40 European member states. Even though most of the responders were aware of neurogenetic diseases, when we came to amenability of carrying out a complete genetic diagnosis, almost one-third of the responders declared they were not happy with the current way of ordering genetic analyses in their countries. Furthermore, although single-gene analysis is diffusely present in Europe, whole exome and genome sequencing are not easily accessible, with considerable variabilities among countries. Almost 10% of the responders did not know if presymptomatic and prenatal diagnosis was available in their countries, and 47.3% were not aware of which newborn screening programs were available. Finally, 96.3% of responders declared that there is a need for education and training in neurogenetics. Conclusions: We believe that this survey may be of importance for all European stakeholders in neurogenetics in identifying key priorities, targeting areas to encourage education/travel fellowships, and educational seminars in the future, because this area will only accelerate, and diagnostic requirements will expand
Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): genetic and clinical aspects
No full textCerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) typically presents in middle life with a combination of neuropathy, ataxia and vestibular disease, with patients reporting progressive imbalance, oscillopsia, sensory disturbance and a dry cough. Examination identifies a sensory neuropathy or neuronopathy and bilaterally impaired vestibulo-ocular reflex. The underlying genetic basis is of biallelic AAGGG expansions in the second intron of replication factor complex subunit 1 (RFC1). The frequency and phenotype spectrum of RFC1 disease is expanding, ranging from typical CANVAS to site-restricted variants affecting the sensory nerves, cerebellum and/or the vestibular system. Given the wide phenotype spectrum of RFC1, the differential diagnosis is broad. RFC1 disease due to biallelic AAGGG expansions is probably the most common cause of recessive ataxia. The key to suspecting the disease (and prompt genetic testing) is a thorough clinical examination assessing the three affected systems and noting the presence of chronic cough
sj-docx-1-wso-10.1177_17474930211062478 – Supplemental material for MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage
No full textSupplemental material, sj-docx-1-wso-10.1177_17474930211062478 for MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage by Ghil Schwarz, Gargi Banerjee, Isabel C Hostettler, Gareth Ambler, David J Seiffge, Hatice Ozkan, Simone Browning, Robert Simister, Duncan Wilson, Hannah Cohen, Tarek Yousry, Rustam Al-Shahi Salman, Gregory Y H Lip, Martin M Brown, Keith W Muir, Henry Houlden, Rolf Jäger and David J Werring in International Journal of Stroke</p
Insights into molecular mechanisms of disease in Neurodegeneration with Brain Iron Accumulation; unifying theories.
No full textNeurodegeneration with brain iron accumulation (NBIA) is a group of disorders characterised by dystonia, parkinsonism and spasticity. Iron accumulates in the basal ganglia and may be accompanied by Lewy bodies, axonal swellings and hyperphosphorylated tau depending on NBIA subtype. Mutations in 10 genes have been associated with NBIA that include Ceruloplasmin (Cp) and Ferritin Light Chain (FTL), both directly involved in iron homeostasis, as well as Pantothenate Kinase 2 (PANK2), Phospholipase A2 group 6 (PLA2G6), Fatty acid hydroxylase 2 (FA2H), Coenzyme A synthase (COASY), C19orf12, WDR45 and DCAF17 (C2orf37). These genes are involved in seemingly unrelated cellular pathways, such as lipid metabolism, Coenzyme A synthesis and autophagy. A greater understanding of the cellular pathways that link these genes and the disease mechanisms leading to iron dyshomeostasis is needed. Additionally, the major overlap seen between NBIA and more common neurodegenerative diseases may highlight conserved disease processes. In this review, we will discuss clinical and pathological findings for each NBIA-related gene, discuss proposed disease mechanisms such as mitochondrial health, oxidative damage, autophagy/mitophagy and iron homeostasis and speculate potential overlap between NBIA subtypes
Targeted next-generation sequencing panels in the diagnosis of Charcot-Marie-Tooth disease
No full textObjectiveTo investigate the effectiveness of targeted next-generation sequencing (NGS) panels in achieving a molecular diagnosis in Charcot-Marie-Tooth disease (CMT) and related disorders in a clinical setting.MethodsWe prospectively enrolled 220 patients from 2 tertiary referral centers, one in London, United Kingdom (n = 120), and one in Iowa (n = 100), in whom a targeted CMT NGS panel had been requested as a diagnostic test. PMP22 duplication/deletion was previously excluded in demyelinating cases. We reviewed the genetic and clinical data upon completion of the diagnostic process.ResultsAfter targeted NGS sequencing, a definite molecular diagnosis, defined as a pathogenic or likely pathogenic variant, was reached in 30% of cases (n = 67). The diagnostic rate was similar in London (32%) and Iowa (29%). Variants of unknown significance were found in an additional 33% of cases. Mutations in GJB1, MFN2, and MPZ accounted for 39% of cases that received genetic confirmation, while the remainder of positive cases had mutations in diverse genes, including SH3TC2, GDAP1, IGHMBP2, LRSAM1, FDG4, and GARS, and another 12 less common genes. Copy number changes in PMP22, MPZ, MFN2, SH3TC2, and FDG4 were also accurately detected. A definite genetic diagnosis was more likely in cases with an early onset, a positive family history of neuropathy or consanguinity, and a demyelinating neuropathy.ConclusionsNGS panels are effective tools in the diagnosis of CMT, leading to genetic confirmation in one-Third of cases negative for PMP22 duplication/deletion, thus highlighting how rarer and previously undiagnosed subtypes represent a relevant part of the genetic landscape of CMT
Identification of common genetic markers of paroxysmal neurological disorders using a network analysis approach
No full textEmerging data have established links between paroxysmal neurological disorders or psychiatric disorder, such as migraine, ataxia, movement disorders and epilepsy. Common gene signatures such as expression, protein interaction and the associated signalling pathways link genes in these associated disorders, with the object to predict unknown disease or risk genes. In this study, we used gene interaction networks to investigate common gene signatures associated with the above phenotypes. In total, 19 candidate genes were used for making an interaction network which further revealed 39 associated genes (including KCNA1, SCN2A, CACNA1A, KCNM4, KCNO3, SCN1B and CACNB4) implicated in paroxysmal neurological disorders development and progression. The meta-regression analysis showed the strongest association of SCN2A with genes involved in schizophrenia and neurodevelopmental disorders. Importantly, our analysis showed KCNMA1 as a common gene signature with a link to epilepsy, movement disorders and wide paroxysmal neurological presentations—with the greatest potential risk of being a disease gene in a paroxysmal or psychiatric disorder. Further gene interaction analysis is required to identify unidentified gene interactions which may be targets for future drugs development
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