TY - JOUR A1 - Schreiber, Olivia A1 - Schneiderat, Peter A1 - Kress, Wolfram A1 - Rautenstrauss, Bernd A1 - Senderek, Jan A1 - Schoser, Bendikt A1 - Walter, Maggie C. T1 - Facioscapulohumeral muscular dystrophy and Charcot-Marie-Tooth neuropathy 1A-evidence for "double trouble" overlapping syndromes JF - BMC Medical Genetics N2 - Background: We report on a patient with genetically confirmed overlapping diagnoses of CMT1A and FSHD. This case adds to the increasing number of unique patients presenting with atypical phenotypes, particularly in FSHD. Even if a mutation in one disease gene has been found, further genetic testing might be warranted in cases with unusual clinical presentation. Case presentation: The reported 53 years old male patient suffered from walking difficulties and foot deformities first noticed at age 20. Later on, he developed scapuloperoneal and truncal muscle weakness, along with atrophy of the intrinsic hand and foot muscles, pes cavus, claw toes and a distal symmetric hypoesthesia. Motor nerve conduction velocities were reduced to 20 m/s in the upper extremities, and not educible in the lower extremities, sensory nerve conduction velocities were not attainable. Electromyography showed both, myopathic and neurogenic changes. A muscle biopsy taken from the tibialis anterior muscle showed a mild myopathy with some neurogenic findings and hypertrophic type 1 fibers. Whole-body muscle MRI revealed severe changes in the lower leg muscles, tibialis anterior and gastrocnemius muscles were highly replaced by fatty tissue. Additionally, fatty degeneration of shoulder girdle and straight back muscles, and atrophy of dorsal upper leg muscles were seen. Taken together, the presenting features suggested both, a neuropathy and a myopathy. Patient's family history suggested an autosomal dominant inheritance. Molecular testing revealed both, a hereditary motor and sensory neuropathy type 1A (HMSN1A, also called Charcot-Marie-Tooth neuropathy 1A, CMT1A) due to a PMP22 gene duplication and facioscapulohumeral muscular dystrophy (FSHD) due to a partial deletion of the D4Z4 locus (19 kb). Conclusion: Molecular testing in hereditary neuromuscular disorders has led to the identification of an increasing number of atypical phenotypes. Nevertheless, finding the right diagnosis is crucial for the patient in order to obtain adequate medical care and appropriate genetic counseling, especially in the background of arising curative therapies. KW - D4Z4 partial deletion KW - sensory neuropathy KW - hereditary motor KW - disease KW - phenotype KW - FSHD KW - myopathy KW - patient KW - duplication KW - diagnosis KW - facioscapulohumeral muscular dystrophy KW - Charcot-Marie-Tooth neuropathy 1A KW - hereditary motor and sensory neuropathy KW - double trouble KW - overlapping syndrome Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121963 SN - 1471-2350 VL - 14 IS - 92 ER - TY - JOUR A1 - Vona, Barbara A1 - Maroofian, Reza A1 - Bellacchio, Emanuele A1 - Najafi, Maryam A1 - Thompson, Kyle A1 - Alahmad, Ahmad A1 - He, Langping A1 - Ahangari, Najmeh A1 - Rad, Abolfazl A1 - Shahrokhzadeh, Sima A1 - Bahena, Paulina A1 - Mittag, Falk A1 - Traub, Frank A1 - Movaffagh, Jebrail A1 - Amiri, Nafise A1 - Doosti, Mohammad A1 - Boostani, Reza A1 - Shirzadeh, Ebrahim A1 - Haaf, Thomas A1 - Diodato, Daria A1 - Schmidts, Miriam A1 - Taylor, Robert W. A1 - Karimiani, Ehsan Ghayoor T1 - Expanding the clinical phenotype of IARS2-related mitochondrial disease JF - BMC Medical Genetics N2 - Background: IARS2 encodes a mitochondrial isoleucyl-tRNA synthetase, a highly conserved nuclear-encoded enzyme required for the charging of tRNAs with their cognate amino acid for translation. Recently, pathogenic IARS2 variants have been identified in a number of patients presenting broad clinical phenotypes with autosomal recessive inheritance. These phenotypes range from Leigh and West syndrome to a new syndrome abbreviated CAGSSS that is characterised by cataracts, growth hormone deficiency, sensory neuropathy, sensorineural hearing loss, and skeletal dysplasia, as well as cataract with no additional anomalies. Methods: Genomic DNA from Iranian probands from two families with consanguineous parental background and overlapping CAGSSS features were subjected to exome sequencing and bioinformatics analysis. Results: Exome sequencing and data analysis revealed a novel homozygous missense variant (c.2625C > T, p.Pro909Ser, NM_018060.3) within a 14.3 Mb run of homozygosity in proband 1 and a novel homozygous missense variant (c.2282A > G, p.His761Arg) residing in an ~ 8 Mb region of homozygosity in a proband of the second family. Patient-derived fibroblasts from proband 1 showed normal respiratory chain enzyme activity, as well as unchanged oxidative phosphorylation protein subunits and IARS2 levels. Homology modelling of the known and novel amino acid residue substitutions in IARS2 provided insight into the possible consequence of these variants on function and structure of the protein. Conclusions: This study further expands the phenotypic spectrum of IARS2 pathogenic variants to include two patients (patients 2 and 3) with cataract and skeletal dysplasia and no other features of CAGSSS to the possible presentation of the defects in IARS2. Additionally, this study suggests that adult patients with CAGSSS may manifest central adrenal insufficiency and type II esophageal achalasia and proposes that a variable sensorineural hearing loss onset, proportionate short stature, polyneuropathy, and mild dysmorphic features are possible, as seen in patient 1. Our findings support that even though biallelic IARS2 pathogenic variants can result in a distinctive, clinically recognisable phenotype in humans, it can also show a wide range of clinical presentation from severe pediatric neurological disorders of Leigh and West syndrome to both non-syndromic cataract and cataract accompanied by skeletal dysplasia. KW - adrenal insufficiency KW - CAGSSS KW - cataracts KW - growth hormone deficiency KW - IARS2 KW - sensory neuropathy KW - sensorineural hearing loss KW - type II esophageal achalasia KW - skeletal dysplasia Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176620 VL - 19 IS - 196 ER -