Gudrun Nürnberg

Splitting schizophrenia: periodic catatonia-susceptibility locus on chromosome 15q15.

The nature of subtypes in schizophrenia and the meaning of heterogeneity in schizophrenia have been considered a principal controversy in psychiatric research. We addressed these issues in periodic catatonia, a clinical entity derived from Leonhards classification of schizophrenias, in a genomewide linkage scan. Periodic catatonia is characterized by qualitative psychomotor disturbances during acute psychotic outbursts and by long-term outcome. On the basis of our previous findings of a lifetime morbidity risk of 26.9% of periodic catatonia in first-degree relatives, we conducted a genome scan in 12 multiplex pedigrees with 135 individuals, using 356 markers with an average spacing of 11 cM. In nonparametric multipoint linkage analyses (by GENEHUNTER-PLUS), significant evidence for linkage was obtained on chromosome 15q15 (P = 2.6 x 10(-5); nonparametric LOD score [LOD*] 3.57). A further locus on chromosome 22q13 with suggestive evidence for linkage (P = 1.8 x 10(-3); LOD* 1.85) was detected, which indicated genetic heterogeneity. Parametric linkage analysis under an autosomal dominant model (affecteds-only analysis) provided independent confirmation of nonparametric linkage results, with maximum LOD scores 2.75 (recombination fraction [theta].04; two-point analysis) and 2.89 (theta =.029; four-point analysis), at the chromosome 15q candidate region. Splitting the complex group of schizophrenias on the basis of clinical observation and genetic analysis, we identified periodic catatonia as a valid nosological entity. Our findings provide evidence that periodic catatonia is associated with a major disease locus, which maps to chromosome 15q15.

Deletions and point mutations of LRRC50 cause primary ciliary dyskinesia due to dynein arm defects.

Genetic defects affecting motility of cilia and flagella cause chronic destructive airway disease, randomization of left-right body asymmetry, and, frequently, male infertility in primary ciliary dyskinesia (PCD). The most frequent defects involve outer and inner dynein arms (ODAs and IDAs) that are large multiprotein complexes responsible for cilia-beat generation and regulation, respectively. Here, we demonstrate that large genomic deletions, as well as point mutations involving LRRC50, are responsible for a distinct PCD variant that is characterized by a combined defect involving assembly of the ODAs and IDAs. Functional analyses showed that LRRC50 deficiency disrupts assembly of distally and proximally DNAH5- and DNAI2-containing ODA complexes, as well as DNALI1-containing IDA complexes, resulting in immotile cilia. On the basis of these findings, we assume that LRRC50 plays a role in assembly of distinct dynein-arm complexes.

Diaphragmatic Spinal Muscular Atrophy with Respiratory Distress Is Heterogeneous, and One Form Is Linked to Chromosome 11q13-q21

To the Editor: n nDiaphragmatic spinal muscular atrophy (SMA) has been delineated as a variant of infantile SMA (SMA1 [MIM 253300]) (Mellins et al. 1974; Bertini et al. 1989). The most prominent symptoms are severe respiratory distress resulting from diaphragmatic paralysis with eventration shown on chest x-ray and predominant involvement of the upper limbs and distal muscles. In contrast to classic SMA1, in diaphragmatic SMA the upper spinal cord is more severely affected than the lower section. The pmn mouse presents with progressive motor neuronopathy and a disease that closely resembles diaphragmatic SMA (Schmalbruch et al. 1991). The pmn locus has been mapped to murine chromosome 13 (Brunialti et al. 1995). n nHere we report on nine patients from three families with diaphragmatic SMA following autosomal recessive inheritance. The diagnosis of diaphragmatic SMA was made on the basis of clinical criteria (Rudnik-Schoneborn et al. 1996). Family 1 is of Lebanese origin; family 2, German origin; and family 3, Italian origin. We obtained DNA samples from these families after receiving informed consent, in accordance with the Declaration of Helsinki. n nIn family 1 (fig. 1A), the parents are first cousins. The first affected son died, at the age of 10 wk, of suspected sudden infant death syndrome (SIDS). One daughter presented, at the age of 6 wk, with feeding difficulties and progressive respiratory distress. Chest x-ray showed eventration of the diaphragm. Mechanical ventilation was initiated at the age of 8 wk. She developed progressive muscular atrophy with complete paralysis of the upper and lower limbs and mild contractures of the knee and ankle joints. Three other children, nonidentical twin daughters and the youngest daughter, died of respiratory failure—the twins at the age of 8 and 9 wk and the youngest daughter at the age of 8 wk. Autopsy specimens were taken from gastrocnemius muscle in both twins and from the upper spinal cord in one twin. Skeletal-muscle histology revealed neurogenic atrophy without signs of reinnervation. Ultrastructurally, the motor end plates lacked nerve terminals and showed postsynaptic degenerative changes characterized by deep invaginations. The diameter of anterior spinal roots was reduced in the upper spinal cord. The remaining motor neurons showed chromatolysis. These findings offer two different pathophysiological concepts: (1) degeneration of the anterior horn cells of the spinal cord with neurogenic muscular atrophy suggests dying-forward atrophy, and (2) presynaptic and postsynaptic signs of motor end-plate degeneration suggest dying-back atrophy. In family 2 (fig. 1B), the first child had severe muscular hypotonia and died, at the age of 9 wk, of cardiorespiratory failure. The third child has been mechanically ventilated since the age of 3 mo. In family 3 (fig. 1C), which has been reported in detail elsewhere (Novelli et al. 1995), the gene locus for SMA1, on chromosome 5q, has been excluded. Both affected sibs presented with respiratory insufficiency right after birth and with the typical signs of diaphragmatic SMA. n n n nFigure 1 n nHaplotypes in families with diaphragmatic SMA subtypes. A, Family 1 (Lebanese origin): age at onset, 6–10 wk. B, Family 2 (German origin): age at onset, 9–12 wk. C, Family 3 (Italian origin): onset at birth. Haplotype analysis indicated ... n n n nFirst, we confirmed that, in families 1 and 2, there is no linkage of the trait to markers of the SMA locus on 5q11.2-q13.3, as there is in family 3. Second, the orthologous regions corresponding to the murine pmn gene region on human chromosomes 1q and 7p were excluded as gene loci responsible for the disease (Grohmann et al. 1998). n nTo locate the gene locus for diaphragmatic SMA, a whole-genome scan was undertaken in family 1. Microsatellite analysis was performed, by standard semiautomated methods, by an ABI 377-Sequencer, and the results were processed by GENESCAN software, as described elsewhere (Saar et al. 1997). The whole-genome linkage scan was performed with the use of 340 polymorphic fluorescence–labeled markers spaced at ∼10-cM intervals throughout the autosomal part of the genome. Subsequent fine mapping was performed with eight additional microsatellite markers. Markers were chosen from the Genethon final linkage map. Two-point parametric linkage analyses were performed with the LINKAGE package, version 5.2 (Lathrop and Lalouel 1984), under the following assumptions: a regular, fully penetrant autosomal recessive trait locus with a disease-allele frequency of .002 and no phenocopy rate, codominant marker loci with uniformly distributed allele frequencies, and standard recombination rates. Multipoint analysis was performed with the GENEHUNTER program, version 1.3 (Kruglyak et al. 1996). n nGenomewide linkage scanning of family 1 revealed linkage of diaphragmatic SMA only to markers on chromosome 11q13-q21. In the following, we name this subtype of diaphragmatic SMA “spinal muscular atrophy with respiratory distress” (SMARD). For the markers D11S1296, D11S4095, D11S901, D11S1358, and D11S1757, a maximum two-point LOD score of 3.16 at recombination fraction (θ) 0 was obtained. The two-point LOD scores for 13 markers on chromosome 11q are summarized in table 1. Haplotype analysis revealed a recombination event in individual 2.4 that placed the disease locus distal to marker D11S1883 (fig. 1A). The crossing-over in individual 2.1 placed the disease locus proximal to marker D11S917. Consistent with parental consanguinity, all affected siblings from family 1 were autozygous for all markers within the cosegregating segment. Multipoint linkage analysis with the use of 13 markers yielded a maximum LOD score of 3.86, which clearly places the disease locus between D11S1883 and D11S917 (Genethon map positions 68.5 cM and 100.9 cM). n n n nTable 1 n nLOD-Score Values at Standard Recombination Rates for Markers on Chromosome 11q in Lebanese Family 1 n n n nIn family 2, the two affected sibs shared two identical parental haplotypes in the SMARD cosegregating segment on 11q13-q21, a finding that supports the assignment of the SMARD locus to this region (fig. 1B). In family 3, haplotype analysis was inconsistent with linkage to the markers tested (fig. 1C). Thus, this locus was excluded as being responsible for the disease in this family. Our finding that diaphragmatic SMA with onset at age 6–12 wk is linked to chromosome 11q markers in two apparently unrelated families from different countries (families 1 and 2) but that diaphragmatic SMA with onset at birth does not show such linkage (family 3) suggests that diaphragmatic SMA is both clinically and genetically heterogeneous. n nThe prevalence of diaphragmatic SMA is unknown. However, in a series of >200 patients with early-onset SMA, ∼1% presented with diaphragmatic SMA and did not have a deletion of the survival motor-neuron gene (SMN) on chromosome 5q (Rudnik-Schoneborn et al. 1996). Considering the case history of the affected son from family 1 who had suspected SIDS, we presume that some of those infants with SIDS may possibly have been misdiagnosed. We are currently looking for further patients with SMARD, to refine the large cosegregating region on chromosome 11q.

Mutations in NEK8 link multiple organ dysplasia with altered Hippo signalling and increased c-MYC expression

Mutations affecting the integrity and function of cilia have been identified in various genes over the last decade accounting for a group of diseases called ciliopathies. Ciliopathies display a broad spectrum of phenotypes ranging from mild manifestations to lethal combinations of multiple severe symptoms and most of them share cystic kidneys as a common feature. Our starting point was a consanguineous pedigree with three affected fetuses showing an early embryonic phenotype with enlarged cystic kidneys, liver and pancreas and developmental heart disease. By genome-wide linkage analysis, we mapped the disease locus to chromosome 17q11 and identified a homozygous nonsense mutation in NEK8/NPHP9 that encodes a kinase involved in ciliary dynamics and cell cycle progression. Missense mutations in NEK8/NPHP9 have been identified in juvenile cystic kidney jck mice and in patients suffering from nephronophthisis (NPH), an autosomal-recessive cystic kidney disease. This work confirmed a complete loss of NEK8 expression in the affected fetuses due to nonsense-mediated decay. In cultured fibroblasts derived from these fetuses, the expression of prominent polycystic kidney disease genes (PKD1 and PKD2) was decreased, whereas the oncogene c-MYC was upregulated, providing potential explanations for the observed renal phenotype. We furthermore linked NEK8 with NPHP3, another NPH protein known to cause a very similar phenotype in case of null mutations. Both proteins interact and activate the Hippo effector TAZ. Taken together, our study demonstrates that NEK8 is essential for organ development and that the complete loss of NEK8 perturbs multiple signalling pathways resulting in a severe early embryonic phenotype.

A gene locus for branchio-otic syndrome maps to chromosome 14q21.3-q24.3

Branchio-oto-renal syndrome (BOR, OMIM 113650) is an autosomal dominant disorder characterised by the association of hearing loss (HL), structural ear anomalies, branchial arch defects, and renal anomalies.1 The prevalence approximates 1:40 000 in the general population, and has been reported in about 2% of deaf children.2 Age of onset for deafness varies from childhood to early adulthood.3 The clinical expression of BOR exhibits wide intra- and interfamilial variability. In addition, reduced penetrance for BOR has been assumed.4 The major feature of BOR, which occurs in 93% of patients, is HL, which can be conductive, sensorineural, or mixed. Besides the classical ear, kidney, and branchial arch anomalies, different developmental manifestations of BOR in other organ systems have been described. Among these, dysfunction of the lacrimal duct system is a common association.5–10 Thus, BOR represents a clinically and genetically heterogeneous disease complex that manifests predominantly during organogenesis. A gene locus for autosomal dominant BOR had been localised on chromosome 8q13.11,12 Subsequently, mutations in the human homologue of the Drosophila eyes absent gene (EYA1) have been shown to be causative for BOR (OMIM 601653).13 Branchio-otic syndrome (BOS) (OMIM 602588) was initially described as a disorder distinct from BOR, featuring the same clinical symptoms as BOR with the exception of renal anomalies.1 The large variety of clinical phenotypes and the description of mutations in the EYA1 gene for BOR and BOS patients13–15 show that BOR and BOS can represent allelic defects of the EYA1 gene. The identification of a second gene locus in a large BOS pedigree on chromosome 1q31 established the presence of genetic locus heterogeneity for BOS.4 No linkage to this locus has been published for BOR families and the gene defect is still to be identified. The issue …

Assignment of PGL3 to chromosome 1 (q21-q23) in a family with autosomal dominant non-chromaffin paraganglioma.

We performed a whole genome scan in a family with maternally transmitted paraganglioma (PGL3). The family included five patients with histologically proven paraganglioma and one patient with imaging findings consistent with a paraganglioma. In addition, there were 33 clinically unaffected family members. Of these eight could be examined by magnetic resonance imaging. Our investigations indicate that PGL3 is located in 1q21-q23 for several reasons: 1) two-point linkage analysis yielded the highest LOD score of 2.25 at 1q21-q23 (marker D1S2675); 2) haplotype analysis was most consistent for 1q21-q23 markers; and 3) the locus was excluded from more than 97% of the genome using a total of 381 highly polymorphic markers.

Exclusion of the neuronal nicotinic acetylcholine receptor α7 subunit gene as a candidate for catatonic schizophrenia in a large family supporting the chromosome 15q13–22 locus

The gene encoding the neuronal nicotinic acetylcholine receptor α7 subunit (CHRNA7) is located on chromosome 15q13.2. This region was suggested to be involved in the etiopathogenesis of: (a) schizophrenia combined with a neurophysiological deficit; (b) lithium-responsive bipolar disorder; and (c) familial catatonic schizophrenia (periodic catatonia). Therefore, members of a large family with periodic catatonia strongly supporting the chromosome 15q13–22 region were genotyped with polymorphic markers localized around the CHRNA7 locus. A recombination event distally of marker D15S144 leading to the exclusion of the CHRNA7 locus from this candidate region was detected in one branch of the pedigree. This result provides strong evidence that a gene located telomeric to CHRNA7 is causative for the pathogenesis of catatonic schizophrenia in this family.

Autosomal dominant SCA5 and autosomal recessive infantile SCA are allelic conditions resulting from SPTBN2 mutations

Although many genes have been identified for the autosomal recessive cerebellar ataxias (ARCAs), several patients are unlinked to the respective loci, suggesting further genetic heterogeneity. We combined homozygosity mapping and exome sequencing in a consanguineous Egyptian family with congenital ARCA, mental retardation and pyramidal signs. A homozygous 5-bp deletion in SPTBN2, the gene whose in-frame mutations cause autosomal dominant spinocerebellar ataxia type 5, was shown to segregate with ataxia in the family. Our findings are compatible with the concept of truncating SPTBN2 mutations acting recessively, which is supported by disease expression in homozygous, but not heterozygous, knockout mice, ataxia in Beagle dogs with a homozygous frameshift mutation and, very recently, a homozygous SPTBN2 nonsense mutation underlying infantile ataxia and psychomotor delay in a human family. As there was no evidence for mutations in 23 additional consanguineous families, SPTBN2-related ARCA is probably rare.

Towards the genetic basis of periodic catatonia: pedigree sample for genome scan I and II.

Abstract In a genome-wide linkage study, we mapped two major susceptibility loci for periodic catatonia, a phenotype with qualitative disturbances of the psychomotor sphere and a morbidity risk of 26.9 % in first-degree relatives of index cases, to chromosome 15q15, and to chromosome 22q13 using nonparametric as well as parametric (autosomal dominant model) analyses. The study included 12 multiplex pedigrees with 135 individuals, among them 57 affected persons. A second genome scan is in progress investigating four families with 21 affected individuals, aiming to confirm linkage results. Age at onset patterns as well as the clinical outcome were similar among affected individuals in both sets of families. Within the pedigrees we observed no physical diseases segregating with periodic catatonia. Under the assumption of genetic homogeneity, the statistical power to detect LOD scores ≥ 2.0 was 98.5 % in the first set of families, and 57.9 % in the second set. Thus, the panel of multiplex pedigrees segregating periodic catatonia seems to represent a homogenous clinical sample, and possesses sufficient statistical power to delineate and confirm linkage to major genetic loci for periodic catatonia.

A C-terminal nonsense mutation links PTPRQ with autosomal-dominant hearing loss, DFNA73

PurposeHearing loss is genetically extremely heterogeneous, making it suitable for next-generation sequencing (NGS). We identified a four-generation family with nonsyndromic mild to severe hearing loss of the mid- to high frequencies and onset from early childhood to second decade in seven members.MethodsNGS of 66 deafness genes, Sanger sequencing, genome-wide linkage analysis, whole-exome sequencing (WES), semiquantitative reverse-transcriptase polymerase chain reaction.ResultsWe identified a heterozygous nonsense mutation, c.6881G>A (p.Trp2294*), in the last coding exon of PTPRQ. PTPRQ has been linked with recessive (DFNB84A), but not dominant deafness. NGS and Sanger sequencing of all exons (including alternatively spliced 5′ and N-scan-predicted exons of a putative “extended” transcript) did not identify a second mutation. The highest logarithm of the odds score was in the PTPRQ-containing region on chromosome 12, and p.Trp2294* cosegregated with hearing loss. WES did not identify other cosegregating candidate variants from the mapped region. PTPRQ expression in patient fibroblasts indicated that the mutant allele escapes nonsense-mediated decay (NMD).ConclusionKnown PTPRQ mutations are recessive and do not affect the C-terminal exon. In contrast to recessive loss-of-function mutations, c.6881G>A transcripts may escape NMD. PTPRQTrp2294* protein would lack only six terminal residues and could exert a dominant-negative effect, a possible explanation for allelic deafness, DFNA73, clinically and genetically distinct from DFNB84A.