An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review
Abstract
:1. Introduction
2. Materials and Methods
3. Case Report
- A homozygous c.1793-2A>G variant in the AP4B1 gene (c.1793-2A>G), which was detected in heterozygosity in the mother.
- A heterozygous c.1201_1202delAA variant in the ERF gene (p.Lys401GlufsTer10), which was absent in the mother.
4. Discussion and Literature Review
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hirst, J.; Irving, C.; Borner, G.H. Adaptor protein complexes AP-4 and AP-5: New players in endosomal trafficking and progressive spastic paraplegia. Traffic 2013, 14, 153–164. [Google Scholar] [CrossRef]
- Tüysüz, B.; Bilguvar, K.; Koçer, N.; Yalçınkaya, C.; Çağlayan, O.; Gül, E.; Şahin, S.; Çomu, S.; Günel, M. Autosomal recessive spastic tetraplegia caused by AP4M1 and AP4B1 gene mutation: Expansion of the facial and neuroimaging features. Am. J. Med. Genet. Part A 2014, 164A, 1677–1685. [Google Scholar] [CrossRef]
- Matsuda, S.; Miura, E.; Matsuda, K.; Kakegawa, W.; Kohda, K.; Watanabe, M.; Yuzaki, M. Accumulation of AMPA receptors in autophagosomes in neuronal axons lacking adaptor protein AP-4. Neuron 2008, 57, 730–745. [Google Scholar] [CrossRef]
- Abou Jamra, R.; Philippe, O.; Raas-Rothschild, A.; Eck, S.H.; Graf, E.; Buchert, R.; Borck, G.; Ekici, A.; Brockschmidt, F.F.; Nöthen, M.M.; et al. Adaptor Protein Complex 4 Deficiency Causes Severe Autosomal-Recessive Intellectual Disability, Progressive Spastic Paraplegia, Shy Character, and Short Stature. Am. J. Hum. Genet. 2011, 88, 788–795. [Google Scholar] [CrossRef]
- Radu, S.; Jedrzejewski, B.; Urbinelli, L. Primary Delayed Onset Craniosynostosis in a Child With ERF-Related Craniosynostosis Syndrome and Familial Cerebral Cavernous Malformation Syndrome. Cleft Palate Craniofac. J. 2023, 60, 1321–1325. [Google Scholar] [CrossRef]
- Glass, G.E.; O’Hara, J.; Canham, N.; Cilliers, D.; Dunaway, D.; Fenwick, A.L.; Jeelani, N.-O.; Johnson, D.; Lester, T.; Lord, H.; et al. ERF-related craniosynostosis: The phenotypic and developmental profile of a new craniosynostosis syndrome. Am. J. Med. Genet. A 2019, 179, 615–627. [Google Scholar] [CrossRef]
- Twigg, S.R.; Vorgia, E.; McGowan, S.J.; Peraki, I.; Fenwick, A.L.; Sharma, V.P.; Allegra, M.; Zaragkoulias, A.; Sadighi Akha, E.; Knight, S.J.; et al. Reduced dosage of ERF causes complex craniosynostosis in humans and mice and links ERK1/2 signaling to regulation of osteogenesis. Nat. Genet. 2013, 45, 308–313. [Google Scholar] [CrossRef]
- Teinert, J.; Behne, R.; Wimmer, M.; Diplock, A.; Carmody, E.; Dies, K.; Jensen, D.; Bennett, J.; Sahin, M.; Ebrahimi-Fakhari, D. The Clinical, Molecular and Radiographic Spectrum of Adaptor Protein Complex 4-associated Hereditary Spastic Paraplegia (AP-4-HSP): Results from the AP-4-HSP International Registry [abstract]. Mov. Disord. 2019, 34 (Suppl. S2), S616. Available online: https://www.mdsabstracts.org/abstract/the-clinical-molecular-and-radiographic-spectrum-of-adaptor-protein-complex-4-associated-hereditary-spastic-paraplegia-ap-4-hsp-results-from-the-ap-4-hsp-international-registry/ (accessed on 5 March 2024).
- Ebrahimi-Fakhari, D.; Behne, R.; Davies, A.K.; Hirst, J. AP-4-Associated Hereditary Spastic Paraplegia. In GeneReviews® [Internet]; Adam, M.P., Feldman, J., Mirzaa, G.M., Pagon, R.A., Wallace, S.E., Bean, L.J.H., Gripp, K.W., Amemiya, A., Eds.; University of Washington: Seattle, WA, USA, 2018. [Google Scholar]
- Ebrahimi-Fakhari, D.; Teinert, J.; Behne, R.; Wimmer, M.; D’Amore, A.; Eberhardt, K.; Brechmann, B.; Ziegler, M.; Jensen, D.M.; Nagabhyrava, P.; et al. Defining the clinical, molecular and imaging spectrum of adaptor protein complex 4-associated hereditary spastic paraplegia. Brain 2020, 143, 2929–2944. [Google Scholar] [CrossRef]
- Ebrahimi-Fakhari, D.; Cheng, C.; Dies, K.; Diplock, A.; Pier, D.B.; Ryan, C.S.; Lanpher, B.C.; Hirst, J.; Chung, W.K.; Sahin, M.; et al. Clinical and genetic characterization of AP4B1-associated SPG47. Am. J. Med. Genet. A 2018, 176, 311–318. [Google Scholar] [CrossRef]
- Roubertie, A.; Hieu, N.; Roux, C.J.; Leboucq, N.; Manes, G.; Charif, M.; Echenne, B.; Goizet, C.; Guissart, C.; Meyer, P.; et al. AP4 deficiency: A novel form of neurodegeneration with brain iron accumulation? Neurol. Genet. 2018, 4, e217. [Google Scholar] [CrossRef]
- Vill, K.; Müller-Felber, W.; Alhaddad, B.; Strom, T.M.; Teusch, V.; Weigand, H.; Blaschek, A.; Meitinger, T.; Haack, T.B. A homozygous splice variant in AP4S1 mimicking neurodegeneration with brain iron accumulation. Mov. Disord. 2017, 32, 797–799. [Google Scholar] [CrossRef]
- Abdollahpour, H.; Alawi, M.; Kortüm, F.; Beckstette, M.; Seemanova, E.; Komárek, V.; Rosenberger, G.; Kutsche, K. An AP4B1 frameshift mutation in siblings with intellectual disability and spastic tetraplegia further delineates the AP-4 deficiency syndrome. Eur. J. Hum. Genet. 2015, 23, 256–259. [Google Scholar] [CrossRef]
- Moreno-De-Luca, A.; Helmers, S.L.; Mao, H.; Burns, T.G.; Melton, A.M.; Schmidt, K.R.; Fernhoff, P.M.; Ledbetter, D.H.; Martin, C.L. Adaptor protein complex-4 (AP-4) deficiency causes a novel autosomal recessive cerebral palsy syndrome with microcephaly and intellectual disability. J. Med. Genet. 2011, 48, 141–144. [Google Scholar] [CrossRef]
- Ruan, W.C.; Wang, J.; Yu, Y.L.; Che, Y.P.; Ding, L.; Li, C.X.; Wang, X.D.; Li, H.F. Novel variants in AP4B1 cause spastic tetraplegia, moderate psychomotor development delay and febrile seizures in a Chinese patient: A case report. BMC Med. Genet. 2020, 21, 51. [Google Scholar] [CrossRef]
- Accogli, A.; Hamdan, F.F.; Poulin, C.; Nassif, C.; Rouleau, G.A.; Michaud, J.L.; Srour, M. A novel homozygous AP4B1 mutation in two brothers with AP-4 deficiency syndrome and ocular anomalies. Am. J. Med. Genet. A 2018, 176, 985–991. [Google Scholar] [CrossRef]
- Lamichhane, D. New AP4B1 mutation in an African-American child associated with intellectual disability. J. Pediatr. Genet. 2013, 2, 191–195. [Google Scholar] [CrossRef]
- Tessa, A.; Battini, R.; Rubegni, A.; Storti, E.; Marini, C.; Galatolo, D.; Pasquariello, R.; Santorelli, F.M. Identification of mutations in AP4S1/SPG52 through next generation sequencing in three families. Eur. J. Neurol. 2016, 23, 1580–1587. [Google Scholar] [CrossRef]
- Verkerk, A.J.; Schot, R.; Dumee, B.; Schellekens, K.; Swagemakers, S.; Bertoli-Avella, A.M.; Lequin, M.H.; Dudink, J.; Govaert, P.; van Zwol, A.L.; et al. Mutation in the AP4M1 gene provides a model for neuroaxonal injury in cerebral palsy. Am. J. Hum. Genet. 2009, 85, 40–52. [Google Scholar] [CrossRef]
- Singh, R.; Cohen, A.S.A.; Poulton, C.; Hjortshøj, T.D.; Akahira-Azuma, M.; Mendiratta, G.; Khan, W.A.; Azmanov, D.N.; Woodward, K.J.; Kirchhoff, M.; et al. Dominant mutations in ERF cause intellectual disability with associated macrocephaly. Hum. Mutat. 2018, 39, 822–829. [Google Scholar] [CrossRef]
- Glass, G.E.; O’Hara, J.; Canham, N.; Cilliers, D.; Dunaway, D.; Fenwick, A.L.; Jeelani, N.O.; Johnson, D.; Lester, T.; Lord, H. Clinical and molecular characterization of an Italian family with ERF-related craniosynostosis: A new mutation in the TWIST box. Eur. J. Med. Genet. 2019, 62, 103524. [Google Scholar] [CrossRef]
Present Study | Moreno De Luca et al. (2011) [15] | Ruan et al. (2020) [16] | Accogli et al. (2018) [17] | Tuysuz et al. (2014) [2] | Abou Jamra et al. (2011) [4] | Lamichhane (2013) [18] | Tessa et al. (2016) [19] | |||||||||
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AP-4 subunit mutation | B1 | E1 | B1 | B1 | B1 | M1 | M1 | B1 | B1 | S1 | E1 | B1 | S1 | |||
Variant | c.1793-2A>G | Deletion 15q21.2 222 kb (consanguineous family) | c.1207C > T/c.52_53delAC | c.991C>T, p.Q331X | c.991C>T, p.Q331X | c.1012C>T | c.952C>T | c.869delC | c.487_488insTAT, p.Glu163_Ser739 delinsVal | c.124C>T, p.Arg42* | c.542þ1_542þ4delGTAA, r.421_542del, p.Glu181Glyfs*20 | c.311delC, c.577G>A | c.138+3_6delAAGT | c.43C>T p.R15* | c.49dupT p.S17Fƒs*2 | |
Other genes involved | ERF gene heterozygosity | SPPL2A (signal peptide peptidase-like-2A) has a role in immune regulation | No | No | No | No | M6PR heterozygosity | No | No | No | No | |||||
Sex, Age at evaluation | M; 14 y | F; 23y | M; 22 y | M; 9 y | M; 16 y | M; 11 y | 2 F; 17 y–11 y | M; 10 y | 2 F; 12.5 y–10.5 y | 2 F, 1 M (siblings); 23 y, 15 y, 11 y. | 2 M, 1 F (siblings); 22 y, 20 y, 18 y. | 1 F, 1 M; 11 y, 6 y, | M; 4 y | F; 5 y F; 2 y (siblings) | M; 15 y | F; 13 y |
Intellectual disability | Moderate | Mild | Mild | Mild | Moderate | Mild | Moderate | Severe | Moderate | Mild (2/2) | Mild | Moderate | ||||
Spasticity | Mild | Mild | Mild | Mild | Mild | Mild | 2/2 | 3/3 | 2/3 | 2/2 | Mild | 1/2 | Mild | Mild | ||
Speech disorder | Mild | Mild | Mild | - | Mild | Mild | Moderate | 2/3 | 3/3 | 2/2 | Mild | Mild | Mild | Mild | ||
Seizures | FS | + | + (onset at 15 y) | FS | GTCS | GTCS | + | - | GMS | FS (1/2) | - | FS and FoS | ||||
Infantile hypotonia | - | Mild | Mild | - | Mild | Mild | N/A | N/A | Mild | 3/3 | Mild | N/A | ||||
Hyper-reflexia | Mild | Mild | Mild | Mild | Mild | Mild | Moderate | 3/3 | 2/2, 1 N/A | N/A | N/A | Mild | ||||
Walking (years) | - | N/A | Walk with support | 2 y (unstable walk) | - | - | 3–5 y | 2.5/2.5/2.5 | Walking with difficulty | Inability to walk unassisted | 3.5 | 2.5 | ||||
Short stature | + (GH deficiency) | N/A | N/A | N/A | -4 SD | N/A | N/A | 3/3 | N/A | N/A | ||||||
Foot deformity | + | N/A | N/A | + | + | N/A | 1/2 | N/A | N/A | N/A | ||||||
Cranial abnormalities | Microcephaly and metopic craniosynostosis | Microcephaly | Microcephaly | - | Microcephaly | Microcephaly | N/A | Microcephaly | ||||||||
Stereotypic laughter | + | + | + | N/A | - | - | + | 3/3 | 3/3 | 1/2 | N/A | |||||
Facial features | Bitemporal narrowing, pointed chin, down-slanting palpebral fissures, and long nose with a wide nasal ridge | Similar to another patient | N/A | Bitemporal narrowing, thick eyebrows, broad nasal ridge, thick nostrils, and short philtrum | Broad nasal ridge, short philtrum, and bulbous nose | Facial hypotonia, broad nasal ridge, short philtrum, wide mouth, and high palate | Microcephaly, high palate, and wide nasal bridge | N/A | N/A | Mild facial dysmorphisms | Mild facial dysmorphisms | |||||
EEG features | Normal | Generalized theta slowing of the background, consistent with diffuse cerebral dysfunction | Normal | Normal | N/A | N/A | ||||||||||
Brain MRI | Thin corpus callosum, white matter hypotrophy, and ectopic neurohypophysis | Ventriculomegaly, cerebellar atrophy, reduced hippocampal volume, and diffuse white matter loss more pronounced in the frontal region of the corpus callosum | Ventriculomegaly with slightly prominent cisterns | Dilated supratentorial ventricle and thin corpus callosum | Ventriculomegaly, thin corpus callosum, and paucity of white matter | Ventriculomegaly and diffuse cortical and subcortical atrophy | Ventriculomegaly, thin splenium of the corpus callosum, white matter loss, and hippocampal globoid formation | N/A | No structural abnormalities | Thinning of the body of the splenium of the corpus callosum | Thinning of the body of the splenium of the corpus callosum | Thinning of the splenium of the corpus callosum | ||||
Other features | Hypertrichosis, clinodactyly | N/A | Lumbar lordosis | Left Horner syndrome, with ptosis and myosis, cataracts, and optic nerve atrophy | Syndactyly of the second and third toes bilaterally | N/A | N/A | N/A. | N/A |
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Orsini, A.; Santangelo, A.; Carmignani, A.; Camporeale, A.; Massart, F.; Tyutyusheva, N.; Peroni, D.G.; Foiadelli, T.; Ferretti, A.; Toschi, B.; et al. An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review. Genes 2024, 15, 436. https://doi.org/10.3390/genes15040436
Orsini A, Santangelo A, Carmignani A, Camporeale A, Massart F, Tyutyusheva N, Peroni DG, Foiadelli T, Ferretti A, Toschi B, et al. An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review. Genes. 2024; 15(4):436. https://doi.org/10.3390/genes15040436
Chicago/Turabian StyleOrsini, Alessandro, Andrea Santangelo, Alessandra Carmignani, Anna Camporeale, Francesco Massart, Nina Tyutyusheva, Diego Giampietro Peroni, Thomas Foiadelli, Alessandro Ferretti, Benedetta Toschi, and et al. 2024. "An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review" Genes 15, no. 4: 436. https://doi.org/10.3390/genes15040436
APA StyleOrsini, A., Santangelo, A., Carmignani, A., Camporeale, A., Massart, F., Tyutyusheva, N., Peroni, D. G., Foiadelli, T., Ferretti, A., Toschi, B., Romano, S., & Bonuccelli, A. (2024). An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review. Genes, 15(4), 436. https://doi.org/10.3390/genes15040436