Genetic Predisposition to Fetal Alcohol Syndrome: Association with Congenital Disorders of N-Glycosylation

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Genetic Predisposition to Fetal Alcohol Syndrome: Association with Congenital Disorders of N-Glycosylation nature publishing group Basic Science Investigation | Articles Genetic predisposition to fetal alcohol syndrome: association with congenital disorders of N-glycosylation María E. de la Morena-Barrio1, María J. Ballesta-Martínez2, Raquel López-Gálvez1, Ana I. Antón1, Vanessa López-González2, Laia Martínez-Ribot3,JoséPadilla1, Antonia Miñano1, Oscar García-Algar4, Miguel Del Campo5, Javier Corral1, Encarna Guillén-Navarro2 and Vicente Vicente1 BACKGROUND: Fetal alcohol syndrome (FAS) is caused by exposure, with the most serious consequences in those fetuses maternal alcohol consumption during pregnancy; although exposed to high concentrations during the initial weeks of additional factors might be involved, as development and pregnancy (6–9); however, additional factors may be involved severity are not directly related to alcohol intake. The as some exposed pregnancies develop FAS, whereas others do abnormal glycosylation caused by alcohol might play a role not, and the severity of patients is highly heterogeneous. The in FAS according to the clinical similarities shared with estimated prevalence of FAS is 1–3/1,000 live births and congenital disorders of glycosylation (CDG). Thus, mutations constitutes the principal cause of non-inherited mental underlying CDG, affecting genes involved in glycosylation, disability (6,7,10,11). could also be involved in FAS. Diverse pathophysiological mechanisms have been pro- METHODS: A panel of 74 genes involved in N-glycosylation posed to underlie FAS, but none of them completely clarifies was sequenced in 25 FAS patients and 20 controls with this disorder. Recently, a new pathogenetic model suggests prenatal alcohol exposure. Transferrin glycoforms were that glycosylation defects underlie FAS based on the evaluated by HPLC. interference of alcoholism in the glycosylation (12,13), a RESULTS: Rare (minor allele frequencyo0.009) missense/ major post-translational modification (14), and the over- splice site variants were more frequent in FAS than controls lapping clinical presentations of FAS and congenital disorders (84% vs. 50%; P = 0.034, odds ratio: 5.25, 95% confidence of glycosylation (CDG) (15). CDG comprises a broad range of interval: 1.3–20.9). Remarkably, three patients, but no controls, rare and mostly severe genetic diseases with multisystem carried variants with functional effects identified in CDG clinical presentations caused by biallelic mutations in genes patients. Moreover, the patient with the most severe clinical involved in glycosylation (16). phenotype was the only one carrying two variants with A new mechanism of hypoglycosylation has been proposed functional effects. Family studies support that the combina- after the identification of patients with transient disorders of tion of a genetic defect and alcohol consumption during glycosylation: the combination of single genetic defects in pregnancy might have a role in FAS development. genes involved in N-glycosylation and alcohol intake (17). CONCLUSIONS: Our study supports that the rare variants of The aim of this study was to evaluate whether this mechanism genes involved in N-glycosylation could play a role in the might also underlie FAS. development and severity of FAS under prenatal alcohol exposure. METHODS Subjects The study included 25 patients with FAS meeting the 4-Digit Code (18) and/or the Revised Institute of Medicine criteria for clinical diagnosis (2), retrospectively recruited from the Medical Genetics & Dysmorphology Unit (Hospital Clínico Universitario Virgen de la etal alcohol spectrum disorders (FASDs) include all Arrixaca, Murcia, Spain) and Clinical Genetics Unit (Hospital Vall Fsyndromes resulting from prenatal alcohol exposure d´Hebron, Barcelona, Spain). Comprehensive clinical evaluation was (1–4). The term fetal alcohol syndrome (FAS) is used to performed to exclude other syndromic conditions (phenocopies). name the most severe disorder of this spectrum with different Available family members of probands were also studied. birth defects: cranio-facial abnormalities, growth deficiencies, As controls, 20 healthy children with documented prenatal alcohol exposure in utero by fatty acid ethyl ester testing in meconium with and central nervous system problems (5). The phenotype ethylglucuronide values between 0.5 and 1.5 nmol/g, but with depends basically on the timing and the level of alcohol completely normal development and without any clinical feature of 1Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain; 2Sección de Genética Médica y Dismorfología, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain; 3Sección Genética Clínica, Hospital Vall d'Hebron, UAB, Barcelona, Spain; 4Grup de Recerca Infància i Entorn (GRIE), Hospital Clínic de Barcelona (Maternitat), ICGON, BCNatal, Barcelona, Spain; 5Division of Dysmorphology and Teratology, Department of Pediatrics, University of California, San Diego, California. Correspondence: Javier Corral ([email protected]) Received 29 May 2017; accepted 5 August 2017; advance online publication 20 September 2017. doi:10.1038/pr.2017.201 Copyright © 2018 International Pediatric Research Foundation, Inc. Volume 83 | Number 1 | January 2018 Pediatric RESEARCH 119 Articles 120 Table 1. Clinical data and overall list of rare variants found in each FAS patient Pediatric RESEARCH Patient Age Sex Growth Facial Microcephaly CNS NP-PAE IQ impairment Other clinical manifestations Prenatal Gene variants retardation features (p10 or op10) criteria alcohol exposurea FAS-1 18 M op10 Weight 3/3 Yes Moderate ID, + 57 Dysgenesis of the corpus callosum and + PMM2p.Phe207Ser, and length ADHD ventriculomegaly. Cryptorchidism, ALG6p.Tyr131His, inguinal hernia, cleft palate, marked DOLK p.Tyr360Cys, RPN1 PMM1 fifth finger clinodactyly, and myopia p.His238Tyr, | Ala5Ser de la Morena-Barrio et al. Volume 83 | Number 1 | January 2018 FAS -2 3 M op10 Weight 3/3 Yes Moderate ID + ND Maternally inherited 22q11.2 deletion. + PMM2c.*26C4T and length Pulmonary atresia with ventricular septal defect. Bilateral pielectasis, Myopia and astigmatism. Sensorineural deafness FAS -3 6 F op10 Weight 3/3 Yes Mild ID, ADHD, + 65 Lower visual acuity + PMM2p.Arg141His, and length language disorder, ALG3 p.Pro424Leu LD FAS -4 13 M p25 Weight 2/3 Yes Borderline + 64 Mild myopia and astigmatism + ALG6p.Tyr131His, and length intelligence ADHD ALG8 p.Ile299Thr FAS -5 12 F op10 Weight 2/3 Yes Mild ID + 60 No Suspected —- and length FAS -6 7 M op10 Weight 2/3 Yes Moderate ID, + ND Refractive error + HK3 p.Gln600His, HK3 p. and length ADHD, ASD Gln578Arg, GFPTI p. Val628Ile FAS -7 10 M op10 Weight 2/3 Yes Mild ID, ADHD + 68 Strabismus Suspected ALG2 p.Gly6Ala and length FAS -8 9 F Weight op10 3/3 Yes Moderate ID, + 50 Ureteral duplication + PMM1 p.Glu155Lys ADHD, Language disorder FAS -9 11 M op10 Weight 3/3 Yes ADHD, phobias + 77 No Suspected —- and length Copyright © 2018 International Pediatric Research Foundation, Inc. FAS-10 8 F op10 Weight 3/3 Yes ADHD + 98 Systolic murmur and autoimmune + MVD p.Asp383His and length thyroiditis FAS-11 11 M op10 Weight 3/3 Yes Mild ID, LD, ADHD, +56No + PMM1 p.Ala5Ser possible DMDD FAS-12 11 F op10 Weight 2/3 Yes ADHD, LD. + 79 Strabismus and systolic murmur Suspected GALT p.Val364Ile FAS-13 12 M op10 Length 2/3 Yes ADHD, LD, ASD + 120 Adenoidhypertrophy + MPI p.Thr350Met, PGM1 p.Glu90Val FAS-14 10 F op10 Weight 3/3 Yes Mild-moderate ID, + 55 Strabismus, lower visual acuity, + MPI p.Thr350Met, SSR3 and length LD language refractive error, velopharyngeal p.Tyr140Cys, GFPT1 p. disorder insufficiency (bifid uvula), and Val628Ile conductive hearing loss FAS-15 3 M op10 Weight 2/3 Yes ADHD + 86 Cryptorchidism and inguinal hernia + PGM1 3'splicesite, and length STT3B p.Ile474Val, STT3B p.His419Arg, TUSC3 p. Ala13Val Copyright © 2018 International Pediatric Research Foundation, Inc. Table 1 Continued Patient Age Sex Growth Facial Microcephaly CNS NP-PAE IQ impairment Other clinical manifestations Prenatal Gene variants retardation features (p10 or op10) criteria alcohol exposurea FAS-16 11 F op10 Weight 3/3 Yes ADHD, LD + ND Lower visual acuity + ALG13 p.Ser891Phe, PGM1 3'splicesite, RPN2p.Gly374Asp, HK3 p.Met668Val FAS-17 8 M op10 Weight 3/3 Yes ADHD, AD + 84 Lower visual acuity Suspected ALG8 p.Arg268Gln, GPI p.Ile208Thr FAS-18 11 F op10 Length 3/3 Yes ADHD, tics, ED + 79 Lower visual acuity, refractive error, Suspected ALG2 p.Gly6Ala,GMPPA and strabismus p.Pro64Ser, HK3 p. Gln600His, HK3 p. Gln578Arg FAS-19 2 F P25 Weight 1/3 Yes (-) Normal + ND Foramen ovale Suspected —- and height psychomotor development FAS-20 13 M P20 Weight, 2/3 Yes ADHD + 99 Myopia and astigmatism. + ALG3 p.Ile411Val, op10 Height Vesicoureteral reflux I PGM1 p.Arg41Trp FAS-21 12 F po1 Weight, 2/3 Yes Borderline + ND Right pielectasis (II) + ALG14 p.Ala11Thr height and intelligence FAS-22 12 F p3 Weight 2/3 No Mild ID + 75 Mild mitral valve insufficiency. Ectopic + ALG10B p.Leu253Trp, Genetics of fetal alcohol syndrome and height right kidney. Scoliosis. Café-au-lait MVD p.Ala357Val, GALE spots p.Arg265Gln FAS-23 16 M p25 Weight 2/3 No Borderline + 88 No Suspected —- and length intelligence 4 — Volume 83 | Number 1 | January 2018 FAS-23 7F p97 Weight 2/3 No Moderate ID. + ND Sensorineural deafness. Suspected - sister and height ADHD Ventriculomegaly FAS-24 11 F p75 Weight 2/3 No Borderline + ND Auricular septal defect.
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