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“Fork and Bracket” Syndrome Expands the Spectrum of SBF1-Related Sensory Motor Polyneuropathies

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“Fork and Bracket” Syndrome Expands the Spectrum of SBF1-Related Sensory Motor Polyneuropathies “Fork and bracket” syndrome expands the spectrum of SBF1-related sensory motor polyneuropathies The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Romani, Marta, Cybel Mehawej, Tommaso Mazza, Andre Mégarbané, and Enza Maria Valente. 2016. ““Fork and bracket” syndrome expands the spectrum of SBF1-related sensory motor polyneuropathies.” Neurology: Genetics 2 (2): e61. doi:10.1212/NXG.0000000000000061. http://dx.doi.org/10.1212/ NXG.0000000000000061. Published Version doi:10.1212/NXG.0000000000000061 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:26859940 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Clinical/Scientific Notes Marta Romani, PhD “FORK AND BRACKET” SYNDROME EXPANDS cranial nerve neuropathies, and moderate to severe Cybel Mehawej, PhD THE SPECTRUM OF SBF1-RELATED SENSORY intellectual disability. Moreover, the sister Tommaso Mazza, PhD MOTOR POLYNEUROPATHIES recently developed a severe oromandibular dysto- Andre Mégarbané, MD, niathatimpairedmouthclosure,makingit PhD Charcot-Marie-Tooth neuropathy type 4 (CMT4) difficult to eat and speak. In contrast to Enza Maria Valente, MD, comprises a large group of genetically heteroge- CMT4B1, CMT4B2, and the pure neuropathic PhD neous progressive sensory motor neuropathies char- form of CMT4B3, which are all characterized by acterized by autosomal recessive inheritance. demyelinating neuropathy with focally folded Neurol Genet 2016;2:e61; doi: 10.1212/ Among these, CMT4B includes 3 forms related to myelin sheaths, both families presented a predom- NXG.0000000000000061 genes of the myotubularin family, namely inantly axonal sensory motor neuropathy with CMT4B1 (MTMR2),CMT4B2(MTMR13/ evidence of denervation, markedly reduced SBF2), and CMT4B3 (MTMR5/SBF1). amplitude of action potentials, and relatively pre- Only 2 CMT4B3 families have been reported to served nerve conduction velocities (table e-1). date. In the original Korean family, 3 siblings showed However, there were also clinical differences, as a homogeneous phenotype of pure sensory motor proprioception, touch, and temperature sensa- demyelinating neuropathy with focally folded myelin tions were largely spared in the 2 Syrian siblings sheaths, closely resembling CMT4B1 and CMT4B2. and they both had joint laxity and thumb sign but All patients had onset of distal atrophy and weakness no syndactyly. Furthermore, their brain MRI in upper and lower limbs, decreased vibration and showed peculiar anomalies at the pontine and position sense, areflexia, and pes planus in the first mesencephalic level described as the “fork and decade, with a slow progression to loss of ambulation bracket sign” (figure e-2),3 presumably related to in the fifth decade of life. None had cognitive impair- the presence of degenerated fiber bundles of ocu- ment, dysmorphic features, or obvious extraneuro- lomotor and facial nerves, which were not reported logic syndromic manifestations.1 in the Saudi Arabian family (see table e-2 for a In the second SBF1-mutated family, from Saudi detailed phenotypic comparison among the 3 Arabia, the 3 affected siblings presented a more families). complex syndromic phenotype. Sensory motor pol- There seem to be relevant genotype–phenotype yneuropathy was associated with progressive micro- correlations in CMT4B3, as the Korean patients with cephaly, intellectual disability, syndactyly, and pure demyelinating neuropathy were compound het- multiple cranial nerve involvement, which resulted erozygous for 2 missense variants, both predicted as in ophthalmoparesis, absence of pupil reactivity to benign or tolerated by most prediction software, light, mild facial weakness, swallowing difficulties, suggesting a mild impact on the protein. On the con- and dysarthria. There was distal muscle wasting and trary, the 2 families with severe syndromic presenta- weakness but no pes cavus. Brain MRI showed tion carried missense mutations that were consistently unspecific diffuse brain atrophy.2 predicted to be deleterious for the protein structure or We further expand the phenotypic spectrum of function (figure 1A). SBF1-associated CMT to include “fork and SBF1 is part of the myotubularin family, a large bracket” syndrome, a peculiar condition that we and highly conserved group of ubiquitously expressed previously described in a Syrian family.3 The 2 phosphatidylinositol 3-phosphatases encompassing affected siblings from this family were recently re- catalytically active (including MTMR2) and inactive Supplemental data at Neurology.org/ng assessed, and whole-exome sequencing was performed (including SBF1 and SBF2) enzymes that share a core in the proband. Only the SBF1 homozygous p.L335P of protein domains.4 Most MTMR2 mutations are mutation survived the filtering pipeline (e-Methods and truncating or missense changes that drastically reduce figure e-1 at Neurology.org/ng). The 2 siblings shared phosphatase activity, suggesting loss of function of relevant features with the Saudi Arabian family, includ- the protein as the key mechanism leading to ing early-onset progressive microcephaly, multiple CMT4B1. Both SBF1 and SBF2 proteins interact Neurology.org/ng © 2016 American Academy of Neurology 1 ª 2016 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Figure 1 Prediction of pathogenicity and protein localization of SBF1 mutations (A) Predicted pathogenicity of SBF1 missense mutations according to 4 distinct software programs (PolyPhen-2, SIFT, Mutation Assessor, and MetaLR). For each software program, predicted pathogenicity is represented as a spectrum of increasing severity, from white (tolerated/benign variants) to black (del- eterious variants). SBF1 mutations are reported with vertical lines of different colors (blue: Korean family; green: Saudi Arabian family; yellow: Syrian family) (see e-Methods for more details). (B) Schematic structure of SBF1 protein and site of mutations. Abbreviation of domains is as follows: DENN 5 differentially expressed in neoplastic vs normal cells domain, made by the 3 modules uDENN (U), DENN, and dDENN (D); GRAM 5 glucosyltransferase, Rab-like GTPase activators and myotubularins; RID 5 Rac-induced recruitment domain; phosphatase 5 inactive catalytic domain of tyrosine and dual-specificity phospha- tase; CC 5 coiled coil domain; PH 5 pleckstrin homology domain. directly with MTMR2 in the cytosol, markedly expression pattern or to a more deleterious impact increasing its enzymatic activity5; the impairment of of missense mutations on the protein structure this interaction, possibly related to protein absence, and function. subcellular mislocalization, or functional changes of From the CSS-Mendel Institute (M.R., T.M., E.M.V.), IRCCS the interacting C-terminus domains, is a likely mech- Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Divi- anism to explain the polyneuropathy associated with sion of Immunology (C.M.), Boston Children’s Hospital and Depart- mutations in both genes. However, the severe syn- ment of Pediatrics, Harvard Medical School, Boston, MA; Institut dromic phenotype shown by 2 SBF1-mutated fami- Jérôme Lejeune (A.M.), Paris, France; and Section of Neurosciences (E.M.V.), Department of Medicine and Surgery, University of Sale- lies calls for additional explanations. rno, Salerno, Italy. Of note, both mutations causative of syndromic Author contributions: M.R.: whole-exome sequencing experiments, CMT4B3 fall within the DENN domain (figure data analysis, and manuscript writing; C.F.M.: data analysis and 1B), shared only by SBF1 and SBF2 among myo- validation of mutations; T.M.: bioinformatics data analysis; A.M.: 4 clinical assessment of patients and critical revision of the manuscript tubularins. This domain was implicated in for important intellectual content; E.M.V.: data analysis, manuscript membrane trafficking and endosome function5 as writing. All authors read and approved the manuscript. well as in regulation of the proteins’ subcellular Study funding: Supported by the European Research Council (ERC localization, which suggests that it may confer Starting Grant 260888). additional functions to SBF1 and SBF2 besides Disclosure: Drs. Romani, Mehawej, and Mazza report no disclosures. 6 Dr. Mégarbané has served on the editorial board of the European interaction with MTMR2. However, an SBF2 Journal of Medical Genetics. Dr. Valente has received funding for deletion abolishing the whole D-DENN module travel and/or speaker honoraria from Allergan, has received research caused nonsyndromic demyelinating neuropathy support from the Italian Ministry of Health, European Community in a Turkish family.7 This phenotypic variability FP7 Program, European Research Council, Italian Ministry of Uni- versity and Research, and Telethon Foundation Italy. Go to Neurol- may relate to yet unknown differences between ogy.org/ng for full disclosure forms. The Article Processing Charge was SBF1 and SBF2 in their function and/or tissue paid by the authors. 2 Neurology: Genetics ª 2016 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. This is an open access article distributed under the terms of the Cre- MRI: a distinct syndrome. Am J Med Genet A 2010; ative Commons Attribution-NonCommercial-NoDerivatives
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