Genetic diagnosis and clinical evaluation of severe fetal akinesia syndrome

Objective

In this retrospective study, we describe the clinical course, ultrasound findings and genetic investigations of fetuses affected by fetal akinesia.

Materials and Methods

We enrolled 22 eukaryotic fetuses of 18 families, diagnosed with fetal akinesia between 2008 and 2016 at the Department of Obstetrics and Feto-Maternal Medicine at the Medical University of Vienna. Routine genetic evaluation included karyotyping and chromosomal microarray analysis. Retrospectively, exome sequencing was performed in the index case of 11 families, if stored DNA was available. Confirmation analyses and genetic diagnosis of siblings were performed by using Sanger sequencing.

Results

Whole exome sequencing identified pathogenic variants of CNTN1, RYR1, NEB, GLDN, HRAS and TNNT3 in six cases of 11 families. In three of these families, the variants were confirmed in the respective sibling.

Conclusions

The present study demonstrates a high diagnostic yield of exome sequencing in fetuses affected by akinesia syndrome, especially if family history is positive. Still, in a large part the underlying genetic cause remained unknown, whereas precise clinical evaluation in combination with exome sequencing shows to be the best tool to find the disease causing variants.     

Prenatal diagnosis of Crigler–Najjar syndrome type I by single-strand conformation polymorphism (SSCP)

Crigler–Najjar syndrome type I (CN-I) is a rare and severe inherited disorder of bilirubin metabolism, caused by the total deficiency of bilirubin-UDP-glucuronosyltransferase (UGT) activity. Enzymatic diagnosis cannot be performed in chorionic villi or amniocytes as UGT is not active in these tissues. The cloning of the UGT1 gene and the identification of disease-causing mutations have led to the possibility of performing DNA-based diagnosis. Here we report DNA-based prenatal diagnosis of CN-I in two Tunisian families in whom CN-I patients were diagnosed. As we had previously shown that CN-I was, in Tunisia, associated with homozygosity for the Q357R mutation within the UGT1 gene, we were able to detect this mutation in both families and to show that it was easily recognized by single-strand conformation polymorphism (SSCP) analysis. In both cases, SSCP analysis of fetal DNA showed that the fetus was heterozygous for the Q357R mutation. In one family, the pregnancy was carried to term and a healthy baby was born, whereas, in the other family, the pregnancy is still continuing. Thus the prenatal diagnosis of CN-I is possible, provided disease-causing mutations have been identified. SSCP analysis of DNA prepared either from amniocytes or from chorionic villi is a simple, reliable and fast method for prenatal diagnosis. Copyright © 2002 John Wiley & Sons, Ltd.     

Prenatal diagnosis for arginase deficiency by second-trimester fetal erythrocyte arginase assay and first-trimester ARG1 mutation analysis

Hyperargininemia is a progressive neurometabolic disorder caused by deficiency of hepatic cytosolic arginase I, resulting from mutations in the ARG1 gene. We diagnosed arginase deficiency in a three-year-old male child of first-cousin Palestinian Arab parents. Prenatal diagnosis of an unaffected fetus was achieved in the second trimester of a subsequent pregnancy by cordocentesis and analysis of arginase activity in fetal erythrocytes. ARG1 mutation analysis in the proband revealed homozygosity for a deletion of 10 753 bp extending from the first intron to beyond the poly (A) site of the gene. This is the first gross deletion in the ARG1 gene to be identified and the first mutation to be described in an arginase-deficient patient of this ethnic origin. The identification of the ARG1 deletion in this family enabled first-trimester prenatal diagnosis in a subsequent pregnancy by multiplex PCR analysis performed on chorionic villous DNA. Copyright © 2004 John Wiley & Sons, Ltd.     

Prenatal diagnosis of molybdenum cofactor deficiency and isolated sulfite oxidase deficiency

Molybdenum cofactor deficiency and isolated sulfite oxidase deficiency are autosomal recessive inborn errors of metabolism with severe neurological symptoms resulting from a lack of sulfite oxidase activity. The deficiencies can be diagnosed prenatally by monitoring sulfite oxidase activity in chorionic villus sampling (CVS) tissue. In those families in which the specific defects have been identified, diagnosis can be achieved by mutation analysis or linkage studies directed at affected genes. These include MOCS1, MOCS2 or GEPH, in cases of molybdenum cofactor deficiency, or SUOX in patients with isolated sulfite oxidase deficiency. Copyright © 2002 John Wiley & Sons, Ltd.     

Evaluation of a fetus at risk for dihydropteridine reductase deficiency by direct mutation analysis using denaturing gradient gel electrophoresis

Dihydropteridine reductase (DHPR) is an enzyme involved in the recycling of tetrahydrobiopterin (BH₄), which is an obligate co-factor of the aromatic amino acid hydroxylases. DHPR deficiency is a rare, autosomal recessive disorder caused by mutations in the QDPR gene. DHPR-deficient patients are diagnosed by a lack of response to a low phenylalanine diet and by severe neurological symptoms. Final diagnosis is made by measurements of neurotransmitters and pterin metabolites in cerebrospinal fluid (CSF) and urine, in addition to DHPR enzyme activity, which can be assessed in whole red blood cells. Treatment of DHPR deficiency can be difficult and the outcome is not always satisfying, even if all treatment strategies are followed. Therefore prenatal diagnosis is of great importance in affected families. Prenatal diagnosis is possible by measuring DHPR activity in different cell types but this is time consuming. More than 25 different mutations have to date been identified in the QDPR gene and direct identification of a mutation in a fetus would be easy and rapid. We have developed a method based on denaturing gradient gel electrophoresis (DGGE) for the analysis of the QDPR gene. The method is useful for rapid and simultaneous scanning of all exons and flanking intronic sequences of the QDPR gene. We describe the first prenatal diagnosis conducted using this method. Copyright © 2001 John Wiley & Sons, Ltd.     

Prenatal diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency in a family with a previous fatal case of sudden unexpected death in childhood

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is a potentially fatal inherited disease with a carrier frequency of approximately 1:100 in most Caucasian populations. The disease is implicated in sudden unexpected death in childhood. A prevalent disease-causing point mutation (A985G) in the MCAD gene has been characterized, thus rendering diagnosis easy in the majority of cases. Since the clinical spectrum of MCAD deficiency ranges from death in the first days of life to an asymptomatic life, there are probably other genetic factors—in addition to MCAD mutations—involved in the expression of the disease. Thus, families who have experienced the death of a child from MCAD deficiency might have an increased risk of a seriously affected subsequent child. In such a family we have therefore performed a prenatal diagnosis on a chorionic villus sample by a highly specific and sensitive polymerase chain reaction (PCR) assay for the G985 mutation. The analysis was positive and resulted in abortion. We verified the diagnosis by direct analysis on blood spots and other tissue material from the aborted fetus and from family members.     

从《老子想尔注》看早期道教构建理想社会的初步尝试

《老子想尔注》认为实现理想社会的前提条件是"尊道"。道不仅是一个哲学概念,在这里被发挥成至高无上的太上老君,成为理想社会的掌控者。《老子想尔注》理想社会的理论在批判现实问题的基础上展开论述,主要讨论了君臣关系、伦理道德和贫富差异等。维系理想社会秩序的手段是道诫,道诫超越法律,内涵丰富。     

Pitfalls in molecular diagnosis in a family with severe factor VII (FVII) deficiency—misdiagnosis by direct sequence analysis using a PCR product

Molecular diagnostic tests are becoming a routine analysis in many laboratories. These modern analyses are widely used in clinical medicine, forensic, genetic and prenatal diagnosis and also in preimplantation genetic diagnosis. The accuracy of analysis is highly dependent on the success achieved in minimising genotyping errors. The pitfalls in molecular diagnostic tests can be due to a simple technique such as the polymerase chain reaction (PCR) used universally. This technique is routinely used for its apparent accuracy, but it is also a well-known source of errors. We report an error introduced during PCR reaction that leads to a wrong sequence result and consequently to a ‘false’ molecular result in a next prenatal diagnosis in a family with severe factor VII (FVII) deficiency. This error was verified using an unsuitable primer design in a rich repetitive sequence of the FVII gene that leads to a false annealing and then to a wrong molecular diagnosis. It is essential to link closely molecular data with clinical and phenotype analysis in order to avoid false-negative or false-positive results, which is of great importance to diagnosis and molecular prevention. Copyright © 2003 John Wiley & Sons, Ltd.     

Prenatal diagnosis of a lethal form of Netherton syndrome by SPINK5 mutation analysis

Netherton syndrome (NS) is a severe autosomal recessive ichthyosis with no specific treatment or prenatal diagnosis available at present. The recent identification of SPINK5, which encodes a serine protease inhibitor, as the defective gene enables DNA-based prenatal diagnosis to be carried out. Here we report the first direct molecular prenatal diagnosis of a lethal form due to a recurrent SPINK5 mutation in three consanguineous Turkish families. XmnI restriction enzyme digestion and DNA sequencing demonstrated that each deceased affected child was homozygous for mutation 153delT inherited from each parent. Analysis of fetal DNA from amniotic fluid cells in Family 1 and from a chorionic villus sampling in Family 3 showed that the fetus was heterozygous for 153delT in both cases. The pregnancies were carried to term and the newborns were unaffected. In Family 2, fetal DNA analysis from chorionic villus biopsy showed in a first pregnancy that the fetus was homozygous for 153delT. The pregnancy was terminated at 13 weeks and DNA analysis of fetal keratinocytes confirmed the prenatal prediction. In a second pregnancy in Family 2, fetal DNA analysis showed heterozygosity for 153delT, and the pregnancy was continued. Direct SPINK5 mutation analysis in families at risk for NS represents the first early, rapid and reliable method for prenatal diagnosis of this life-threatening form of ichthyosis. Copyright © 2002 John Wiley & Sons, Ltd.     

Prenatal diagnosis of neurofibromatosis type 1: From flanking rflps to intragenic microsatellite markers

Even though the neurofibromatosis type 1 (NF1) gene was cloned more than 3 years ago, the process of identifying mutations has not been fruitful, and genetic counselling is mainly based on the use of linked markers. Since 1990, we have analysed 130 NF1 families and have performed six prenatal diagnoses. In each case, genetic counselling has relied on linked markers and informativity was achieved in all of them. The use of intragenic microsatellite polymorphisms (IVS27AAAT2.1, IVS27AC28.4, IVS27AC33.1, and IVS38GT53.0) has increased the informativeness in our series of NF1 families to an average of 90 per cent, providing accurate diagnosis and confirmation of the disease status.     

Molecular genetic prenatal diagnosis for a case of autosomal recessive spondylocostal dysostosis

Autosomal recessive spondylocostal dysostosis type 1 (ARSCD1) is a member of the heterogeneous group of disorders termed the spondylocostal dysostoses that are characterized by multiple vertebral segmentation defects and rib anomalies. In these patients, the entire vertebral column is malformed and is replaced by multiple hemivertebrae giving rise to truncal shortening, abdominal protrusion and non-progressive spinal curvature. Genetic studies have shown that some cases of ARSCD are due to mutations in the somitogenesis gene, Delta-like 3 (DLL3), that encodes a ligand for the Notch signalling pathway—ARSCD type 1. To date, 17 different DLL3 gene mutations have been reported. A consanguineous family of Turkish origin with ARSCD type 1 due to a homozygous DLL3 mutation requested genetic prenatal diagnosis. Using DNA from a chorionic villus sample, both linkage analysis of the DLL3/19q region and direct sequencing for the familial mutation demonstrated that the unborn fetus was an unaffected carrier. This is the first case of molecular genetic prenatal diagnosis in any form of SCD. Copyright © 2003 John Wiley & Sons, Ltd.     

Novel mutations in the human CYP21 gene

The great majority of genetic defects underlying steroid 21-hydroxylase deficiency appear to result from intergenic recombinations between the homologous CYP21 and CYP21P genes. For a minority, novel sporadic point mutations have been detected. De novo mutations in CYP21 have also been reported, but only a few studies have systematically screened their occurrence. We here describe a population-based patient sample in order to estimate the rate of single-family (i.e. sporadic) and de novo germline mutations in the human CYP21 locus. Among 76 Finnish families were observed three single-family mutations and two de novo mutations in CYP21. The rates obtained, ∼5% and ∼2% for novel and de novo mutations, respectively, indicate that they are not rare and that their occurrence should not be ignored in genetic diagnostics of this disorder. Copyright © 2001 John Wiley & Sons, Ltd.     

Two unrelated fetuses with ITPR1 missense variants and fetal hydrops

We describe two fetuses from unrelated families with likely pathogenic variants in ITPR1 that presented with nonimmune fetal hydrops. Trio exome sequencing revealed a de novo heterozygous likely pathogenic missense variant c.7636G > A (p.Val2531Met) in ITPR1 (NM_001378452.1) in proband 1 and a de novo heterozygous likely pathogenic missense variant c.34G > A [p.Gly12Arg] in proband 2. Variants in ITPR1 have been associated with several genetic conditions, including spinocerebellar ataxia 15, spinocerebellar ataxia 29, and Gillespie syndrome. Our report on two patients details a previously undescribed severe fetal presentation of nonimmune hydrops fetalis associated with missense variants in the ITPR1 gene.     

基于读者反应的红色旅游英译文本可读性研究

随着我国红色旅游业的快速发展,以翻译为主要途径的外宣工作的重要性日益彰显,如何评价外宣文本的可读性逐渐成为学界关注的热点问题。文中以井冈山景区的英译文本为例,通过问卷调查和访谈的方式收集了十五位目标语读者关于外宣文本的反馈意见。结果显示:译文的可读性受文本质量、文本长度和读者背景等诸多因素的影响。由于译者对英译文本的目标语读者和文本功能认识不足,译文在词汇、语句和语篇等层面均存在不同程度的问题。     

Prenatal diagnosis of CLCN4-related neurodevelopmental disorder in fetuses with congenital brain anomalies

We report two male fetuses born to a healthy unrelated couple, with agenesis of the corpus callosum identified on detailed 20-week ultrasound scans and confirmed by in-utero MRI. Whole-genome sequencing identified a likely pathogenic missense variant in the CLCN4 gene, establishing this as the causative gene in the family. Pathogenic variants in the CLCN4 gene cause a neurodevelopmental disorder (also called Raynaud-Claes syndrome) inherited in an X-linked pattern. The disorder is characterised by developmental delay, intellectual disability, autism spectrum disorder, epilepsy, mental health conditions, and significant feeding difficulties, predominantly, but not exclusively, affecting males. This is the first report of a prenatal phenotype associated with variants in the CLCN4 gene. The diagnosis of the CLCN4-related neurodevelopmental disorder in this family allowed accurate genetic counseling and discussion of reproductive choices. This leaves uncertainty about the possibility of a postnatal neurodevelopmental phenotype in heterozygous females, which we discuss.     

用于废水处理系统中目标酵母动态解析的绿色荧光蛋白基因质粒构建

绿色荧光蛋白(green fluorescent protein,GFP)可用于研究复合微生物体系中特定目标功能菌的特性及动态变化,本研究为确立用于解析酵母细胞在混合酵母废水处理系统中的动态特性的GFP技术体系奠定了基础.将gfp基因克隆到酵母载体pACT-URA3中,再用构建的重组质粒转化宿主菌大肠杆菌(Escherichia coli JMl09),扩增得到含gfp的重组质粒,荧光显微镜照片显示gfp基因在大肠杆菌内得到了表达,但表达程度不高;电泳图谱及聚合酶链反应结果表明,含gfp基因的质粒不是以游离的形式存在,而可能是以某种特殊的形式和细胞染色体发生了相互作用.     

植被恢复对刺萼龙葵根际土壤细菌群落结构与功能的影响

入侵植物可以改变入侵地土壤微生物群落,从而有助于其入侵,在前期研究中发现,植被恢复措施可有效控制刺萼龙葵（Solanum rostratum）的入侵,但植被恢复前后刺萼龙葵根际土壤细菌群落结构与功能尚未清楚.选取了前期研究中的2个植被组合：沙打旺（Astragalus adsurgens）+披碱草（Elymus dahuricus）+无芒雀麦（Bromus inermis）（T1）;沙打旺+苇状羊茅（Festuca arundinacea）+冰草（Agropyron cristatum）+羊草（Leymus chinensis）（T2）,并选取刺萼龙葵（SR）及本地植被（NR）作为对照,采用16S rDNA MiSeq高通量测序技术研究刺萼龙葵入侵及植被恢复后刺萼龙葵根际细菌群落组成,同时采用PICRUSt功能预测分析其功能.结果表明,刺萼龙葵入侵（SR）后Simpson指数和Chao1指数均高于本地植被（NP）,但未达到显著水平,而植被恢复（T1和T2）后,Shannon指数和Chao1指数显著降低（P<0.05）.刺萼龙葵（SR）显著降低了变形菌门（Proteobacteria）中的微枝形杆菌属（Microvirga）、斯科曼氏菌属（Skermanella）、鞘氨醇单胞菌属（Sphingomonas）及酸杆菌门（Acidobacteria）的Bryobacter属相对丰度（P<0.05）,而植被恢复后,这些菌属丰度也随之上升.RDA分析结果显示,土壤有机质、总氮、总磷、总钾和速效钾是影响细菌群落组成的重要因素.PICRUSt功能预测分析表明,刺萼龙葵入侵显著提高了氨基酸合成（biosynthesis of amino acids）、嘌呤代谢（purine metabolism）、嘧啶代谢（pyrimidine metabolism）、核糖体（ribosome）和氨酰-tRNA合成（aminoacyl-tRNA biosynthesis）等方面的功能,而植被恢复以后其相对丰度显著降低.本文探讨了刺萼龙葵入侵及植被恢复后根际细菌群落和功能,为刺萼龙葵的入侵机制及生态恢复提供理论依据.     

柴达木盆地达布逊盐湖微生物多样性研究

本研究采用高通量测序与传统培养技术相结合的方式研究达布逊湖微生物的多样性。结果显示,达布逊盐湖中的细菌多样性与丰度远高于古菌。高通量测序所得的16SrRNA基因序列分别归属广古菌门(Euryarchaeota),放线菌门(Actinobacteria),拟杆菌门(Bacteroidetes),变形菌门(Proteobacteria)和疣微菌门(Verrucomicrobia)。广古菌门序列占原核微生物(细菌与古菌之和)的5.5%,以嗜盐的盐杆菌科(Halobacteriaceae)为主,而属于放线菌门、拟杆菌门、变形菌门和疣微菌门的细菌序列分别占原核微生物的53.0%、25.8%、14.1%和1.6%。定量PCR结果显示,达布逊盐湖水体中的细菌和古菌16S rRNA基因丰度分别为3.27×107和4.35×104拷贝/毫升。培养分离获得的纯细菌菌株分别属于假单胞菌属(Pseudomonas)和芽孢杆菌属(Bacillus)。古菌菌株则分别属于盐杆菌科的盐盒菌属(Haloarcula)、盐红菌属(Halorubrum)和盐棍菌属(Halorhabdus)。本研究为青藏高原盐湖微生物资源的开发和利用提供了有利的数据支持。     

凤眼莲对富营养化水体中氨氧化和反硝化微生物的影响

凤眼莲近年来广泛应用于富营养化淡水湖泊的生态修复中,但其对微生物的相互作用和对水体中氮素的去除鲜有报道.本研究在氮素去除过程中对比凤眼莲和细菌的相对重要性,并且检测浮游植物对硝化细菌和反硝化细菌相对丰度及多样性的影响.水体中氮素的去除率以及硝化和反硝化作用的潜在能力使用定量聚合酶链式反应(qPCRs)对硝化作用基因amoA和反硝化作用基因nirS/K进行检测,从微观角度研究富营养化水体中是否会受到凤眼莲存在的影响.结果表明,TN的减少在70d的实验周期中所有处理组表现较为一致,但凤眼莲存在的实验组在24h内TN和NH_4~+-N的去除上有显著的降低,并且amoA的丰度有所增加,nirS/K的丰度有所降低.T-RFLP结果表明亚硝化单胞菌在氨氧化微生物中占优势.凤眼莲的种植可以实现富营养化水体中NH_4~+-N的快速有效减少,且微生物的相互作用可以充分利用到淡水生态系统的修复中.