Monogenic variants in dystonia: an exome-wide sequencing study.
Journal article

Monogenic variants in dystonia: an exome-wide sequencing study.

  • Zech M Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Jech R Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Boesch S Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
  • Škorvánek M Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovakia; Department of Neurology, University Hospital of Louis Pasteur, Košice, Slovakia.
  • Weber S Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Wagner M Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Zhao C Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.
  • Jochim A Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Necpál J Department of Neurology, Zvolen Hospital, Zvolen, Slovakia.
  • Dincer Y Lehrstuhl für Sozialpädiatrie, Technical University of Munich, Munich, Germany; Zentrum für Humangenetik und Laboratoriumsdiagnostik, Martinsried, Germany.
  • Vill K Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Distelmaier F Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
  • Stoklosa M Department of Neonatology, Clinical Hospital No 2, Rzeszow, Poland.
  • Krenn M Institute of Human Genetics, Technical University of Munich, Munich, Germany; Department of Neurology, Medical University of Vienna, Vienna, Austria.
  • Grunwald S Crystallography, Max Delbrück Center for Molecular Medicine, Berlin, Germany; Institute of Chemistry and Biochemistry, Free University of Berlin, Berlin, Germany.
  • Bock-Bierbaum T Crystallography, Max Delbrück Center for Molecular Medicine, Berlin, Germany; Institute of Chemistry and Biochemistry, Free University of Berlin, Berlin, Germany.
  • Fečíková A Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Havránková P Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Roth J Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Příhodová I Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Adamovičová M Department of Paediatric Neurology, Thomayer Hospital, Prague, Czech Republic.
  • Ulmanová O Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Bechyně K Department of Neurology, Hospital Písek, Pisek, Czech Republic.
  • Danhofer P Department of Child Neurology, Faculty of Medicine of Masaryk University Brno and University Hospital, Brno, Czech Republic.
  • Veselý B Department of Neurology, Faculty Hospital, Constantine the Philosopher University, Nitra, Slovakia.
  • Haň V Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovakia; Department of Neurology, University Hospital of Louis Pasteur, Košice, Slovakia.
  • Pavelekova P Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovakia; Department of Neurology, University Hospital of Louis Pasteur, Košice, Slovakia.
  • Gdovinová Z Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovakia; Department of Neurology, University Hospital of Louis Pasteur, Košice, Slovakia.
  • Mantel T Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Meindl T Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Sitzberger A Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Schröder S Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Blaschek A Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Roser T Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Bonfert MV Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Haberlandt E Clinic for Pediatrics, Krankenhaus Stadt Dornbirn, Dornbirn, Austria.
  • Plecko B Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.
  • Leineweber B Sozialpädiatrisches Zentrum, Klinikum Dritter Orden, Munich, Germany.
  • Berweck S Ludwig-Maximilians-Universität München, Munich, Germany; Hospital for Neuropediatrics and Neurological Rehabilitation, Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany.
  • Herberhold T Hospital for Neuropediatrics and Neurological Rehabilitation, Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany.
  • Langguth B Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
  • Švantnerová J Second Department of Neurology, Faculty of Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia.
  • Minár M Second Department of Neurology, Faculty of Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia.
  • Ramos-Rivera GA Department of Pediatric Neurology, National Institute of Children's Diseases, Bratislava, Slovakia.
  • Wojcik MH Divisions of Newborn Medicine and Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
  • Pajusalu S Department of Clinical Genetics, Tartu University Hospital, Tartu, Estonia; Department of Clinical Genetics, University of Tartu, Tartu, Estonia; Department of Genetics, Yale School of Medicine, New Haven, CT, USA.
  • Õunap K Department of Clinical Genetics, Tartu University Hospital, Tartu, Estonia; Department of Clinical Genetics, University of Tartu, Tartu, Estonia.
  • Schatz UA Institute of Human Genetics, Technical University of Munich, Munich, Germany; Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria.
  • Pölsler L Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria.
  • Milenkovic I Department of Neurology, Medical University of Vienna, Vienna, Austria.
  • Laccone F Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria.
  • Pilshofer V Ordensklinikum Linz, Barmherzige Schwestern, Linz, Austria.
  • Colombo R Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Patzer S Klinik für Kinder-und Jugendmedizin St Elisabeth und St Barbara, Halle, Germany.
  • Iuso A Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Vera J Child Neurology Service, Hospital San Borja Arriarán, University of Chile, Santiago, Chile.
  • Troncoso M Child Neurology Service, Hospital San Borja Arriarán, University of Chile, Santiago, Chile.
  • Fang F Department of Neurology, National Center for Children's Health, Beijing Children's Hospital and Capital Medical University, Beijing, China.
  • Prokisch H Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Wilbert F Department of Neuropediatrics and Muscle Disorders, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
  • Eckenweiler M Department of Neuropediatrics and Muscle Disorders, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
  • Graf E Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Westphal DS Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Riedhammer KM Institute of Human Genetics, Technical University of Munich, Munich, Germany; Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Brunet T Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Alhaddad B Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Berutti R Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Strom TM Institute of Human Genetics, Technical University of Munich, Munich, Germany.
  • Hecht M Neurologische Klinik am Klinikum Kaufbeuren, Bezirkskliniken Schwaben, Kaufbeuren, Germany.
  • Baumann M Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria.
  • Wolf M Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany; Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim, University of Heidelberg, Mannheim, Germany.
  • Telegrafi A GeneDx, Gaithersburg, MD, USA.
  • Person RE GeneDx, Gaithersburg, MD, USA.
  • Zamora FM GeneDx, Gaithersburg, MD, USA.
  • Henderson LB GeneDx, Gaithersburg, MD, USA.
  • Weise D Klinik für Neurologie, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany.
  • Musacchio T Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
  • Volkmann J Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
  • Szuto A Division of Clinical and Metabolic Genetics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
  • Becker J Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany.
  • Cremer K Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany.
  • Sycha T Department of Neurology, Medical University of Vienna, Vienna, Austria.
  • Zimprich F Department of Neurology, Medical University of Vienna, Vienna, Austria.
  • Kraus V Department of Paediatrics, School of Medicine, Technical University of Munich, Munich, Germany.
  • Makowski C Department of Paediatrics, School of Medicine, Technical University of Munich, Munich, Germany.
  • Gonzalez-Alegre P Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.
  • Bardakjian TM Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.
  • Ozelius LJ Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA.
  • Vetro A Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy.
  • Guerrini R Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy.
  • Maier E Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Borggraefe I Dr von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Kuster A Inborn Errors of Metabolism, Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
  • Wortmann SB Institute of Human Genetics, Technical University of Munich, Munich, Germany; University Children's Hospital, Salzburger Landeskliniken and Paracelsus Medical University, Salzburg, Austria; Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen, Netherlands.
  • Hackenberg A Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland.
  • Steinfeld R Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland.
  • Assmann B Division of Neuropediatrics and Metabolic Medicine, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany.
  • Staufner C Division of Neuropediatrics and Metabolic Medicine, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany.
  • Opladen T Division of Neuropediatrics and Metabolic Medicine, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany.
  • Růžička E Department of Neurology, Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Cohn RD Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Hospital for Sick Children Research Institute, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
  • Dyment D Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada.
  • Chung WK Department of Pediatrics and Department of Medicine, Columbia University, New York, NY, USA.
  • Engels H Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany.
  • Ceballos-Baumann A Schön Klinik München Schwabing, Munich, Germany.
  • Ploski R Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland.
  • Daumke O Crystallography, Max Delbrück Center for Molecular Medicine, Berlin, Germany; Institute of Chemistry and Biochemistry, Free University of Berlin, Berlin, Germany.
  • Haslinger B Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
  • Mall V Lehrstuhl für Sozialpädiatrie, Technical University of Munich, Munich, Germany; kbo-Kinderzentrum München, Munich, Germany.
  • Oexle K Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.
  • Winkelmann J Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University of Munich, Munich, Germany; Lehrstuhl für Neurogenetik, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology, SyNergy, Munich, Germany. Electronic address: juliane.winkelmann@tum.de.
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  • 2020-10-25
Published in:
  • The Lancet. Neurology. - 2020
English BACKGROUND
Dystonia is a clinically and genetically heterogeneous condition that occurs in isolation (isolated dystonia), in combination with other movement disorders (combined dystonia), or in the context of multisymptomatic phenotypes (isolated or combined dystonia with other neurological involvement). However, our understanding of its aetiology is still incomplete. We aimed to elucidate the monogenic causes for the major clinical categories of dystonia.


METHODS
For this exome-wide sequencing study, study participants were identified at 33 movement-disorder and neuropaediatric specialty centres in Austria, Czech Republic, France, Germany, Poland, Slovakia, and Switzerland. Each individual with dystonia was diagnosed in accordance with the dystonia consensus definition. Index cases were eligible for this study if they had no previous genetic diagnosis and no indication of an acquired cause of their illness. The second criterion was not applied to a subset of participants with a working clinical diagnosis of dystonic cerebral palsy. Genomic DNA was extracted from blood of participants and whole-exome sequenced. To find causative variants in known disorder-associated genes, all variants were filtered, and unreported variants were classified according to American College of Medical Genetics and Genomics guidelines. All considered variants were reviewed in expert round-table sessions to validate their clinical significance. Variants that survived filtering and interpretation procedures were defined as diagnostic variants. In the cases that went undiagnosed, candidate dystonia-causing genes were prioritised in a stepwise workflow.


FINDINGS
We sequenced the exomes of 764 individuals with dystonia and 346 healthy parents who were recruited between June 1, 2015, and July 31, 2019. We identified causative or probable causative variants in 135 (19%) of 728 families, involving 78 distinct monogenic disorders. We observed a larger proportion of individuals with diagnostic variants in those with dystonia (either isolated or combined) with coexisting non-movement disorder-related neurological symptoms (100 [45%] of 222; excepting cases with evidence of perinatal brain injury) than in those with combined (19 [19%] of 98) or isolated (16 [4%] of 388) dystonia. Across all categories of dystonia, 104 (65%) of the 160 detected variants affected genes which are associated with neurodevelopmental disorders. We found diagnostic variants in 11 genes not previously linked to dystonia, and propose a predictive clinical score that could guide the implementation of exome sequencing in routine diagnostics. In cases without perinatal sentinel events, genomic alterations contributed substantively to the diagnosis of dystonic cerebral palsy. In 15 families, we delineated 12 candidate genes. These include IMPDH2, encoding a key purine biosynthetic enzyme, for which robust evidence existed for its involvement in a neurodevelopmental disorder with dystonia. We identified six variants in IMPDH2, collected from four independent cohorts, that were predicted to be deleterious de-novo variants and expected to result in deregulation of purine metabolism.


INTERPRETATION
In this study, we have determined the role of monogenic variants across the range of dystonic disorders, providing guidance for the introduction of personalised care strategies and fostering follow-up pathophysiological explorations.


FUNDING
Else Kröner-Fresenius-Stiftung, Technische Universität München, Helmholtz Zentrum München, Medizinische Universität Innsbruck, Charles University in Prague, Czech Ministry of Education, the Slovak Grant and Development Agency, the Slovak Research and Grant Agency.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/82437
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