Departamento de Genética Humana
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- A 1.77 Mb deletion in 3p26.3 encompassing CNTN6 and CNTN4 genes: case reportPublication . Brito, Filomena; Marques, Bárbara; Pedro, Sónia; Serafim, Silvia; Gonçalves, Rui; Freixo, João; Correia, HildebertoChromosome microarray analysis is a powerful diagnostic tool and is being used as a first-line approach to detect chromosome imbalances associated with intellectual disability, dysmorphic features and congenital abnormalities. This test enables the identification of new copy number variants (CNVs) and their association with new microdeletion/microduplication syndromes in patients previously without diagnosis. We report the case of a 7 year-old female with moderate intellectual disability, severe speech delay and auto and hetero aggressivity with a previous 45,XX,der(13;14)mat karyotype performed at a younger age. Affymetrix CytoScan 750K chromosome microarray analysis was performed detecting a 1.77 Mb deletion at 3p26.3, encompassing 2 OMIM genes, CNTN6 and CNTN4. These genes play an important role in the formation, maintenance, and plasticity of functional neuronal networks. Deletions or mutations in CNTN4 gene have been implicated in intellectual disability and learning disabilities. Disruptions or deletions in the CNTN6 gene have been associated with development delay and other neurodevelopmental disorders. The haploinsufficiency of these genes has been suggested to participate to the typical clinical features of 3p deletion syndrome. Nevertheless inheritance from a healthy parent has been reported, suggesting incomplete penetrance and variable phenotype for this CNV. We compare our patient with other similar reported cases, adding additional value to the phenotype-genotype correlation of deletions in this region.
- 15q11.2q13.1 interstitial gain in a fetus with an increased risk for T21: When classification and clinical outcome are divergentPublication . Serafim, Sílvia; Pedro, Sónia; Marques, Bárbara; Tarelho, Ana; Viegas, Mónica; Simão, Laurentino; Ferreira, Cristina; Carvalho, Inês; Cohen, Álvaro; Correia, HildebertoIntroduction: Copy number variants (CNV) of the 15q11.2q13.1 region are associated to recurrent microdeletion/microduplication syndromes in which the phenotype is dependent on the parental origin of the CNV. We report the case of a fetus from a healthy 39-year-old G6P3A2 woman, with an increased risk for trisomy 21 in the 1st trimester prenatal screening. Chromosomal microarray analysis (CMA) was requested and revealed a pathogenic duplication in which the outcome was dependent of the parental origin of the affected allele. Methods: DNA was extracted from a chorionic villus sample and CMA was performed using Cytoscan™ 750K. Parental follow-up studies to assess the origin of the CNV were performed. Results: The CMA profile revealed a male fetus with a 4,89 Mb interstitial gain in 15q11.2q13.1. CMA of the parents showed that the duplication was paternally inherited. Discussion: The detected CNV is a recurrent known microduplication and according to the American College of Medical Genetics and Genomics guidelines is classified as pathogenic. However the phenotype is dependent on the parental origin of the duplication. When it arises in the maternally allele it has a severe outcome with hypotonia, cognitive deficit, seizures, among others. If the CNV occurs in the paternal allele although some patients might show developmental delays and behavioral disturbances most cases are rarely symptomatic. In this case, CMA of both parents showed that the CNV identified in the fetus was paternally inherited. Although the CMA result did not explained the increased risk for T21 after determining the duplication had been inherited from the father it allowed the prediction of the most likely resulting phenotype for the fetus as a milder or even asymptomatic. Follow-up ultrasounds at gestation age of 17w+6d and echocardiogram at 21w+3d showed no structural abnormalities. The baby was born at 37w+5d with an Apgar index of 10/10/10, with no dysmorphic features or malformations, and a normal physical exam. This case illustrates that although the use of genetic tools using artificial intelligence and following determined guidelines can be helpful for the purpose of consistency and standardization on the classification we always need careful evaluation from a clinical laboratory geneticist on the context of each case. Additionally it also shows how critical parental testing can be, not only to assess recurrence risk but to provide the best possible tool to ascertain the outcoming phenotype and allow the best choices to the couple after genetic counselling.
- 16p13.11 microduplication: a case reportPublication . Marques, Bárbara; Ferreira, Cristina; Ventura, Catarina; Pedro, Sonia; Antunes, Diana; Nunes, Luis; Correia, HildebertoThe short arm of chromosome 16 is very rich in segmental duplications, predisposing this region of the genome to a number of recurrent rearrangements, namely deletions and duplications. Although it is already known that there is a strong association between 16p13.11 deletion and neuropsychiatric disorders, the clinical significance of its reciprocal duplication is not clearly defined yet. 16p13.11 microduplication that results of non-allelic homologous recombination is a very rare genetic alteration which can be associated with variable clinical features including behavioural abnormalities, developmental delay, congenital heart defects and skeletal anomalies. We report a 7-years-old boy with global developmental delay, speech absence, microcephaly, dysmorphic facial features and inexpressive facies. Microarray analysis revealed a 3.3Mb duplication comprising the 16p13.11- p12.3 region, which was confirmed by fluorescence in situ hybridization with a BAC clone for 16p13.11. Eight annotated genes are present in this region including NDE1, the candidate gene for neurological and behavioural phenotype. Although this microduplication has been found in the normal population, is significantly enriched in patients with autism, schizophrenia and cognitive impairment. Several case reports until now suggest that this genomic abnormality has incomplete penetrance and variable expressivity and can constitute a new syndrome. With this case we intend to contribute to expand the spectrum of clinical findings associated to this genomic abnormality and provide further knowledge of the pathogenic involvement of this duplication.
- 1º Workshop sobre Biomonitorização Humana em Portugal: síntese do encontroPublication . Silva, Maria João; Lavinha, JoãoRealizou-se no passado dia 11 de maio de 2018 o 1st HBM-PT, tendo reunido no Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), em Lisboa, mais de oitenta participantes da Academia, Indústria, Saúde Ocupacional e Regulamentação, entre outros. O Encontro partiu da iniciativa do conjunto de parceiros que constituem o denominado National Hub (NH-PT) para o projeto “Human Biomonitoring Initiative - HBM4EU” que inclui a Fundação para a Ciência e a Tecnologia, I.P. (FCT), Instituto Nacional de Saúde Dr. Ricardo Jorge, I.P. (INSA), Direção Geral da Saúde (DGS) e Agência Portuguesa do Ambiente, I.P. (APA), em colaboração com a Faculdade de Medicina, Universidade de Lisboa (FMUL) e Escola Superior de Tecnologia da Saúde Lisboa (ESTeSL), Instituto Politécnico de Lisboa. Este primeiro Workshop visou juntar investigadores reguladores, público em geral e outros atores-chave para discutir a contribuição da biomonitorização humana para as políticas de saúde e ambiente e para a avaliação de risco para a saúde humana. Para além disso, pretendeu informar as partes interessadas acerca do projeto HBM4EU, incluindo aspetos relevantes, tais como a sua estrutura e as atividades já desenvolvidas durante o primeiro ano do projeto ou a desenvolver futuramente. Nesta síntese os autores pretenderam oferecer uma visão geral do evento, através de um breve resumo das apresentações dos oradores convidados e dos temas abordados pelo painel de discussão tecendo ainda algumas considerações finais sobre o evento.
- 1st Workshop on Human Biomonitoring in Portugal "Briding Chemical Exposure to Human Health": Programme and Abstract BookPublication . Namorado, Sónia; Assunção, Ricardo; Silva, Maria João; Louro, Henriqueta; Alvito, Paula; Lavinha, João; Dias, Carlos; Albuquerque, José Maria; Moura, Isabel; Borges, Teresa; Cavaleiro, Rita; Abrantes, Marta; Núncio, TeresaThe 1st Human Biomonitoring Workshop in Portugal aims to bring together stakeholders, researchers and regulators to discuss the contribution of HBM to health and environmental policies and human health risk assessment; inform experts and stakeholders about key aspects, structure and activities of the HBM4EU project; share the achievements of the first year of the Portuguese participation in the HBM4EU project.
- 2-DIGE of Red Blood Cells from Sickle-Cell Disease Patients with Severe Vaso-Occlusion.Publication . Vaz, Fátima; Charro, Nuno; Morais, Anabela; Lavinha, João; Penque, Deborah
- 3- Methylcrotonyl-coa Carboxylase Deficiency: Biochemical and Molecular Studies in 36 PatientsPublication . Fonseca, Helena; Sousa, Carmen; Marcão, Ana; Rocha, Hugo; Lopes, Lurdes; Vilarinho, Laura3-methylcrotonylglycinuria (MCG) is a disease included in the expanded newborn screening that until recently was considered a rare inherited disorder of the metabolism. In the catabolism of leucine, MCG is blocked in the fourth step due to deficiency of the enzyme 3-methylcrotonyl-CoA carboxylase (3-MCC) (Dantas et al). The biochemical diagnosis of disability in 3-MCC is characterized by marked increase of acid 3-hydroxyisovaleric (3-HIVA) and 3-methylcrotonylglycine (3-MCG) in urine and high concentrations of 3-hydroxyisovalerylcarnitine (C5-OH) in the blood. The molecular characterization is the study of genes MCCA and MCCB that encodes the enzyme 3-MCC. The authors report biochemical and mutation data of 36 MCC deficient individuals, one diagnosed due to clinical symptoms, 25 identified by newborn screening and 10 mothers identified following the positive newborn screening of their sons. All patients had an increased value of C5-OH, primary biochemical marker screening for this condition. In this cohort of 36 patients the genetic study intended to identify the pathogenic mutations using an analysis of 19 exons in the MCCA gene and 17 exons in the MCCB gene. A total of 32 mutations were detected of which 24 (75%) have, neither been described in the literature nor in the Human Gene Mutation Database. The results described show that the genotype cannot predict the phenotype or metabolic risk of these cases, but it is capable to confirm the diagnosis in doubtful cases. The clinical phenotype is very heterogeneous, most patients showing different mutations making the phenotype-genotype correlation difficult. The 3-MCC deficiency is a pathology not completely understood described as a genetic condition with low clinic penetrance. However, it can lead to a severe clinic phenotype resembling classic organic acidurias, has it was recently demonstrated by Grunert et al. Dantas, M. F., T. Suormala, et al. (2005). 3-Methylcrotonyl-CoA carboxylase deficiency: mutation analysis in 28 probands, 9 symptomatic and 19 detected by newborn screening.
- 3-Methylcrotonyl CoA Carboxylase Deficiency: Disorder or Just a Biochemical Phenotype?Publication . Fonseca, Helena; Bueno, Maria; Sousa, Carmen; Marcão, Ana; Lopes, Lurdes; Rocha, Hugo; Vilarinho, LauraIntroduction: 3-methylcrotonyl-CoA carboxylase deficiency (MCCD) was considered extremely rare before newborn screening (NBS) was undertaken but is now found in a number of asymptomatic babies or sometimes their mothers. This disorder of leucine metabolism, is the commonest organic aciduria found by screening, with a incidence of about 1:32 392 in our country. The clinical phenotype has been shown to vary considerably, ranging from entirely asymptomatic to death in infancy. A review of the literature on 37 individuals indicates that only 27% developed normally and stayed completely asymptomatic. Approximately 30% were reported to suffer from muscular hypotonia and psychomotor retardation, and almost half suffer from various other neurological symptoms. Even a lethality of 11% was observed. The metabolic phenotype characterizing MCCD is the elevated excretion of the diagnostic compounds 3-methylcrotonylglycine and 3-hydroxyisovaleric acid, and the presence of abnormally elevated blood levels of 3-hydroxyisovalerylcarnitine (C5-OH), as determined by tandem mass spectrometry (MS/MS). Patient and methods: The authors present a symptomatic case with an increase of C5-OH in the acylcarnitine profile who have a developmental delay. Blood spot samples from newborns are collected between day 3 and 6 in Watman 903 filter paper. Acylcarnitines in samples are analysed by MS/MS. Genes MCCA and MCCB that encodes the enzyme 3-MCC were studied by reported methods. Results: The molecular study has allowed the identification of the compound heterozygous in this patient: the frameshift mutation p.S173FfsX25 and the missense mutation p.V339M. Both mutations are described in the literature. Discussion: The newborn screening identification of a patient which developed symptoms seems to indicate that this disease should be included in NBS programs. More studies are needed to find genetic and/or biochemical markers that explain why a relatively small number of individuals are at risk of developing a severe disease phenotype. Another important reason to include MCCD in our panel is that other disorders are also detected by the marker C5OH; for example deficiencies of holocarboxylase synthetase, and 3-hydroxy- 3-methylglutaryl-CoA lyase.
- 3-Methylcrotonylglycinuria: a new common mutation in the Portuguese population?Publication . Fonseca, Helena; Sousa, Carmen; Marcão, Ana; Rocha, Hugo; Lopes, Lurdes; Vilarinho, LauraIntroduction: 3-Methylcrotonylglycinuria (MCG) is an inborn error of the leucine catabolism resulting from isolated biotin-insensitive deficiency of 3-methylcrotonyl-CoA carboxylase (3-MCC), the enzyme converting 3-methylcrotonoyl-CoA to 3-methylglutaconyl-CoA. The metabolic phenotype characterizing MCC deficiency is the elevated excretion of the diagnostic compounds 3-methylcrotonylglycine and 3-hydroxyisovaleric acid, and the presence of abnormally elevated blood levels of 3-hydroxyisovalerylcarnitine (C5-OH), as determined by tandem mass spectrometry (MS/MS). Expanded newborn screening for inborn errors of metabolism using MS/MS has demonstrated that 3-MCC deficiency is one of the most commonly detected inherited organic acidurias. Patient and methods: The authors report the results of molecular studies performed in six cases in a universe of thirty patients with an increase of C5-OH in the acylcarnitine profile. Blood spot samples from newborns are collected between day 3 and 6 in Watman 903 filter paper. Acylcarnitines in samples are analysed in tandem mass spectrometer. The molecular characterization is the study of genes MCCA and MCCB that encodes the enzyme 3-MCC. Results: The six cases showed the same novel mutation p.N230D in the MCCB gene, proving that this is the most common new mutation in our population. According to the studies conducted to this new mutation using bioinformatic applications, it is considered a benign mutation, but the alignment of species and the population study conducted, showed that this mutation is responsible for the biochemical phenotype found in these cases. Discussion: Of the thirty MCC cases studied, p.N230D mutation revealed to be the most frequent new mutation. Bioinformatic analysis showed that this mutation is located in a non conserved area but the mutant residue was never present in the homologous proteins analyzed.
- 3-Metilcrotonilglcinuria: identificação e caracterização molecularPublication . Fonseca, Helena Susana Rodrigues Almeida; Mendo, Sónia; Vilarinho, LauraO rastreio neonatal é um programa sistemático destinado a todos os recémnascidos, tendo como objectivo evitar a evolução da patologia rastreada através do diagnóstico pré-sintomático e da instituição precoce de terapia adequada. A 3-metilcrotonilglicinúria (MCG) é uma doença incluída no rastreio que até recentemente era considerada uma doença hereditária do metabolismo rara. Na MCG o catabolismo da leucina é bloqueado no quarto passo devido a deficiência da enzima 3-metilcrotonil-CoA carboxilase (3-MCC). A 3-MCC catalisa a conversão do 3-metilcrotonil-CoA a 3-metilglutaconil-CoA, uma reacção reversível dependente de ATP e utilizando o bicarbonato como fonte de grupos carboxílo. O diagnóstico bioquímico da deficiência em 3-MCC é caracterizado pelo aumento marcado dos ácidos 3-hidroxisovalérico (3-HIVA) e 3-metilcrotonilglicina (3-MCG) na urina e concentrações elevadas de 3- hidroxisovalerilcarnitina (C5-OH) no sangue. A caracterização molecular reside no estudo dos genes MCCA e MCCB que codificam a enzima 3-MCC. O objectivo deste trabalho foi estabelecer um diagnóstico etiológico em doentes com MCG detectados pelo Programa Nacional de Diagnóstico Precoce e que possuíam um valor de C5-OH, marcador bioquímico primário de rastreio para esta patologia, superiores ao cut-off estabelecido. Numa amostra de 20 doentes pretende-se identificar e caracterizar as mutações mais frequentes na nossa população recorrendo a análise de 19 exões no gene MCCA e 17 exões no gene MCCB. Destes casos seleccionados para estudo, foram detectadas 26 mutações das quais 16 não se encontram ainda descritas na literatura nem na base de dados Human Gene Mutation Database, o que corresponde a uma percentagem de novas mutações de 61.5%. Os resultados obtidos permitiram concluir que o génotipo não consegue predizer o fenótipo ou o risco metabólico destes casos, mas permite confirmar o diagnóstico nos casos duvidosos. A deficiência em 3-MCC ainda não é uma patologia completamente conhecida e a sua apresentação clínica é bastante heterogénea, sendo a maioria dos doentes portadores de mutações próprias não sendo visível uma correlação genótipo – fenótipo. A continuação deste estudo é necessária para encontrar marcadores genéticos e/ou bioquímicos que expliquem a razão pela qual um número relativamente reduzido de indivíduos apresenta risco de desenvolver um fenótipo severo da doença. Verificou-se também que o estudo molecular é importante no diagnóstico de portadores sintomáticos ou assintomáticos (diagnóstico preditivo), no diagnóstico pré-natal, aconselhamento genético e com indicação para suplementação com biotina para os pacientes que tem a mutação que responde à biotina.