Klein Izabella, Szocs Katalin, Vincze Katalin, Benkovits Judit, Somogyi Szilvia, Herman Levente, Rethelyi Janos M
MTA-SE NAP-B, Molecular Psychiatry and in vitro Disease Modelling Research Group, Budapest, Hungary.
Neuropsychopharmacol Hung. 2016 Dec;18(4):209-218.
Schizophrenia is a severe debilitating psychiatric disorder, with a typical onset in adolescence or early adulthood. This condition is characterized by heterogeneous symptoms (hallucinations, delusions, disorganized behaviour, affective flattening, and social isolation) and a life-time prevalence of 0.5-1.2%. In spite of the efforts to uncover the etiology of the disorder, its pathogenesis and neurobiological background are poorly understood. Given the high heritability in schizophrenia, genetic research remains an important area of focus. Besides the common variations of low penetrance - single nucleotid polymorphisms (SNPs) -, rare variants, mainly copy number variations (CNVs) play a role in the genetic architecture of the disorder. The most frequent CNV associated with schizophrenia is the hemizygous deletion of the 22q11.2 region. According to previous research this genetic variant occurs in 1% of the patients and conversely, 25% of the carriers of the 22q11.2 microdeletion will develop schizophrenia. The 22q11.2 deletion syndrome (22Q11DS, velocardiofacial (VCFS) syndrome, DiGeorge-syndrome) is usually a childhood diagnosis. Its prevalence is 1:2000-4000 considering all births. Patients can demonstrate heart developmental disorders, craniofacial (elongated face, hypertelorism), immunological (thymus-hypoplasia), endocrinological (hypocalcaemia) abnormalities, and neurodevelopmental alterations, but only a proportion will have these abnormalities due to incomplete penetrance. The variable symptoms complicate the recognition of the syndrome in the day to day medical practice. 25% of the known 22Q11DS patients develop schizophrenia but the risk of neuropsychiatric problems, like autism, ADHD and childhood conduct disorder is also increased, while early onset Parkinson's disease in also more frequent in adults. The schizophrenia phenotype is not distinguishable at the moment in patients with or without the 22q11 deletion. But emerging evidence suggests that early onset Parkinson's disease is more frequent in 22Q11DS and the effects of clozapine treatment could be different in schizophrenia with 22Q11DS. The question arises what is the incidence rate of the 22q11.2 microdeletion among our Hungarian DNA samples with schizophrenia. To answer the question, we utilized a new method used in routine genetic diagnostics, multiplex ligation-based probe amplification (MLPA). Although we genotyped the DNA of 315 Hungarian schizophrenia patients, we found no 22Q11DS in this cohort. The findings are discussed in terms of basic research and their translation into everyday clinical practice.
精神分裂症是一种严重的致残性精神障碍,通常在青春期或成年早期发病。这种疾病的特征是症状多样(幻觉、妄想、行为紊乱、情感平淡和社交孤立),终生患病率为0.5%-1.2%。尽管人们努力揭示该疾病的病因,但其发病机制和神经生物学背景仍知之甚少。鉴于精神分裂症的高遗传性,基因研究仍然是一个重要的重点领域。除了低外显率的常见变异——单核苷酸多态性(SNP)——之外,罕见变异,主要是拷贝数变异(CNV)在该疾病的遗传结构中也起作用。与精神分裂症相关的最常见CNV是22q11.2区域的半合子缺失。根据先前的研究,这种基因变异在1%的患者中出现,相反,22q11.2微缺失的携带者中有25%会发展为精神分裂症。22q11.2缺失综合征(22Q11DS,心脏颜面综合征(VCFS),迪乔治综合征)通常在儿童期被诊断出来。考虑到所有出生人口,其患病率为1:2000-4000。患者可能表现出心脏发育障碍、颅面异常(长脸、眼距过宽)、免疫异常(胸腺发育不全)、内分泌异常(低钙血症)和神经发育改变,但由于外显不全,只有一部分患者会出现这些异常。这些多样的症状使在日常医疗实践中识别该综合征变得复杂。已知的22Q11DS患者中有25%会发展为精神分裂症,但神经精神问题的风险也会增加,如自闭症、注意力缺陷多动障碍和儿童品行障碍,而成年早期帕金森病在患者中也更常见。目前,有或没有22q11缺失的患者的精神分裂症表型无法区分。但新出现的证据表明,22Q11DS患者中早期帕金森病更为常见,并且氯氮平治疗对22Q11DS精神分裂症患者的效果可能不同。问题是,在我们匈牙利的精神分裂症DNA样本中,22q11.2微缺失的发生率是多少。为了回答这个问题,我们采用了一种常规基因诊断中使用的新方法,即多重连接探针扩增(MLPA)。尽管我们对315名匈牙利精神分裂症患者的DNA进行了基因分型,但在这个队列中未发现22Q11DS。我们将根据基础研究及其转化为日常临床实践的情况来讨论这些发现。