一项针对优势小脑性共济失调患者的面板研究强调了通道病的频率。
A panel study on patients with dominant cerebellar ataxia highlights the frequency of channelopathies.
机构信息
INSERM U 1127, 75013, Paris, France.
Centre National de la Recherche Scientifique UMR 7225, 75013, Paris, France.
出版信息
Brain. 2017 Jun 1;140(6):1579-1594. doi: 10.1093/brain/awx081.
Autosomal dominant cerebellar ataxias have a marked heterogeneous genetic background, with mutations in 34 genes identified so far. This large amount of implicated genes accounts for heterogeneous clinical presentations, making genotype-phenotype correlations a major challenge in the field. While polyglutamine ataxias, linked to CAG repeat expansions in genes such as ATXN1, ATXN2, ATXN3, ATXN7, CACNA1A and TBP, have been extensively characterized in large cohorts, there is a need for comprehensive assessment of frequency and phenotype of more 'conventional' ataxias. After exclusion of CAG/polyglutamine expansions in spinocerebellar ataxia genes in 412 index cases with dominantly inherited cerebellar ataxias, we aimed to establish the relative frequencies of mutations in other genes, with an approach combining panel sequencing and TaqMan® polymerase chain reaction assay. We found relevant genetic variants in 59 patients (14.3%). The most frequently mutated were channel genes [CACNA1A (n = 16), KCND3 (n = 4), KCNC3 (n = 2) and KCNA1 (n = 2)]. Deletions in ITPR1 (n = 11) were followed by biallelic variants in SPG7 (n = 9). Variants in AFG3L2 (n = 7) came next in frequency, and variants were rarely found in STBN2 (n = 2), ELOVL5, FGF14, STUB1 and TTBK2 (n = 1 each). Interestingly, possible risk factor variants were detected in SPG7 and POLG. Clinical comparisons showed that ataxias due to channelopathies had a significantly earlier age at onset with an average of 24.6 years, versus 40.9 years for polyglutamine expansion spinocerebellar ataxias and 37.8 years for SPG7-related forms (P = 0.001). In contrast, disease duration was significantly longer in the former (20.5 years versus 9.3 and 13.7, P=0.001), though for similar functional stages, indicating slower progression of the disease. Of interest, intellectual deficiency was more frequent in channel spinocerebellar ataxias, while cognitive impairment in adulthood was similar among the three groups. Similar differences were found among a single gene group, comparing 23 patients with CACNA1A expansions (spinocerebellar ataxia 6) to 22 patients with CACNA1A point mutations, which had lower average age at onset (25.2 versus 47.3 years) with longer disease duration (18.7 versus 10.9), but lower severity indexes (0.39 versus 0.44), indicating slower progression of the disease. In conclusion, we identified relevant genetic variations in up to 15% of cases after exclusion of polyglutamine expansion spinocerebellar ataxias, and confirmed CACNA1A and SPG7 as major ataxia genes. We could delineate firm genotype-phenotype correlations that are important for genetic counselling and of possible prognostic value.
常染色体显性小脑共济失调具有明显的异质性遗传背景,迄今为止已发现 34 个基因突变。大量涉及的基因导致了不同的临床表现,使得基因型-表型相关性成为该领域的主要挑战。虽然与 ATXN1、ATXN2、ATXN3、ATXN7、CACNA1A 和 TBP 等基因中的 CAG 重复扩展相关的多聚谷氨酰胺共济失调已在大型队列中得到广泛研究,但仍需要全面评估更多“常规”共济失调的频率和表型。在排除 412 例具有显性遗传性小脑共济失调的指数病例中的脊髓小脑共济失调基因中的 CAG/多聚谷氨酰胺扩展后,我们旨在确定其他基因中突变的相对频率,采用结合小组测序和 TaqMan®聚合酶链反应测定的方法。我们在 59 名患者(14.3%)中发现了相关的遗传变异。最常突变的是通道基因[CACNA1A(n=16)、KCND3(n=4)、KCNC3(n=2)和 KCNA1(n=2)]。紧随其后的是 ITPR1 缺失(n=11),然后是 SPG7 的双等位基因突变(n=9)。AFG3L2 的变体(n=7)紧随其后,STBN2 的变体很少(n=2),ELOVL5、FGF14、STUB1 和 TTBK2 的变体各有 1 例(n=1)。有趣的是,在 SPG7 和 POLG 中检测到了可能的风险因素变体。临床比较显示,由于通道病引起的共济失调的发病年龄明显较早,平均为 24.6 岁,而多聚谷氨酰胺扩展型脊髓小脑共济失调为 40.9 岁,SPG7 相关形式为 37.8 岁(P=0.001)。相比之下,前者的疾病持续时间明显更长(20.5 年与 9.3 和 13.7 年,P=0.001),尽管在相似的功能阶段,表明疾病的进展较慢。有趣的是,在通道性脊髓小脑共济失调中智力缺陷更为常见,而在三组中成年认知障碍相似。在比较 23 例 CACNA1A 扩展(脊髓小脑共济失调 6)患者和 22 例 CACNA1A 点突变患者的单个基因组时,也发现了类似的差异,后者的平均发病年龄(25.2 岁比 47.3 岁)较低,疾病持续时间较长(18.7 年比 10.9 年),但严重程度指数较低(0.39 比 0.44),表明疾病进展较慢。总之,我们在排除多聚谷氨酰胺扩展脊髓小脑共济失调后,在多达 15%的病例中发现了相关的遗传变异,并证实 CACNA1A 和 SPG7 是主要的共济失调基因。我们可以描绘明确的基因型-表型相关性,这对遗传咨询很重要,并且可能具有预后价值。