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重新评估 EFHC1 变异在具有不同遗传全面性癫痫表型患者中的临床影响。

Revisiting the clinical impact of variants in EFHC1 in patients with different phenotypes of genetic generalized epilepsy.

机构信息

Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil.

Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil.

出版信息

Epilepsy Behav. 2020 Nov;112:107469. doi: 10.1016/j.yebeh.2020.107469. Epub 2020 Sep 29.

Abstract

The most common form of genetic generalized epilepsy (GGE) is juvenile myoclonic epilepsy (JME), which accounts for 5 to 10% of all epilepsy cases. The gene EFHC1 has been implicated as a putative cause of JME. However, it remains debatable whether testing for EFHC1 mutations should be included in the diagnostic epilepsy gene panels. To investigate the clinical utility of EFHC1 testing, we studied 125 individuals: 100 with JME and 25 with other GGEs. We amplified and sequenced all EFHC1 coding exons. Then, we predicted the pathogenicity or benign impact of the variants using the analyses proposed by the American College of Medical Genetics and Genomics (ACMG)/Association for Molecular Pathology (AMP). Mutation screening revealed 11 missense variants in 44 probands with JME (44%) and one of the seven individuals with generalized tonic-clonic seizures on awakening (14%). Six of the 11 variants (54%) were classified as 'benign,' and the remaining variants were considered variants of uncertain significance (VUS). There is currently a limitation to test for genes that predispose an individual to complex, nonmonogenic phenotypes. Thus, we show suggestive evidence that EFHC1 testing lacks a scientific foundation based on the disputed nature of the gene-disease relationship and should be currently limited to research purposes.

摘要

最常见的遗传全面性癫痫(GGE)形式是青少年肌阵挛性癫痫(JME),占所有癫痫病例的 5%至 10%。EFHC1 基因已被认为是 JME 的可能原因。然而,是否应该将 EFHC1 突变检测纳入诊断性癫痫基因检测仍存在争议。为了研究 EFHC1 检测的临床实用性,我们研究了 125 个人:100 名 JME 患者和 25 名其他 GGE 患者。我们扩增并测序了所有 EFHC1 编码外显子。然后,我们使用美国医学遗传学与基因组学学院(ACMG)/分子病理学协会(AMP)提出的分析方法预测了变异的致病性或良性影响。突变筛选在 44 名 JME 先证者(44%)和 7 名觉醒时全身强直阵挛性发作的患者(14%)中发现了 11 个错义变异。11 个变异中的 6 个(54%)被归类为“良性”,其余变异被认为是意义未明的变异(VUS)。目前,测试易患个体复杂、非单基因表型的基因存在局限性。因此,我们根据基因与疾病关系的争议性质以及 EFHC1 检测目前应仅限于研究目的的情况,显示了 EFHC1 检测缺乏科学依据的提示性证据。

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