Dataset Information

Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders.

ABSTRACT: MED27 is a subunit of the Mediator multiprotein complex, which is involved in transcriptional regulation. Biallelic MED27 variants have recently been suggested to be responsible for an autosomal recessive neurodevelopmental disorder with spasticity, cataracts and cerebellar hypoplasia. We further delineate the clinical phenotype of MED27-related disease by characterizing the clinical and radiological features of 57 affected individuals from 30 unrelated families with biallelic MED27 variants. Using exome sequencing and extensive international genetic data sharing, 39 unpublished affected individuals from 18 independent families with biallelic missense variants in MED27 have been identified (29 females, mean age at last follow-up 17 ± 12.4 years, range 0.1-45). Follow-up and hitherto unreported clinical features were obtained from the published 12 families. Brain MRI scans from 34 cases were reviewed. MED27-related disease manifests as a broad phenotypic continuum ranging from developmental and epileptic-dyskinetic encephalopathy to variable neurodevelopmental disorder with movement abnormalities. It is characterized by mild to profound global developmental delay/intellectual disability (100%), bilateral cataracts (89%), infantile hypotonia (74%), microcephaly (62%), gait ataxia (63%), dystonia (61%), variably combined with epilepsy (50%), limb spasticity (51%), facial dysmorphism (38%) and death before reaching adulthood (16%). Brain MRI revealed cerebellar atrophy (100%), white matter volume loss (76.4%), pontine hypoplasia (47.2%) and basal ganglia atrophy with signal alterations (44.4%). Previously unreported 39 affected individuals had seven homozygous pathogenic missense MED27 variants, five of which were recurrent. An emerging genotype-phenotype correlation was observed. This study provides a comprehensive clinical-radiological description of MED27-related disease, establishes genotype-phenotype and clinical-radiological correlations and suggests a differential diagnosis with syndromes of cerebello-lental neurodegeneration and other subtypes of 'neuro-MEDopathies'.

SUBMITTER: Maroofian R

PROVIDER: S-EPMC10690011 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders.

Maroofian Reza R Kaiyrzhanov Rauan R Cali Elisa E Zamani Mina M Zaki Maha S MS Ferla Matteo M Tortora Domenico D Sadeghian Saeid S Saadi Saadia Maryam SM Abdullah Uzma U Karimiani Ehsan Ghayoor EG Efthymiou Stephanie S Yeşil Gözde G Alavi Shahryar S Al Shamsi Aisha M AM Tajsharghi Homa H Abdel-Hamid Mohamed S MS Saadi Nebal Waill NW Al Mutairi Fuad F Alabdi Lama L Beetz Christian C Ali Zafar Z Toosi Mehran Beiraghi MB Rudnik-Schöneborn Sabine S Babaei Meisam M Isohanni Pirjo P Muhammad Jameel J Khan Sheraz S Al Shalan Maha M Hickey Scott E SE Marom Daphna D Elhanan Emil E Kurian Manju A MA Marafi Dana D Saberi Alihossein A Hamid Mohammad M Spaull Robert R Meng Linyan L Lalani Seema S Maqbool Shazia S Rahman Fatima F Seeger Jürgen J Palculict Timothy Blake TB Lau Tracy T Murphy David D Mencacci Niccolo Emanuele NE Steindl Katharina K Begemann Anais A Rauch Anita A Akbas Sinan S Aslanger Ayça Dilruba AD Salpietro Vincenzo V Yousaf Hammad H Ben-Shachar Shay S Ejeskär Katarina K Al Aqeel Aida I AI High Frances A FA Armstrong-Javors Amy E AE Zahraei Seyed Mohammadsaleh SM Seifi Tahereh T Zeighami Jawaher J Shariati Gholamreza G Sedaghat Alireza A Asl Samaneh Noroozi SN Shahrooei Mohmmad M Zifarelli Giovanni G Burglen Lydie L Ravelli Claudia C Zschocke Johannes J Schatz Ulrich A UA Ghavideldarestani Maryam M Kamel Walaa A WA Van Esch Hilde H Hackenberg Annette A Taylor Jenny C JC Al-Gazali Lihadh L Bauer Peter P Gleeson Joseph J JJ Alkuraya Fowzan Sami FS Lupski James R JR Galehdari Hamid H Azizimalamiri Reza R Chung Wendy K WK Baig Shahid Mahmood SM Houlden Henry H Severino Mariasavina M

Brain : a journal of neurology 20231201 12

MED27 is a subunit of the Mediator multiprotein complex, which is involved in transcriptional regulation. Biallelic MED27 variants have recently been suggested to be responsible for an autosomal recessive neurodevelopmental disorder with spasticity, cataracts and cerebellar hypoplasia. We further delineate the clinical phenotype of MED27-related disease by characterizing the clinical and radiological features of 57 affected individuals from 30 unrelated families with biallelic MED27 variants. Us ...[more]

PMID: 37517035

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Project description:The acyl-CoA-binding domain-containing protein 6 (ACBD6) is ubiquitously expressed, plays a role in the acylation of lipids and proteins, and regulates the N-myristoylation of proteins via N-myristoyltransferase enzymes (NMTs). However, its precise function in cells is still unclear, as is the consequence of ACBD6 defects on human pathophysiology. Utilizing exome sequencing and extensive international data sharing efforts, we describe 43 affected individuals from 27 unrelated families with bi-allelic pathogenic, predominantly loss-of-function (18/20) variants in ACBD6. We generated zebrafish and Xenopus tropicalis acbd6 knockouts by CRISPR/Cas9 and characterized the role of ACBD6 on protein N-myristoylation with YnMyr chemical proteomics in the model organisms and human cells, with the latter also being subjected further to ACBD6 peroxisomal localization studies. The affected individuals (21 males and 22 females), with ages ranging from 1 to 50 years old, typically present with a complex and progressive disease involving moderate-to-severe global developmental delay/intellectual disability (100%) with significant expressive language impairment (97%), facial dysmorphism (94%), movement disorders (94%), and mild cerebellar ataxia (85%) associated with gait impairment (94%), limb spasticity/hypertonia (74%), oculomotor (68%) and behavioural abnormalities (63%), weight gain (59%), microcephaly (38%) and epilepsy (37%). The most conspicuous and common movement disorder was dystonia (90%), frequently leading to early-onset progressive postural deformities (93%), limb dystonia (40%), and cervical dystonia (25%). A jerky tremor in the upper limbs (61%), a mild head tremor (56%), parkinsonism/hypokinesia developing with advancing age (31%), and simple motor and vocal tics were among other frequent movement disorders. Midline brain malformations including corpus callosum abnormalities (66.6%), hypoplasia/agenesis of the anterior commissure (62.9%), short midbrain and small inferior cerebellar vermis (40.7% each), hypertrophy of the clava (18.5%) were common neuroimaging findings. Acbd6-deficient zebrafish and Xenopus models effectively recapitulated many clinical phenotypes reported in patients including movement disorders, progressive neuromotor impairment, seizures, microcephaly, craniofacial dysmorphism, and midbrain defects accompanied with developmental delay with increased mortality over time. Unlike ACBD5, ACBD6 did not show a peroxisomal localisation and ACBD6-deficiency was not associated with altered peroxisomal parameters in patient fibroblasts. Significant differences in YnMyr-labelling were observed for 68 co- and 18 post-translationally N-myristoylated proteins in patient-derived fibroblasts. N-Myristoylation was similarly affected in acbd6-deficient zebrafish and Xenopus models, including of FUS, MARCKS and CHCHD-related proteins implicated in neurological diseases. The present study provides evidence that bi-allelic pathogenic variants in ACBD6 lead to a distinct neurodevelopmental syndrome accompanied by complex and progressive cognitive and movement disorders.

Project description:The acyl-CoA-binding domain-containing protein 6 (ACBD6) is ubiquitously expressed, plays a role in the acylation of lipids and proteins and regulates the N-myristoylation of proteins via N-myristoyltransferase enzymes (NMTs). However, its precise function in cells is still unclear, as is the consequence of ACBD6 defects on human pathophysiology. Using exome sequencing and extensive international data sharing efforts, we identified 45 affected individuals from 28 unrelated families (consanguinity 93%) with bi-allelic pathogenic, predominantly loss-of-function (18/20) variants in ACBD6. We generated zebrafish and Xenopus tropicalis acbd6 knockouts by CRISPR/Cas9 and characterized the role of ACBD6 on protein N-myristoylation with myristic acid alkyne (YnMyr) chemical proteomics in the model organisms and human cells, with the latter also being subjected further to ACBD6 peroxisomal localization studies. The affected individuals (23 males and 22 females), aged 1-50 years, typically present with a complex and progressive disease involving moderate-to-severe global developmental delay/intellectual disability (100%) with significant expressive language impairment (98%), movement disorders (97%), facial dysmorphism (95%) and mild cerebellar ataxia (85%) associated with gait impairment (94%), limb spasticity/hypertonia (76%), oculomotor (71%) and behavioural abnormalities (65%), overweight (59%), microcephaly (39%) and epilepsy (33%). The most conspicuous and common movement disorder was dystonia (94%), frequently leading to early-onset progressive postural deformities (97%), limb dystonia (55%) and cervical dystonia (31%). A jerky tremor in the upper limbs (63%), a mild head tremor (59%), parkinsonism/hypokinesia developing with advancing age (32%) and simple motor and vocal tics were among other frequent movement disorders. Midline brain malformations including corpus callosum abnormalities (70%), hypoplasia/agenesis of the anterior commissure (66%), short midbrain and small inferior cerebellar vermis (38% each) as well as hypertrophy of the clava (24%) were common neuroimaging findings. Acbd6-deficient zebrafish and Xenopus models effectively recapitulated many clinical phenotypes reported in patients including movement disorders, progressive neuromotor impairment, seizures, microcephaly, craniofacial dysmorphism and midbrain defects accompanied by developmental delay with increased mortality over time. Unlike ACBD5, ACBD6 did not show a peroxisomal localization and ACBD6-deficiency was not associated with altered peroxisomal parameters in patient fibroblasts. Significant differences in YnMyr-labelling were observed for 68 co- and 18 post-translationally N-myristoylated proteins in patient-derived fibroblasts. N-myristoylation was similarly affected in acbd6-deficient zebrafish and X. tropicalis models, including Fus, Marcks and Chchd-related proteins implicated in neurological diseases. The present study provides evidence that bi-allelic pathogenic variants in ACBD6 lead to a distinct neurodevelopmental syndrome accompanied by complex and progressive cognitive and movement disorders.

Project description:Primary mitochondrial diseases (PMDs) are among the most common inherited neurological disorders. They are caused by pathogenic variants in mitochondrial or nuclear DNA that disrupt mitochondrial structure and/or function, leading to impaired oxidative phosphorylation (OXPHOS). One emerging subcategory of PMDs involves defective phospholipid metabolism. Cardiolipin, the signature phospholipid of mitochondria, resides primarily in the inner mitochondrial membrane, where it is biosynthesized and remodelled via multiple enzymes and is fundamental to several aspects of mitochondrial biology. Genes that contribute to cardiolipin biosynthesis have recently been linked with PMD. However, the pathophysiological mechanisms that underpin human cardiolipin-related PMDs are not fully characterized. Here, we report six individuals, from three independent families, harbouring biallelic variants in PTPMT1, a mitochondrial tyrosine phosphatase required for de novo cardiolipin biosynthesis. All patients presented with a complex, neonatal/infantile onset neurological and neurodevelopmental syndrome comprising developmental delay, microcephaly, facial dysmorphism, epilepsy, spasticity, cerebellar ataxia and nystagmus, sensorineural hearing loss, optic atrophy and bulbar dysfunction. Brain MRI revealed a variable combination of corpus callosum thinning, cerebellar atrophy and white matter changes. Using patient-derived fibroblasts and skeletal muscle tissue, combined with cellular rescue experiments, we characterized the molecular defects associated with mutant PTPMT1 and confirmed the downstream pathogenic effects that loss of PTPMT1 has on mitochondrial structure and function. To further characterize the functional role of PTPMT1 in cardiolipin homeostasis, we created a ptpmt1 knockout zebrafish. This model had abnormalities in body size, developmental alterations, decreased total cardiolipin levels and OXPHOS deficiency. Together, these data indicate that loss of PTPMT1 function is associated with a new autosomal recessive PMD caused by impaired cardiolipin metabolism, highlighting the contribution of aberrant cardiolipin metabolism towards human disease and emphasizing the importance of normal cardiolipin homeostasis during neurodevelopment.

Dataset Information

Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders.

Publications

Biallelic MED27 variants lead to variable ponto-cerebello-lental degeneration with movement disorders.

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