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2.
Commun Biol ; 4(1): 666, 2021 06 02.
Article in English | MEDLINE | ID: mdl-34079053

ABSTRACT

Calcium dynamics control synaptic transmission. Calcium triggers synaptic vesicle fusion, determines release probability, modulates vesicle recycling, participates in long-term plasticity and regulates cellular metabolism. Mitochondria, the main source of cellular energy, serve as calcium signaling hubs. Mitochondrial calcium transients are primarily determined by the balance between calcium influx, mediated by the mitochondrial calcium uniporter (MCU), and calcium efflux through the sodium/lithium/calcium exchanger (NCLX). We identified a human recessive missense SLC8B1 variant that impairs NCLX activity and is associated with severe mental retardation. On this basis, we examined the effect of deleting NCLX in mice on mitochondrial and synaptic calcium homeostasis, synaptic activity, and plasticity. Neuronal mitochondria exhibited basal calcium overload, membrane depolarization, and a reduction in the amplitude and rate of calcium influx and efflux. We observed smaller cytoplasmic calcium transients in the presynaptic terminals of NCLX-KO neurons, leading to a lower probability of release and weaker transmission. In agreement, synaptic facilitation in NCLX-KO hippocampal slices was enhanced. Importantly, deletion of NCLX abolished long term potentiation of Schaffer collateral synapses. Our results show that NCLX controls presynaptic calcium transients that are crucial for defining synaptic strength as well as short- and long-term plasticity, key elements of learning and memory processes.


Subject(s)
Intellectual Disability/genetics , Intellectual Disability/metabolism , Mitochondrial Proteins/genetics , Mitochondrial Proteins/metabolism , Sodium-Calcium Exchanger/genetics , Sodium-Calcium Exchanger/metabolism , Amino Acid Sequence , Amino Acid Substitution , Animals , Calcium Signaling , Cardiomyopathies/genetics , Cardiomyopathies/metabolism , Female , Hippocampus/metabolism , Humans , In Vitro Techniques , Long-Term Potentiation , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , Mitochondrial Proteins/chemistry , Mitochondrial Proteins/deficiency , Neuronal Plasticity , Neurons/metabolism , Pedigree , Point Mutation , Presynaptic Terminals/metabolism , Sodium-Calcium Exchanger/chemistry , Synaptic Transmission/genetics , Synaptic Transmission/physiology
3.
Genet Med ; 23(2): 352-362, 2021 02.
Article in English | MEDLINE | ID: mdl-33106617

ABSTRACT

PURPOSE: Neurodevelopmental disorders (NDD) caused by protein phosphatase 2A (PP2A) dysfunction have mainly been associated with de novo variants in PPP2R5D and PPP2CA, and more rarely in PPP2R1A. Here, we aimed to better understand the latter by characterizing 30 individuals with de novo and often recurrent variants in this PP2A scaffolding Aα subunit. METHODS: Most cases were identified through routine clinical diagnostics. Variants were biochemically characterized for phosphatase activity and interaction with other PP2A subunits. RESULTS: We describe 30 individuals with 16 different variants in PPP2R1A, 21 of whom had variants not previously reported. The severity of developmental delay ranged from mild learning problems to severe intellectual disability (ID) with or without epilepsy. Common features were language delay, hypotonia, and hypermobile joints. Macrocephaly was only seen in individuals without B55α subunit-binding deficit, and these patients had less severe ID and no seizures. Biochemically more disruptive variants with impaired B55α but increased striatin binding were associated with profound ID, epilepsy, corpus callosum hypoplasia, and sometimes microcephaly. CONCLUSION: We significantly expand the phenotypic spectrum of PPP2R1A-related NDD, revealing a broader clinical presentation of the patients and that the functional consequences of the variants are more diverse than previously reported.


Subject(s)
Intellectual Disability , Microcephaly , Neurodevelopmental Disorders , Humans , Intellectual Disability/genetics , Muscle Hypotonia , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/genetics , Protein Phosphatase 2/genetics , Transcription Factors
4.
N Biotechnol ; 37(Pt A): 117-122, 2017 Jul 25.
Article in English | MEDLINE | ID: mdl-27373779

ABSTRACT

Agro-industrial residues with a low carbon content, such as whey, stillage or wastewater from plant oil mills are abundant and cheap. However, they cannot be used directly in highly productive industrial poly(3-hydroxybutyrate) (P3HB) production, as the classical fed-batch fermentation strategy requires highly concentrated feed streams. This problem has been circumvented in this report by retaining the cells during the fermentation in the bioreactor using an external microfiltration module. Synthetic medium containing a glucose concentration of 50g/L was continuously fed to Cupriavidus necator, which converted the sugar to P3HB. With this setup we were able to achieve high productivities (3.10g P3HB/(Lh)) and reach high cell densities (148g/L) containing 76% P3HB, and obtained good yields (0.33g P3HB/g added glucose). The added sugar from the feed was instantly consumed by the bacteria, resulting in a negligible loss of sugar to the permeate. This approach creates the possibility of polyhydroxyalkanoate production from a range of cheap and easily available substrates, for which only waste water treatment or biogas production has been cost-competitive until now.


Subject(s)
Bioreactors , Hydroxybutyrates/metabolism , Polyesters/metabolism , Biomass , Bioreactors/microbiology , Biotechnology , Cupriavidus necator/metabolism , Fermentation , Glucose/metabolism , Nitrogen/metabolism
5.
J Chem Technol Biotechnol ; 90(4): 648-657, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25937690

ABSTRACT

BACKGROUND: Lactic acid is an important biorefinery platform chemical. The use of thermophilic amylolytic microorganisms to produce lactic acid by fermentation constitutes an efficient strategy to reduce operating costs, including raw materials and sterilization costs. RESULTS: A process for the thermophilic production of lactic acid by Geobacillus stearothermophilus directly from potato starch was characterized and optimized. Geobacillus stearothermophilus DSM 494 was selected out of 12 strains screened for amylolytic activity and the ability to form lactic acid as the major product of the anaerobic metabolism. In total more than 30 batches at 3-l scale were run at 60 °C under non-sterile conditions. The process developed produced 37 g L-1 optically pure (98%) L-lactic acid in 20 h from 50 g L-1 raw potato starch. As co-metabolites smaller amounts (<7% w/v) of acetate, formate and ethanol were formed. Yields of lactic acid increased from 66% to 81% when potato residues from food processing were used as a starchy substrate in place of raw potato starch. CONCLUSIONS: Potato starch and residues were successfully converted to lactic acid by G. stearothermophilus. The process described in this study provides major benefits in industrial applications and for the valorization of starch-rich waste streams. © 2015 The Authors.Journal of Chemical Technology & Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

6.
Am J Hum Genet ; 94(2): 278-87, 2014 Feb 06.
Article in English | MEDLINE | ID: mdl-24439110

ABSTRACT

Glycosylphophatidylinositol (GPI)-anchored proteins play important roles in many biological processes, and mutations affecting proteins involved in the synthesis of the GPI anchor are reported to cause a wide spectrum of intellectual disabilities (IDs) with characteristic additional phenotypic features. Here, we describe a total of five individuals (from three unrelated families) in whom we identified mutations in PGAP3, encoding a protein that is involved in GPI-anchor maturation. Three siblings in a consanguineous Pakistani family presented with profound developmental delay, severe ID, no speech, psychomotor delay, and postnatal microcephaly. A combination of autozygosity mapping and exome sequencing identified a 13.8 Mb region harboring a homozygous c.275G>A (p.Gly92Asp) variant in PGAP3 region 17q11.2-q21.32. Subsequent testing showed elevated serum alkaline phosphatase (ALP), a GPI-anchored enzyme, in all three affected children. In two unrelated individuals in a cohort with developmental delay, ID, and elevated ALP, we identified compound-heterozygous variants c.439dupC (p.Leu147Profs(∗)16) and c.914A>G (p.Asp305Gly) and homozygous variant c.314C>G (p.Pro105Arg). The 1 bp duplication causes a frameshift and nonsense-mediated decay. Further evidence supporting pathogenicity of the missense mutations c.275G>A, c.314C>G, and c.914A>G was provided by the absence of the variants from ethnically matched controls, phylogenetic conservation, and functional studies on Chinese hamster ovary cell lines. Taken together with recent data on PGAP2, these results confirm the importance of the later GPI-anchor remodelling steps for normal neuronal development. Impairment of PGAP3 causes a subtype of hyperphosphatasia with ID, a congenital disorder of glycosylation that is also referred to as Mabry syndrome.


Subject(s)
Abnormalities, Multiple/genetics , Intellectual Disability/genetics , Mutation, Missense , Phosphorus Metabolism Disorders/genetics , Receptors, Cell Surface/genetics , Abnormalities, Multiple/pathology , Alkaline Phosphatase/blood , Amino Acid Sequence , Animals , Asian People/genetics , CHO Cells , Carboxylic Ester Hydrolases , Child , Child, Preschool , Chromosome Mapping , Consanguinity , Cricetinae , Cricetulus , Exome , Female , Homozygote , Humans , Intellectual Disability/pathology , Molecular Sequence Data , Pakistan , Pedigree , Phosphorus Metabolism Disorders/pathology , Phylogeny , Polymorphism, Single Nucleotide , Receptors, Cell Surface/metabolism , Saudi Arabia , United States , White People/genetics
7.
Gene ; 520(2): 194-7, 2013 May 15.
Article in English | MEDLINE | ID: mdl-23473829

ABSTRACT

Fraser syndrome (FS) is a rare autosomal recessive inherited disorder characterized by cryptophthalmos, laryngeal defects and oral clefting, mental retardation, syndactyly, and urogenital defects. To date, 250 patients have been described in the literature. Mutations in the FRAS1 gene on chromosome 4 have been identified in patients with Fraser syndrome. So far, 26 mutations have been identified, most of them are truncating mutations. The mutational spectrum includes nucleotide substitutions, splicing defects, a large insertion, and small deletions/insertions. Moreover, single heterozygous missense mutations in FRAS1 seem to be responsible for non-syndromic unilateral renal agenesis. Here we report the first case of a family with two patients affected by Fraser syndrome due to a deletion of 64 kb (deletion 4q21.21) and an additional novel frameshift mutation in exon 66 of the FRAS1 gene. To date, large deletions of the FRAS1 gene have not yet been described. Large deletions seem to be a rare cause for Fraser syndrome, but should be considered in patients with a single heterozygous mutation.


Subject(s)
Extracellular Matrix Proteins/genetics , Fraser Syndrome/genetics , Sequence Deletion , Aborted Fetus/pathology , Abortion, Induced , Family , Female , Frameshift Mutation/genetics , Frameshift Mutation/physiology , Fraser Syndrome/pathology , Heterozygote , Humans , Pedigree , Pregnancy , Sequence Deletion/physiology
8.
Hum Genet ; 131(11): 1761-73, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22773132

ABSTRACT

Autosomal recessive cutis laxa (ARCL) syndromes are phenotypically overlapping, but genetically heterogeneous disorders. Mutations in the ATP6V0A2 gene were found to underlie both, autosomal recessive cutis laxa type 2 (ARCL2), Debré type, and wrinkly skin syndrome (WSS). The ATP6V0A2 gene encodes the a2 subunit of the V-type H(+)-ATPase, playing a role in proton translocation, and possibly also in membrane fusion. Here, we describe a highly variable phenotype in 13 patients with ARCL2, including the oldest affected individual described so far, who showed strikingly progressive dysmorphic features and heterotopic calcifications. In these individuals we identified 17 ATP6V0A2 mutations, 14 of which are novel. Furthermore, we demonstrate a localization of ATP6V0A2 at the Golgi-apparatus and a loss of the mutated ATP6V0A2 protein in patients' dermal fibroblasts. Investigation of brefeldin A-induced Golgi collapse in dermal fibroblasts as well as in HeLa cells deficient for ATP6V0A2 revealed a delay, which was absent in cells deficient for the ARCL-associated proteins GORAB or PYCR1. Furthermore, fibroblasts from patients with ATP6V0A2 mutations displayed elevated TGF-ß signalling and increased TGF-ß1 levels in the supernatant. Our current findings expand the genetic and phenotypic spectrum and suggest that, besides the known glycosylation defect, alterations in trafficking and signalling processes are potential key events in the pathogenesis of ATP6V0A2-related ARCL.


Subject(s)
Cutis Laxa/congenital , Mutation/genetics , Proton-Translocating ATPases/genetics , Transforming Growth Factor beta1/metabolism , Adolescent , Adult , Apoptosis , Blotting, Western , Brefeldin A/pharmacology , Cells, Cultured , Child, Preschool , Cutis Laxa/genetics , Cutis Laxa/metabolism , Cutis Laxa/pathology , Enzyme-Linked Immunosorbent Assay , Fibroblasts/drug effects , Fibroblasts/metabolism , Fibroblasts/pathology , Fluorescent Antibody Technique , Glycosylation/drug effects , Golgi Apparatus/drug effects , Golgi Apparatus/metabolism , Humans , Infant , Male , Protein Synthesis Inhibitors/pharmacology , Protein Transport/drug effects , RNA, Messenger/genetics , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Skin/drug effects , Skin/metabolism , Skin/pathology , Young Adult
9.
Nat Genet ; 43(1): 20-2, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21131976

ABSTRACT

We identified a deletion of a gene encoding a subunit of RNA polymerases I and III, POLR1D, in an individual with Treacher Collins syndrome (TCS). Subsequently, we detected 20 additional heterozygous mutations of POLR1D in 252 individuals with TCS. Furthermore, we discovered mutations in both alleles of POLR1C in three individuals with TCS. These findings identify two additional genes involved in TCS, confirm the genetic heterogeneity of TCS and support the hypothesis that TCS is a ribosomopathy.


Subject(s)
Mandibulofacial Dysostosis/genetics , Mutation , RNA Polymerase III/genetics , RNA Polymerase I/genetics , Adult , Alleles , Child , Child, Preschool , Female , Genetic Heterogeneity , Humans , Male , Mandibulofacial Dysostosis/enzymology , Phenotype , Protein Subunits/genetics
10.
Hum Genet ; 127(5): 555-61, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20157829

ABSTRACT

Schizencephaly (SCH) is a clinically and etiologically heterogeneous cerebral malformation presenting as unilateral or bilateral hemispheric cleft with direct connection between the inner and outer liquor spaces. The SCH cleft is usually lined by gray matter, which appears polymicrogyric implying an associated impairment of neuronal migration. The majority of SCH patients are sporadic, but familial SCH has been described. An initial report of heterozygous mutations in the homeobox gene EMX2 could not be confirmed in 52 patients investigated in this study in agreement with two independent SCH patient cohorts published previously. SCH frequently occurs with additional cerebral malformations like hypoplasia or aplasia of the septum pellucidum or optic nerve, suggesting the involvement of genes important for the establishment of midline forebrain structures. We therefore considered holoprosencephaly (HPE)-associated genes as potential SCH candidates and report for the first time heterozygous mutations in SIX3 and SHH in a total of three unrelated patients and one fetus with SCH; one of them without obvious associated malformations of midline forebrain structures. Three of these mutations have previously been reported in independent patients with HPE. SIX3 acts directly upstream of SHH, and the SHH pathway is a key regulator of ventral forebrain patterning. Our data indicate that in a subset of patients SCH may develop as one aspect of a more complex malformation of the ventral forebrain, directly result from mutations in the SHH pathway and hence be considered as yet another feature of the broad phenotypic spectrum of holoprosencephaly.


Subject(s)
Eye Proteins/genetics , Hedgehog Proteins/genetics , Holoprosencephaly/genetics , Homeodomain Proteins/genetics , Malformations of Cortical Development/genetics , Mutation , Nerve Tissue Proteins/genetics , Base Sequence , Child , Child, Preschool , Female , Heterozygote , Humans , Male , Molecular Sequence Data , Homeobox Protein SIX3
11.
Immunobiology ; 214(6): 441-53, 2009.
Article in English | MEDLINE | ID: mdl-19157637

ABSTRACT

MT110 is an EpCAM/CD3-bispecific antibody construct in clinical development for the treatment of patients with adenocarcinoma expressing EpCAM (CD326). Like other members of this antibody class, MT110 can engage resting, polyclonal CD8(+) and CD4(+) T cells for highly potent redirected lysis of target cells. Here we further explored the mechanism of this action. Complete lysis of EpCAM(+) Kato III gastric cancer cells by previously unstimulated T cells was achieved within 48 h. During this period, a high percentage of CD4(+) and CD8(+) T cells became activated and increased expression of granzyme B. This apparently boosted the capacity for serial target cell lysis as studied at very low effector-to-target ratios. Elimination of cancer cells by MT110-redirected T cells involved membrane damage as was evident from nuclear uptake of propidium iodide and release of the cytosolic enzyme adenylate kinase. Redirected T cells also potently triggered programmed cell death in cancer cells as was evident by membrane blebbing, activation of procaspases 3 and 7, fragmentation of nuclear DNA and cleavage of the caspase substrate poly (ADP ribose) polymerase. Chelation of extracellular calcium fully protected cancer cells from lysis by MT110-redirected T cells, while the pan-caspase inhibitor Z-VAD-FMK blocked activation of procaspases, cleavage of poly (ADP ribose) polymerase and fragmentation of nuclear DNA in cancer cells, but could not prevent nuclear uptake of propidium iodide. Soluble factors did not significantly contribute to cancer cell death. Our study shows that MT110 can efficiently gear up the potential of CD8(+) and CD4(+) T cells for serial lysis, and mediate kill of cancer cells predominantly through poreforming and pro-apoptotic components of cytotoxic T cell granules.


Subject(s)
Antibodies, Monoclonal/pharmacology , CD4-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/metabolism , Cytotoxicity, Immunologic/drug effects , Adenylyl Cyclases/metabolism , Amino Acid Chloromethyl Ketones/pharmacology , Antigens, Neoplasm/immunology , Antigens, Neoplasm/metabolism , Apoptosis , CD3 Complex/immunology , CD3 Complex/metabolism , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/drug effects , CD8-Positive T-Lymphocytes/immunology , Caspase Inhibitors , Cell Adhesion Molecules/immunology , Cell Adhesion Molecules/metabolism , Cell Line, Tumor , Collagen Type XI/antagonists & inhibitors , Cytotoxicity, Immunologic/immunology , DNA Fragmentation/drug effects , Epithelial Cell Adhesion Molecule , Granzymes/genetics , Granzymes/immunology , Granzymes/metabolism , Humans , Lymphocyte Activation/drug effects , Neoplasms/immunology , Neoplasms/pathology , Neoplasms/therapy , Single-Chain Antibodies
12.
Breast Cancer Res Treat ; 110(2): 273-81, 2008 Jul.
Article in English | MEDLINE | ID: mdl-17899370

ABSTRACT

BACKGROUND: Breast cancer is characterized by malignant transformation of epithelial cells, but stromal cells also play an important role in tumorigenesis. While tumor-derived fibroblasts display unique phenotypic properties, it is unclear whether they also represent are a specific subpopulation. MATERIALS AND METHODS: Stromal fibroblasts deriving from malignant tissue of 10 women with invasive breast cancer, and from normal breast tissue of 10 women with benign breast disorders, were subjected to differential complementary DNA Microarray Analysis by using a 2,400 gene cDNA array. Individual gene expression pattern were confirmed by RT-PCR. RESULTS: In a cDNA array that allows to analyze the differential gene expression of more than 2,400 genes, the mRNA expression of 135 genes were increased more than 2 fold in fibroblasts from malignant breast tumors. The majority of these genes encode tumor-promoting cytokines, transcription factors and cell-matrix associated proteins. The mRNA expression of 110 genes decreased to less than 0.5 fold. The remaining 2,155 genes were not significantly altered. RT-PCR performed on individual biopsies from breast cancer and normal breast tissues confirmed the validity of the pooled gene expression signature. CONCLUSION: Breast cancer-derived stromal fibroblasts show a distinctive gene expression pattern that differentiates them from normal breast stroma. Our observation of increased expression of tumor promotion-associated genes even in the absence of adjacent malignant epithelium suggests that tumor stroma is comprised of a fibroblastic subpopulation that provides for a microenvironment which supports tumor growth and invasion.


Subject(s)
Breast Neoplasms/metabolism , Fibroblasts/metabolism , Gene Expression Profiling , Apoptosis , Cell Transformation, Neoplastic , Epithelial Cells/metabolism , Gene Expression Regulation, Neoplastic , Humans , Keratins/biosynthesis , Leukocyte Common Antigens/biosynthesis , Nucleic Acid Hybridization , Oligonucleotide Array Sequence Analysis , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Vimentin/biosynthesis
13.
Cancer Immunol Immunother ; 56(10): 1551-63, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17310380

ABSTRACT

BiTE molecules comprise a new class of bispecific single-chain antibodies redirecting previously unstimulated CD8+ and CD4+ T cells for the elimination of target cells. One example is MT103 (MEDI-538; bscCD19xCD3), a CD19-specific BiTE that can induce lysis of normal and malignant B cells at low picomolar concentrations, which is accompanied by T cell activation. Here, we explored in cell culture the impact of the glucocorticoid derivative dexamethasone on various activation parameters of human T cells in response to MT103. In case cytokine-related side effects should occur with BiTE molecules and other T cell-based approaches during cancer therapy it is important to understand whether glucocorticoids do interfere with the cytotoxic potential of T cells. We found that MT103 induced in the presence of target cells secretion by peripheral T cells of interleukin (IL)-2, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), IL-6, IL-10 and IL-4 into the cell culture medium. Production of all studied cytokines was effectively reduced by dexamethasone at a concentration between 1 and 3x10(-7) M. In contrast, upregulation of activation markers CD69, CD25, CD2 and LFA-1 on both CD4+ and CD8+ T cells, and T cell proliferation were barely affected by the steroid hormone analogue. Most importantly, dexamethasone did not detectably inhibit the cytotoxic activity of MT103-activated T cells against a human B lymphoma line as investigated with lymphocytes from 12 human donors. Glucocorticoids thus qualify as a potential co-medication for therapeutic BiTE molecules and other cytotoxic T cell therapies for treatment of cancer.


Subject(s)
Antibodies, Bispecific/pharmacology , CD4-Positive T-Lymphocytes/drug effects , CD8-Positive T-Lymphocytes/drug effects , Dexamethasone/pharmacology , Glucocorticoids/pharmacology , Neoplasms/immunology , Antigens, CD/metabolism , Antigens, CD19/immunology , CD3 Complex/immunology , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Cell Line, Tumor , Cytokines/metabolism , Cytotoxicity, Immunologic/drug effects , Humans , Lymphocyte Activation/drug effects , Lymphocyte Function-Associated Antigen-1/metabolism , Neoplasms/therapy
14.
Am J Med Genet A ; 140(7): 764-8, 2006 Apr 01.
Article in English | MEDLINE | ID: mdl-16523518

ABSTRACT

In recent years, the spectrum of available methods for the characterization of chromosomal aberrations has significantly increased. Micro-array technologies now allow the rapid fine mapping of small genomic imbalances. Here we used various technologies to characterize a de novo translocation t(2;15) in a girl with dysmorphic features, severe developmental delay and frequent seizures. Multiplex-FISH (M-FISH) excluded the involvement of other chromosomes than chromosomes 2 and 15. We used an oligonucleotide array containing more than 10.000 SNPs, that is, the GeneChip Mapping 10K 2.0 SNP Affymetrix array, and readily fine-mapped a deletion in chromosomal region 2q24.1 --> 2q31.1. The extent of this deletion was verified with multicolor BAC-clone hybridizations. The deletion has a size of about 13 Mb and is within a gene rich region containing about 76 genes. Interestingly, several of these genes are ion channel genes or genes involved in neuron differentiation, so that the frequently occurring seizures are probably due to loss or haploinsufficiency of one or more of these genes.


Subject(s)
Abnormalities, Multiple/genetics , Chromosome Deletion , Chromosomes, Human, Pair 2/genetics , Ear/abnormalities , Epilepsy/pathology , Abnormalities, Multiple/pathology , Child, Preschool , Chromosome Banding , Fatal Outcome , Female , Genome, Human , Humans , Karyotyping , Nucleic Acid Hybridization/methods
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