Genetic testing of leukodystrophies unraveling extensive heterogeneity in a large cohort and report of five common diseases and 38 novel variants.

This study evaluates the genetic spectrum of leukodystrophies and leukoencephalopathies in Iran. 152 children, aged from 1 day to 15 years, were genetically tested for leukodystrophies and leukoencephalopathies based on clinical and neuroradiological findings from 2016 to 2019. Patients with a suggestive specific leukodystrophy, e. g. metachromatic leukodystrophy, Canavan disease, Tay-Sachs disease were tested for mutations in single genes (108; 71%) while patients with less suggestive findings were evaluated by NGS. 108 of 152(71%) had MRI patterns and clinical findings suggestive of a known leukodystrophy. In total, 114(75%) affected individuals had (likely) pathogenic variants which included 38 novel variants. 35 different types of leukodystrophies and genetic leukoencephalopathies were identified. The more common identified disorders included metachromatic leukodystrophy (19 of 152; 13%), Canavan disease (12; 8%), Tay-Sachs disease (11; 7%), megalencephalic leukodystrophy with subcortical cysts (7; 5%), X-linked adrenoleukodystrophy (8; 5%), Pelizaeus-Merzbacher-like disease type 1 (8; 5%), Sandhoff disease (6; 4%), Krabbe disease (5; 3%), and vanishing white matter disease (4; 3%). Whole exome sequencing (WES) revealed 90% leukodystrophies and genetic leukoencephalopathies. The total diagnosis rate was 75%. This unique study presents a national genetic data of leukodystrophies; it may provide clues to the genetic pool of neighboring countries. Patients with clinical and neuroradiological evidence of a genetic leukoencephalopathy should undergo a genetic analysis to reach a definitive diagnosis. This will allow a diagnosis at earlier stages of the disease, reduce the burden of uncertainty and costs, and will provide the basis for genetic counseling and family planning.

NGS-based expanded carrier screening for genetic disorders in North Indian population reveals unexpected results - a pilot study.

BACKGROUND: To determine the carrier frequency and pathogenic variants of common genetic disorders in the north Indian population by using next generation sequencing (NGS). METHODS: After pre-test counselling, 200 unrelated individuals (including 88 couples) were screened for pathogenic variants in 88 genes by NGS technology. The variants were classified as per American College of Medical Genetics criteria. Pathogenic and likely pathogenic variants were subjected to thorough literature-based curation in addition to the regular filters. Variants of unknown significance were not reported. Individuals were counselled explaining the implications of the results, and cascade screening was advised when necessary. RESULTS: Of the 200 participants, 52 (26%) were found to be carrier of one or more disorders. Twelve individuals were identified to be carriers for congenital deafness, giving a carrier frequency of one in 17 for one of the four genes tested (SLC26A4, GJB2, TMPRSS3 and TMC1 in decreasing order). Nine individuals were observed to be carriers for cystic fibrosis, with a frequency of one in 22. Three individuals were detected to be carriers for Pompe disease (frequency one in 67). None of the 88 couples screened were found to be carriers for the same disorder. The pathogenic variants observed in many disorders (such as deafness, cystic fibrosis, Pompe disease, Canavan disease, primary hyperoxaluria, junctional epidermolysis bullosa, galactosemia, medium chain acyl CoA deficiency etc.) were different from those commonly observed in the West. CONCLUSION: A higher carrier frequency for genetic deafness, cystic fibrosis and Pompe disease was unexpected, and contrary to the generally held view about their prevalence in Asian Indians. In spite of the small sample size, this study would suggest that population-based carrier screening panels for India would differ from those in the West, and need to be selected with due care. Testing should comprise the study of all the coding exons with its boundaries in the genes through NGS, as all the variants are not well characterized. Only study of entire coding regions in the genes will detect carriers with adequate efficiency, in order to reduce the burden of genetic disorders in India and other resource poor countries.

[An epidemiological study of spongiform leucoencephalopathy among heorin abusers].

OBJECTIVE: To understand the distribution and related risk factors of heroin spongiform leucoencephalopathy among drug users in coastland of Guangdong Province. METHODS: A cross-sectional study was conducted in four thousand four hundred and twenty eight drug users from eighteen detoxification organizations in six cities on coastland of Guangdong, using clustered random sampling methods. The six cities are Chaoyang (714), Heyuan (462), Shantou (572), Huidong (1286), Guangzhou (871) and Zhanjiang (523) and heroin abuse was considered serious in these cities. Questionnaire was used to collect the data on sex (man 3632, 82 percent; woman 795, 18 percent), age (minimum 15y, maximum 54y), duration of using heroin (minimum 1 month, maximum 150 months), daily dosage (minimum 0.02 g, maximum 6.0 g) and manner of using heroin. In addition, the neurological examination was taken in all of them and cerebral MRI was carried out in those with signs of cerebellar ataxia. RESULTS: Results showed that the total incidence of heroin spongiform leucoencephalopathy in six cities is 3.16 per thousand. Poisson regression analysis showed that the incidence was related to residential areas. In comparison with other cities, there are higher incidences in Chaoyang and Heyuan. Our investigation also showed that all the patients with this disease used heroin by inhaling the pyrolysate. The incidence of heroin spongiform leucoencephalopathy was unrelated to the daily inhaling amount of heroin and the duration of inhaling heroin. No differences could be observed between the groups of different age and sex. CONCLUSIONS: Spongiform leucoencephalopathy after inhalation of heroin is a rare complication and has never been reported in mainland of China before. The lesions are symmetrical and spongiform, but not necrotic and the cerebellum is invariably involved--a feature consistent with the clinical presentation that begins with ataxia. Cerebral CT showed symmetrical non-enhancing hypodense areas in both cerebellar hemispheres. Cerebral MRI showed the corresponding areas with decreased signal intensity on T1 weighted images and increased signal intensity on T2 weighted images. There was no contrast enhancement. When it occurs, several cases are affected as a small epidemic. It is suggested that the aetiology is related to the heroin batch and could perhaps be a toxic effect of a substance which came from heroin pyrolysis.

Recent advances in Canavan disease.

More studies are needed to elucidate the pathophysiology of Canavan disease and how the inability to hydrolyze NAA leads to spongy degeneration. The creation of an animal model would be helpful in the understanding of the disease and the formulation of gene therapy.

The frequency of the C854 mutation in the aspartoacylase gene in Ashkenazi Jews in Israel.

Canavan disease (CD) is an infantile neurodegenerative disease that is transmitted in an autosomal recessive manner and has mainly been reported in Ashkenazi Jewish families. The primary enzymatic defect is aspartoacylase deficiency, and an A-to-C transition at nucleotide 854 of the cDNA has recently been reported. We screened 18 patients with CD and 879 healthy individuals, all Israeli Ashkenazi Jews, for the mutation. All 18 patients were homozygotes for the mutation, and 15 heterozygotes were found among the healthy individuals. The results disclose a carrier rate of 1:59 and suggest that a screening for the mutation is warranted among Ashkenazi Jewish couples.