Sarcoglycanopathies: a multiplex molecular analysis for the most common mutations.

Sarcoglycanopathies (SGpathies) are highly frequent among severely affected limb-girdle muscular dystrophy patients. On the basis of the findings of 5 common mutations in the 4 sarcoglycan (SG) genes in the Brazilian population, we standardized a multiplex polymerase chain reaction-single-strand conformation polymorphism methodology for their concomitant analysis in DNA samples. The test was able to confirm the diagnosis in about 63% of new patients with a suspected SGpathy and was particularly important in patients in advanced stages of the disease, when obtaining a muscle biopsy for analysis may be very difficult. As common mutations have been described in several countries, this multiplex analysis could be useful for the diagnosis of SGpathies if established according to the most prevalent mutations in each population. Besides, even though the disorder studied is rare, the technique could be broadly applicable to other genes and disorders.     

Genetic abnormalities and CNS tumors: report of two cases of ependymoma associated with Klinefelter’s Syndrome (KS)

Objects Genetic syndromes associated with ependymoma are uncommon, with the exception of NF2. We describe two cases of ependymoma presenting with Klinefelter’s Syndrome (KS) as co-morbid condition. Materials and methods The first patient was diagnosed for KS during pregnancy; he also presented a thyroid agenesis and a deficit of methyltetrahydrofolate reductase (MTHFR); at 30 months of age he was operated on for a grade II ependymoma of IV ventricle; after a multiple-stage surgery, he underwent oral chemotherapy and stereotactic radiotherapy, but after 15 months he presented a local recurrence and died. The second patient was diagnosed for KS at the age of 16 months; at 10 years of age, due to back pain, he underwent an MRI, which showed a cauda equine tumor. He underwent surgery and radiotherapy. Histology was of mixopapillary ependymoma. Conclusion In a review of literature, various neoplasms have been described in association with KS. To our knowledge, these are the first two cases reported of ependymoma associated to KS. A retrospective study of 44 monoinstitutional ependymoma cases demonstrated association with genetic syndromes in 22%.     

Screening of male patients with autosomal recessive Duchenne dystrophy through dystrophin and DNA studies

Previously we estimated that about 2.5-4% of isolated male patients diagnosed as Duchenne dystrophy (DMD) may have the autosomal recessive form (AR-DMD). Such cases can be distinguished from X-linked DMD through the analysis of dystrophin. Fifty DMD patients from 47 families were investigated for dystrophin and DNA deletions. Based on our results, we estimate that the frequency of AR-DMD may be about 8-12% among male patients diagnosed as DMD in whom X-linked inheritance could not be confirmed through pedigree data, serum enzymes in female relatives or DNA studies. Such an estimate must be confirmed in a larger sample; however, it shows the importance of assessing dystrophin in all patients diagnosed as DMD in whom X-linked inheritance cannot be proved, since the distinction between these 2 forms has implications for genetic counseling.     

Assessment of occupational exposure to aromatic polycyclic hydrocarbons determining urinary levels of 1-pyrenol

In conformity with Italian law 626/94, occupational exposure to Polycyclic Aromatic Hydrocarbons (PAH) in several types of work environments was assessed by analysing urinary levels of 1-pyrenol. A total of 231 non-smokers exposed to PAH (82 workers, employed in two different thermoelectric power plants using combustible oil (30 subjects from plant A and 52 from plant B), 18 subjects working for a company recovering exhausted oils, 12 working on rubber production, 10 on road surface asphalting operations, 22 working in the anodizing section of an aluminium plant, 27 chimney-sweeps, and 60 coke-oven workers (30 topside workers, and 30 doing other jobs)) were enrolled. There were also 53 non-smoker control subjects, not occupationally exposed to PAH. Current smokers were excluded, since smoking is an important confounding factor when occupational exposure to low PAH concentrations are monitored. Confounding factors, i.e., diet and passive smoking, were checked by means of a questionnaire which, in addition to personal data and habits, also requested specific details about the type of diet followed and possible exposure to passive smoking during the 24-hour period preceding urine collection. In controls, exposure to PAH in the diet significantly increased 1-pyrenol levels in urine: in subjects introducing > or = 1 microgram of pyrene with the diet, the mean urinary level of 1-pyrenol was significantly higher than that introduced with < 1 microgram (high versus low dietary intake, mean +/- SD, 0.08 +/- 0.13 and 0.04 +/- 0.06 1-pyrenol mumoles/mole of creatinine, respectively; Mann-Whitney U-test Z = 2.67, p < 0.01). Conversely, passive smoking did not influence 1-pyrenol levels. In the overall population (controls and exposed), multiple linear regression analysis showed that levels of urinary 1-pyrenol were significantly influenced by occupational exposure to PAH in asphalt workers, anodizing plant workers, chimney-sweeps, and coke-oven workers, both those working at the top side of the oven and those doing other jobs (t = 2.19, p = 0.02; t = 2.56, p = 0.01; t = 5.25, p = 0.001; t = 3.34, p = 0.001; t = 7.82, p = 0.001, respectively; F = 9.7, p < 0.01), but not in power plant workers in contact with combustible oils, workers recovering exhausted oils, or rubber production workers. Diet and passive smoking did not influence urinary 1-pyrenol levels in the entire sample population. This biomarker also allowed an assessment of exposure levels among certainly exposed subjects. The percentage of subjects with urinary 1-pyrenol values higher than the 99th percentile of the reference population (0.67 mumoles 1-pyrenol/mole of creatinine) was significantly higher than that of controls in asphalt workers (20%), anodizing plant workers (14%), chimney-sweeps (13%) and coke-oven workers (33%) (chi-square test: asphalt workers = 6.1, p = 0.01; anodizing plant workers = 4.3, p = 0.04; chimney-sweeps = 7.1, p = 0.008; coke-oven workers with other duties = 4.4, p = 0.04; top side workers = 16.5, p < 0.001). In chimney sweeps and top side workers, respectively 2 and 4 subjects (7% and 13%) exceeded the precautionary level of 1.4 mumoles 1-pyrenol/mole of creatinine; of these, 1 chimney sweep and 3 top side workers (4% and 10%) exceeded the recommended biological threshold of 2.3 mumoles 1-pyrenol/mole of creatinine.     

Dominant or recessive mutations in the RYR1 gene causing central core myopathy in Brazilian patients

Central Core Disease (CCD) is an inherited neuromuscular disorder characterized by the presence of cores in muscle biopsy. CCD is caused by mutations in the RYR1 gene. This gene encodes the ryanodine receptor 1, which is an intracellular calcium release channel from the sarcoplasmic reticulum to the cytosol in response to depolarization of the plasma membrane. Mutations in this gene are also associated with susceptibility to Malignant Hyperthermia (MHS).In this study, we evaluated 20 families with clinical and histological characteristics of CCD to identify primary mutations in patients, for diagnosis and genetic counseling of the families.We identified variants in the RYR1 gene in 19/20 families. The molecular pathogenicity was confirmed in 16 of them. Most of these variants (22/23) are missense and unique in the families. Two variants were recurrent in two different families. We identified six families with biallelic mutations, five compound heterozygotes with no consanguinity, and one homozygous, with consanguineous parents, resulting in 30% of cases with possible autosomal recessive inheritance. We identified seven novel variants, four of them classified as pathogenic. In one family, we identified two mutations in exon 102, segregating in cis, suggesting an additive effect of two mutations in the same allele.This work highlights the importance of using Next-Generation Sequencing technology for the molecular diagnosis of genetic diseases when a very large gene is involved, associated to a broad distribution of the mutations along it. These data also influence the prevention through adequate genetic counseling for the families and cautions against malignant hyperthermia susceptibility.Key words: central core disease, RYR1, Next Generation Sequencing     

Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes.

Clinical or biochemical findings were reevaluated in 34 pediatric patients with primary renal tubular hypokalemic metabolic alkalosis. The patients were subdivided into two groups. Bartter syndrome (primary renal tubular hypokalemic metabolic alkalosis with normocalciuria or hypercalciuria) was diagnosed in 18 patients with molar urinary calcium/creatinine ratios greater than 0.20, and Gitelman syndrome (primary renal tubular hypokalemic metabolic alkalosis with magnesium deficiency and hypocalciuria) was diagnosed in 16 patients with molar urinary calcium/creatinine ratios less than or equal to 0.20 and plasma magnesium levels less than 0.75 mmol/L. Some clinically important differences between the groups were observed. Patients with Bartter syndrome were often born after pregnancies complicated by polyhydramnios (8/18) or premature delivery (7/18) and had short stature (11/18) or polyuria, polydipsia, and a tendency to dehydration (16/18) during infancy (12/18) or before school age (18/18). Patients with Gitelman syndrome had tetanic episodes (12/16) or short stature (3/16) at school age (14/16). We conclude that the Bartter and Gitelman syndromes represent two distinct variants of primary renal tubular hypokalemic metabolic alkalosis and are easily distinguished on the basis of urinary calcium levels.