Lessons learned from 40 novel PIGA patients and a review of the literature.

Allan Bayat, Alexej Knaus, Manuela Pendziwiat, Alexandra Afenjar, Tahsin Stefan Barakat, Friedrich Bosch, Bert Callewaert, Patrick Calvas, Berten Ceulemans, Nicolas Chassaing, Christel Depienne, Milda Endziniene, Carlos R Ferreira, Carolina Fischinger Moura de Souza, Cécile Freihuber, Shiva Ganesan, Svetlana Gataullina, Renzo Guerrini, Anne-Marie Guerrot, Lars Hansen, Aleksandra Jezela-Stanek, Caroline Karsenty, Anneke Kievit, Frank R Kooy, Christian M Korff, Johanne Kragh Hansen, Martin Larsen, Valérie Layet, Gaetan Lesca, Kim L McBride, Marije Meuwissen, Cyril Mignot, Martino Montomoli, Hannah Moore, Sophie Naudion, Caroline Nava, Marie-Christine Nougues, Elena Parrini, Matthew Pastore, Jurgen H Schelhaas, Steven Skinner, Krzysztoł Szczałuba, Ashley Thomas, Mads Thomassen, Lisbeth Tranebjaerg, Marjon van Slegtenhorst, Lynne A Wolfe, Dennis Lal, Elena Gardella, Lilian Bomme Ousager, Tobias Brünger, Ingo Helbig, Peter Krawitz, Rikke S Møller

Journal: Epilepsia 2020;61(6):1142-1155

PMID: 32452540

Abstract

OBJECTIVE

To define the phenotypic spectrum of phosphatidylinositol glycan class A protein (PIGA)-related congenital disorder of glycosylation (PIGA-CDG) and evaluate genotype-phenotype correlations.

METHODS

Our cohort encompasses 40 affected males with a pathogenic PIGA variant. We performed a detailed phenotypic assessment, and in addition, we reviewed the available clinical data of 36 previously published cases and assessed the variant pathogenicity using bioinformatical approaches.

RESULTS

Most individuals had hypotonia, moderate to profound global developmental delay, and intractable seizures. We found that PIGA-CDG spans from a pure neurological phenotype at the mild end to a Fryns syndrome-like phenotype. We found a high frequency of cardiac anomalies including structural anomalies and cardiomyopathy, and a high frequency of spontaneous death, especially in childhood. Comparative bioinformatical analysis of common variants, found in the healthy population, and pathogenic variants, identified in affected individuals, revealed a profound physiochemical dissimilarity of the substituted amino acids in variant constrained regions of the protein.

SIGNIFICANCE

Our comprehensive analysis of the largest cohort of published and novel PIGA patients broadens the spectrum of PIGA-CDG. Our genotype-phenotype correlation facilitates the estimation on pathogenicity of variants with unknown clinical significance and prognosis for individuals with pathogenic variants in PIGA.

© 2020 International League Against Epilepsy.

Address: Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.; Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark.; Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.; Department of Neuropediatrics, University Medical Center Schleswig-Holstein Christian Albrechts University, Kiel, Germany.; CRMR Congenital Malformations and Diseases of the Cerebellum and Rare Causes of Intellectual Disabilities, Department of Genetics, Sorbonne University, AP-HP, Trousseau Hospital, Paris, France.; Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.; Children's Hospital, Fürth, Germany.; Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.; Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.; UMR1056 INSERM-Université de Toulouse, Department of Genetics, University Hospital of Toulouse, Toulouse, France.; Department of Pediatric Neurology, University Hospital and University of Antwerp, Antwerp, Belgium.; Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.; UMR S1127, Inserm U1127, CNRS UMR 7225, Institute of brain and spinal cord, Sorbonne University, Paris, France.; Neurology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.; Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.; Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.; Department of Pediatric Neurology, AP-HP, GHUEP, Armand Trousseau University Hospital, Paris, France.; GRC ConCer-LD, Sorbonne University, UPMC University of Paris 06, Paris, France.; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Sleep Disorders Center, AP-HP, Antoine-Béclère Hospital, Clamart, France.; Department of Pediatrics and Neonatal Intensive Care, André Grégoire Hospital, Montreuil, France.; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Department of Neuroscience, A. Meyer Children's Hospital, University of Florence, Florence, Italy.; Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandy University, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France.; Department of Cellular and Molecular Medicine, Faculty of Health Science, Copenhagen Center for Glycomics, Copenhagen, Denmark.; Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.; Neuropediatrics Department, University Hospital of Toulouse, Toulouse, France.; Department of Medical Genetics, University of Antwerp, Antwerp, Belgium.; Pediatric Neurology Unit, Department of the Woman, Child, and Adolescent, University Hospitals Geneva, Geneva, Switzerland.; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.; Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.; Department of Genetics, Du Havre Hospital, Le Havre, France.; Department of Medical Genetics, Lyon University Hospital, Lyon, France.; Institut Neuromyogene, University Claude Bernard Lyon 1, Lyon University, Lyon, France.; Division of Genetic and Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.; Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio, USA.; Department of Pediatrics, Ohio State University, Columbus, Ohio, USA.; APHP, Department of Genetics, Pitié-Salpêtrière Hospital, Reference Center for Rare Causes of Intellectual Disabilities, Paris, France.; Department of Genetics, Inserm U1127, CNRS UMR 7225, Institute for brain and spinal cord, ICM, AP-HP, De la Pitié Salpêtrière Hospital, Sorbonne University, Paris, France.; Greenwood Genetic Center, Greenwood, South Carolina, USA.; Department of Genetics, University of Bordeaux, Bordeaux, France.; Department of Genetics, Inserm U1127, CNRS UMR 7225, Institute for brain and spinal cord, ICM, AP-HP, De la Pitié Salpêtrière Hospital, Sorbonne University, Paris, France.; Department of Neuropaediatrics, Armand Trousseau Hospital, APHP, Paris, France.; Division of Genetic and Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.; Department of Pediatrics, Ohio State University, Columbus, Ohio, USA.; Department of Epilepsy, Zwolle, the Netherlands.; Department of Medical Genetics, Warsaw Medical University, Warsaw, Poland.; Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.; Department of Clinical Genetics, Rigshospitalet/Kennedy Center, Glostrup, Denmark.; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Undiagnosed Diseases Program, Common Fund, National Institutes of Health, Bethesda, Maryland, USA.; Section of Human Biochemical Genetics, National Human Genome Research Institute, Bethesda, Maryland, USA.; Cologne Center for Genomics, University Hospital Cologne, University of Cologne, Cologne, Germany.; Stanley Center for Psychiatric Research, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA.; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.; Genomic Medicine Institute, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, USA.; Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.; Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark.; Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.; Cologne Center for Genomics, University Hospital Cologne, University of Cologne, Cologne, Germany.; Department of Neuropediatrics, University Medical Center Schleswig-Holstein Christian Albrechts University, Kiel, Germany.; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

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