背景:ITPR1基因编码肌醇1,4,5-三磷酸(IP3)受体1型(IP3R1),小脑细胞内钙信号的关键角色。ITPR1的致病错义变异导致先天性脊髓小脑共济失调29型(SCA29),Gillespie综合征(GLSP),和严重的脑桥/小脑发育不全。对不同表型的病理生理学基础了解甚少。
目的:我们旨在鉴定新的SCA29和GLSP病例,以确定核心表型,描述整个ITPR1的错义变化谱,标准化ITPR1变体命名法,并研究与小脑萎缩有关的疾病进展。
方法:通过解密发育障碍研究,使用下一代测序鉴定病例,10万个基因组项目,和临床合作。通过定量聚合酶链反应研究了人小脑中的ITPR1选择性剪接。
结果:我们报告了最大的,46例患者的多国病例系列,有28个独特的ITPR1错义变异。变体聚集在蛋白质的功能域中,特别是在N端IP3结合域中,碳酸酐酶8(CA8)结合区,和C端跨膜通道结构域。这些领域之外的变体具有可疑的临床意义。标准化的成绩单注释,根据我们的ITPR1转录物表达数据,大大促进了分析。基因型-表型关联高度可变。重要的是,虽然小脑萎缩很常见,小脑体积减少与症状进展无关。
结论:该数据集代表了最大的ITPR1错义变异患者队列,扩大SCA29和GLSP的临床范围。标准化的抄本注释对于未来的报告至关重要。我们的发现将有助于临床诊断解释,并指导临床前研究的变体选择。©2023作者。由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
BACKGROUND: The ITPR1 gene encodes the inositol 1,4,5-trisphosphate (IP3 ) receptor type 1 (IP3 R1), a critical player in cerebellar intracellular calcium signaling. Pathogenic missense variants in ITPR1 cause congenital spinocerebellar ataxia type 29 (SCA29), Gillespie syndrome (GLSP), and severe pontine/cerebellar hypoplasia. The pathophysiological basis of the different phenotypes is poorly understood.
OBJECTIVE: We aimed to identify novel SCA29 and GLSP cases to define core phenotypes, describe the spectrum of missense variation across ITPR1, standardize the ITPR1 variant nomenclature, and investigate disease progression in relation to cerebellar atrophy.
METHODS: Cases were identified using next-generation sequencing through the Deciphering Developmental Disorders study, the 100,000 Genomes project, and clinical collaborations. ITPR1 alternative splicing in the human cerebellum was investigated by quantitative polymerase chain reaction.
RESULTS: We report the largest, multinational case series of 46 patients with 28 unique ITPR1 missense variants. Variants clustered in functional domains of the protein, especially in the N-terminal IP3 -binding domain, the carbonic anhydrase 8 (CA8)-binding region, and the C-terminal transmembrane channel domain. Variants outside these domains were of questionable clinical significance. Standardized transcript annotation, based on our ITPR1 transcript expression data, greatly facilitated analysis. Genotype-phenotype associations were highly variable. Importantly, while cerebellar atrophy was common, cerebellar volume loss did not correlate with symptom progression.
CONCLUSIONS: This dataset represents the largest cohort of patients with ITPR1 missense variants, expanding the clinical spectrum of SCA29 and GLSP. Standardized transcript annotation is essential for future reporting. Our findings will aid in diagnostic interpretation in the clinic and guide selection of variants for preclinical studies. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.