Critical appraisal of genotype assessment in molybdenum cofactor deficiency

被引:18
作者
Hinderhofer, Katrin [1 ]
Mechler, Konstantin [2 ]
Hoffmann, Georg F. [3 ,4 ]
Lampert, Anette [5 ,6 ]
Mountford, William K. [7 ,8 ]
Ries, Markus [3 ,4 ]
机构
[1] Heidelberg Univ, Inst Human Genet, Heidelberg, Germany
[2] Heidelberg Univ, Med Fac Mannheim, Cent Inst Mental Hlth, Pediat Psychopharmacol,Dept Child & Adolescent Ps, J 5, D-68159 Mannheim, Germany
[3] Heidelberg Univ Hosp, Pediat Neurol & Metab Med, Ctr Pediat & Adolescent Med, Heidelberg, Germany
[4] Heidelberg Univ Hosp, Ctr Rare Disorders, Heidelberg, Germany
[5] Heidelberg Univ Hosp, Dept Clin Pharmacol & Pharmacoepidemiol, Heidelberg, Germany
[6] Heidelberg Univ Hosp, Cooperat Unit Clin Pharm, Heidelberg, Germany
[7] Univ North Carolina Wilmington, Wilmington, NC USA
[8] Quintiles Inc, Smyrna, GA USA
关键词
MOLYBDOPTERIN SYNTHASE; CHRONOLOGICAL CHANGES; SEQUENCE VARIANTS; GENES MOCS1; MUTATIONS; FEATURES; ASSOCIATION; GENETICS; NEONATE; NEWBORN;
D O I
10.1007/s10545-017-0077-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction Molybdenum cofactor deficiency (MoCD) is an ultra-orphan, life-threatening disease. Substrate substitution therapy has successfully been performed in single cases of MoCD type A and clinical trials are underway for drug registration. We present an innovative approach for classification of genotype severity to test the hypothesis that milder sequence variants in MoCD result in a less severe disease phenotype quantitated by patient survival. Methods All available worldwide published cases with clinical and genetic data were included (n = 40). We stratified the already published disease causing sequence variants as mild or severe with the use of in silico prediction programs, where possible and assessed the possible impact of the variants on the expression of the gene or function of the expressed protein. In a compound heterozygous situation the mildest sequence variant determined the genotype. Subsequently, clinical manifestations and outcomes of both groups were compared. Results Patients with a severe genotype showed a median survival of 15 months and had a lower probability of survival compared to patients with mild genotypes who were all alive at last reported follow-up (p = 0.0203, Log-rank test). Discussion The severity of the genotype assessed by in silico prediction and further classification explained survival in molybdenum cofactor deficiency and may therefore be considered a confounder for the outcome of therapeutic clinical trials requiring adjustment in the clinical trial design or analysis. These results should further be investigated by future in vitro or in vivo functional studies. Caution should be taken with this approach for the classification of variants in molecular genetic diagnostics or genetic counseling.
引用
收藏
页码:801 / 811
页数:11
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