PURA syndrome : clinical delineation and genotype-phenotype study in 32 individuals with review of published literature

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Reijnders , M R F , Janowski , R , Alvi , M , Self , J E , van Essen , T J , Vreeburg , M , Rouhl , R P W , Stevens , S J C , Stegmann , A P A , Schieving , J , Pfundt , R , van Dijk , K , Smeets , E , Stumpel , C T R M , Bok , L A , Cobben , J M , Engelen , M , Mansour , S , Whiteford , M , Chandler , K E , Douzgou , S , Cooper , N S , Tan , E-C , Foo , R , Lai , A H M , Rankin , J , Green , A , Lönnqvist , T , Isohanni , P , Williams , S , Ruhoy , I , Carvalho , K S , Dowling , J J , Lev , D L , Sterbova , K , Lassuthova , P , Neupauerova , J , Waugh , J L , Keros , S , Clayton-Smith , J , Smithson , S F , Brunner , H G , van Hoeckel , C , Anderson , M , Clowes , V E , Siu , V M , Selber , P , Leventer , R J , Nellaker , C , Niessing , D & DDD Study 2018 , ' PURA syndrome : clinical delineation and genotype-phenotype study in 32 individuals with review of published literature ' , Journal of Medical Genetics , vol. 55 , no. 2 , pp. 104-113 . https://doi.org/10.1136/jmedgenet-2017-104946

Title: PURA syndrome : clinical delineation and genotype-phenotype study in 32 individuals with review of published literature
Author: Reijnders, Margot R. F.; Janowski, Robert; Alvi, Mohsan; Self, Jay E.; van Essen, Ton J.; Vreeburg, Maaike; Rouhl, Rob P. W.; Stevens, Servi J. C.; Stegmann, Alexander P. A.; Schieving, Jolanda; Pfundt, Rolph; van Dijk, Katinke; Smeets, Eric; Stumpel, Connie T. R. M.; Bok, Levinus A.; Cobben, Jan Maarten; Engelen, Marc; Mansour, Sahar; Whiteford, Margo; Chandler, Kate E.; Douzgou, Sofia; Cooper, Nicola S.; Tan, Ene-Choo; Foo, Roger; Lai, Angeline H. M.; Rankin, Julia; Green, Andrew; Lönnqvist, Tuula; Isohanni, Pirjo; Williams, Shelley; Ruhoy, Ilene; Carvalho, Karen S.; Dowling, James J.; Lev, Dorit L.; Sterbova, Katalin; Lassuthova, Petra; Neupauerova, Jana; Waugh, Jeff L.; Keros, Sotirios; Clayton-Smith, Jill; Smithson, Sarah F.; Brunner, Han G.; van Hoeckel, Ceciel; Anderson, Mel; Clowes, Virginia E.; Siu, Victoria Mok; Selber, Paulo; Leventer, Richard J.; Nellaker, Christoffer; Niessing, Dierk; DDD Study
Contributor organization: Clinicum
Children's Hospital
Lastenneurologian yksikkö
University of Helsinki
Research Programs Unit
Anu Wartiovaara / Principal Investigator
Research Programme for Molecular Neurology
HUS Children and Adolescents
Date: 2018-02
Language: eng
Number of pages: 10
Belongs to series: Journal of Medical Genetics
ISSN: 0022-2593
DOI: https://doi.org/10.1136/jmedgenet-2017-104946
URI: http://hdl.handle.net/10138/233379
Abstract: Background De novo mutations in PURA have recently been described to cause PURA syndrome, a neurodevelopmental disorder characterised by severe intellectual disability (ID), epilepsy, feeding difficulties and neonatal hypotonia. Objectives T o delineate the clinical spectrum of PURA syndrome and study genotype-phenotype correlations. Methods Diagnostic or research-based exome or Sanger sequencing was performed in individuals with ID. We systematically collected clinical and mutation data on newly ascertained PURA syndrome individuals, evaluated data of previously reported individuals and performed a computational analysis of photographs. We classified mutations based on predicted effect using 3D in silico models of crystal structures of Drosophila-derived Pur-alpha homologues. Finally, we explored genotypephenotype correlations by analysis of both recurrent mutations as well as mutation classes. Results We report mutations in PURA (purine-rich element binding protein A) in 32 individuals, the largest cohort described so far. Evaluation of clinical data, including 22 previously published cases, revealed that all have moderate to severe ID and neonatal-onset symptoms, including hypotonia (96%), respiratory problems (57%), feeding difficulties (77%), exaggerated startle response (44%), hypersomnolence (66%) and hypothermia (35%). Epilepsy (54%) and gastrointestinal (69%), ophthalmological (51%) and endocrine problems (42%) were observed frequently. Computational analysis of facial photographs showed subtle facial dysmorphism. No strong genotype-phenotype correlation was identified by subgrouping mutations into functional classes. Conclusion We delineate the clinical spectrum of PURA syndrome with the identification of 32 additional individuals. The identification of one individual through targeted Sanger sequencing points towards the clinical recognisability of the syndrome. Genotype-phenotype analysis showed no significant correlation between mutation classes and disease severity.
3112 Neurosciences
3124 Neurology and psychiatry
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion

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