Browsing by Author "Antunes, D"
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- Acroparestesias, Diarreia e Dor Abdominal Recorrente – a Importância do “Awareness” no Diagnóstico da Doença RaraPublication . Freitas, J; Ferreira, AC; Vieira, JP; Candeias, F; Brito, MJ; Ramos, M; Farela Neves, J; Oliveira, L; Antunes, D; Sequeira, SIntrodução: A doença de Anderson-Fabry é uma doença hereditária ligada ao cromossoma X causada pela deficiência da enzima lisossomal alfa-galactosidase com acumulação de globotriaosilceramida e comprometimento multissistémico progressivo. No sexo masculino, manifesta-se geralmente na infância e adolescência com acroparestesias, angioqueratomas e sintomas gastrointestinais, evoluindo na idade adulta precoce com complicações cardíacas, neurológicas e renais. Caso clínico: Jovem de 14 anos, sexo masculino, internado por infeção respiratória. Na história clínica constatou-se quadro com cinco anos de evolução de dor abdominal intermitente, diarreia crónica e episódios recorrentes de dor nas mãos e pés, tipo queimadura, agravados pela febre. O tio materno tinha um quadro clínico semelhante. Foi feita investigação reumatológica, gastrointestinal, auto-imune, neurológica e genética, mas foi o “awareness” diagnóstico para esta entidade que motivou o pedido da atividade enzimática da alfa-galactosidase A e confirmou o diagnóstico de doença de Anderson-Fabry. O estudo molecular do gene GLA revelou, em hemizigotia, a mutação c.195-1G>A. O estudo familiar confirmou a doença no tio materno e em mais um familiar do sexo masculino e três do sexo feminino Comentários: O diagnóstico da doença de Anderson-Fabry é frequentemente tardio devido à raridade da doença, inespecificidade das manifestações iniciais e ao vasto espectro de diagnósticos diferenciais. O diagnóstico precoce é importante pela intervenção na progressão da doença com terapêutica enzimática de substituição. O rastreio familiar é fundamental para a detecção de casos pré-sintomáticos e sintomáticos ainda não diagnosticados.
- Case Report: Mutation in NPPA Gene As a Cause of Fibrotic Atrial MyopathyPublication . Silva Cunha, P; Antunes, D; Laranjo, S; Coutinho, A; Abecasis, J; Oliveira, MMEarly-onset atrial fibrillation (AF) can be the manifestation of a genetic atrial myopathy. However, specific genetic identification of a mutation causing atrial fibrosis is rare. We report a case of a young patient with an asymptomatic AF, diagnosed during a routine examination. The cardiac MRI revealed extensive atrial fibrosis and the electrophysiology study showed extensive areas of low voltage. The genetic investigation identified a homozygous pathogenic variant in the NPPA gene in the index case and the presence of the variant in heterozygosity in both parents.
- Ectodermal DysplasiasPublication . João, AL; Antunes, D; Cordeiro, AI; Paiva Lopes, MJEctodermal dysplasias are a heterogeneous group of rare inherited disorders. Molecular findings and clarification of cell sig naling processes and ectodermal-mesenchyme interaction enabled the development of a clinical-functional model, which in turn helps to explain clinical signs, with variability in severity, associated non-ectodermal abnormalities and overlap seen in many patients. We herein review the current state of knowledge regarding this distinct entity and illustrate with an elucidative case report. The need for early multidisciplinary intervention is highlighted, and further studies will focus on genetically-target therapeutic approaches.
- Hyperprolinemia as a Clue in the Diagnosis of a Patient with Psychiatric ManifestationsPublication . Duarte, M; Afonso, J; Moreira, A; Antunes, D; Ferreira, C; Correia, H; Marques, M; Sequeira, SLately, microdeletions of the 22q region, responsible for DiGeorge syndrome or velocardiofacial syndrome, have been increasingly related to neuropsychiatric disorders including schizophrenia and bipolar disorder. These manifestations seem to be related to certain genes located in the hemideleted region such as the proline dehydrogenase (PRODH) and the catechol-o-methyltransferase (COMT) genes. We describe a teenager who started his adolescent psychiatric care presenting cognitive impairment, irritable mood and aggressive behaviour with schizophrenia-like symptoms that scored 153 in the Positive and Negative Symptoms Scale (PANSS) assessment. Worsening of symptoms when the patient was treated with valproic acid, and plasma aminoacids showing an increase in alanine and proline, suggested a mitochondrial involvement of the proline metabolic pathway. Mild dysmorphic features also suggested a possible 22q11 deletion syndrome that was confirmed. A mutation for Hyperprolinemia type I was also detected. Knowledge of the correct diagnosis was crucial for an adequate treatment.
- A Known Pathogenic Variant in the Essential Mitochondrial Translation Gene RMND1 Causes a Perrault-Like Syndrome with Renal DefectsPublication . Demain, LAM; Antunes, D; O'Sullivan, J; Bhaskhar, SS; O'Keefe, RT; Newman, WG
- TANGO2 Deficiency Disorder: Two Cases of Developmental Delay Preceding Metabolic CrisisPublication . Dias, JV; Carvalho, AA; Freixo, JP; Antunes, D; Martins, AA; Painho, T; Jacinto, SBackground: TANGO2 deficiency disorder is a rare genetic disease caused by biallelic defects in TANGO2 gene. Methods: We report the clinical phenotype of two children with TANGO2 deficiency disorder. Results: Patient 1 is a female child presenting with developmental delay and microcephaly during the second year of life, who evolved with severe cognitive impairment, facial dysmorphisms, spastic paraparesis, and atonic seizures. At age 13 years, she was hospitalized due to an episode of rhabdomyolysis complicated with cardiac arrhythmia and hypothyroidism. Patient 2 is a female child with dysmorphic facial features, cleft palate, and developmental delay who was diagnosed with DiGeorge syndrome. At age three years, she presented with an acute episode of severe rhabdomyolysis in the context of human herpesvirus 6 infection. After the resolution of this acute episode, she maintained recurrent muscle weakness with axial hypotonia and progressive spasticity of the lower extremities. In both patients, diagnosis of TANGO2 deficiency disorder was only confirmed after an acute metabolic crisis. Conclusions: A high index of suspicion for TANGO2 deficiency disorder is needed in patients with developmental delay or other neurological symptoms and episodic rhabdomyolysis.
- Targeted Next-Generation Sequencing Study in Familial ALS-FTD Portuguese Patients Negative for C9orf72 HREPublication . Gromicho, M; Coutinho, AM; Pronto-Laborinho, AC; Raposeiro, R; Tavares, J; Antunes, D; de Carvalho, MAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with clinical and etiological heterogeneity and a complex genetic contribution. Clinical, neuropathological, and genetic evidence revealed that ALS and frontotemporal dementia (FTD) are in part of a single disease continuum. Genetic causes have been identified in sporadic (SALS) and familial patients (FALS) and the recurrent genetic factor underlying ALS and FTD is the C9orf72 hexanucleotide repeat expansion (HRE). However, in our population, the concomitance of ALS and FTD cannot be explained by C9orf72 HRE in many FALS and SALS cases. Our aim is to further understand the genetic basis of ALS in Portuguese patients. 34 patients with FALS or SALS-FTD, negative for C9orf72 HRE, were screened for rare variants in a panel of 29 relevant genes by next-generation sequencing. We detected 15 variants in 11 genes, one classified as pathogenic in TARDBP, two as likely pathogenic in TARDBP and PRPH, and the others as variants of unknown significance (VUS). Gene variants, including VUS, were found in 41.2% FALS patients and 40% SALS-FTD. In most patients, no potential pathogenic variants were found. Our results emphasize the need to enhance the efforts to unravel the genetic architecture of ALS-FTD.
- The Role of AKT3 Copy Number Changes in Brain Abnormalities and Neurodevelopmental Disorders: Four New Cases and Literature ReviewPublication . Lopes, F; Torres, F; Soares, G; van Karnebeek, CD; Martins, C; Antunes, D; Silva, J; Muttucomaroe, L; Botelho, LF; Sousa, S; Rendeiro, P; Tavares, P; Van Esch, H; Rajcan-Separovic, E; Maciel, PMicrodeletions at 1q43-q44 have been described as resulting in a clinically recognizable phenotype of intellectual disability (ID), facial dysmorphisms and microcephaly (MIC). In contrast, the reciprocal microduplications of 1q43-q44 region have been less frequently reported and patients showed a variable phenotype, including macrocephaly. Reports of a large number of patients with copy number variations involving this region highlighted the AKT3 gene as a likely key player in head size anomalies. We report four novel patients with copy number variations in the 1q43-q44 region: one with a larger deletion (3.7Mb), two with smaller deletions affecting AKT3 and SDCCAG8 genes (0.16 and 0.18Mb) and one with a quadruplication (1Mb) that affects the entire AKT3 gene. All patients with deletions presented MIC without structural brain abnormalities, whereas the patient with quadruplication had macrocephaly, but his carrier father had normal head circumference. Our report also includes a comparison of phenotypes in cases with 1q43-q44 duplications to assist future genotype-phenotype correlations. Our observations implicate AKT3 as a contributor to ID/development delay (DD) and head size but raise doubts about its straightforward impact on the latter aspect of the phenotype in patients with 1q43-q44 deletion/duplication syndrome.