CASE REPORT OF ANGELMAN SYNDROME- A CHILD WITH PATHOGENIC VARIANT c.678dup, p.(Leu227iLefster4) IN THE EXON 7 OF UBEZA GENE

  • Danilo Nonkulovski University Clinic for Pediatric Diseases, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Aspazija Sofijanova University Clinic for Pediatric Diseases, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Sonja Bojadzieva University Clinic for Pediatric Diseases, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Ilija Kirovski University Clinic for Pediatric Diseases, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Olivera Viktor Jordanova University Clinic for Pediatric Diseases, Skopje, North Macedonia

Abstract

Angelman syndrome is rare and belongs to the group of genetic imprinting disorders where pathogenic mutations in the active gene are responsible for the disease, while pathogenic mutations in the inactive gene do not cause the disease. It's usually caused by problems with a gene located on chromosome 15 called the ubiquitin protein ligase E3A (UBE3A) gene. Some of pediatric patient don't have a family history of the disease. We present to you a 2 and a half year old female child with seizures which are difficult to control and recur in clusters, alternating with periods without attacks. Due to suspicion of epilepsy sent for genetic diagnosis. The presence of a pathogenic variant c.678dup, p.(Leu227iLefster4) in the in exon 7 of UBEZA gene in heterozygous form was proven. There is a change in the reading frame (frameshift), i.e. replacement of the amino acid leucine at position 227 with the amino acid isoleucine and termination of the protein after 4 amino acids. This variant has not been published in the literature so far. Family studies showed that the c678dup variant in the UBEZA gene was not present in the child's parents.  Additional analysis confirmed the biological connection of the parents with the child. These findings confirm that the pathogenic c678dup variant in the child arose de novo. Anticonvulsant therapy was prescribed and ketonic diet. Early diagnosis of Angelman syndrome and appropriate therapy enables a better quality of life for children.


Keywords: Angelman syndrome, epilepsy, seizures, UBE3A gene

References

1. Amos-Landgraf JM, Ji Y, Gottlieb W, Depinet T, Wandstrat AE, Cassidy SB, Driscoll DJ, Rogan PK, Schwartz S, Nicholls RD (1999) Chromosome breakage in the Prader-Willi and Angelman syndromes involves recombination between large, transcribed repeats at proximal and distal breakpoints. Am J Hum Genet 65: 370– 386.
2. Buiting K, Saitoh S, Gross S, Dittrich B, Schwartz S, Nicholls RD, Horsthemke B. Inherited microdeletions in the Angelman and Prader-Willi syndromes define an imprinting centre on human chromosome 15. Nat Genet. 1995 Apr;9(4):395-400. [PubMed].
3. Castro-Gago M, Gomez-Lado C, Eiris-Punal J, Rodriguez-Mugico VM. Abnormal myelination in Angelman syndrome. Eur J Paediatr Neurol. 2010;14:292. [PubMed].
4. Christian SL, Fantes JA, Mewborn SK, Huang B, Ledbetter DH. Large genomic duplicons map to sites of instability in the Prader-Willi/Angelman syndrome chromosome region (15q11-q13). Hum Mol Genet. 1999;8:1025–37. [PubMed].
5. Ciechanover A. The ubiquitin-proteasome pathway: on protein death and cell life. EMBO J. 1998;17:7151–60. [PMC free article] [PubMed].
6. Dagli A, Buiting K, Williams CA. Molecular and Clinical Aspects of Angelman Syndrome. Mol Syndromol. 2012 Apr;2(3-5):100-112. [PMC free article] [PubMed].
7. Elia M. Myoclonic status in nonprogressive encephalopathies: an update. Epilepsia. 2009;50:41–4. [PubMed].
8. Fairbrother LC, Cytrynbaum C, Boutis P, Buiting K, Weksberg R, Williams C. Mild Angelman syndrome phenotype due to a mosaic methylation imprinting defect. Am J Med Genet A. 2015;167:1565–9. [PubMed].
9. Hosoki K, Takano K, Sudo A, Tanaka S, Saitoh S. Germline mosaicism of a novel UBE3A mutation in Angelman syndrome. Am J Med Genet A. 2005;138A:187–9. [PubMed].
10. Tang HS, Wang DG, Xie XM, Li DZ. Apparent germline mosaicism for a 15q11-q13 deletion causing recurrent Angelman syndrome in a Chinese family. Eur J Obstet Gynecol Reprod Biol. 2019;236:255–7. [PubMed].
11. Williams CA, Driscoll DJ, Dagli AI. Clinical and genetic aspects of Angelman syndrome. Genet Med. 2010;12:385–95. [PubMed].
12. Worden L, Grocott O, Tourjee A, Chan F, Thibert R. Diazepam for outpatient treatment of nonconvulsive status epilepticus in pediatric patients with Angelman syndrome. Epilepsy Behav. 2018;82:74–80. [PubMed].
13. Williams CA, Lossie A, Driscoll D., R.C. Phillips Unit. Angelman syndrome: mimicking conditions and phenotypes. Am J Med Genet. 2001 Jun 01;101(1):59-64. [PubMed].
14. Saitoh S, Harada N, Jinno Y, Hashimoto K, Imaizumi K, Kuroki Y, Fukushima Y, Sugimoto T, Renedo M, Wagstaff J, Lalande M, Mutirangura A, Kuwano A, Ledbetter DH, Nikawa N. Molecular and clinical study of 61 Angelman syndrome patients. Am J Med Genet. 1994;52:158–163. doi: 10.1002/ajmg.1320520207. [PubMed] [CrossRef] [Google Scholar].
15. Matsumoto A, Kumagai T, Miura K, Myazaki S, Hayakawa C, Yamanaka T. Epilepsy in Angelman syndrome associated with chromosome 15q deletion. Epilepsia. 1992;33(6):1083–1090. doi: 10.1111/j.1528-1157.1992.tb01763.x. [PubMed] [CrossRef] [Google Scholar].
16. Viani F, Romeo A, Viri M, Mastrangelo M, Lalatta F, Selicorni A, Gobbi G, Lanzi G, Bettio D, Briscioli V. Seizures and EEG pattern in Angelman syndrome. J Chid Neurol. 1995;10(6):467–471. doi: 10.1177/088307389501000609. [PubMed] [CrossRef] [Google Scholar].
17. Guerrini R, Carrozzo R, Rinaldi R, Bonanni P. Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms. Paediatr Drugs. 2003;5(10):647–661. doi: 10.2165/00148581-200305100-00001. [PubMed] [CrossRef] [Google Scholar].
18. Valente KD, Koiffmann CP, Fridman C, Varella M, Kok F, Andrade JQ, Grossmann RM, Marques-Dias MJ. Epilepsy in patients with Angelman syndrome caused by deletion of the chromosome 15q11-q13. Arch Neurol. 2006;63:122–128. doi: 10.1001/archneur.63.1.122. [PubMed] [CrossRef] [Google Scholar].
19. Buoni S, Grosso S, Pucci L, Fois A. Diagnosis of Angelman syndrome: clinical and EEG criteria. Brain Dev. 1999;21:296–302. doi: 10.1016/S0387-7604(99)00007-8. [PubMed] [CrossRef] [Google Scholar].
20. Pelc K, Boyd SG, Cheron G, Dan B. Epilepsy in Angelman syndrome. Seizure. 2008;17:211–217. doi: 10.1016/j.seizure.2007.08.004. [PubMed] [CrossRef] [Google Scholar].
21. Elia M. Myoclonic status in nonprogressive envephalopathies: an update. Epilepsia. 2009;50(suppl.5):41–44. doi: 10.1111/j.1528-1167.2009.02119.x. [PubMed] [CrossRef] [Google Scholar].
22. Valente KD. Another Rett patient with a Typical Angelman EEG. Epilepsia. 2003;44(6):873–874. doi: 10.1046/j.1528-1157.2003.04803_3.x. [PubMed] [CrossRef] [Google Scholar].
23. Boyd SG, Harden A, Patton MA. The EEG in early diagnosis of Angelman syndrome. Eur J Pediatr. 1988;147:508–513. doi: 10.1007/BF00441976. [PubMed] [CrossRef] [Google Scholar].
24. Laan LAEM, Vein AA. Angelman syndrome: is there a characteristic EEG? Brain Develop. 2005;27:80–87. doi: 10.1016/j.braindev.2003.09.013. [PubMed] [CrossRef] [Google Scholar].
Published
2023-12-27
How to Cite
NONKULOVSKI, Danilo et al. CASE REPORT OF ANGELMAN SYNDROME- A CHILD WITH PATHOGENIC VARIANT c.678dup, p.(Leu227iLefster4) IN THE EXON 7 OF UBEZA GENE. Journal of Morphological Sciences, [S.l.], v. 6, n. 3, p. 72-77, dec. 2023. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol6no3-10>. Date accessed: 21 dec. 2024.
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Articles