De novo ATP1A3 and compound heterozygous NLRP3 mutations in a child with autism spectrum disorder, episodic fatigue and somnolence, and muckle-wells syndrome

Published in Molecular Genetics and Metabolism Reports, 2018

Complex phenotypes may represent novel syndromes that are the composite interaction of several genetic and environmental factors. We describe an 9-year old male with high functioning autism spectrum disorder and Muckle-Wells syndrome who at age 5  years of age manifested perseverations that interfered with his functioning at home and at school. After age 6, he developed intermittent episodes of fatigue and somnolence lasting from hours to weeks that evolved over the course of months to more chronic hypersomnia. Whole exome sequencing showed three mutations in genes potentially involved in his clinical phenotype. The patient has a predicted pathogenic de novo heterozygous p.Ala681Thr mutation in the ATP1A3 gene (chr19:42480621C>T, GRCh37/hg19). Mutations in this gene are known to cause Alternating Hemiplegia of Childhood, Rapid Onset Dystonia Parkinsonism, and CAPOS syndrome, sometimes accompanied by autistic features. The patient also has compound heterozygosity for p.Arg490Lys/p.Val200Met mutations in the NLRP3 gene (chr1:247588214G>A and chr1:247587343G>A, respectively). NLRP3 mutations are associated in an autosomal dominant manner with clinically overlapping auto-inflammatory conditions including Muckle-Wells syndrome. The p.Arg490Lys is a known pathogenic mutation inherited from the patient’s father. The p.Val200Met mutation, inherited from his mother, is a variant of unknown significance (VUS). Whether the de novoATP1A3mutation is responsible for or plays a role in the patient’s episodes of fatigue and somnolence remains to be determined. The unprecedented combination of two NLRP3 mutations may be responsible for other aspects of his complex phenotype.

Article Link

https://www.sciencedirect.com/science/article/pii/S2214426918300648

Bibtex

@article{torres2018novo,
  title={De novo ATP1A3 and compound heterozygous NLRP3 mutations in a child with autism spectrum disorder, episodic fatigue and somnolence, and muckle-wells syndrome},
  author={
    Torres, Alcy and
    Brownstein, Catherine A and
    Tembulkar, Sahil K and
    Graber, Kelsey and
    Genetti, Casie and
    Kleiman, Robin J and
    Sweadner, Kathleen J and
    Mavros, Chrystal and
    Liu, Kevin X and
    Smedemark-Margulies, Niklas and
    Maski, Kiran and
    Yang, Edward and
    Agrawal, Pankaj B and
    Shi, Jiahai and
    Beggs, Alan H and
    D'Angelo, Eugene and
    Lincoln, Sarah Hope and
    Carroll, Devon and
    Dedeoglu, Fatma and
    Gahl, William A and
    Biggs, Catherine M and
    Swoboda, Kathryn J and
    Berry, Gerard T and
    Gonzalez-Heydrich, Joseph},
  journal={Molecular Genetics and Metabolism Reports},
  volume={16},
  pages={23--29},
  year={2018},
  publisher={Elsevier}
}