Descripción general
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La paraplejía espástica hereditaria (HSP) incluye un grupo de enfermedades familiares que se caracterizan por la degeneración progresiva de los tractos corticoespinales responsables del movimiento y la sensación. Las PSH se diferencian en formas «puras» si hay afectación de la vejiga y «complicadas» si hay anomalías neurológicas o sistémicas adicionales. La clasificación genética de HSP se basa en el modo de herencia, el locus cromosómico y la mutación causal. Los modos de herencia incluyen las formas autosómicas dominante, autosómica recesiva y ligada al cromosoma X. La correlación de la clasificación clínica con la clasificación genética aún no está definida, ya que algunos tipos genéticos de HSP están asociados con fenotipos puros y complejos.
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El panel de precisión de paraplejía espástica hereditaria de Igenomix puede servir como una herramienta de diagnóstico precisa y dirigida, así como un diagnóstico diferencial de la debilidad muscular que, en última instancia, conduce a un mejor manejo y pronóstico de la enfermedad. Proporciona un análisis completo de los genes involucrados en esta enfermedad utilizando secuenciación de próxima generación (NGS) para comprender completamente el espectro de genes relevantes involucrados.
Indicaciones
- El panel de precisión de paraplejía espástica hereditaria Igenomix está indicado en pacientes con sospecha clínica o diagnóstico que presenten o sin las siguientes manifestaciones:
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Debilidad de la pierna
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Espasticidad de piernas
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Reflejos tendinosos enérgicos
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Reflejo plantar extensor
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Disfunción de la vejiga (urgencia urinaria)
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Pérdida visual
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Pérdida de la audición
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Dificultad para hablar
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Neuropatía periférica
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Utilidad clínica
La utilidad clínica de este panel es:
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El diagnóstico genético y molecular para un diagnóstico clínico preciso de un paciente sintomático.
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Inicio temprano del tratamiento con un equipo multidisciplinario para el tratamiento sintomático para mejorar la movilidad, aumentar la amplitud de movimiento y aliviar las molestias mediante el tratamiento farmacológico, así como la medicina física y la rehabilitación.
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Evaluación de riesgos y asesoramiento genético de familiares asintomáticos según modalidad hereditaria.
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Mejora de la delimitación de la correlación genotipo-fenotipo.
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Genes y enfermedades
GENE |
OMIM DISEASES |
INHERITANCE* |
% GENE COVERAGE (20X) |
HGMD** |
ABCC8 |
Permanent Neonatal |
AD,AR |
99.98 |
710 of 712 |
ACADM |
Medium Chain |
AR |
99.98 |
181 of 181 |
ACTA1 |
Congenital Myopathy |
AD,AR |
100 |
224 of 224 |
ADCY6 |
Lethal Congenital |
AR |
100 |
2 of 2 |
ADGRG6 |
Lethal Congenital |
AR |
99.91 |
NA of NA |
AGRN |
Congential Myasthenic |
AR |
99.71 |
18 of 18 |
AIMP1 |
Hypomyelinating |
AR |
100 |
10 of 10 |
AK9 |
Postsynaptic |
– |
98.37 |
4 of 4 |
ALG14 |
Congenital |
AR |
99.99 |
7 of 7 |
ALG2 |
Congenital Disorder |
AR |
99.61 |
7 of 7 |
ALG3 |
Congenital Disorder |
AR |
99.2 |
25 of 25 |
ASCC1 |
Spinal Muscular |
AR |
99.97 |
6 of 6 |
ATAD1 |
Hereditary |
AR |
99.97 |
3 of 3 |
AUTS2 |
Autosomal Dominant |
AD |
99.63 |
9 of 17 |
BICD2 |
Autosomal Dominant |
AD |
99.94 |
39 of 39 |
BIN1 |
Autosomal Recessive |
AR |
100 |
20 of 20 |
C12ORF65 |
Combined Oxidative |
AR |
na |
na |
CACNA1E |
Epileptic |
AD |
99.94 |
25 of 25 |
CASK |
Nonspherocytic Hemolytic |
X,XR,XD,G |
99.98 |
NA of NA |
CCDC47 |
Trichohepatoneu- |
AR |
99.94 |
5 of 5 |
CDK5 |
Lissencephaly With |
AR |
100 |
5 of 5 |
CEP55 |
Multinucleated Neurons, |
AR |
99.22 |
3 of 3 |
CFL2 |
Nemaline Myopathy |
AR |
99.98 |
9 of 9 |
CHAT |
Congenital Myasthenic |
AR |
100 |
49 of 49 |
CHMP1A |
Pontocerebellar |
AR |
100 |
4 of 4 |
CHRNA1 |
Multiple Pterygium |
AD,AR |
100 |
35 of 35 |
CHRNB1 |
Congential Myasthenic |
AD,AR |
95 |
9 of 9 |
CHRND |
Multiple Pterygium |
AD,AR |
100 |
31 of 31 |
CHRNE |
Familial Infantile |
AD,AR |
99.87 |
138 of 138 |
CHRNG |
Multiple Pterygium |
AR |
100 |
36 of 36 |
CHST14 |
Musculocontractural |
AR |
97.7 |
21 of 22 |
CHUK |
Cocoon |
AR |
100 |
5 of 5 |
CNTNAP1 |
Lethal Congenital |
AR |
99.97 |
25 of 25 |
COL13A1 |
Congenital Myasthenic |
AR |
99.97 |
16 of 16 |
COL6A2 |
Bethlem Myopathy |
AD,AR |
100 |
223 of 225 |
COLQ |
Endplate Acetylcholinesterase |
AR |
100 |
70 of 71 |
DHCR24 |
Desmosterolosis |
AR |
100 |
10 of 10 |
DOK7 |
Fetal Akinesia Deformation |
AR |
99.88 |
72 of 72 |
DPAGT1 |
Congenital Disorder Of |
AR |
100 |
41 of 41 |
DSE |
Musculocontractural |
AR |
99.94 |
3 of 3 |
ECEL1 |
Distal Arthrogryposis |
AR |
99.52 |
39 of 39 |
EGR2 |
Demyelinating Charcot- |
AD,AR |
100 |
23 of 23 |
ERBB3 |
Lethal Congenital |
AD,AR |
99.91 |
6 of 6 |
ERCC1 |
Cerebrooculofacioskeletal |
AR |
93.12 |
6 of 6 |
ERCC2 |
Cerebrooculofacioskeletal |
AR |
100 |
102 of 102 |
ERCC5 |
Cerebrooculofacioskeletal |
AR |
99.94 |
58 of 58 |
ERCC6 |
Cerebrooculofacioskeletal |
AD,AR |
99.98 |
127 of 128 |
ERGIC1 |
Neurogenic |
AR |
100 |
2 of 2 |
EXOSC3 |
Pontocerebellar |
AR |
100 |
19 of 20 |
FAM20C |
Lethal Osteosclerotic |
AR |
97.8 |
29 of 29 |
FBN2 |
Congenital Contractural |
AD |
100 |
115 of 115 |
FHL1 |
Reducing Body Myopathy, |
X,XR,XD,G |
99.98 |
NA of NA |
FIG4 |
Amyotrophic Lateral |
AD,AR |
99.92 |
72 of 72 |
FKBP10 |
Bruck Syndrome, |
AR |
100 |
51 of 51 |
FKTN |
Muscular Dystrophy- |
AR |
98 |
54 of 56 |
FLAD1 |
Lipid Storage Myopathy |
AR |
97.13 |
13 of 14 |
FLVCR2 |
Proliferative Vasculopathy |
AR |
99.97 |
16 of 16 |
GBA |
Gaucher Disease- |
AD,AR |
100 |
469 of 471 |
GBE1 |
Glycogen Storage |
AR |
99.95 |
71 of 74 |
GCK |
Permanent Neonatal |
AD,AR |
100 |
905 of 909 |
GFM2 |
Combined Oxidative |
AR |
99.35 |
5 of 7 |
GFPT1 |
Congenital Myasthenic |
AR |
100 |
57 of 57 |
GLDN |
Lethal Congenital |
AR |
98.46 |
13 of 13 |
GLE1 |
Congenital Arthrogryposis |
AR |
100 |
17 of 17 |
GLI3 |
Greig Cephalopolysyndactyly |
AD,AR |
100 |
231 of 231 |
GMPPB |
Muscular Dystrophy- |
AR |
99.95 |
53 of 53 |
HSPG2 |
Dyssegmental Dysplasia, |
AR |
99.41 |
68 of 69 |
HYMAI |
Paternal Uniparental |
AD |
na |
na |
IBA57 |
Multiple Mitochondrial |
AR |
93.35 |
25 of 27 |
INS |
Permanent Neonatal |
AD,AR |
100 |
78 of 84 |
ITGA6 |
Epidermolysis Bullosa |
AR |
100 |
10 of 10 |
ITGB4 |
Epidermolysis Bullosa |
AD,AR |
99.12 |
115 of 115 |
KAT6B |
Genitopatellar Syndrome, |
AD |
99.97 |
80 of 80 |
KBTBD13 |
Childhood-Onset |
AD |
99.66 |
15 of 15 |
KCNJ11 |
Permanent Neonatal |
AD,AR |
100 |
190 of 191 |
KIAA1109 |
Alkuraya-Kucinskas |
AR |
99.95 |
21 of 21 |
KIF14 |
Meckel Syndrome, |
AR |
99.84 |
18 of 18 |
KIF1A |
Autosomal Dominant |
AD,AR |
100 |
76 of 76 |
KIF5C |
Cortical Dysplasia, |
AD |
99.96 |
7 of 7 |
KLHL40 |
Severe Congenital |
AR |
99.98 |
26 of 26 |
KLHL41 |
Childhood-Onset |
AR |
99.92 |
8 of 8 |
LAMB2 |
Pierson Syndrome , |
AR |
100 |
129 of 129 |
LGI4 |
Arthrogryposis Multiplex |
AR |
99.86 |
9 of 9 |
LMNA |
Charcot-Marie-Tooth Disease |
AD,AR |
100 |
619 of 620 |
LMOD3 |
Severe Congenital |
AR |
98.68 |
23 of 26 |
LRP4 |
Cenani-Lenz Syndactyly |
AD,AR |
100 |
32 of 32 |
MAGEL2 |
Prader-Willi |
AD |
99.99 |
43 of 48 |
MED13L |
Mental Retardation And |
AD |
100 |
90 of 92 |
MPZ |
Axonal Type Charcot-Marie- |
AD,AR |
99.98 |
245 of 245 |
MTM1 |
Myotubular Myopathy, |
X,XR,G |
99.98 |
NA of NA |
MUSK |
Fetal Akinesia |
AR |
95.58 |
23 of 25 |
MYBPC1 |
Distal Arthrogryposis |
AD,AR |
100 |
13 of 13 |
MYH2 |
Proximal Myopathy |
AD,AR |
99.98 |
31 of 31 |
MYH3 |
Distal Arthrogryposis, |
AD,AR |
100 |
46 of 47 |
MYH8 |
Carney Complex Variant, |
AD |
100 |
6 of 6 |
MYO9A |
Congenital Myasthenic |
AR |
99.62 |
7 of 7 |
MYOD1 |
Congenital Myopathy With |
AR |
99.97 |
6 of 6 |
MYPN |
Nemaline Myopathy, |
AD,AR |
99.94 |
49 of 49 |
NALCN |
Congenital Contractures |
AD,AR |
99.97 |
69 of 69 |
NEB |
Nemaline Myopathy, |
AR |
86.77 |
304 of 339 |
NEK9 |
Arthrogryposis, Perthes |
AR |
99.98 |
4 of 4 |
NUP88 |
Fetal Akinesia |
AR |
95.82 |
3 of 3 |
PDX1 |
Pancreatic Permanent |
AD,AR |
98.02 |
32 of 36 |
PHGDH |
Neu-Laxova Syndrome, |
AR |
100 |
26 of 26 |
PI4KA |
Polymicrogyria, Perisylvian, |
AR |
99.76 |
4 of 4 |
PIEZO2 |
Distal Arthrogryposis, |
AD,AR |
96.93 |
37 of 37 |
PIGS |
Glycosylphosphatidylinositol |
AR |
100 |
6 of 6 |
PIP5K1C |
Lethal Congenital |
AR |
99.83 |
3 of 3 |
PLAGL1 |
Paternal Uniparental |
– |
95.56 |
2 of 2 |
PLEC |
Epidermolysis Bullosa |
AD,AR |
99.98 |
113 of 113 |
PLOD2 |
Bruck Syndrome |
AR |
99.97 |
29 of 29 |
PLXND1 |
Moebius |
– |
98.44 |
6 of 6 |
PMM2 |
Congenital Disorder |
AR |
100 |
127 of 129 |
PPP3CA |
Arthrogryposis, Cleft Palate, |
AD |
99.98 |
16 of 16 |
PREPL |
Congenital Myasthenic |
AR |
99.92 |
7 of 12 |
PSAT1 |
Neu-Laxova Syndrome, |
AR |
99.95 |
9 of 9 |
PSMB8 |
Proteasome-Associated |
AR |
100 |
11 of 11 |
RAPSN |
Fetal Akinesia Deformation |
AR |
99.98 |
59 of 61 |
RARS2 |
Pontocerebellar |
AR |
99.98 |
39 of 40 |
REV3L |
Moebius |
|
99.08 |
7 of 7 |
RFT1 |
Congenital Disorder |
AR |
99.98 |
18 of 18 |
RIPK4 |
Popliteal Pterygium |
AR |
99.98 |
16 of 16 |
RYR1 |
Central Core Disease |
AD,AR |
97.63 |
733 of 746 |
SCN4A |
Congenital Myasthenic |
AD,AR |
99.77 |
136 of 142 |
SCO2 |
Autosomal Recessive |
AD,AR |
100 |
38 of 38 |
SELENON |
Congoenital Myopathy |
AD,AR |
89 |
NA of NA |
SHPK |
Isolated Sedoheptulokinase |
– |
99.96 |
2 of 2 |
SLC18A3 |
Congenital Myasthenic |
AR |
99.97 |
5 of 5 |
SLC25A1 |
Congenital Myasthenic |
AR |
90 |
23 of 25 |
SLC35A3 |
Arthrogryposis, Mental |
AR |
99.94 |
5 of 5 |
SLC5A7 |
Congenital Myasthenic |
AD,AR |
99.92 |
21 of 21 |
SLC6A9 |
Glycine Encephalopathy |
AR |
99.99 |
5 of 5 |
SLC9A6 |
Christianson |
X,XD,G |
98.87 |
NA of NA |
SMN1 |
Spinal Muscular |
AR |
5.2 |
17 of 91 |
SMN2 |
Spinal Muscular |
AR |
7.6 |
0 of 3 |
SNAP25 |
Congenital Myasthenic |
AD |
100 |
6 of 6 |
SOX10 |
Peripheral Demyelinating |
AD |
99.74 |
139 of 147 |
STAC3 |
Native American |
AR |
99.98 |
5 of 5 |
STAT3 |
Multisystem Autoimmune |
AD |
100 |
171 of 171 |
STIM1 |
Immune Dysfunction |
AD,AR |
100 |
28 of 28 |
SYNE1 |
Arthrogryposis Multiplex |
AD,AR |
99.99 |
193 of 193 |
SYT2 |
Congenital Myasthenic |
AD |
99.98 |
4 of 4 |
TBCD |
Progressive Encephalopathy, |
AR |
94.89 |
28 of 28 |
TGFB3 |
Loeys-Dietz Syndrome, |
AD |
100 |
34 of 35 |
TK2 |
External Ophthalmoplegia |
AR |
97.08 |
64 of 65 |
TNNI2 |
Distal Arthrogryposis |
AD |
100 |
11 of 11 |
TNNT1 |
Nemaline |
AR |
89.94 |
7 of 8 |
TNNT3 |
Distal Arthrogryposis |
AD |
99.98 |
5 of 5 |
TPM2 |
Distal Arthrogryposis, |
AD,AR |
100 |
41 of 41 |
TPM3 |
Congenital Myopathy |
AD,AR |
100 |
27 of 27 |
TRIP4 |
Congenital Muscular |
AR |
99.92 |
3 of 3 |
TRPV4 |
Brachyrachia, Familial |
AD |
100 |
88 of 88 |
TSEN2 |
Pontocerebellar |
AR |
95.47 |
4 of 5 |
TSEN54 |
Fatal Infantile |
AR |
96.94 |
20 of 22 |
UBA1 |
Infantile-Onset X- |
X,XR,G |
99.58 |
NA of NA |
VAMP1 |
Spastic Ataxia, |
AD,AR |
99.51 |
8 of 8 |
VIPAS39 |
Arthrogryposis, |
AR |
100 |
15 of 15 |
VPS33B |
Arthrogryposis, |
AR |
100 |
62 of 62 |
VRK1 |
Pontocerebellar |
AR |
99.64 |
15 of 15 |
YY1 |
Gabriele-de Vries |
AD |
99.89 |
13 of 13 |
ZBTB42 |
Lethal Congenital |
AR |
99.81 |
1 of 1 |
ZC4H2 |
Wieacker-Wolff |
X,XR,XD,G |
99.69 |
NA of NA |
ZFP57 |
Transient Neonatal |
AD |
100 |
15 of 15 |
ZMPSTE24 |
Mandibuloacral |
AR |
100 |
35 of 36 |
ZNF335 |
Primary Autosomal |
AR |
99.83 |
20 of 20 |
ZNHIT3 |
Peho |
AR |
73.96 |
1 of 1 |
* Herencia: AD: Autosómico Dominante; AR: autosómico recesivo; X: ligado a X; XLR: recesivo vinculado a X; Mi: mitocondrial; Mu: multifactorial; G: herencia gonosomal; D: herencia digénica
** HGMD: número de mutaciones clínicamente relevantes según HGMD
Referencias
Niles, K. M., Blaser, S., Shannon, P., & Chitayat, D. (2019). Fetal arthrogryposis multiplex congenita/fetal akinesia deformation sequence (FADS)-Aetiology, diagnosis, and management. Prenatal diagnosis, 39(9), 720–731. https://doi.org/10.1002/pd.5505
Bamshad, M., Van Heest, A. E., & Pleasure, D. (2009). Arthrogryposis: A review and update. Journal of Bone and Joint Surgery, 91(Supplement_4), 40-46. doi:10.2106/jbjs.i.00281
Ravenscroft, G., Clayton, J. S., Faiz, F., Sivadorai, P., Milnes, D., Cincotta, R., Moon, P., Kamien, B., Edwards, M., Delatycki, M., Lamont, P. J., Chan, S. H., Colley, A., Ma, A., Collins, F., Hennington, L., Zhao, T., McGillivray, G., Ghedia, S., Chao, K., … Davis, M. R. (2020). Neurogenetic fetal akinesia and arthrogryposis: genetics, expanding genotype-phenotypes and functional genomics. Journal of medical genetics, jmedgenet-2020-106901. Advance online publication. https://doi.org/10.1136/jmedgenet-2020-106901
Farmakidis, C., Pasnoor, M., Barohn, R. J., & Dimachkie, M. M. (2018). Congenital Myasthenic Syndromes: a Clinical and Treatment Approach. Current treatment options in neurology, 20(9), 36. https://doi.org/10.1007/s11940-018-0520-7
Rodríguez Cruz, P. M., Palace, J., & Beeson, D. (2018). The Neuromuscular Junction and Wide Heterogeneity of Congenital Myasthenic Syndromes. International journal of molecular sciences, 19(6), 1677. https://doi.org/10.3390/ijms19061677
Finsterer J. (2019). Congenital myasthenic syndromes. Orphanet journal of rare diseases, 14(1), 57. https://doi.org/10.1186/s13023-019-1025-5
Engel A. G. (2018). Genetic basis and phenotypic features of congenital myasthenic syndromes. Handbook of clinical neurology, 148, 565–589. https://doi.org/10.1016/B978-0-444-64076-5.00037-5
Engel A. G. (2018). Congenital Myasthenic Syndromes in 2018. Current neurology and neuroscience reports, 18(8), 46. https://doi.org/10.1007/s11910-018-0852-4
Abicht, A., Müller, J., S, & Lochmüller, H. (2003). Congenital Myasthenic Syndromes. In M. P. Adam (Eds.) et. al., GeneReviews®. University of Washington, Seattle.
Hall, J. G. (2014). Arthrogryposis (multiple congenital contractures): Diagnostic approach to etiology, classification, genetics, and general principles. European Journal of Medical Genetics, 57(8), 464-472. doi:10.1016/j.ejmg.2014.03.008