J Pediatr Genet 2017; 06(03): 129-141
DOI: 10.1055/s-0037-1601335
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Further Clinical Delineation of the MEF2C Haploinsufficiency Syndrome: Report on New Cases and Literature Review of Severe Neurodevelopmental Disorders Presenting with Seizures, Absent Speech, and Involuntary Movements

Irena Vrečar
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
2   Clinical Institute of Medical Genetics, University Medical Centre of Ljubljana, Ljubljana, Slovenia
,
Josie Innes
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
,
Elizabeth A. Jones
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
3   Division of Evolution and Genomic Sciences, University of Manchester, School of Biological Sciences, Manchester, United Kingdom
,
Helen Kingston
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
3   Division of Evolution and Genomic Sciences, University of Manchester, School of Biological Sciences, Manchester, United Kingdom
,
William Reardon
4   Department of Clinical Genetics, Our Lady's Children Hospital Crumlin, Dublin, Ireland
,
Bronwyn Kerr
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
3   Division of Evolution and Genomic Sciences, University of Manchester, School of Biological Sciences, Manchester, United Kingdom
,
Jill Clayton-Smith
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
3   Division of Evolution and Genomic Sciences, University of Manchester, School of Biological Sciences, Manchester, United Kingdom
,
Sofia Douzgou
1   Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Academic Health Sciences Centre, Manchester, United Kingdom
3   Division of Evolution and Genomic Sciences, University of Manchester, School of Biological Sciences, Manchester, United Kingdom
› Author Affiliations
Further Information

Publication History

27 January 2017

16 February 2017

Publication Date:
12 April 2017 (online)

Abstract

Mutations in the MEF2C (myocyte enhancer factor 2) gene have been established as a cause for an intellectual disability syndrome presenting with seizures, absence of speech, stereotypic movements, hypotonia, and limited ambulation. Phenotypic overlap with Rett's and Angelman's syndromes has been noted. Following the first reports of 5q14.3q15 microdeletions encompassing the MEF2C gene, further cases with point mutations and partial gene deletions of the MEF2C gene have been described. We present the clinical phenotype of our cohort of six patients with MEF2C mutations and compare our findings with previously reported patients as well as with a growing number of genetic conditions presenting with a severe neurodevelopmental, Rett-like, phenotype. We aim to add to the current knowledge of the natural history of the “MEF2C haploinsufficiency syndrome” as well as of the differential diagnosis, clinical management, and genetic counseling in this diagnostically challenging group of patients.

 
  • References

  • 1 Watson P, Black G, Ramsden S. , et al. Angelman syndrome phenotype associated with mutations in MECP2, a gene encoding a methyl CpG binding protein. J Med Genet 2001; 38 (04) 224-228
  • 2 Allou L, Julia S, Amsallem D. , et al. Rett-like phenotypes: expanding the genetic heterogeneity to the KCNA2 gene and first familial case of CDKL5-related disease. Clin Genet 2016; DOI: 10.1111/cge.12784.
  • 3 Tan WH, Bird LM, Thibert RL, Williams CA. If not Angelman, what is it? A review of Angelman-like syndromes. Am J Med Genet A 2014; 164A (04) 975-992
  • 4 Florian C, Bahi-Buisson N, Bienvenu T. FOXG1-related disorders: from clinical description to molecular genetics. Mol Syndromol 2012; 2 (3-5): 153-163
  • 5 Peippo M, Ignatius J. Pitt-Hopkins syndrome. Mol Syndromol 2012; 2 (3-5): 171-180
  • 6 Smogavec M, Cleall A, Hoyer J. , et al. Eight further individuals with intellectual disability and epilepsy carrying bi-allelic CNTNAP2 aberrations allow delineation of the mutational and phenotypic spectrum. J Med Genet 2016; 53 (12) 820-827
  • 7 Schroer RJ, Holden KR, Tarpey PS. , et al. Natural history of Christianson syndrome. Am J Med Genet A 2010; 152A (11) 2775-2783
  • 8 Lambert L, Bienvenu T, Allou L. , et al. MEF2C mutations are a rare cause of Rett or severe Rett-like encephalopathies. Clin Genet 2012; 82 (05) 499-501
  • 9 Novara F, Beri S, Giorda R. , et al. Refining the phenotype associated with MEF2C haploinsufficiency. Clin Genet 2010; 78 (05) 471-477
  • 10 Zweier M, Rauch A. The MEF2C-related and 5q14.3q15 microdeletion syndrome. Mol Syndromol 2012; 2 (3-5): 164-170
  • 11 Nowakowska BA, Obersztyn E, Szymańska K. , et al. Severe mental retardation, seizures, and hypotonia due to deletions of MEF2C. Am J Med Genet B Neuropsychiatr Genet 2010; 153B (05) 1042-1051
  • 12 Le Meur N, Holder-Espinasse M, Jaillard S. , et al. MEF2C haploinsufficiency caused by either microdeletion of the 5q14.3 region or mutation is responsible for severe mental retardation with stereotypic movements, epilepsy and/or cerebral malformations. J Med Genet 2010; 47 (01) 22-29
  • 13 Rocha H, Sampaio M, Rocha R, Fernandes S, Leão M. MEF2C haploinsufficiency syndrome: report of a new MEF2C mutation and review. Eur J Med Genet 2016; 59 (09) 478-482
  • 14 Tanteles GA, Alexandrou A, Evangelidou P, Gavatha M, Anastasiadou V, Sismani C. Partial MEF2C deletion in a Cypriot patient with severe intellectual disability and a jugular fossa malformation: review of the literature. Am J Med Genet A 2015; 167A (03) 664-669
  • 15 Cesaretti C, Spaccini L, Righini A. , et al. Prenatal detection of 5q14.3 duplication including MEF2C and brain phenotype. Am J Med Genet A 2016; 170A (05) 1352-1357
  • 16 Engels H, Wohlleber E, Zink A. , et al. A novel microdeletion syndrome involving 5q14.3-q15: clinical and molecular cytogenetic characterization of three patients. Eur J Hum Genet 2009; 17 (12) 1592-1599
  • 17 Zweier M, Gregor A, Zweier C. , et al; Cornelia Kraus. Mutations in MEF2C from the 5q14.3q15 microdeletion syndrome region are a frequent cause of severe mental retardation and diminish MECP2 and CDKL5 expression. Hum Mutat 2010; 31 (06) 722-733
  • 18 Bienvenu T, Diebold B, Chelly J, Isidor B. Refining the phenotype associated with MEF2C point mutations. Neurogenetics 2013; 14 (01) 71-75
  • 19 Lin Q, Schwarz J, Bucana C, Olson EN. Control of mouse cardiac morphogenesis and myogenesis by transcription factor MEF2C. Science 1997; 276 (5317): 1404-1407
  • 20 Deprez L, Weckhuysen S, Holmgren P. , et al. Clinical spectrum of early-onset epileptic encephalopathies associated with STXBP1 mutations. Neurology 2010; 75 (13) 1159-1165
  • 21 Saitsu H, Kato M, Mizuguchi T. , et al. De novo mutations in the gene encoding STXBP1 (MUNC18-1) cause early infantile epileptic encephalopathy. Nat Genet 2008; 40 (06) 782-788
  • 22 Costales JL, Kolevzon A. Phelan-McDermid syndrome and SHANK3: implications for treatment. Neurotherapeutics 2015; 12 (03) 620-630
  • 23 Edery P, Chabrier S, Ceballos-Picot I, Marie S, Vincent M-F, Tardieu M. Intrafamilial variability in the phenotypic expression of adenylosuccinate lyase deficiency: a report on three patients. Am J Med Genet A 2003; 120A (02) 185-190
  • 24 Garavelli L, Mainardi PC. Mowat-Wilson syndrome. Orphanet J Rare Dis 2007; 2 (01) 42
  • 25 Gitiaux C, Ceballos-Picot I, Marie S. , et al. Misleading behavioural phenotype with adenylosuccinate lyase deficiency. Eur J Hum Genet 2009; 17 (01) 133-136
  • 26 Spiegel EK, Colman RF, Patterson D. Adenylosuccinate lyase deficiency. Mol Genet Metab 2006; 89 (1-2): 19-31
  • 27 Jurecka A, Zikanova M, Kmoch S, Tylki-Szymańska A. Adenylosuccinate lyase deficiency. J Inherit Metab Dis 2015; 38 (02) 231-242
  • 28 Tran Mau-Them F, Willems M, Albrecht B. , et al. Expanding the phenotype of IQSEC2 mutations: truncating mutations in severe intellectual disability. Eur J Hum Genet 2014; 22 (02) 289-292
  • 29 Al-Shehhi M, Betts D, Mc Ardle L, Donoghue V, Reardon W. Jugular pit associated with 5q14.3 deletion incorporating the MEF2C locus: a recurrent clinical finding. Clin Dysmorphol 2016; 25 (01) 23-26
  • 30 Verzi MP, Agarwal P, Brown C, McCulley DJ, Schwarz JJ, Black BL. The transcription factor MEF2C is required for craniofacial development. Dev Cell 2007; 12 (04) 645-652
  • 31 Verzi MP, McCulley DJ, De Val S, Dodou E, Black BL. The right ventricle, outflow tract, and ventricular septum comprise a restricted expression domain within the secondary/anterior heart field. Dev Biol 2005; 287 (01) 134-145
  • 32 Cardoso C, Boys A, Parrini E. , et al. Periventricular heterotopia, mental retardation, and epilepsy associated with 5q14.3-q15 deletion. Neurology 2009; 72 (09) 784-792
  • 33 Carr CW, Zimmerman HH, Martin CL, Vikkula M, Byrd AC, Abdul-Rahman OA. 5q14.3 neurocutaneous syndrome: a novel continguous gene syndrome caused by simultaneous deletion of RASA1 and MEF2C. Am J Med Genet A 2011; 155A (07) 1640-1645
  • 34 Lin Q, Lu J, Yanagisawa H. , et al. Requirement of the MADS-box transcription factor MEF2C for vascular development. Development 1998; 125 (22) 4565-4574
  • 35 Novara F, Rizzo A, Bedini G. , et al. MEF2C deletions and mutations versus duplications: a clinical comparison. Eur J Med Genet 2013; 56 (05) 260-265
  • 36 Berland S, Houge G. Late-onset gain of skills and peculiar jugular pit in an 11-year-old girl with 5q14.3 microdeletion including MEF2C. Clin Dysmorphol 2010; 19 (04) 222-224
  • 37 Paciorkowski AR, Traylor RN, Rosenfeld JA. , et al. MEF2C haploinsufficiency features consistent hyperkinesis, variable epilepsy, and has a role in dorsal and ventral neuronal developmental pathways. Neurogenetics 2013; 14 (02) 99-111
  • 38 Seltzer LE, Paciorkowski AR. Genetic disorders associated with postnatal microcephaly. Am J Med Genet C Semin Med Genet 2014; 166C (02) 140-155
  • 39 Fehr S, Wilson M, Downs J. , et al. The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy. Eur J Hum Genet 2013; 21 (03) 266-273
  • 40 Hagberg G, Stenbom Y, Engerström IW. Head growth in Rett syndrome. Brain Dev 2001; 23 (Suppl. 01) S227-S229
  • 41 Neul JL, Kaufmann WE, Glaze DG. , et al; RettSearch Consortium. Rett syndrome: revised diagnostic criteria and nomenclature. Ann Neurol 2010; 68 (06) 944-950
  • 42 Olson HE, Tambunan D, LaCoursiere C. , et al. Mutations in epilepsy and intellectual disability genes in patients with features of Rett syndrome. Am J Med Genet A 2015; 167A (09) 2017-2025
  • 43 Hoffjan S, Ibisler A, Tschentscher A, Dekomien G, Bidinost C, Rosa AL. WDR45 mutations in Rett (-like) syndrome and developmental delay: case report and an appraisal of the literature. Mol Cell Probes 2016; 30 (01) 44-49
  • 44 Hayflick SJ, Kruer MC, Gregory A. , et al. b-Propeller protein-associated neurodegeneration: a new X-linked dominant disorder with brain iron accumulation. Brain 2013; 136 (Pt 6): 1708-1717
  • 45 Strauss KA, Puffenberger EG, Huentelman MJ. , et al. Recessive symptomatic focal epilepsy and mutant contactin-associated protein-like 2. N Engl J Med 2006; 354: 1370-1377