Andoni Echaniz-Laguna1,2,3, Jean-Marie Cuisset4, Lucie Guyant-Marechal5, Patrick Aubourg6,7, Laurent Kremer8,9, Naziha Baaloul10, Alain Verloes11, Kouider Beladgham12, Jimmy Perrot13, Bruno Francou14, Philippe Latour13. 1. Neurology Department, APHP, CHU de Bicêtre, 78 rue du Général Leclerc, 94276, Le Kremlin-Bicêtre Cedex, France. Andoni.echaniz-laguna@aphp.fr. 2. French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France. Andoni.echaniz-laguna@aphp.fr. 3. INSERM U1195 Paris-Sud University, 94276, Le Kremlin-Bicêtre, France. Andoni.echaniz-laguna@aphp.fr. 4. Pediatrics Department, CHU de Lille, Lille, France. 5. Genetics Department, CHU de Rouen, Rouen, France. 6. Department of Pediatric Neurology, APHP, Bicêtre University Hospital, Le Kremlin-Bicêtre, France. 7. Paris-Sud University, Inserm U 1169, Le Kremlin-Bicêtre, France. 8. Department of Neurology, Hôpitaux Universitaires, 67098, Strasbourg, France. 9. INSERM U1119, FMTS, UDS, Strasbourg, France. 10. , Constantine, Algeria. 11. Genetics Department, APHP, Robert Debré Hospital, Paris, France. 12. Department of Pediatrics, OPGI complex, Ain Temouchent, Algeria. 13. Biology and Pathology Department, Hospices Civils, Lyon, Bron, France. 14. Department of Molecular Genetics Pharmacogenomics and Hormonology, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France.
Abstract
Giant axonal neuropathy (GAN) is an autosomal recessive disease caused by mutations in the GAN gene encoding gigaxonin. Patients develop a progressive sensorimotor neuropathy affecting peripheral nervous system (PNS) and central nervous system (CNS). Methods: In this multicenter observational retrospective study, we recorded French patients with GAN mutations, and 10 patients were identified. Mean age of patients was 9.7 years (2-18), eight patients were female (80%), and all patients met infant developmental milestones and had a family history of consanguinity. Mean age at disease onset was 3.3 years (1-5), and progressive cerebellar ataxia and distal motor weakness were the initial symptoms in all cases. Proximal motor weakness and bulbar symptoms appeared at a mean age of 12 years (8-14), and patients used a wheelchair at a mean age of 16 years (14-18). One patient died at age 18 years from aspiration pneumonia. In all cases, nerve conduction studies showed a mixed demyelinating and axonal sensorimotor neuropathy and MRI showed brain and cerebellum white matter abnormalities. Polyneuropathy and encephalopathy both aggravated during the course of the disease. Patients also showed a variety of associated findings, including curly hair (100% of cases), pes cavus (80%), ophthalmic abnormalities (30%), and scoliosis (30%). Five new GAN mutations were found, including the first synonymous mutation and a large intragenic deletion. Our findings expand the genotypic spectrum of GAN mutations, with relevant implications for molecular analysis of this gene, and confirm that GAN is an age-related progressive neurodegenerative disease involving PNS and CNS.
Giant axonal neuropathy (GAN) is an autosomal recessive disease caused by mutations in the GAN gene encoding gigaxonin. Patients develop a progressive sensorimotor neuropathy affecting peripheral nervous system (PNS) and central nervous system (CNS). Methods: In this multicenter observational retrospective study, we recorded French patients with GAN mutations, and 10 patients were identified. Mean age of patients was 9.7 years (2-18), eight patients were female (80%), and all patients met infant developmental milestones and had a family history of consanguinity. Mean age at disease onset was 3.3 years (1-5), and progressive cerebellar ataxia and distal motor weakness were the initial symptoms in all cases. Proximal motor weakness and bulbar symptoms appeared at a mean age of 12 years (8-14), and patients used a wheelchair at a mean age of 16 years (14-18). One patient died at age 18 years from aspiration pneumonia. In all cases, nerve conduction studies showed a mixed demyelinating and axonal sensorimotor neuropathy and MRI showed brain and cerebellum white matter abnormalities. Polyneuropathy and encephalopathy both aggravated during the course of the disease. Patients also showed a variety of associated findings, including curly hair (100% of cases), pes cavus (80%), ophthalmic abnormalities (30%), and scoliosis (30%). Five new GAN mutations were found, including the first synonymous mutation and a large intragenic deletion. Our findings expand the genotypic spectrum of GAN mutations, with relevant implications for molecular analysis of this gene, and confirm that GAN is an age-related progressive neurodegenerative disease involving PNS and CNS.
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