Thalamus, timing and TSC1 deletions

Tuberous Sclerosis. Tuberous Sclerosis Complex (TSC) is a neurodevelopmental disorder caused by lack of function of the TSC1 or TSC2 tumor suppressor gene. With respect to the Central Nervous System, this disease is characterized by so-called tubers, benign tumors consisting of dysplastic neurons that are highly epileptogenic. Accordingly, TSC is one of the most common causes of West Syndrome. However, there is also evidence for neurological dysfunction beyond tubers. Increasing evidence suggests that the mutations alone can result in abnormalities of neuronal networks, resulting in epilepsy, intellectual disability or autism. The thalamus appears to be a key structure that is affected by this dysfunction. Now, a recent study in Cell explores the effects of TSC1 deletions at different developmental stages with respect to neuronal development in the thalamus. Continue reading

DEPDC5, meet the mTOR pathway – a novel mechanism in genetic focal epilepsies

Variable foci. A few weeks ago, we discussed the recent gene finding in Familial Partial Epilepsy with Variable Foci, a rare but puzzling familial epilepsy syndrome. DEPDC5 was identified as the culprit gene. However, the potential function of the gene product left researcher scratching their heads. Now, a recent paper in Science suggests that DEPDC5 might interact with the mTOR pathway, the master regulator of growth. Should we reconsider the role of the mTOR pathway in genetic focal epilepsies? Continue reading

Dealing with the genetic incidentaloma – the ACMG recommendations on incidental findings in clinical exome and genome sequencing

Clinical genome sequencing. While exome and genome sequencing is widely used as a research tool, these technologies are also routinely applied in a clinical setting. As with many other data-rich diagnostic tests in medicine, there is an ongoing question on how to deal with potentially relevant findings that turn up indicentally. Now the American College of Medical Genetics and Genomics (ACMG) has released their long-expected recommendations on data return of incidental findings in clinical exome and genome sequencing. Their recommendations provide an interesting basis for discussion on what to do with genetic findings that are found by chance. Continue reading

STRADA mutations, mTOR activation and personalized medicine using rapamycin

Rapamycin. The mTOR pathway, known through its role in Tuberous Sclerosis Complex (TSC), becomes increasingly important in epilepsy. A wide range of epilepsies caused by brain malformations are due to mutations in genes involved in this pathway, and several neurodevelopmental disorders associated with macrocephaly, intellectual disability and epilepsy are known, where components of this pathway are altered due to germline mutations. For one of these disorders named PMSE (polyhydramnios, megalencephaly and symptomatic epilepsy), a recent paper in Science Translational Medicine reports the effects of treatment with rapamycin, an mTOR inhibitor. The results demonstrate that personalized medicine might in part be promising, asexisting drugs can be used in rare genetic diseases. Continue reading