SYNGAP1-related intellectual disability explained

SYNGAP1-related intellectual disability is a monogenetic developmental and epileptic encephalopathy that affects the central nervous system.[1] [2] Symptoms include intellectual disability, epilepsy, autism, sensory processing deficits, hypotonia and unstable gait.[3] [4] [5]

Signs and symptoms

The first signs of SYNGAP1-related encephalopathy are typically gross motor delays in infancy followed by developmental delays, seizure onset and language impairment.[6] Penetrance is 100%. Mild to severe intellectual or developmental disability is present in the majority of patients.[7] Epilepsy is present in the majority of cases, with approximately 80-98% of patients affected by seizures.[8] Truncal hypotonia and clumsy or ataxic gait are typical. Behavioral and sleep problems are also common.[9] [10] Approximately 50% of patients receive a diagnosis of autism spectrum disorder. Some patients have significant feeding issues.[11] Constipation has also been reported.[12] Some patients experience strabismus.

Cause

SYNGAP1 encephalopathy is an autosomal dominant genetic disorder caused by haploinsufficiency of the SynGAP protein, usually due to the presence of a heterozygous protein-truncating loss-of-function variation on the SYNGAP1 gene. Missense variations, which may result in either a loss or a change-of-function can also result in the disorder. These pathogenic variations disrupt early cognitive development, particularly in the hippocampus and cortex.

The majority of mutations are considered de novo, however cases of inheritance from both somatic mosaic and germ-line mosaic parents have been reported.

Diagnosis

Diagnosis is based on genetic testing, with the recommended testing approach being chromosomal microarray analysis followed by an intellectual disability multigene panel or whole exome sequencing. A diagnosis is established following the identification of a heterozygous pathogenic (or likely pathogenic) point mutation of the SYNGAP1 gene (present in approximately 89% of patients), a micro deletion of chromosome 6 incorporating SYNGAP1 (approximately 11% of patients), or a balanced translocation disrupting SYNGAP1.[13]

Electroencephalography (EEG) monitoring frequently shows generalized epilepsy, predominantly in the occipital regions. Seizure onset usually occurs around 2 years of age.[14] MRI is usually normal.[15]

Seizure types

SYNGAP1-related encephalopathy can result in a specific seizure type, characterized by eyelid myoclonia followed by an atonic drop. Reflex seizures are also seen, often triggered by eating and photosensitivity.[16]

Differential diagnosis

Treatment

There is currently no cure or definitive treatment. Epilepsy may be controlled by the use of one or more anti-epileptic drugs, vagus nerve stimulation, or the ketogenic diet in some cases. Approximately half of patients have seizures that are pharmacoresistant. Patients with significant feeding issues may require the use of a gastrostomy tube. Communication may be supported with the use of an augmentative and alternative communication device. Patients with significant mobility or gait issues may require the use of wheelchairs, adaptive strollers or ankle-foot orthoses.

Supportive treatments can include:[18]

Prognosis

Despite the common mechanism of haploinsufficiency, there is distinct phenotypic variability amongst patients. Although one third of patients are non-verbal, others can communicate with single words, while others can speak conversationally using four to five word sentences.

Epidemiology

SYNGAP1 encephalopathy is estimated to comprise approximately 0.7–2% of all cases of intellectual disability[19] [20] [21] with over one million people expected to be affected worldwide.[22] [23] The SynGAP Research Fund, a US patient advocacy group, reviewed all the studies that support these estimates. SRF pointed to a more recent study by Lopez-Riviera et al. that predicts an incidence per 100,000 births of 6.107.[24]

History

Although the SynGAP protein was first identified in 1998,[25] SYNGAP1 mutations were not found to be responsible for cases of intellectual disability until 2009.[26]

On October 1, 2021, the first ICD-10 Code for SYNGAP1-related disorders became effective.

On August 11, 2021, SYNGAP1-related Disorders was included in the Social Security Administration list of diseases for Compassionate Use.

Research and potential therapies

The use of antisense oligonucleotides to up-regulate the expression of SynGAP protein is currently being researched.[27] The use of statins to address the downstream impacts of loss of SynGAP function on the Ras signaling pathway is also being studied.[28]

Three patient registry efforts are run by third parties and currently gathering patient data:

  1. The Ciitizen SYNGAP1 Registry, established in collaboration with the SynGAP Research Fund
  2. The Simons Searchlight Study supported by the Simons Foundation
  3. The SYNGAP1 Registry supported by the SYNGAP1 Foundation in partnership with the National Organization of Rare Disorders

There are multiple academic labs publicly working on potential therapies for SYNGAP1:

A number of companies have also demonstrated interest in SYNGAP1. Stoke Therapeutics has a published patent for SYNGAP1, Praxis Precision Medicines and Q-State Biosciences have listed SYNGAP1 on their treatment pipelines.

External links

Notes and References

  1. Web site: SYNGAP1-related non-syndromic intellectual disability - About the Disease - Genetic and Rare Diseases Information Center . 2022-12-30 . rarediseases.info.nih.gov . en.
  2. Jeyabalan N, Clement JP . SYNGAP1: Mind the Gap . English . Frontiers in Cellular Neuroscience . 10 . 32 . 2016 . 26912996 . 4753466 . 10.3389/fncel.2016.00032 . free .
  3. Web site: SYNGAP1-Related Epilepsy. 2021-12-29. Epilepsy Foundation. en.
  4. Web site: SYNGAP1 Gene Mutation. 2021-12-29. www.kennedykrieger.org. en.
  5. Web site: SYNGAP1-Related Disorder . 2022-12-30 . Child Neurology Foundation.
  6. Web site: 4 August 2020. SYNGAP1-related intellectual disability. 9 August 2020. MedlinePlus . US National Library of Medicine.
  7. Book: Holder JL, Hamdan FF, Michaud JL . SYNGAP1-Related Intellectual Disability. 21 February 2019. http://www.ncbi.nlm.nih.gov/books/NBK537721/. GeneReviews®. Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJ, Mirzaa G, Amemiya A . Seattle (WA). University of Washington, Seattle . Review. 2 April 2024. National Library of Medicine. Bookshelf ID NBK537721. 30789692.
  8. Vlaskamp DR, Shaw BJ, Burgess R, Mei D, Montomoli M, Xie H, Myers CT, Bennett MF, XiangWei W, Williams D, Maas SM, Brooks AS, Mancini GM, van de Laar IM, van Hagen JM, Ware TL, Webster RI, Malone S, Berkovic SF, Kalnins RM, Sicca F, Korenke GC, van Ravenswaaij-Arts CM, Hildebrand MS, Mefford HC, Jiang Y, Guerrini R, Scheffer IE . 6 . SYNGAP1 encephalopathy: A distinctive generalized developmental and epileptic encephalopathy . Neurology . 92 . 2 . e96–e107 . January 2019 . 30541864 . 6340340 . 10.1212/WNL.0000000000006729 .
  9. Wright D, Kenny A, Eley S, McKechanie AG, Stanfield AC . Clinical and behavioural features of SYNGAP1-related intellectual disability: a parent and caregiver description . Journal of Neurodevelopmental Disorders . 14 . 1 . 34 . June 2022 . 35655128 . 9164368 . 10.1186/s11689-022-09437-x . free .
  10. Mignot C, von Stülpnagel C, Nava C, Ville D, Sanlaville D, Lesca G, Rastetter A, Gachet B, Marie Y, Korenke GC, Borggraefe I, Hoffmann-Zacharska D, Szczepanik E, Rudzka-Dybała M, Yiş U, Çağlayan H, Isapof A, Marey I, Panagiotakaki E, Korff C, Rossier E, Riess A, Beck-Woedl S, Rauch A, Zweier C, Hoyer J, Reis A, Mironov M, Bobylova M, Mukhin K, Hernandez-Hernandez L, Maher B, Sisodiya S, Kuhn M, Glaeser D, Weckhuysen S, Myers CT, Mefford HC, Hörtnagel K, Biskup S, Lemke JR, Héron D, Kluger G, Depienne C . 6 . Genetic and neurodevelopmental spectrum of SYNGAP1-associated intellectual disability and epilepsy . Journal of Medical Genetics . 53 . 8 . 511–522 . August 2016 . 26989088 . 10.1136/jmedgenet-2015-103451 . 40830735 .
  11. Web site: Intellectual disability, autosomal dominant 5 - NIH Genetic Testing Registry (GTR) - NCBI . 2022-12-30 . www.ncbi.nlm.nih.gov.
  12. Web site: Simons Searchlight SYNGAP1. 2021-07-04. www.simonssearchlight.org. en-US.
  13. Berryer MH, Hamdan FF, Klitten LL, Møller RS, Carmant L, Schwartzentruber J, Patry L, Dobrzeniecka S, Rochefort D, Neugnot-Cerioli M, Lacaille JC, Niu Z, Eng CM, Yang Y, Palardy S, Belhumeur C, Rouleau GA, Tommerup N, Immken L, Beauchamp MH, Patel GS, Majewski J, Tarnopolsky MA, Scheffzek K, Hjalgrim H, Michaud JL, Di Cristo G . 6 . Mutations in SYNGAP1 cause intellectual disability, autism, and a specific form of epilepsy by inducing haploinsufficiency . Human Mutation . 34 . 2 . 385–394 . February 2013 . 23161826 . 10.1002/humu.22248 . 11397001 .
  14. Web site: Philadelphia. The Children's Hospital of. 2020-05-12. SYNGAP1-Related Disorders. 2021-07-04. www.chop.edu. en.
  15. Web site: SYNGAP1-related NSID . 2022-12-30 . NORD (National Organization for Rare Disorders) . en-US.
  16. von Stülpnagel C, Hartlieb T, Borggräfe I, Coppola A, Gennaro E, Eschermann K, Kiwull L, Kluger F, Krois I, Møller RS, Rössler F, Santulli L, Schwermer C, Wallacher-Scholz B, Zara F, Wolf P, Kluger G . 6 . Chewing induced reflex seizures ("eating epilepsy") and eye closure sensitivity as a common feature in pediatric patients with SYNGAP1 mutations: Review of literature and report of 8 cases . English . Seizure . 65 . 131–137 . February 2019 . 30685520 . 10.1016/j.seizure.2018.12.020 . 56595032 . free .
  17. Parker MJ, Fryer AE, Shears DJ, Lachlan KL, McKee SA, Magee AC, Mohammed S, Vasudevan PC, Park SM, Benoit V, Lederer D, Maystadt I, Study D, FitzPatrick DR . 6 . De novo, heterozygous, loss-of-function mutations in SYNGAP1 cause a syndromic form of intellectual disability . American Journal of Medical Genetics. Part A . 167A . 10 . 2231–2237 . October 2015 . 26079862 . 4744742 . 10.1002/ajmg.a.37189 .
  18. Web site: SYNGAP1-related NSID. 2020-07-24. NORD (National Organization for Rare Disorders). en-US.
  19. Web site: SYNGAP1-related intellectual disability: MedlinePlus Genetics . 2022-12-30 . medlineplus.gov . en.
  20. Fitzgerald TW, Gerety SS, Jones WD, Van Kogelenberg M, King DA, McRae J, Morley KI, Parthiban V, Al-Turki S, Ambridge K, Barrett DM, Bayzetinova T, Clayton S, Coomber EL, Gribble S, Jones P, Krishnappa N, Mason LE, Middleton A, Miller R, Prigmore E, Rajan D, Sifrim A, Tivey AR, Ahmed M, Akawi N, Andrews R, Anjum U, Archer H, etal . 6 . Deciphering Developmental Disorders Study . Large-scale discovery of novel genetic causes of developmental disorders . Nature . 519 . 7542 . 223–228 . March 2015 . 25533962 . 5955210 . 10.1038/nature14135 . 2015Natur.519..223T .
  21. Carvill GL, Heavin SB, Yendle SC, McMahon JM, O'Roak BJ, Cook J, Khan A, Dorschner MO, Weaver M, Calvert S, Malone S, Wallace G, Stanley T, Bye AM, Bleasel A, Howell KB, Kivity S, Mackay MT, Rodriguez-Casero V, Webster R, Korczyn A, Afawi Z, Zelnick N, Lerman-Sagie T, Lev D, Møller RS, Gill D, Andrade DM, Freeman JL, Sadleir LG, Shendure J, Berkovic SF, Scheffer IE, Mefford HC . 6 . Targeted resequencing in epileptic encephalopathies identifies de novo mutations in CHD2 and SYNGAP1 . Nature Genetics . 45 . 7 . 825–830 . July 2013 . 23708187 . 3704157 . 10.1038/ng.2646 .
  22. Hamdan FF, Daoud H, Piton A, Gauthier J, Dobrzeniecka S, Krebs MO, Joober R, Lacaille JC, Nadeau A, Milunsky JM, Wang Z, Carmant L, Mottron L, Beauchamp MH, Rouleau GA, Michaud JL . 6 . De novo SYNGAP1 mutations in nonsyndromic intellectual disability and autism . Biological Psychiatry . 69 . 9 . 898–901 . May 2011 . 21237447 . 10.1016/j.biopsych.2010.11.015 . Genes, Autism, and Associated Phenotypes . 11318735 .
  23. Krupp DR, Barnard RA, Duffourd Y, Evans SA, Mulqueen RM, Bernier R, Rivière JB, Fombonne E, O'Roak BJ . 6 . Exonic Mosaic Mutations Contribute Risk for Autism Spectrum Disorder . American Journal of Human Genetics . 101 . 3 . 369–390 . September 2017 . 28867142 . 5590950 . 10.1016/j.ajhg.2017.07.016 .
  24. López-Rivera JA, Pérez-Palma E, Symonds J, Lindy AS, McKnight DA, Leu C, Zuberi S, Brunklaus A, Møller RS, Lal D . 6 . A catalogue of new incidence estimates of monogenic neurodevelopmental disorders caused by de novo variants . Brain . 143 . 4 . 1099–1105 . April 2020 . 32168371 . 7174049 . 10.1093/brain/awaa051 .
  25. Gamache TR, Araki Y, Huganir RL . Twenty Years of SynGAP Research: From Synapses to Cognition . The Journal of Neuroscience . 40 . 8 . 1596–1605 . February 2020 . 32075947 . 7046327 . 10.1523/JNEUROSCI.0420-19.2020 .
  26. Hamdan FF, Gauthier J, Spiegelman D, Noreau A, Yang Y, Pellerin S, Dobrzeniecka S, Côté M, Perreau-Linck E, Carmant L, D'Anjou G, Fombonne E, Addington AM, Rapoport JL, Delisi LE, Krebs MO, Mouaffak F, Joober R, Mottron L, Drapeau P, Marineau C, Lafrenière RG, Lacaille JC, Rouleau GA, Michaud JL . 6 . Mutations in SYNGAP1 in autosomal nonsyndromic mental retardation . The New England Journal of Medicine . 360 . 6 . 599–605 . February 2009 . 19196676 . 2925262 . 10.1056/NEJMoa0805392 .
  27. Lim KH, Han Z, Jeon HY, Kach J, Jing E, Weyn-Vanhentenryck S, Downs M, Corrionero A, Oh R, Scharner J, Venkatesh A, Ji S, Liau G, Ticho B, Nash H, Aznarez I . 6 . Antisense oligonucleotide modulation of non-productive alternative splicing upregulates gene expression . Nature Communications . 11 . 1 . 3501 . July 2020 . 32647108 . 7347940 . 10.1038/s41467-020-17093-9 . 2020NatCo..11.3501L .
  28. Kluger G, von Stülpnagel-Steinbeis C, Arnold S, Eschermann K, Hartlieb T . Positive Short-Term Effect of Low-Dose Rosuvastatin in a Patient with SYNGAP1-Associated Epilepsy . Neuropediatrics . 50 . 4 . 266–267 . August 2019 . 30875700 . 10.1055/s-0039-1681066 . 80619705 .

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