Predicting and quantifying phenotypic consequences of genetic variants in rare disorders is a major challenge, particularly pertinent for 'actionable' genes such as thyroid hormone transporter MCT8 (encoded by the X-linked SLC16A2 gene), where loss-of-function (LoF) variants cause a rare neurodevelopmental and (treatable) metabolic disorder in males. The combination of deep phenotyping data with functional and computational tests and with outcomes in population cohorts, enabled us to: (i) identify the genetic aetiology of divergent clinical phenotypes of MCT8 deficiency with genotype-phenotype relationships present across survival and 24 out of 32 disease features; (ii) demonstrate a mild phenocopy in ~400,000 individuals with common genetic variants in MCT8; (iii) assess therapeutic effectiveness, which did not differ among LoF-categories; (iv) advance structural insights in normal and mutated MCT8 by delineating seven critical functional domains; (v) create a pathogenicity-severity MCT8 variant classifier that accurately predicted pathogenicity (AUC:0.91) and severity (AUC:0.86) for 8151 variants. Our information-dense mapping provides a generalizable approach to advance multiple dimensions of rare genetic disorders.

• MeSH
• Deep Learning * MeSH
• Child MeSH
• Adult MeSH
• Phenotype * MeSH
• Genetic Variation MeSH
• Genetic Association Studies MeSH
• Genomics methods   MeSH
• Thyroid Hormones metabolism   genetics   MeSH
• Humans MeSH
• X-Linked Intellectual Disability genetics   metabolism   MeSH
• Adolescent MeSH
• Loss of Function Mutation MeSH
• Child, Preschool MeSH
• Monocarboxylic Acid Transporters * genetics   metabolism   MeSH
• Severity of Illness Index MeSH
• Muscular Atrophy genetics   metabolism   pathology   MeSH
• Muscle Hypotonia genetics   metabolism   MeSH
• Symporters * genetics   metabolism   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: This cross-sectional study investigated the relationship between genetic variations in monocarboxylate transporter genes and blood lactate production and removal after high-intensity efforts in humans. The study was conducted to explore how genetic variations in the MCT1, MCT2, and MCT4 genes influenced lactate dynamics and to advance the field of sports genetics by pinpointing critical genetic markers that can enhance athletic performance and recovery. METHODS: 337 male athletes from Poland and the Czech Republic underwent two intermittent all-out Wingate tests. Before the tests, DNA samples were taken from each participant, and SNP (single nucleotide polymorphism) analysis was carried out. Two intermittent all-out tests were implemented, and lactate concentrations were assessed before and after these tests. RESULTS: Sprinters more frequently exhibited the haplotype TAC in the MCT2 gene, which was associated with an increase in the difference between maximum lactate and final lactate concentration. Additionally, this haplotype was linked to higher maximum lactate concentration and was more frequently observed in sprinters. The genotypic interactions AG/T- and GGxT- (MCT1 rs3789592 x MCT4 rs11323780), TTxTT (MCT1 rs12028967 x MCT2 rs3763979), and MCT1 rs7556664 x MCT4 rs11323780 were all associated with an increase in the difference between maximum lactate concentration and final lactate concentration. Conversely, the AGxGG (MCT1 rs3789592 x MCT2 rs995343) interaction was linked to a decrease in this difference. The relationship between maximum lactate concentration and genotypic interactions can be observed as follows: when ATxTT (MCT2 rs3763980 x MCT4 rs11323780) or CTxCT (MCT1 rs10857983 x MCT2 rs3763979) genotypic combinations are present, it leads to a decrease in maximum lactate concentration. Similarly, the combination of CTxCT (MCT1 rs4301628 x MCT2 rs3763979), CT x TT (MCT1 rs4301628 x MCT4 rs11323780), and CTxTT (MCT1 rs4301628 x MCT2 rs3763979) results in decreased maximum lactate concentration. CONCLUSIONS: The TAC haplotype (rs3763980, rs995343, rs3763979) in the MCT2 gene is associated with altered lactate clearance in sprinters, potentially affecting performance and recovery by elevating post-exercise lactate concentrations. While MCT4 rs11323780 is also identified as a significant variant in lactate metabolism, suggesting its role as a biomarker for sprinting performance, further investigation is necessary to clarify underlying mechanisms and consider additional factors. Based on elite male athletes from Poland and the Czech Republic, the study may not generalize to all sprinters or diverse athletic populations. Although genetic variants show promise as biomarkers for sprinting success, athletic performance is influenced by a complex interplay of genetics, environment, and training extending beyond MCT genes.

• MeSH
• Adult MeSH
• Genotype MeSH
• Haplotypes * MeSH
• Polymorphism, Single Nucleotide * MeSH
• Kinetics MeSH
• Lactic Acid * blood   metabolism   MeSH
• Humans MeSH
• Young Adult MeSH
• Monocarboxylic Acid Transporters * genetics   metabolism   MeSH
• Cross-Sectional Studies MeSH
• Athletes MeSH
• Muscle Proteins * genetics   metabolism   MeSH
• Symporters * genetics   metabolism   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

X-linked agammaglobulinemia (XLA) was one of the first inborn errors of immunity to be described. It is caused by pathogenic variants in the gene for Bruton tyrosine kinase (BTK), which has important functions in B cell development and maturation. Recurrent bacterial infections in the first two years of life and hypogammaglobulinemia with absent B cells in male patients are the most common symptoms. A four-month-old male patient underwent surgical removal of urachus persistens complicated with recurrent scar abscesses. Hypogammaglobulinemia (IgG, IgA, and IgM), low phagocytic activity, mild neutropenia, and a normal percentage of B cells were observed in the patient's immune laboratory profile. Over time, he suffered recurrent respiratory infections (otitis media and rhinosinusitis) and developed B cell depletion, but interestingly, this was with a normalisation of IgG and IgA levels along with undetectable IgM. Molecular-genetic testing confirmed the presence of the pathogenic variant c.1843C>T in the BTK gene, which is associated with a milder phenotype of XLA. Molecular-genetic testing uncovers the variability of clinical and laboratory features of apparently well-known inherited disorders. Patients with mild "leaky" XLA may have normal levels of non-functional or oligoclonal immunoglobulins.

• MeSH
• Agammaglobulinemia * genetics   diagnosis   MeSH
• Genetic Diseases, X-Linked * genetics   diagnosis   MeSH
• Genetic Testing * MeSH
• Infant MeSH
• Humans MeSH
• Agammaglobulinaemia Tyrosine Kinase * genetics   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

BACKGROUND: The oculo-facio-cardio-dental syndrome (OFCD) is an ultra-rare multiple congenital anomaly. This report describes clinical findings emphasising dental phenotype in five, molecularly confirmed, female cases from two Czech families. CASE PRESENTATION: Dental examinations were carried out. An orthopantomogram was taken in three patients, and all patients' intraoral cavities and teeth were photographed. Exome sequencing was performed in both probands. Results were validated by Sanger DNA sequencing which was also used to follow segregation of the variants in first-degree relatives. Dental abnormalities and congenital cataracts were present in all five cases, whilst other signs were variable and included facial dysmorphism, microphthalmia, and cardiac and skeletal abnormalities. Two individuals had cleft lip and/or cleft palate. Radiculomegaly occurred in three patients with permanent teeth and was diagnosed on orthopantomograms. Two patients had agenesis of permanent teeth. Malocclusion was also present in two patients due to crowding and a Class III malocclusion and mandibular overjet. De novo novel pathogenic variants in the BCOR gene were identified; c.2382del p.(Lys795Argfs*12) and c.3914dup p.(Gln1306Alafs*20) and co-segregated with the disease in each family. CONCLUSIONS: The OFCD syndrome has a unique dental phenotype and dentists should be aware of signs of this ultra-rare genetic disorder. All patients with congenital cataracts and dental abnormalities, including those without a family history, should be referred for genetic testing and indicated to specialised dental care.

• MeSH
• Eye Abnormalities genetics   MeSH
• Tooth Abnormalities * genetics   MeSH
• Heart Septal Defects MeSH
• Child MeSH
• Adult MeSH
• Phenotype MeSH
• Genetic Diseases, X-Linked MeSH
• Cataract genetics   congenital   MeSH
• Humans MeSH
• Microphthalmos * genetics   MeSH
• Adolescent MeSH
• Abnormalities, Multiple genetics   MeSH
• Proto-Oncogene Proteins * genetics   MeSH
• Radiography, Panoramic MeSH
• Repressor Proteins * genetics   MeSH
• Pedigree MeSH
• Heart Defects, Congenital genetics   complications   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Geographicals
• Czech Republic MeSH

Mutations in UBA1, which are disease-defining for VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, have been reported in patients diagnosed with myelodysplastic syndromes (MDS). Here, we define the prevalence and clinical associations of UBA1 mutations in a representative cohort of patients with MDS. Digital droplet polymerase chain reaction profiling of a selected cohort of 375 male patients lacking MDS disease-defining mutations or established World Health Organization (WHO) disease classification identified 28 patients (7%) with UBA1 p.M41T/V/L mutations. Using targeted sequencing of UBA1 in a representative MDS cohort (n = 2027), we identified an additional 27 variants in 26 patients (1%), which we classified as likely/pathogenic (n = 12) and of unknown significance (n = 15). Among the total 40 patients with likely/pathogenic variants (2%), all were male and 63% were classified by WHO 2016 criteria as MDS with multilineage dysplasia or MDS with single-lineage dysplasia. Patients had a median of 1 additional myeloid gene mutation, often in TET2 (n = 12), DNMT3A (n = 10), ASXL1 (n = 3), or SF3B1 (n = 3). Retrospective clinical review, where possible, showed that 82% (28/34) UBA1-mutant cases had VEXAS syndrome-associated diagnoses or inflammatory clinical presentation. The prevalence of UBA1 mutations in patients with MDS argues for systematic screening for UBA1 in the management of MDS.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Mutation * MeSH
• Myelodysplastic Syndromes * genetics   diagnosis   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Ubiquitin-Activating Enzymes * genetics   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Dyskeratosis congenita (DC) is a rare inherited bone marrow failure syndrome, caused by genetic mutations that principally affect telomere biology. Approximately 35% of cases remain uncharacterised at the genetic level. To explore the genetic landscape, we conducted genetic studies on a large collection of clinically diagnosed cases of DC as well as cases exhibiting features resembling DC, referred to as 'DC-like' (DCL). This led us to identify several novel pathogenic variants within known genetic loci and in the novel X-linked gene, POLA1. In addition, we have also identified several novel variants in POT1 and ZCCHC8 in multiple cases from different families expanding the allelic series of DC and DCL phenotypes. Functional characterisation of novel POLA1 and POT1 variants, revealed pathogenic effects on protein-protein interactions with primase, CTC1-STN1-TEN1 (CST) and shelterin subunit complexes, that are critical for telomere maintenance. ZCCHC8 variants demonstrated ZCCHC8 deficiency and signs of pervasive transcription, triggering inflammation in patients' blood. In conclusion, our studies expand the current genetic architecture and broaden our understanding of disease mechanisms underlying DC and DCL disorders.

• MeSH
• Child MeSH
• Dyskeratosis Congenita * genetics   MeSH
• Humans MeSH
• Mutation MeSH
• Telomere-Binding Proteins * genetics   metabolism   MeSH
• Shelterin Complex MeSH
• Telomere * genetics   metabolism   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Schimke immuno-osseous dysplasia is a rare multisystemic disorder caused by biallelic loss of function of the SMARCAL1 gene that plays a pivotal role in replication fork stabilization and thus DNA repair. Individuals affected from this disease suffer from disproportionate growth failure, steroid resistant nephrotic syndrome leading to renal failure and primary immunodeficiency mediated by T cell lymphopenia. With infectious complications being the leading cause of death in this disease, researching the nature of the immunodeficiency is crucial, particularly as the state is exacerbated by loss of antibodies due to nephrotic syndrome or immunosuppressive treatment. Building on previous findings that identified the loss of IL-7 receptor expression as a possible cause of the immunodeficiency and increased sensitivity to radiation-induced damage, we have employed spectral cytometry and multiplex RNA-sequencing to assess the phenotype and function of T cells ex-vivo and to study changes induced by in-vitro UV irradiation and reaction of cells to the presence of IL-7. Our findings highlight the mature phenotype of T cells with proinflammatory Th1 skew and signs of exhaustion and lack of response to IL-7. UV light irradiation caused a severe increase in the apoptosis of T cells, however the expression of the genes related to immune response and regulation remained surprisingly similar to healthy cells. Due to the disease's rarity, more studies will be necessary for complete understanding of this unique immunodeficiency.

• MeSH
• Apoptosis genetics   MeSH
• Arteriosclerosis genetics   etiology   immunology   MeSH
• Child MeSH
• DNA Helicases genetics   MeSH
• Humans MeSH
• Bone Diseases, Metabolic etiology   genetics   MeSH
• Nephrotic Syndrome etiology   genetics   MeSH
• DNA Repair * genetics   MeSH
• Osteochondrodysplasias * genetics   immunology   MeSH
• Pulmonary Embolism genetics   etiology   MeSH
• Growth Disorders genetics   etiology   MeSH
• Primary Immunodeficiency Diseases * genetics   diagnosis   immunology   MeSH
• Immunologic Deficiency Syndromes genetics   immunology   MeSH
• T-Lymphocytes immunology   MeSH
• Ultraviolet Rays adverse effects   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Altered cholesterol, oxysterol, sphingolipid, and fatty acid concentrations are reported in blood, cerebrospinal fluid, and brain tissue of people with relapsing-remitting multiple sclerosis (RRMS) and are linked to disease progression and treatment responses. CD4 + T cells are pathogenic in RRMS, and defective T-cell function could be mediated in part by liver X receptors (LXRs)-nuclear receptors that regulate lipid homeostasis and immunity. RNA-sequencing and pathway analysis identified that genes within the 'lipid metabolism' and 'signalling of nuclear receptors' pathways were dysregulated in CD4 + T cells isolated from RRMS patients compared with healthy donors. While LXRB and genes associated with cholesterol metabolism were upregulated, other T-cell LXR-target genes, including genes involved in cellular lipid uptake (inducible degrader of the LDL receptor, IDOL), and the rate-limiting enzyme for glycosphingolipid biosynthesis (UDP-glucosylceramide synthase, UGCG) were downregulated in T cells from patients with RRMS compared to healthy donors. Correspondingly, plasma membrane glycosphingolipids were reduced, and cholesterol levels increased in RRMS CD4 + T cells, an effect partially recapitulated in healthy T cells by in vitro culture with T-cell receptor stimulation in the presence of serum from RRMS patients. Notably, stimulation with LXR-agonist GW3965 normalized membrane cholesterol levels, and reduced proliferation and IL17 cytokine production in RRMS CD4 + T-cells. Thus, LXR-mediated lipid metabolism pathways were dysregulated in T cells from patients with RRMS and could contribute to RRMS pathogenesis. Therapies that modify lipid metabolism could help restore immune cell function.

• MeSH
• CD4-Positive T-Lymphocytes * immunology   metabolism   MeSH
• Cholesterol metabolism   MeSH
• Adult MeSH
• Glycosphingolipids metabolism   MeSH
• Liver X Receptors * metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lipid Metabolism * MeSH
• Multiple Sclerosis, Relapsing-Remitting * immunology   metabolism   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Genová terapie (GT) se postupně stává běžným způsobem léčby. Již není výsadou velkých univerzitních pracovišť, jejichž laboratoře zvládají analytické postupy zaměřené na nukleové kyseliny a jejichž klinické týmy zvládají aplikaci. Původně byla určena pro dědičné choroby, které vzhledem ke svému řídkému výskytu byly označovány jako vzácná onemocnění a GT se dosud uplatňovala jen u dětí, aby působila ještě před rozvojem onemocnění. Nové způsoby léčby začaly být používány i u chorob běžných, jakými jsou např. metabolické poruchy (diabetes), a dokonce u takových, které nás sužují stále častěji, jako nejrůznější malignity a nemoci centrální nervové soustavy (např. Alzheimerova choroba). Cílem genové terapie jsou geny, jejichž změny v podobě patogenních variant (dříve mutací) vyvolávají poruchy fenotypu. Naší snahou je buď jejich vyřazení z funkce (např. u hemoglobinopatií), nebo jejich nahrazení geny s normální funkcí. Ty lze do genomu vnést pomocí některého z vhodných přenašečů (tzv. vektorů), jakými jsou např. viry nebo lipozomy. Proces GT může probíhat přímo v těle pacienta (in vivo), nebo mimo něj na jeho izolovaných buňkách (ex vivo), kterými jsou obvykle indukované pluripotentní kmenové buňky (iPSC – induced pluripotent stem cell). Po úpravě se tyto buňky vracejí do pacientova těla, aby tak naplnily svůj „úděl“. V širším slova smyslu může být GT namířena i na produkt genové transkripce, kterým je messenger RNA (mRNA), nebo konečný produkt realizace genové funkce, jakým jsou funkční bílkoviny (např. u cystické fibrózy). U různých chorob se úspěšně používají uvedené přístupy v závislosti na jejich dostupnosti, která je mimo jiné dána i náklady s GT spojenými nebo přístupností cílové tkáně. Nejen ověřování účinnosti a bezpečnosti GT, ale i ekonomické důvody rozhodují o tom, proč se GT rozvíjí jen pozvolna a proč se jí ujímají většinou jen velké a bohaté instituce. Rozhodující je také to, že celý proces vývoje od výchozích experimentálních prací přes klinické zkoušky až ke konečnému přípravku běžně trvá i dekádu či déle.

Gene therapy is gradually becoming a mainstream treatment modality and is no longer the preserve of large university departments whose laboratories master nucleic acid analytical procedures and whose clinical teams manage its administration. It was originally designed for genetic diseases that, because of their prevalence, were a group known as rare diseases. Gene therapy has so far been applied in children to act before the disease development. These new treatments have also begun to be applied for common diseases such as metabolic disorders (e. g. diabetes) and even for those that are increasingly affecting us, such as various malignancies and diseases of the central nervous system (e. g. Alzheimer’s disease). The targets targeted by GT are genes, where pathogenic alterations in the form of pathogenic variants (formerly mutations) induce phenotypic disorders, and our aim is either to knock them out of function (e. g. haemoglobinopathies) or to replace them with genes with normal function, which we introduce into the genome using one of the appropriate vectors, such as viruses or liposomes. The process of GT can take place directly inside the patient's body (in vivo) or outside the body on isolated cells (ex vivo), which are usually stem cells (iPSCs, induced pluripotent stem cell). After treatment, these cells are returned to the patient's body to fulfil their "destiny". In a broader sense, GT can target the product of gene transcription, which is the messenger RNA, or the end product of gene function, such as functional proteins (eg. cystic fibrosis). Any of these approaches have been used successfully in various diseases, depending on their availability, which is determined, among other things, by the costs associated with GT or the accessibility of the target tissue. Ultimately, it is not only the validation of the efficacy and safety of GT, but also economic reasons that determine why GT has been slow to develop and is mostly undertaken only by large and wealthy institutions. Another decisive factor is that from initial experimental work through clinical trials, the whole process of its development normally takes up to a decade.

• MeSH
• Cystic Fibrosis genetics   therapy   MeSH
• alpha 1-Antitrypsin Deficiency genetics   therapy   MeSH
• Muscular Dystrophy, Duchenne genetics   therapy   MeSH
• Genetic Therapy * methods   MeSH
• Huntington Disease genetics   therapy   MeSH
• Hematologic Diseases genetics   therapy   MeSH
• Humans MeSH
• Myotonic Dystrophy genetics   therapy   MeSH
• Neoplasms genetics   therapy   MeSH
• Retinitis Pigmentosa genetics   therapy   MeSH
• Muscular Atrophy, Spinal genetics   therapy   MeSH
• Rare Diseases * genetics   therapy   MeSH
• Check Tag
• Humans MeSH

VEXAS syndrom (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) je vzácné autoinflamatorní onemocnění, způsobené somatickou mutací v genu UBA1 v hematopoetických progenitorových buňkách, které postihuje dospělé pacienty ve vyšším věku. Onemocnění se projevuje systémovými příznaky (horečky, únava), zánětlivými projevy na kůži, v oblasti očí, postižením plic, cév a chrupavek s přidruženými hematologickými symptomy, jako jsou makrocytární anémie, trombocytopenie a přítomnost vakuol v myeloidních a erytroidních prekurzorech. Zároveň je spojené se zvýšeným rizikem rozvoje maligního hematologického onemocnění. Většina pacientů je refrakterních vůči běžné protizánětlivé a imunosupresivní léčbě. Záněty a selhávání kostní dřeně často postupně vedou k závažným zdravotním komplikacím a významné mortalitě. V současné chvíli neexistuje efektivní standardizovaná léčba. Pro určitou skupinu nemocných je vhodnou terapií transplantace krvetvorných kmenových buněk, která může být kurativní. Dalšími možnostmi léčby mohou být hypometylační látky či léčiva cílící na dráhy cytokinů a zánětlivé odpovědi. Společně se souhrnnou informací o VEXAS syndromu zde prezentujeme dvě kazuistiky pacientů, u nichž jsme na našem pracovišti detekovali mutace v genu UBA1.

VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a rare autoinflammatory late-onset disease caused by the UBA1 gene somatic mutation in haematopoietic progenitor cells. In patients, we can observe systemic symptoms (fever and fatigue), inflammatory manifestations on the skin, in the eye area, and involvement of the lungs, blood vessels, and cartilage with associated haematological symptoms such as macrocytic anaemia, thrombocytopenia, and presence of vacuoles in myeloid and erythroid precursors. In most cases, patients are refractory to common anti-inflammatory and immunosuppressive treatments and have a higher risk of developing haematological malignancies. Subsequently, inflammation and bone marrow failure often lead to severe morbidity and significant mortality. Currently, there is no effective standardized therapy. Haematopoietic stem cell transplantation may be a suitable treatment for a specific group of patients. Hypomethylating agents and/or drugs targeting cytokine and inflammatory response pathways appear to be other therapeutic options. Together with an overview of VEXAS syndrome, we present two case reports of patients with the UBA1 mutations detected in our laboratory.

• Keywords
• syndrom VEXAS, gen UBA1,
• MeSH
• Diagnosis, Differential MeSH
• Genetic Diseases, X-Linked * diagnosis   drug therapy   genetics   classification   MeSH
• Hematopoietic Stem Cells pathology   MeSH
• Case Reports as Topic MeSH
• Humans MeSH
• Mutation genetics   MeSH
• Myelodysplastic Syndromes diagnosis   classification   pathology   MeSH
• Aged MeSH
• Vacuoles pathology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH