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BEND4 as a Candidate Gene for an Infection-Induced Acute Encephalopathy Characterized by a Cyst and Calcification of
Bülent Kara1, Oya Uyguner2, Hülya Maraş Genç1
1Division of Child Neurology, Department of Pediatrics, Kocaeli University Medical Faculty, Izmit, Turkey.
Insights
Pathogenic variants in the BEND4 gene can cause acute necrotizing encephalopathy, triggered by infections. This genetic condition affects brain development and function in affected children.
Area of Science:
- Genetics
- Neuroscience
- Molecular Biology
Background:
- Normal brain development in three siblings was followed by acute neurological deterioration.
- Deterioration involved loss of motor, social, and language functions after infections.
- Neuroimaging revealed pontine cyst, calcification, and cerebellar atrophy.
Purpose of the Study:
- To identify the genetic cause of the observed neurological disorder.
- To investigate the functional consequences of the identified genetic variant.
Main Methods:
- Exome sequencing to identify genetic alterations.
- In silico analysis to predict the pathogenicity of variants.
- Immunofluorescence microscopy to analyze protein localization.
- Differential proteome analysis to identify affected cellular pathways.
Main Results:
- A homozygous c.1297G>A (p.Gly433Ser) alteration in the BEND4 gene was identified.
- The BEND4 variant segregated with the disease in affected family members.
- Mutant BEND4 showed altered cellular localization and affected endoplasmic reticulum protein levels (reticulocalbin-1, ER resident protein-29), impacting protein folding pathways.
Conclusions:
- Pathogenic BEND4 variants are associated with infection-induced acute necrotizing encephalopathy.
- This study identifies BEND4 as a novel gene linked to severe neurological disease.
- Disrupted protein folding due to BEND4 mutations may underlie the observed neurodegeneration.
Abstract:
Three siblings born to Turkish parents from the same village had normal brain development until acute neurological deterioration between 12 months and 8 years of age. Consequent loss of all acquired motor, social, and language functions following infections was associated with a pontine cyst, calcification, and cerebellar atrophy. Exome sequencing revealed a homozygous c.1297G>A (p.Gly433Ser) alteration in BEND4, which was predicted to be deleterious in in silico analysis tools and segregated in multiple affected individuals in the family. BEND4 has not been associated with any existing disease. Immunofluorescence microscopy analysis of wild-type and mutant BEND4 expressing Vero cells showed nuclear and cytoplasmic localization. Wild-type BEND4 displayed a network-like distribution, whereas mutant BEND4 showed a juxtanuclear distribution pattern. Differential proteome analysis of Vero cells expressing BEND4 revealed that mutant BEND4 expression caused selective increase in reticulocalbin-1 and endoplasmic reticulum resident protein-29. Both proteins are associated with the endoplasmic reticulum and are primarily involved in protein processing and folding pathways. Any defect or stress in protein folding creates stress on cells and may cause chronic damage. This is the first study showing that pathogenic BEND4 variants may lead to an infection-induced acute necrotizing encephalopathy as demonstrated in characteristic neuroimaging findings.
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