Clinical, Neuroimaging, and Metabolic Footprint of the Neurodevelopmental Disorder Caused by Monoallelic HK1 Variants
Saskia B Wortmann1, Rene G Feichtinger1, Lucia Abela1
1From the University Children's Hospital Salzburg (S.B.W., R.G.F., J.A.M.), Austria; Amalia Children's Hospital (S.B.W., L.A.G., J. Hebbink, M.A.W.), Department of Pediatrics (Pediatric Neurology), Nijmegen, The Netherlands; Division of Child Neurology (L.A., E.B.), University Children's Hospital Zurich, Switzerland; Pediatric Neurology Department (M.A.), Necker-Enfants Malades University Hospital, Paris Cité University, APHP; Reference Centre for Mitochondrial Disorders (CARAMMEL) (C.-M.D.-B., M.S.), Hôpital Necker-Enfants-Malades, APHP, Université Paris Cité, Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163; 6Paediatric Radiology Department (N.B.), AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163France; Department of Toxicogenomics (R.C.), Research School of Mental Health and Neuroscience, Maastricht University, The Netherlands; Institute of Medical Genetics and Applied Genomics (L.S., T.B.H.), University of Tübingen; Praxis für Humangenetik (W.H.); Carl-Thiem-Klinikum Cottbus (W.H.); Center for Human Genetics Tübingen (J. Hildebrandt, N.H.); CeGaT GmbH (J. Hildebrandt, N.H.), Tübingen; Department Pediatrics (N.H., C.T.), Centre for Child and Adolescent Medicine, University of Heidelberg; Department of Neuropediatrics (C.K.), University Children's Hospital, Klinikum Oldenburg, Germany; University of British Columbia (A.L.), Vancouver, Canada; Royal Belfast Hospital for Sick Children (T.L.), Belfast, Northern Ireland; University Hospital (C. Makowski), LMU Munich, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Munich, Germany; Department of Neurology (R.J.M.M.), Hospital Universitario La Paz, Madrid, Spain; Reference Center for Intellectual Disabilities of Rare causes (P.M., M.R.), Federation de médecine Génomique des maladies Rares, APHP, Hôpital Necker-Enfants Malades, Paris, France; University Medical Centre Göttingen (C. Mühlhausen), Department of Pediatrics and Adolescent Medicine, Göttingen, Germany; Université Paris Cité (A.R.), Imagine Institute, Genetics of Mitochondrial Disorders, INSERM UMR 1163; Paediatric Radiology Department (C.-J.R), AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, Paris France; Division of Pediatric Epileptology (S.S.), Centre for Child and Adolescent Medicine, University of Heidelberg, Germany; Department of Neurology (S.A.Z.), LangeLand Hospital, Zoetermeer, The Netherlands; Metabolic Research Group (M.V.C., E.S.), de Duve Institute and UCLouvain, Brussels, Belgium; Technical University of Munich (M. Wagner), School of Medicine, Institute of Human Genetics, Munich, Germany; and Department of Human Genetics (R.A.W.), Translational Metabolic Laboratory (TML), Radboud University Medical Center, Nijmegen, The Netherlands.
Monoallelic variants in the Hexokinase 1 gene (HK1) cause neurodevelopmental disorders (NDD). A distinct cerebrospinal fluid biomarker profile, including low glucose and high lactate, aids in diagnosis and understanding disease mechanisms.
Area of Science:
- Biochemistry
- Genetics
- Neurology
Background:
- Hexokinase 1 (HK1) is crucial for glycolysis, catalyzing glucose phosphorylation.
- Monoallelic HK1 variants are linked to neurodevelopmental disorders (NDD).
Purpose of the Study:
- Investigate clinical, neuroimaging, and cerebrospinal fluid (CSF) findings in 15 individuals with NDD and monoallelic HK1 variants.
- Correlate genotype with phenotype and identify diagnostic biomarkers.
Main Methods:
- Clinical assessment of 15 previously unpublished individuals with monoallelic HK1 variants.
- Analysis of brain MRI scans and CSF samples.
- Genomic variant analysis.
Main Results:
- Recurrent, likely gain-of-function HK1 variants were identified.
- Two distinct phenotypes emerged: infantile-onset developmental and epileptic encephalopathy, and a biphasic course with later progressive deterioration.
- CSF analysis revealed low glucose and CSF/blood glucose ratio, with significantly elevated CSF lactate, differentiating it from glucose transporter type 1 deficiency syndrome.
Conclusions:
- Genotype-phenotype correlations for HK1 variants exist and can inform genetic counseling.
- A specific CSF biomarker profile (low glucose, low CSF/blood glucose, high lactate) suggests monoallelic HK1 variants in NDD.
- Hypothesized pathomechanisms involve progressive intoxication or energy deficiency.
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