Genetic Insights Into Hypothalamic Hamartoma: Unraveling Somatic Variants
Lina Sami1, Mathilde Chipaux1, Sarah Ferrand-Sorbets1
1From the Institut du Cerveau-Paris Brain Institute-ICM (L.S., M.D., J.-M.D.S.A., E.L., Sara Baldassari, Stephanie Baulac), Sorbonne Université, Inserm, CNRS, Hôpital de la Pitié Salpêtrière; Department of Pediatric Neurosurgery (M.C., S.F.-S., C.B., E.R., S.R., G.D., R.C.), Rothschild Foundation Hospital EPICARE; Department of Medical Genetics (J.-M.D.S.A., E.L.), AP-HP, Sorbonne Université, Hôpital de la Pitié Salpêtrière; and Université de Paris Cité (H.A.-B.), service d'Anatomie Pathologique, AP-HP, Hôpital Lariboisière, DMU DREAM, Biobank BB-0033-00064, UMR 1141, INSERM, Paris, France.
This study identifies genetic causes for hypothalamic hamartomas (HHs), linking somatic variants in Shh and cilia genes, and a novel gene, TNK2, to this rare epilepsy disorder. Genetic testing of brain tissue is crucial for diagnosis.
Area of Science:
- Neurogenetics
- Developmental Neuroscience
- Epilepsy Research
Background:
- Hypothalamic hamartomas (HHs) are rare brain lesions causing drug-resistant epilepsy.
- Somatic variants in Sonic hedgehog (Shh) and primary cilia pathways are implicated in ~50% of nonsyndromic HHs.
Purpose of the Study:
- To investigate the genetic basis of HHs in a new cohort of 9 patients.
- To identify novel genetic contributors to HH development and associated epilepsy.
Main Methods:
- Recruited 9 HH cases (8 nonsyndromic, 4 type IV).
- Performed high-depth whole-exome sequencing on peripheral blood and surgical brain tissues.
- Analyzed somatic variants in known and novel HH-associated genes.
Main Results:
- Identified pathogenic somatic variants in known HH genes (GLI3, OFD1, PRKACA) in 7/9 cases.
- Discovered a novel 2-hit event in TNK2 (germline + somatic LOH) in one case.
- Confirmed the role of Shh and cilia pathway somatic variants in HH etiology.
Conclusions:
- Reinforces the significance of somatic variants in Shh and cilia genes for HHs.
- Highlights TNK2 as a potential novel gene involved in HH pathogenesis.
- Emphasizes brain mosaicism and genetic analysis of resected tissue for epilepsy disorders.
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