Alpha-mannosidosis in Tunisian consanguineous families: Potential involvement of variants in GHR and SLC19A3 genes in the variable expressivity of cognitive impairment

• Published in: PloS one Vol. 16; no. 10; p. e0258202
• Main Authors: Mkaouar, Rahma, Riahi, Zied, Charfeddine, Cherine, Chelly, Imen, Boudabbous, Hela, Dallali, Hamza, Bonnet, Crystel, Hechmi, Meriem, Bekri, Soumeya, Zitouna, Nadia, Zekri, Lotfi, Tounsi, Amel, Kefi, Rym, Marrakchi, Jihene, Messaoud, Olfa, Kraoua, Ichraf, Maalej, Sonia, Turki Ben Youssef, Ilhem, Ben Hmid, Ahlem, Giraudet, Fabrice, Bouchoucha, Sami, Tebib, Neji, Besbes, Ghazi, Petit, Christine, Mrad, Ridha, Abdelhak, Sonia, Trabelsi, Mediha
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 06.10.2021; Public Library of Science (PLoS)
• Subjects: alpha-Mannosidosis; Audiometry; Base Sequence; Biology and Life Sciences; Carrier Proteins; Cognition disorders; Cognitive ability; Cognitive Dysfunction; Congenital diseases; Consanguinity; Diagnosis; Disease; Enzymatic activity; Enzymes; Epidemiology; Exome Sequencing; Family; Female; Genes; Genetic disorders; Genetic Predisposition to Disease; Genetics; Genomics; Geography; Health aspects; Hearing loss; Hospitals; Humans; Impairment; Intellectual disabilities; Laboratories; Life Sciences; Male; Mannosidase; Mannosidosis; Maxillofacial surgery; Medicine; Medicine and Health Sciences; Membrane Transport Proteins; Metabolic disorders; Missense mutation; Mutation; Neurology; Nicolle, Charles (1866-1936); Nonsense mutation; Otolaryngology; Patients; Pediatrics; Pedigree; Phenotype; Phenotypes; Prevention; Public health; Research and Analysis Methods; Risk factors; Sign language; Tunisia; Tunisia; France; Paris France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258202

Alpha-Mannosidosis (AM) is an ultra-rare storage disorder caused by a deficiency of lysosomal alpha-mannosidase encoded by the MAN2B1 gene. Clinical presentation of AM includes mental retardation, recurrent infections, hearing loss, dysmorphic features, and motor dysfunctions. AM has never been reported in Tunisia. We report here the clinical and genetic study of six patients from two Tunisian families with AM. The AM diagnosis was confirmed by an enzymatic activity assay. Genetic investigation was conducted by Sanger sequencing of the mutational hotspots for the first family and by ES analysis for the second one. In the first family, a frameshift duplication p.(Ser802GlnfsTer129) was identified in the MAN2B1 gene. For the second family, ES analysis led to the identification of a missense mutation p.(Arg229Trp) in the MAN2B1 gene in four affected family members. The p.(Ser802GlnfsTer129) mutation induces a premature termination codon which may trigger RNA degradation by the NMD system. The decrease in the levels of MAN2B1 synthesis could explain the severe phenotype observed in the index case. According to the literature, the p.(Arg229Trp) missense variant does not have an impact on MAN2B1 maturation and transportation, which correlates with a moderate clinical sub-type. To explain the intra-familial variability of cognitive impairment, exome analysis allowed the identification of two likely pathogenic variants in GHR and SLC19A3 genes potentially associated to cognitive decline. The present study raises awareness about underdiagnosis of AM in the region that deprives patients from accessing adequate care. Indeed, early diagnosis is critical in order to prevent disease progression and to propose enzyme replacement therapy.