Mitochondrial Disorders Genetic Testing

Size: px
Start display at page:

Download "Mitochondrial Disorders Genetic Testing"

Transcription

1 Mitochondrial Disorders Genetic Testing A Comprehensive Guide

2 1

3 Introduction Mitochondrial disorders are a group of related, clinically diverse, genetic diseases with a prevalence of 1/5,000 to 1/8,500 that result from dysfunction of the mitochondrial respiratory chain. 1 They can be caused by defects in either the mitochondrial DNA (mtdna) or in nuclear genes. The heterogeneous clinical features and genetic causes make diagnosing mitochondrial disorders challenging. An accurate diagnosis is important for patient management and genetic counseling. CLINICAL INFORMATION Clinical Presentation Mitochondrial disorders may affect a single organ, but many involve multiple organ systems, particularly those that are highly dependent on aerobic metabolism, such as the brain, skeletal muscle, heart, kidney, and endocrine system (Figure 1). Patients may present at any age; however, nuclear DNA mutations generally present in childhood and mtdna mutations are more likely to present in late childhood or in adults. Some affected individuals exhibit clinical features that fall into discrete clinical syndromes, such as Leber s Hereditary Optic Neuropathy (LHON) and Kearns-Sayre syndrome (KSS) (Table 1). However, often the clinical features are highly variable and non-specific and many affected persons do not fit into one particular category. Similar clinical features can be caused by different mutations in mtdna or mutations in many different nuclear genes. Common features of mitochondrial disease may include: 1-4 Common Symptoms of Mitochondrial Disorders Ataxia Cardiomyopathy Chorea Chronic diarrhea or constipation Delayed gastric emptying Dementia Developmental delay /Intellectual disability Diabetes mellitus Exercise intolerance Failure to thrive Gastrointestinal reflux Hypotonia Liver failure Migraines Muscle weakness Optic atrophy Pigmentary retinopathy Progressive external ophthalmoplegia Ptosis Recurrent vomiting Seizures Sensorineural deafness Spasticity Stroke-like episodes MITOCHONDRIAL DISORDERS GUIDE 2

4 CLINICAL INFORMATION Table 1. Clinical syndromes of mitochondrial diseases (adapted from Chinnery, PF. 2010) Disorder Primary symptoms CPEO Eye muscle paralysis, droopy eyelids (both eyes) Late childhood- or adult-onset peripheral neuropathy, lack of muscular coordination, pigmentary retinopathy Stroke-like episodes at younger than 40, seizures, dementia, lactic acidosis and/or ragged red fibers NARP MELAS MEMSA Myopathy, seizures, cerebellar ataxia MERRF Muscle twitching, seizures, cerebellar ataxia, myopathy LHON Subacute bilateral painless visual failure Leigh Syndrome (LS) Onset in first year, psychomotor regression, respiratory failure, failure to thrive, hypotonia CPEO, chronic progressive external opthalmoplegia; NARP, neurologic weakness with ataxia and retinitis pigmentosa; MELAS, mitochondria encephalopathy with lactic acidosis and stroke-like episodes; MEMSA, myoclonic epilepsy myopathy sensory ataxia; MERRF, myoclonic epilepsy with ragged red fibers; LHON, Leber's Hereditary Optic Neuropathy Figure 1. Symptoms of Mitochondrial Disorders Heart Conduction disorder Wolff-Parkinson-White syndrome Cardiomyopathy Skeletal muscle Weakness Fatigue Myopathy Neuropathy Brain Seizures Myoclonus Ataxia Stroke Dementia Migraine Nuclear DNA Subunits Oxidative phosphorylation Eye Optic neuropathy Ophthalmoplegia Retinopathy Liver Hepatopathy ATP Kidney Fanconi s syndrome Glomerulopathy Mitochondrial DNA Pancreas Diabetes mellitus Nuclear DNA Colon Pseudo-obstruction 3 Inner ear Sensorineural hearing loss Blood Pearson s syndrome

5 Diagnosis Diagnosing patients with mitochondrial disorders is challenging due to the varied clinical presentation, genetic heterogeneity, and frequent need for invasive testing procedures. The diagnosis is typically considered in patients with progressive disorders involving multiple organ systems and is sometimes obvious if the patient exhibits one of the classic syndromes with stereotypical features such as MELAS, MERRF, LHON, NARP, or KSS. If the diagnosis is not obvious, the following studies can be used to help guide the diagnostic process: Family history: especially if a maternal inheritance pattern is present. Neuroimaging studies: CT and MRI. Functional studies: brain stem dysfunction, abnormal BAERS/ VERS/EEG, increased signal in the basal ganglia, delayed myelination, white matter abnormalities, cerebellar atrophy and lactate elevation on magnetic resonance spectroscopy (MRS). Laboratory investigations: lactate, pyruvate, lactate/pyruvate ratio, alanine, acylcarnitine profile and urine organic acids.* Muscle, liver and/or heart biopsy: assay of electron transport chain activity, light microscopy, and electron microscopy.* Genetic testing *Biochemical test results for mitochondrial disorders may not be reliable or reproducible, and rarely can the underlying etiology be determined without molecular studies. Molecular genetic testing is required to make a definitive diagnosis, provide guidance on management and prognosis, and permit accurate risk counseling. For mitochondrial disorders that result from mutations in nuclear genes, molecular genetic testing can also facilitate prenatal diagnosis. MITOCHONDRIAL DISORDERS GUIDE 4

6 Genetic Heterogeneity The inheritance pattern can be autosomal dominant, autosomal recessive, X-linked or maternal. Similar clinical features can be caused by mitochondrial (mtdna) variants or nuclear gene variants (genetic heterogeneity), and conversely, a variant in a single nuclear or mitochondrial gene may be associated with different clinical features (clinical heterogeneity). Symptoms may present at any age; however, individuals with nuclear DNA variants generally present in childhood and those with mtdna variants generally present in late childhood or in adults. Approximately 1,500 nuclear genes and the mitochondrial genome are involved in maintaining proper mitochondrial respiratory chain function. Each mitochondrion has multiple copies of mtdna and there are hundreds to thousands of mitochondria per cell, dependent on the cell type. The mtdna encodes for ribosomal RNAs (two genes), transfer RNAs (22 genes), and 13 proteins that are part of the respiratory chain. The other genes required for mitochondrial function are encoded in the nuclear genome (Figure 2). MtDNA variants can arise de novo (has arisen new in that individual and was not inherited from the mother) or are maternally inherited. In most cases, mtdna point variants are inherited, whereas large deletions arise de novo. Usually, mtdna pathogenic variants affect only a fraction of the mitochondria; the coexistence of normal and pathogenic mtdna is called heteroplasmy. When the percentage of pathogenic mtdna reaches a certain threshold, which varies by tissue type, age, and specific variant, the function of that tissue may become impaired. The pathogenic load varies within and between tissues, and the manifestation of mitochondrial disease reflects tissuespecific pathogenic load. However, access to the relevant tissues for testing is not always possible. 5

7 Due to the bottle neck effect, the inheritance of mitochondrial DNA disorders within families is difficult to predict: A mother can pass on a small proportion of pathogenic mtdna, or a very high proportion. In certain tissues, like blood, there may be selection against some of these variants, so that cells with normal mtdna are selectively retained. Therefore, results of genetic testing from the blood may not accurately reflect the heteroplasmy in the relevant tissue(s). Pathogenic variants in mtdna may only be identified in specific tissues, particularly those with a lower rate of cell division, such as skeletal muscle, heart, and brain. Disorders that arise from nuclear gene variants that affect mitochondrial function may be inherited in an autosomal dominant, autosomal recessive, or X-linked manner, and genetic testing from blood samples accurately reflects the genetic defect in all tissues. Figure 2. Mitochondrial genome and respiratory chain ND1 ND2 165 rrna 125 rrna Cyt b Complex I Complex III Complex IV Complex V Transfer RNA Ribosomal RNA Control region of DNA ND6 ND5 ND4 COXI COXII ATPase8 COXIII ND3 ND4L ATPase6 Matrix Succinate Fumarate O 2 ADP H 2 O ATP IMM ND1 ND2 ND3 COX I ND6 ND4 Cyt b COX II A8 ND5 ND4L CoQ COX III A6 IMS Complex I Complex II Complex III Cyt c Complex IV Complex V/ATP synthase mtdna-encoded subunits ndna-encoded subunits ~ ~16 The mitochondrial genome and mitochondrial respiratory chain (RC), showing ndna-encoded subunits (blue) and mtdnaencoded subunits (colors corresponding to the genes in the mitochondrial genome above). MITOCHONDRIAL DISORDERS GUIDE 6

8 7

9 Clinical Indications 1. Diagnostic testing in an individual with a mitochondrial disorder a. Confirm a clinical diagnosis of a specific genetic syndrome or type of mitochondrial disorder b. Provide information about prognosis 2. Assistance with selection of optimal treatment options 3. Predictive testing for asymptomatic family members of a proband with a known pathogenic variant associated with a genetic form of mitochondrial disease a. Enable clinical monitoring, follow-up, and optimal treatment when symptoms develop in an individual with a positive result b. Reduce anxiety and forego clinical monitoring if result is negative 4. Prenatal diagnosis in at-risk pregnancies for known, pathogenic variants in nuclear genes TEST INFORMATION 5. Genetic counseling, recurrence risk determination, and family planning MITOCHONDRIAL DISORDERS GUIDE 8

10 TEST INFORMATION Testing Options Testing of the Mitochondrial Genome and Nuclear Genes Test Name Genes / Mutations Included TAT Combined Mito Genome Plus Mito Nuclear Genes (319 Genes) XomeDxPlus Full mitochondrial genome plus AARS, AARS2, ABCB11, ABCB4, ABCB7, ABCD4, ACAD9, ACADM, ACADVL, ACO2, ACSF3, ADCK3 (CABC1; COQ8), ADCK4, AFG3L2, AGK, AGL, AIFM1, ALAS2, ALDOA, ALDOB, ALG1, ALG11, ALG13, ALG2, ALG3, ALG6, ALG9, AMACR, APOPT1, APTX, ARG1, ASL, ASS1, ATP5A1, ATP5E, ATP7B, ATP8B1, ATPAF2 (ATP12), AUH, B4GALT1, BCKDHA, BCKDHB, BCS1L, BOLA3, C10ORF2, C12ORF65, C19ORF12, CA5A, CARS2, CHKB, CISD2, CLPB, COA5 (C2ORF64), COA6, COASY, COG4, COG5, COG6, COG7, COG8, COQ2, COQ4, COQ6, COQ9, COX10, COX14 (C12ORF62), COX15, COX20 (FAM36A), COX4I2, COX6A1, COX6B1, COX7B, CPS1, CPT1A, CPT2, CYC1, DARS, DARS2, DBT, DDHD1, DDHD2, DDOST, DGUOK, DLAT, DLD, DMGDH, DNA2, DNAJC19, DNM1L, DNM2, DOLK, DPAGT1, DPM1, DPM3, EARS2, ECHS1, ELAC2, ENO3, ETFA, ETFB, ETFDH, ETHE1, FAH, FARS2, FASTKD2, FBP1, FBXL4, FDX1L, FH, FLAD1, FOXRED1, G6PC, GAA, GAMT, GARS, GATM, GBE1, GCDH, GFER, GFM1 (EFG1), GFM2, GLRX5, GMPPA, GSS, GTPBP3, GYG1, GYG2, GYS1, GYS2, HADHA, HADHB, HARS2, HCFC1, HIBCH, HLCS, HMGCL, HMGCS2, HSD17B10, HSPD1, IARS2, IBA57, ISCA2, ISCU, IVD, LAMP2, LARS, LARS2, LDHA, LIAS, LIPT1, LMBRD1, LRPPRC, LYRM4, LYRM7, MARS, MARS2, MCCC1, MCCC2, MCEE, MFF, MFN2, MGAT2, MGME1, MICU1, MLYCD, MMAA, MMAB, MMACHC, MMADHC (C2ORF25), MOGS, MPC1 (BRP44L), MPDU1, MPI, MPV17, MRPL12, MRPL3, MRPL44, MRPS16, MRPS22, MRPS7, MTFMT, MTO1, MTPAP, MTR, MTRR, MUT, NADK2, NAGS, NARS2, NDUFA1, NDUFA10, NDUFA11, NDUFA12, NDUFA2, NDUFA4, NDUFA9, NDUFAF1, NDUFAF2, NDUFAF3 (C3ORF60), NDUFAF4 (C6ORF66), NDUFAF5, NDUFAF6, NDUFAF7 (C2ORF56), NDUFB3, NDUFB9, NDUFS1, NDUFS2, NDUFS3, NDUFS4, NDUFS6, NDUFS7, NDUFS8, NDUFV1, NDUFV2, NFS1, NFU1, NGLY1, NR2F1, NUBPL, OPA1, OPA3, OTC, PARS2, PC, PCCA, PCCB, PDHA1, PDHB, PDHX, PDP1, PDSS1, PDSS2, PET100, PFKM, PGAM2, PGM1, PHKA1, PHKA2, PHKB, PHKG2, PMM2, PNPT1, POLG, POLG2, PRKAG2, PRPS1, PTRH2, PUS1, PYGM, QARS, RANBP2, RARS, RARS2, REEP1 (C2ORF23), RFT1, RMND1, RRM2B, SARS2, SCO1, SCO2, SDHA, SDHAF1, SERAC1, SFXN4, SLC19A2, SLC19A3, SLC22A5, SLC25A1, SLC25A13, SLC25A15, SLC25A19, SLC25A20, SLC25A22, SLC25A3 (PHC), SLC25A38, SLC25A4, SLC2A2, SLC35A1, SLC35A2, SLC35C1, SLC37A4, SLC6A8, SLC7A7, SPAST, SPG7, SPTLC1, SRD5A3, SSR4, STT3A, STT3B, STXBP1, SUCLA2, SUCLG1, SURF1, TACO1, TARS2, TAZ, TIMM8A, TK2, TMEM126A, TMEM165, TMEM70, TPK1, TRIT1, TRMU, TRNT1, TSFM, TTC19, TUFM, TYMP, UQCC2, UQCC3, UQCRB, UQCRC2, UQCRQ, VARS2, WDR45, WFS1, YARS2 Whole exome sequencing (WES) plus mitochondrial genome sequencing and deletion testing Testing of the Mitochondrial Genome (mtdna) 6 weeks 8 weeks Test Name Genes / Mutations Included TAT Next-Generation Sequence Analysis and Deletion Testing of the Mitochondrial Genome Full mitochondrial genome (including non-specific phenotypes, and MELAS, MERRF, NARP, LHON, MIDD, MICM, LS, KSS, CPEO, Pearson syndrome etc.) 4 weeks 58 Confirmed Disease- Causing mtdna Point Mutations and Deletion Testing Deletion/Duplication Testing of the Mitochondrial Genome 58 confirmed disease-causing mtdna point mutations (see list in Test Info Sheet) and large scale deletion analysis of the mitochondrial genome (including LHON [18 mutations], MELAS [13 mutations], LS/NARP [22 mutations], MIHL/MIDM [10 mutations)] MERRF [6 mutations], KSS, CPEO, Pearson syndrome, etc.) Large scale deletion/duplication analysis of the mitochondrial genome 3-4 weeks 3-4 weeks 9

11 Testing Options Testing of Nuclear Genes Important for Normal Mitochondrial Function Test Name Genes / Mutations Included TAT Comprehensive Mitochondrial Nuclear Gene Panel (319 Genes) AARS, AARS2, ABCB11, ABCB4, ABCB7, ABCD4, ACAD9, ACADM, ACADVL, ACO2, ACSF3, ADCK3 (CABC1; COQ8), ADCK4, AFG3L2, AGK, AGL, AIFM1, ALAS2, ALDOA, ALDOB, ALG1, ALG11, ALG13, ALG2, ALG3, ALG6, ALG9, AMACR, APOPT1, APTX, ARG1, ASL, ASS1, ATP5A1, ATP5E, ATP7B, ATP8B1, ATPAF2 (ATP12), AUH, B4GALT1, BCKDHA, BCKDHB, BCS1L, BOLA3, C10ORF2, C12ORF65, C19ORF12, CA5A, CARS2, CHKB, CISD2, CLPB, COA5 (C2ORF64), COA6, COASY, COG4, COG5, COG6, COG7, COG8, COQ2, COQ4, COQ6, COQ9, COX10, COX14 (C12ORF62), COX15, COX20 (FAM36A), COX4I2, COX6A1, COX6B1, COX7B, CPS1, CPT1A, CPT2, CYC1, DARS, DARS2, DBT, DDHD1, DDHD2, DDOST, DGUOK, DLAT, DLD, DMGDH, DNA2, DNAJC19, DNM1L, DNM2, DOLK, DPAGT1, DPM1, DPM3, EARS2, ECHS1, ELAC2, ENO3, ETFA, ETFB, ETFDH, ETHE1, FAH, FARS2, FASTKD2, FBP1, FBXL4, FDX1L, FH, FLAD1, FOXRED1, G6PC, GAA, GAMT, GARS, GATM, GBE1, GCDH, GFER, GFM1 (EFG1), GFM2, GLRX5, GMPPA, GSS, GTPBP3, GYG1, GYG2, GYS1, GYS2, HADHA, HADHB, HARS2, HCFC1, HIBCH, HLCS, HMGCL, HMGCS2, HSD17B10, HSPD1, IARS2, IBA57, ISCA2, ISCU, IVD, LAMP2, LARS, LARS2, LDHA, LIAS, LIPT1, LMBRD1, LRP- PRC, LYRM4, LYRM7, MARS, MARS2, MCCC1, MCCC2, MCEE, MFF, MFN2, MGAT2, MGME1, MICU1, MLYCD, MMAA, MMAB, MMACHC, MMADHC (C2ORF25), MOGS, MPC1 (BRP44L), MPDU1, MPI, MPV17, MRPL12, MRPL3, MRPL44, MRPS16, MRPS22, MRPS7, MTFMT, MTO1, MTPAP, MTR, MTRR, MUT, NADK2, NAGS, NARS2, NDUFA1, NDUFA10, NDUFA11, NDUFA12, NDUFA2, NDUFA4, NDUFA9, NDUFAF1, NDUFAF2, NDUFAF3 (C3ORF60), NDUFAF4 (C6ORF66), NDUFAF5, NDUFAF6, NDUFAF7 (C2ORF56), NDUFB3, NDUFB9, NDUFS1, NDUFS2, NDUFS3, NDUFS4, NDUFS6, NDUFS7, NDUFS8, NDUFV1, NDUFV2, NFS1, NFU1, NGLY1, NR2F1, NUBPL, OPA1, OPA3, OTC, PARS2, PC, PCCA, PCCB, PDHA1, PDHB, PDHX, PDP1, PDSS1, PDSS2, PET100, PFKM, PGAM2, PGM1, PHKA1, PHKA2, PHKB, PHKG2, PMM2, PNPT1, POLG, POLG2, PRKAG2, PRPS1, PTRH2, PUS1, PYGM, QARS, RANBP2, RARS, RARS2, REEP1 (C2ORF23), RFT1, RMND1, RRM2B, SARS2, SCO1, SCO2, SDHA, SDHAF1, SERAC1, SFXN4, SLC19A2, SLC19A3, SLC22A5, SLC25A1, SLC25A13, SLC25A15, SLC25A19, SLC25A20, SLC25A22, SLC25A3 (PHC), SLC25A38, SLC25A4, SLC2A2, SLC35A1, SLC35A2, SLC35C1, SLC37A4, SLC6A8, SLC7A7, SPAST, SPG7, SPTLC1, SRD5A3, SSR4, STT3A, STT3B, STXBP1, SUCLA2, SUCLG1, SURF1, TACO1, TARS2, TAZ, TIMM8A, TK2, TMEM126A, TMEM165, TMEM70, TPK1, TRIT1, TRMU, TRNT1, TSFM, TTC19, TUFM, TYMP, UQCC2, UQCC3, UQCRB, UQCRC2, UQCRQ, VARS2, WDR45, WFS1, YARS2 6 weeks Mitochondrial Encephalopathy/Leigh Syndrome Nuclear Gene Panel (146 Genes) AARS2, ACAD9, ACO2, ADCK3 (CABC1; COQ8), AFG3L2, AIFM1, APOPT1, APTX, ATP5A1, ATP5E, ATPAF2 (ATP12), AUH, BCS1L, BOLA3, C10ORF2, C12ORF65, CA5A, COG8, COQ2, COQ4, COQ6, COQ9, COX10, COX14 (C12ORF62), COX15, COX20 (FAM36A), COX6B1, CPT1A, CPT2, CYC1, DARS, DARS2, DGUOK, DLAT, DLD, DNM1L, EARS2, ECHS1, ETFDH, ETHE1, FARS2, FASTKD2, FBP1, FBXL4, FH, FOXRED1, GCDH, GFER, GFM1 (EFG1), GFM2, GTPBP3, GYG2, HIBCH, HLCS, HSPD1, IARS2, IBA57, ISCA2, LARS2, LIAS, LIPT1, LRPPRC, LYRM7, MARS2, MFF, MFN2, MPC1 (BRP44L), MPV17, MRPL44, MRPS22, MTFMT, MTPAP, NADK2, NARS2, NDUFA1, NDUFA10, NDUFA11, NDUFA12, NDUFA2, NDUFA4, NDUFA9, NDUFAF1, NDUFAF2, NDUFAF3 (C3ORF60), NDUFAF4 (C6ORF66), NDUFAF5, NDUFAF6, NDUFAF7 (C2ORF56), NDUFB3, NDUFS1, NDUFS2, NDUFS3, NDUFS4, NDUFS6, NDUFS7, NDUFS8, NDUFV1, NDUFV2, NFU1, NUBPL, PC, PCCA, PCCB, PDHA1, PDHB, PDHX, PDP1, PDSS1, PDSS2, PET100, PNPT1, POLG, RANBP2, RARS2, RMND1, RRM2B, SCO1, SCO2, SDHA, SDHAF1, SERAC1, SLC19A3, SLC22A5, SLC25A1, SLC25A15, SLC25A19, SLC25A22, SLC35A2, STXBP1, SUCLA2, SUCLG1, SURF1, TACO1, TARS2, TK2, TMEM70, TPK1, TRMU, TSFM, TTC19, TUFM, TYMP, UQCC2, UQCC3, UQCRQ, VARS2 6 weeks MITOCHONDRIAL DISORDERS GUIDE 10

12 Testing Options Testing of Nuclear Genes Important for Normal Mitochondrial Function Cont. Test Name Genes / Mutations Included TAT Lactic Acidosis/Pyruvate Metabolism Nuclear Gene Panel (153 Genes) ACAD9, ADCK3 (CABC1; COQ8), AGK, AGL, AIFM1, ALDOB, ATP5E, ATPAF2 (ATP12), B4GALT1, BCKDHA, BCKDHB, BCS1L, BOLA3, C10ORF2, C12ORF65, CA5A, CARS2, COG4, COG8, COQ2, COQ4, COQ9, COX10, COX14 (C12ORF62), COX15, COX6B1, CYC1, DARS2, DBT, DGUOK, DLAT, DLD, DNM1L, EARS2, ECHS1, ELAC2, ETFA, ETFB, ETFDH, ETHE1, FARS2, FBP1, FBXL4, FDX1L, FH, FOXRED1, G6PC, GFER, GFM1 (EFG1), GTPBP3, GYG2, GYS2, HADHA, HADHB, HIBCH, HLCS, HMGCS2, HSD17B10, HSPD1, IBA57, ISCU, LARS, LARS2, LDHA, LIAS, LIPT1, LRPPRC, LYRM4, LYRM7, MARS, MFF, MLYCD, MPC1 (BRP44L), MPV17, MRPL12, MRPL44, MRPS16, MRPS22, MRPS7, MTFMT, MTO1, NADK2, NARS2, NDUFA1, NDUFA10, NDUFA11, NDUFA9, NDUFAF1, NDUFAF3 (C3ORF60), NDUFAF5, NDUFAF6, NDUFB3, NDUFB9, NDUFS1, NDUFS2, NDUFS3, NDUFS4, NDUFS6, NDUFS7, NDUFS8, NDUFV1, NFS1, NFU1, PARS2, PC, PCCA, PCCB, PDHA1, PDHB, PDHX, PDP1, PDSS1, PDSS2, PFKM, PHKG2, PNPT1, POLG, POLG2, PUS1, RARS2, RMND1, RRM2B, SARS2, SCO2, SDHAF1, SERAC1, SFXN4, SLC25A13, SLC25A19, SLC25A3 (PHC), SLC25A4, SLC2A2, SLC35A2, SLC37A4, SLC7A7, SUCLA2, SUCLG1, SURF1, TARS2, TAZ, TK2, TMEM70, TPK1, TRMU, TRNT1, TSFM, TTC19, TUFM, TYMP, UQCC2, UQCC3, UQCRB, UQCRC2, UQCRQ, YARS2 6 weeks Progressive External Ophthalmoplegia (PEO)/ Optic Atrophy Nuclear Gene Panel (55 Genes) Methylglutaconic Aciduria Nuclear Gene Panel (13 Genes) POLG Sequence Analysis Mitochondrial Myopathy, Lactic Acidosis and Sideroblastic Anemia (MLASA) ACO2, ALG13, ALG3, APTX, AUH, C10ORF2, C12ORF65, CISD2, CLPB, COX7B, DARS, DDHD2, DGUOK, DNA2, DNAJC19, DNM1L, DPM1, EARS2, FH, GYG2, ISCA2, MCEE, MFF, MFN2, MGME1, MOGS, MTFMT, MTO1, MTPAP, NARS2, NDUFAF3 (C3ORF60), NR2F1, OPA1, OPA3, PDHX, PDSS1, POLG, POLG2, PRPS1, RRM2B, SLC19A2, SLC19A3, SLC25A4, SPG7, SRD5A3, STT3B, SUCLA2, TACO1, TIMM8A, TK2, TMEM126A, TSFM, TYMP, VARS2, WFS1 AGK, ATP5E, ATPAF2 (ATP12), AUH, CLPB, DNAJC19, HMGCL, OPA3, POLG, SERAC1, SUCLA2, TAZ, TMEM70 POLG PUS1 4 weeks 4 weeks 4-5 weeks 4-5 weeks Mitochondrial Complex II Deficiency (MT-C2D) SDHA 4 weeks Additional testing options are available, including targeted variant testing for a previously identified pathogenic or likely pathogenic variant. Appropriate test selection depends on the specific clinical history of a patient, including family and personal health histories as well as familial test results. Testing for most genes includes sequencing and deletion/duplication analysis via next-generation sequencing and/or exon array testing. 11

13 Sample Submission Genetic testing can be performed on blood, oral rinse or extracted DNA samples. GeneDx test kits are available to ordering providers, and include sample collection items (such as mouthwash for oral rinse and collection tubes), the necessary sample submission paperwork, and a self-addressed return shipping label. Additionally, all test requisition forms are available for download from the GeneDx website: Please note that all testing must be performed under the guidance of a healthcare provider. For more information on the sample submission process, please visit our website: or us at: zebras@genedx.com MITOCHONDRIAL DISORDERS GUIDE 12

14 13

15 Genetic Test Results Nearly all test results fall into one of four categories: 1. Positive (pathogenic variant(s) identified) 2. Likely pathogenic variant(s) identified 3. Variant(s) of uncertain significance (VUS) identified 4. Negative (no variants of clinical significance identified) GeneDx test reports contain detailed information about a specific genetic result and, if available, medical management options. Genetic counseling is recommended prior to genetic testing to understand the benefits and limitations of testing and after genetic testing to discuss the implications of the genetic test results. Genetic counseling services across the country can be found at Positive Result A positive result indicates a pathogenic (disease-causing) genetic variant (change) was identified in a specific disease gene. This finding confirms an underlying genetic cause for the patient's symptoms and provides a diagnosis of a specific genetic disorder or indicates an increased risk for developing a genetic disorder. Knowledge of the specific pathogenic variant(s) provides valuable information to the patients, their healthcare providers and family members because it helps to determine the recurrence risk and to develop an appropriate medical management plan. A medical management plan may include lifestyle modifications, ongoing screening, preventative medications and measures, and/ or surgical/medical device interventions. Furthermore, a positive genetic test result allows targeted testing of at-risk relatives to determine if any of them carry the pathogenic variant(s) as well as to address the recurrence risk of the disorder in future offspring. RESULTS & MANAGEMENT MITOCHONDRIAL DISORDERS GUIDE 14

16 Likely Pathogenic Variant Result A likely pathogenic result indicates the presence of genetic variant(s) in a specific disease gene for which there is significant, but not conclusive, evidence that the variant(s) are diseasecausing. This finding strongly suggests an underlying genetic cause of the patient s disorder or indicates an increased risk for developing a genetic disorder. With this type of result, medical management options and testing of family members are often similar as described above for a positive result. Variant of Uncertain Significance (VUS) A variant of uncertain significance (VUS) result indicates an inconclusive outcome of a genetic test. A VUS is a change in a gene for which the association with disease cannot be clearly established. The available information for the variant is either insufficient or conflicting, and it cannot be determined at this time whether the variant is associated with a specific genetic disorder or if the variant is a unrelated (benign) variant unrelated to the patient s disorder. RESULTS & MANAGEMENT In the case of a VUS test result, all medical management recommendations should be based on clinical symptoms, and past personal and family history. Predictive genetic testing of family members for a VUS is not indicated. Nevertheless, in some circumstances, it can be useful to test other family members through our Variant Testing Program to gain more evidence about the variant itself and its possible association with disease. Over time, additional clinical evidence may be collected about certain VUS, which could ultimately lead to the reclassification of the variant and test result. 15

17 Negative Result A negative result indicates that the genetic test did not identify reportable, medically relevant variant(s) in any of the genes tested. Therefore, the cause for the patient s disorder or family history remains unknown. Although the patient s disorder may be caused by non-genetic factors, a negative genetic test result does not completely rule out an underlying genetic cause. For example, the patient s disorder may be due to unidentified genetic changes in gene regions or genes not included in the initial test. Depending on the patient s personal and family health history, additional genetic testing may be indicated for the patient or another family member. A genetic specialist or other healthcare providers can determine if further genetic testing is appropriate. In case of a negative genetic test result, all medical management recommendations should be based on clinical symptoms in addition to past personal and family history. Predictive genetic testing of family members is not available. When an individual tests negative for a familial pathogenic variant that was previously identified in another affected family member, this is considered a true negative test result. In most cases, this means that the individual has no greater risk for developing the specific genetic disorder that runs in the family than anyone in the general population. Medical Management The treatment of mitochondrial can vary. In most cases, physicians use a combination of vitamins, optimized nutrition, overall general health and prevention of symptom worsening during times of illness. Knowledge of the genetic etiology of a mitochondrial disorder may guide selection of the most appropriate treatment options in some cases. MITOCHONDRIAL DISORDERS GUIDE 16

18 17

19 Implications for Family Members Regardless of the result, patients should share their test report with their blood relatives, who can then discuss the results with their healthcare providers. Sharing a copy of the test result with family members and healthcare providers will help to determine if additional testing is necessary and will ensure that the proper test is ordered for relatives, if indicated. For positive or likely pathogenic test results in autosomal dominant conditions, first-degree relatives (including parents, siblings, and children) have a 50% chance to have the same variant. The risk for other family members to carry the variant depends on how closely related they are to the person with a positive or likely pathogenic test result. It is important to remember that for most of these genes, not all people who inherit a pathogenic or likely pathogenic variant will mitochondrial impairment due to reduced penetrance. In cases where the gene is associated with an autosomal recessive condition, an individual inherits two pathogenic variants, one from each parent. Siblings of the individual with a mitochondrial disorder have a 25% chance to inherit both pathogenic variants and develop a mitochondrial disorder Genetic Counseling Prior to genetic testing, patients should speak with their healthcare provider and/or a genetics specialist about their personal and family health history. Healthcare providers should discuss the benefits and limitations of testing, as well as possible test results. These conversations help to determine if the patient is an appropriate candidate for testing, facilitate the ordering of appropriate test(s) and ensure that the patient has agreed to the proposed genetic testing (written informed consent). If pathogenic variant(s) have already been identified in a family member, testing of the specific variant(s) is appropriate. If no pathogenic variant(s) are known in a family with a specific genetic disorder, an affected family member with the highest likelihood of a positive test outcome (an individual manifesting associated clinical symptoms) is ideally the best person for initial testing within a family. In instances when an affected family member is MITOCHONDRIAL DISORDERS GUIDE 18 KEY INFORMATION

20 not available, testing of an unaffected family member may be considered, although a negative test result will not guarantee that the unaffected individual does not have an increased risk to develop the clinical symptoms that are present in the family. Once a patient makes the decision to undergo genetic testing, post-test genetic counseling is recommended to understand the implications of the results, including a discussion of the appropriate medical management based on both the test results and the patient s medical and family history. Genetic counseling services across the country can be found at Insurance Coverage and Cost for Genetic Testing GeneDx accepts all commercial insurance plans and is a Medicare provider. Additionally, GeneDx is a registered provider with several Medicaid plans. If a patient does not have health insurance coverage or cannot afford to pay the cost of testing, GeneDx offers a financial assistance program to help ensure that all patients have access to medically necessary genetic testing. KEY INFORMATION For more information on the paperwork that is required by some insurance carriers, as well as additional details on patient billing and our financial assistance program, please visit our website: Genetic Information Nondiscrimation Act The Genetic Information Nondiscrimination Act of 2008, also referred to as GINA, is a federal law that protects Americans from discrimination by health insurance companies and employers based on their genetic information. However, this law does not cover life insurance, disability insurance, or long-term care insurance. GINA s employment protections do not extend to individuals in the U.S. military, federal employees, Veterans Health Administration and Indian Health Service. Some of these organizations may have internal policies to address genetic discrimination. For more information, please visit: 19

21 Genetic Testing Process Patient Identification Sample Submission Discussion of personal and family history The patient s sample and necessary paperwork are sent to the laboratory Explanation of genetic testing options Genetic Testing At the laboratory, genetic testing for most genes includes next-generation sequencing and/or exon array analysis Genetic Test Results Genetic Testing Report Neurogenetic Test Report Contains information on the results of the genetic test and available medical management options Patient Name: Date of Birth: Specimen Type: Submitters ID No: Ordered By: No: Not Provided GeneDx Accession Comprehensive Epilepsy Panel Obtained: 12/11/2015 Date Specimen, Not Received: PROVIDED 3/7/2016 Date Specimen Name: Accession No: MockTest015 PatientGeneDx Not Provided Started: Test 3/22/2016 Date Test(s) Birth: Date Specimen Obtained: Not Provided Date of Other: Validation Date of Report: DateType: Specimen Received: 3/9/2012 Specimen None N TESTS ID No: - VALIDATIO Xpanded Panel Submitters GENEDX 3/9/2012 Date Test(s) Started: / Autism/ID By: 2000 Genes seizures. Ordered Analysis of l delay, and Date of Report: 4/11/2012 SAMPLE, Epilepsy Not Provided Blood in EDTA None Dr. Neurology Genetics Diagnostic Test(s) requested: for Testing / Sequence disorder, developmenta also submitted ) were of autism spectrum father (GeneDx# ) and mother (GeneDx# history Requested: Comprehensive Epilepsy Panel / Sequencing Deletion/Duplication Analysis of 53 Genes Test(s)and with reported Female Test Indication(s): Epileptic encephalopathy. Result: POSITIVE Relevant History: Result: Gene Variant STXBP1 Partial gene deletion, exons 6-8 this individual's A sample from analysis. variant segregation POSITIVE Gene Zygosity HeterozygousWDR45 Inherited Classification From DNA Zygosity Variant Coding Variant of De Mode of Heterozygous Novo Uncertain Inheritance C>T Significance p.q16x c.46 with an iron gene is associated gene. This brain iron the WDR45 ration with variant in of neurodegene for a pathogenic diagnosis is heterozygousis consistent with the signal involved in result Disease tion X-linked Classification Neurodegenera with brain Disease-causing accumulation mutation This individual This of the 53 genes complexes pathogenic No other reportable variants were detected by sequencing: and deletion/duplication analysis X-linked disorder. form multi-protein 2012). De novo Interpretation et al.,. proteins, which control (Haack et al., included on this panel. (NBIA) (Haack with accumulation WD repeat Interpretation: STXBP1 partial deletion: The final report is sent to the ordering healthcare provider l delay one of the and cell cycle iron accumulation gene encodes regulation, autophagy tion with brain global developmenta and dementia The WDR45 This individual is heterozygous for a partial deletion of the STXBP1 gene,transcriptional which is consistent cause neurodegenera including early-onset parkinsonism, have transduction, X-linked WDR45 gene in males and females, of dystonia, WDR45 Summary: WDR45 variants et al., with the diagnosis of epileptic encephalopathy. the or adult onset are similar variants in with pathogenic syndrome (Ohba adolescent clinical features followed by y 50% of patients overlap with Rett 2012). The y in childhood may childhood encephalopath Saitsu et al., 2013). Approximatel Intragenic deletion including exons 6-8 of the STXBP1 gene [transcript static NM_ ]. features in of the 2012; The clinical gene, [93.40]% Genomic coordinates: chr9: [hg19/grch37] (Haack et al., et al., 2015)..3). For this epilepsy (Nishioka gene (NM_ al., 2013). Hayflick et 3 in the WDR45 Xpanded Panel. in the This individual is heterozygous for a partial deletion of the STXBP1 gene2014; that includes exons 6-8. C>T in exon Autism/ID c.46both the Q16X variant 10x by the not harbor (CAA>TAA): minimum partial and complete STXBP1 gene deletions have been identified in patients with epilepsy (Boone al., of at a et ) do p.gln16ter was covered father (GeneDx# 2010; Saitsu et al., 2010; Milh et al., 2011; Mignot et al.,p.q16x: 2011). The presence the deletion is consistent codingofregion WDR ) and to cause loss mother (GeneDx# with the diagnosis of epileptic encephalopathy in this individual. variant is predicted not observed This individual's Q16X nonsensemrna decay. It was gene. The iated WDR45 gene. Exome Sequencing the WDR45 in not nonsense-med NHLBI or the Mutations in the STXBP1 gene have been identified in patients with early infantile epileptic has been identified variant has truncation ancestry in pathogenic variant through proteinand African American Although this neurodegeneration with encephalopathy, also called Ohtahara syndrome. Most individuals with STXBP1 mutations exhibiteither clonic A pathogenic of European protein function in these populations.the diagnosis of of normal individuals spasms with a suppression-burst pattern on EEG, intractable seizures, and severe intellectual disability 6,500 benign variant is consistent with in approximately not a common its presence it is reported (Saitsu et al., 2008; Mignot et al., 2011). Some individuals with STXBP1 mutations have been to our knowledge, Project, indicating previously with myoclonic seizures, hypomyelination or delayed myelination, and/or a non-epileptic movement disorder this individual. (NBIA) in been reported characterized by tremor, dystonic posturing, or choreaform movements (Saitsu etiron al., accumulation 2010; Saitsu et al., brain 2008; Milh et al., 2011). More recently, STXBP1 mutations have been identified in patients with isolated intellectual disability or intellectual disability and nonsyndromic epilepsy (Hamdan et al., 2011; Hamdan et al., 2009). Mutations in the STXBP1 gene are inherited in autosomal dominant manner and are typically de novo, although inheritance of a mutation from an unaffected parent with somatic mosaicism has been reported (Saitsu et al., 2011). Recommendation: 1. Testing for the partial deletion in the STXBP1 gene is available to the parents of this child to determine if the deletion was inherited or arose de novo. If desired, molecular prenatal diagnosis is available to at-risk family members to address the recurrence risk. MD Gaithersburg, 2. Genetic counseling is recommended to discuss the implications of this test Parkway report, specifically including 207 Perry the risk of recurrence for this family and testing optionsgenedx for other- at-risk family members. GeneDx Perry Parkway - Gaithersburg, MD Tel (301) Fax (301) Page 1 of Tel (301) Fax (301) Page 1 of 2 Post-Test Discussion Healthcare provider discusses the test results, medical management options, and implications for family members with the patient MITOCHONDRIAL DISORDERS GUIDE 20

22 Resources for Patients 1. United Mitochondrial Disease Foundation, a patient organization that promotes research and education for the diagnosis, treatment, and cure of mitochondrial disorders: 2. American Epilepsy Society: 3. Epilepsy Foundation: 4. GeneDx neurology page: 5. GeneReviews, a database of genetic diseases: 6. National Society of Genetic Counselors, to help you find a counselor near you: References 1. Chinnery, P.F. Mitochondrial disorders overview. NCBI Bookshelf GeneReviews. NIH National Library of Medicine [ 2. Longo, N. Mitochondrial encephalopathy. Neurol Clin N Am 21: van Adel B.A. and Tarnopolsky, M.A. Metabolic myopathies: Update J Clin Neuromuscular Disease. 10(3): Tarnopolsky, MA and Sandeep, R. Mitochondrial myopathies: Diagnosis, exercise intolerance and treatment options. (2005). Medicine and Science in Sports and Exercise. 37(12):

23 Notes MITOCHONDRIAL DISORDERS GUIDE 22

24 About GeneDx GeneDx was founded in 2000 by two scientists from the National Institutes of Health (NIH) to address the needs of patients diagnosed with rare disorders and the clinicians treating these conditions. Today, GeneDx has grown into a global industry leader in genomics, having provided testing to patients and their families in over 55 countries. Led by its world-renowned whole exome sequencing program, and an unparalleled comprehensive genetic testing menu, GeneDx has a continued expertise in rare and ultra-rare disorders. Additionally, GeneDx also offers a number of other genetic testing services, including: diagnostic testing for hereditary cancers, cardiac, mitochondrial, and neurological disorders, prenatal diagnostics, and targeted variant testing. At GeneDx, our technical services are backed by our unmatched scientific expertise and our superior customer support. Our growing staff includes more than 30 geneticists and 100 genetic counselors specializing in clinical genetics, molecular genetics, metabolic genetics, and cytogenetics who are just a phone call or away to assist you with your questions and testing needs. We invite you to visit our website: to learn more about us. 207 Perry Parkway Gaithersburg, MD T (Toll-free), F E wecare@genedx.com GeneDx. All rights reserved /16 Information current as of 10/16

COMPREHENSIVE DIAGNOSIS FOR MITOCHONDRIAL DISORDERS

COMPREHENSIVE DIAGNOSIS FOR MITOCHONDRIAL DISORDERS COMPREHENSIVE DIAGNOSIS FOR MITOCHONDRIAL DISORDERS MITOCHONDRIAL DISORDERS NGS PANELS MITOCHONDRIAL DISORDERS NGS PANELS Name Test code Gene Name Mitome200-Nuclear 2086 (164 nuclear genes) AARS2, ACACA,

More information

Subject ID: Date Test Started: Specimen Type: Peripheral Blood Date of Report: Date Specimen Obtained:

Subject ID: Date Test Started: Specimen Type: Peripheral Blood Date of Report: Date Specimen Obtained: TEST PERFORMED Whole exome sequencing (WES) with Focused Diagnostic Panel(s): Neuropathy, Leukodystrophy, Myopathy See below for a complete list of genes analyzed. RESULTS 1 sequence variant with potential

More information

Long QT. Long QT Syndrome. A Guide for Patients

Long QT. Long QT Syndrome. A Guide for Patients Long QT Long QT Syndrome A Guide for Patients Long QT Syndrome What is long QT syndrome? Long QT syndrome (LQTS) is a condition that affects the ability of the heart to beat (contract) regularly and efficiently.

More information

An Introduction to mitochondrial disease.

An Introduction to mitochondrial disease. 9 th September 2017 An Introduction to mitochondrial disease. Dr Andy Schaefer Consultant Neurologist and Clinical Lead NHS Highly Specialised Rare Mitochondrial Disease Service and Wellcome Trust Centre

More information

Test Ordered- EPIC: Next generation sequencing(next Gen) Sunquest: NGS

Test Ordered- EPIC: Next generation sequencing(next Gen) Sunquest: NGS UNIVERSITY OF MINNESOTA PHYSICIANS OUTREACH LABS MOLECULAR DIAGNOSTICS (612) 273-8445 DATE: TIME COLLECTED: AM PM PCU/CLINIC: DIAGNOSIS (Dx) / DIAGNOSIS CODES (ICD-9) - OUTPATIENTS ONLY (1) (2) SPECIMEN

More information

Referring Physician Information Name: (Last, First, Middle):

Referring Physician Information Name: (Last, First, Middle): Page 1 of 5 Patient Information Clinical Indication: Patient Name: (Last, First, Middle): DOB (M/D/Y): Sex: M F Guardian Name (for minor patients only): Address: City: State: ZIP: Phone: Ethnic Background

More information

INVITAE METABOLIC DISORDERS AND NEWBORN SCREENING GENE PANEL TESTS

INVITAE METABOLIC DISORDERS AND NEWBORN SCREENING GENE PANEL TESTS INVITAE METABOLIC DISORDERS AND NEWBORN SCREENING GENE PANEL TESTS A broad menu covering the vast majority of inherited metabolic disorders that are routinely tested as part of state newborn screening

More information

MITOCHONDRIAL DISEASE. Amel Karaa, MD Mitochondrial Disease Program Massachusetts General Hospital

MITOCHONDRIAL DISEASE. Amel Karaa, MD Mitochondrial Disease Program Massachusetts General Hospital MITOCHONDRIAL DISEASE Amel Karaa, MD Mitochondrial Disease Program Massachusetts General Hospital Disclosures & Disclaimers United Mitochondrial Disease Foundation Research Grant North American Mitochondrial

More information

PRICE AND TEST LIST January 4, 2018 (by Test Code)

PRICE AND TEST LIST January 4, 2018 (by Test Code) Test Code Test Description TAT Price 2018 CPT Codes WHOLE EXOME SEQUENCING WES001 MNG Exome TM Trio Sequencing and Copy Number Analysis + mtdna (Proband + 2 Family Members) 2-4 Weeks $6,900.00 81415, 81416,

More information

REQUISITION FORM NOTE: ALL FORMS MUST BE FILLED OUT COMPLETELY FOR SAMPLE TO BE PROCESSED. Last First Last First

REQUISITION FORM NOTE: ALL FORMS MUST BE FILLED OUT COMPLETELY FOR SAMPLE TO BE PROCESSED. Last First Last First #: DEPARTMENT OF NEUROLOGY COLUMBIA COLLEGE OF PHYSICIANS & SURGEONS Room 4-420 630 West 168th Street, New York, NY 10032 Telephone #: 212-305-3947 Fax#: 212-305-3986 REQUISITION FORM NOTE: ALL FORMS MUST

More information

PRICE AND TEST LIST August 24, 2018 (by Test Code)

PRICE AND TEST LIST August 24, 2018 (by Test Code) Test Code Test Description TAT Price 2018 CPT Codes WHOLE GENOME SEQUENCING WGS001 MNGenome TRIO Sequencing 2-6 Weeks Call 81425, 81426 x2 WGS003 MNGenome Proband Only Sequencing 2-6 Weeks Call 81425 WHOLE

More information

Presentation and investigation of mitochondrial disease in children

Presentation and investigation of mitochondrial disease in children Presentation and investigation of mitochondrial disease in children Andrew Morris Willink Unit, Manchester Mitochondrial function Carbohydrate Fat Respiratory chain Energy Mitochondria are the product

More information

The mitochondrion and its disorders

The mitochondrion and its disorders 100 PRACTICAL NEUROLOGY H O W T O U N D E R S T A N D I T The mitochondrion and its disorders Patrick F. Chinnery Department of Neurology, Regional Neurosciences Centre, Newcastle General Hospital and

More information

MNGenome Sequencing Test Request Form

MNGenome Sequencing Test Request Form MNGenome Sequencing Test Request Form Whole Whole Genome Exome Sequencing Note: Clinical Information and Consent Form are required for MNGenome Orders. *Please note if samples are shipping separately as

More information

Patient Last Name Patient First Name MI Date of Birth (MM / DD / YYYY) Address City State Zip Phone. the hospital/facility:

Patient Last Name Patient First Name MI Date of Birth (MM / DD / YYYY) Address City State Zip Phone. the hospital/facility: PATIENT INFORMATION (COMPLETE ONE FORM FOR EACH PERSON TESTED) Patient Last Name Patient First Name MI Date of Birth (MM / DD / YYYY) Address City State Zip Phone Patient discharged from Biological Sex:

More information

variant led to a premature stop codon p.k316* which resulted in nonsense-mediated mrna decay. Although the exact function of the C19L1 is still

variant led to a premature stop codon p.k316* which resulted in nonsense-mediated mrna decay. Although the exact function of the C19L1 is still 157 Neurological disorders primarily affect and impair the functioning of the brain and/or neurological system. Structural, electrical or metabolic abnormalities in the brain or neurological system can

More information

The Organism as a system

The Organism as a system The Organism as a system PATIENT 1: Seven-year old female with a history of normal development until age two. At this point she developed episodic vomiting, acidosis, epilepsy, general weakness, ataxia

More information

CURRENT GENETIC TESTING TOOLS IN NEONATAL MEDICINE. Dr. Bahar Naghavi

CURRENT GENETIC TESTING TOOLS IN NEONATAL MEDICINE. Dr. Bahar Naghavi 2 CURRENT GENETIC TESTING TOOLS IN NEONATAL MEDICINE Dr. Bahar Naghavi Assistant professor of Basic Science Department, Shahid Beheshti University of Medical Sciences, Tehran,Iran 3 Introduction Over 4000

More information

Brain MRI in Mitochondrial Disorders: Correlating the Phenotype with the Genotype. Bindu Parayil Sankaran

Brain MRI in Mitochondrial Disorders: Correlating the Phenotype with the Genotype. Bindu Parayil Sankaran Brain MRI in Mitochondrial Disorders: Correlating the Phenotype with the Genotype Bindu Parayil Sankaran copyright Bindu Parayil Sankaran, Maastricht 2018 Printing: Datawyse Universitaire Pers Maastricht

More information

Related Policies None

Related Policies None Medical policy MP 2.04.117 BCBSA Ref. Policy: 2.04.117 Last Review: 06/22/2017 Effective Date: 06/22/2017 Section: Medicine End Date: 06/26/2018 Related Policies None DISCLAIMER Our medical policies are

More information

MNG Exome Sequencing Test Request Form

MNG Exome Sequencing Test Request Form Whole Exome Sequencing MNG Exome Sequencing Test Request Form Note: Clinical Information and Consent Form are required for MNG Exome Orders. IMPORTANT: Please note if any additional samples will be shipped

More information

Mitochondrial Diseases

Mitochondrial Diseases Mitochondrial Diseases Simon Heales SWIM Conference Taunton, November 29 th 2018 Respiratory Failure Cardiomyopathy Optic Atrophy / Retinitis Pigmentosa Seizures / Developmental delay Liver Failure Deafness

More information

Mitochondrial disorders are among the most severe

Mitochondrial disorders are among the most severe NEUROLOGY GRAND ROUNDS Leigh Map: A Novel Computational Diagnostic Resource for Mitochondrial Disease Joyeeta Rahman, BSc, 1 Alberto Noronha, MSc, 2 Ines Thiele, PhD, 2 and Shamima Rahman, FRCP, PhD 1,3

More information

THIAMINE TRANSPORTER TYPE 2 DEFICIENCY

THIAMINE TRANSPORTER TYPE 2 DEFICIENCY THIAMINE TRANSPORTER TYPE 2 DEFICIENCY WHAT IS THE THIAMINE TRANSPORTER TYPE 2 DEFICIENCY (hthtr2)? The thiamine transporter type 2 deficiency (hthtr2) is a inborn error of thiamine metabolism caused by

More information

Nutritional Interventions in Primary Mitochondrial Disorders

Nutritional Interventions in Primary Mitochondrial Disorders Nutritional Interventions in Primary Mitochondrial Disorders Carolyn J Ellaway MBBS PhD FRACP CGHGSA Genetic Metabolic Disorders Service Sydney Children s Hospital Network Disciplines of Child and Adolescent

More information

Patterns of Single-Gene Inheritance Cont.

Patterns of Single-Gene Inheritance Cont. Genetic Basis of Disease Patterns of Single-Gene Inheritance Cont. Traditional Mechanisms Chromosomal disorders Single-gene gene disorders Polygenic/multifactorial disorders Novel mechanisms Imprinting

More information

Movement Disorders Requisition Form

Movement Disorders Requisition Form Movement Disorders Requisition Form The University of Chicago Genetic Services Laboratories 5841 South Maryland Avenue, Room G701/MC0077, Chicago, IL 60637 Toll Free: 888.824.3637 Local: 773.834.0555 Fax:

More information

Evolution of Genetic Testing. Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University

Evolution of Genetic Testing. Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University Evolution of Genetic Testing Joan Pellegrino MD Associate Professor of Pediatrics SUNY Upstate Medical University Genetic Testing Chromosomal analysis Flourescent in situ hybridization (FISH) Chromosome

More information

Genetics and Genetic Testing for Autism:

Genetics and Genetic Testing for Autism: STAR Training 2/22/2018 Genetics and Genetic Testing for Autism: Demystifying the Journey to Find a Cause Alyssa (Ah leesa) Blesson, MGC, CGC Certified Genetic Counselor Center for Autism and Related Disorders

More information

NEW TOOLS FOR MITOCHONDRIAL DISEASE DIAGNOSIS: FGF21, GDF15 AND NEXT- GENERATION SEQUENCING

NEW TOOLS FOR MITOCHONDRIAL DISEASE DIAGNOSIS: FGF21, GDF15 AND NEXT- GENERATION SEQUENCING Research Programs Unit for Molecular Neurology Faculty of Medicine Doctoral Programme in Biomedicine University of Helsinki Finland NEW TOOLS FOR MITOCHONDRIAL DISEASE DIAGNOSIS: FGF21, GDF15 AND NEXT-

More information

MEDICAL GENOMICS LABORATORY. Non-NF1 RASopathy panel by Next-Gen Sequencing and Deletion/Duplication Analysis of SPRED1 (NNP-NG)

MEDICAL GENOMICS LABORATORY. Non-NF1 RASopathy panel by Next-Gen Sequencing and Deletion/Duplication Analysis of SPRED1 (NNP-NG) Non-NF1 RASopathy panel by Next-Gen Sequencing and Deletion/Duplication Analysis of SPRED1 (NNP-NG) Ordering Information Acceptable specimen types: Blood (3-6ml EDTA; no time limitations associated with

More information

Neurogenic Muscle Weakness, Ataxia, and Retinitis Pigmentosa (NARP) Genetic Testing Policy

Neurogenic Muscle Weakness, Ataxia, and Retinitis Pigmentosa (NARP) Genetic Testing Policy Neurogenic Muscle Weakness, Ataxia, and Retinitis Pigmentosa (NARP) Genetic Testing Policy Procedure(s) addressed by this policy: Procedure Code(s) MT-ATP6 Targeted Mutation Analysis 81401 Whole Mitochondrial

More information

Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier

Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier Test Disease Population Triad Disease name Epileptic encephalopathy, early infantile 4. OMIM number for disease 612164 Disease

More information

MOLECULAR DIAGNOSIS for X-LINKED INTELLECTUAL DISABILITY

MOLECULAR DIAGNOSIS for X-LINKED INTELLECTUAL DISABILITY MOLECULAR DIAGNOSIS for X-LINKED INTELLECTUAL DISABILITY Intellectual disability (ID) or mental retardation is characterized by significant limitations in cognitive abilities and social/behavioral adaptive

More information

JULY 21, Genetics 101: SCN1A. Katie Angione, MS CGC Certified Genetic Counselor CHCO Neurology

JULY 21, Genetics 101: SCN1A. Katie Angione, MS CGC Certified Genetic Counselor CHCO Neurology JULY 21, 2018 Genetics 101: SCN1A Katie Angione, MS CGC Certified Genetic Counselor CHCO Neurology Disclosures: I have no financial interests or relationships to disclose. Objectives 1. Review genetic

More information

FIRST NAME MI LAST NAME BIRTH DATE (MM/DD/YYYY) GENDER. Name of person previously tested and relationship:

FIRST NAME MI LAST NAME BIRTH DATE (MM/DD/YYYY) GENDER. Name of person previously tested and relationship: REQUEST FOR GERMLINE BAP1TESTING Please provide the following information. We cannot perform your test without ALL of this information. PLEASE PRINT ALL ANSWERS PATIENT INFORMATION* FIRST NAME MI LAST

More information

CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY

CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY More genetic information requires cutting-edge interpretation techniques Whole Exome Sequencing For certain patients the combination of symptoms does not allow

More information

CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY

CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY CentoXome FUTURE'S KNOWLEDGE APPLIED TODAY More genetic information requires cutting-edge interpretation techniques Whole Exome Sequencing For some patients, the combination of symptoms does not allow

More information

MYOCLONIC EPILEPSY WITH RAGGED RED FIBERS (MERRF) By- Promie Faruque

MYOCLONIC EPILEPSY WITH RAGGED RED FIBERS (MERRF) By- Promie Faruque MYOCLONIC EPILEPSY WITH RAGGED RED FIBERS (MERRF) By- Promie Faruque PHYSIOLOGY -MERRF is a rare panethnic mitochondrial disease which is caused by mutations in the mtdna -It mainly affects the muscle

More information

Mitochondrial Disorders Overview

Mitochondrial Disorders Overview Mitochondrial Disorders Overview [Mitochondrial Encephalomyopathies, Mitochondrial Myopathies, Oxidative Phosphorylation Disorders, Respiratory Chain Disorders] PMID: 20301403 Patrick F Chinnery, PhD,

More information

MITOCHONDRIAL DISORDERS IN NEUROLOGY

MITOCHONDRIAL DISORDERS IN NEUROLOGY MITOCHONDRIAL DISORDERS IN NEUROLOGY Michio Hirano, MD Columbia University Medical Center New York, NY In the opening lecture of this course, Dr. Eric Schon will describe the molecular genetic and pathogenic

More information

Diagnosis and Therapy in Neuromuscular Disorders: Diagnosis and New Treatments in Mitochondrial Diseases

Diagnosis and Therapy in Neuromuscular Disorders: Diagnosis and New Treatments in Mitochondrial Diseases Diagnosis and Therapy in Neuromuscular Disorders: Diagnosis and New Treatments in Mitochondrial Diseases Shamima Rahman, Michael Hanna To cite this version: Shamima Rahman, Michael Hanna. Diagnosis and

More information

Basic Definitions. Dr. Mohammed Hussein Assi MBChB MSc DCH (UK) MRCPCH

Basic Definitions. Dr. Mohammed Hussein Assi MBChB MSc DCH (UK) MRCPCH Basic Definitions Chromosomes There are two types of chromosomes: autosomes (1-22) and sex chromosomes (X & Y). Humans are composed of two groups of cells: Gametes. Ova and sperm cells, which are haploid,

More information

Promo Code (if applicable) mutation description. 1. Name of Physician. 2. Clinic. 3. Department. 4. Street. 5. Zip Code / Town. 6.

Promo Code (if applicable) mutation description. 1. Name of Physician. 2. Clinic. 3. Department. 4. Street. 5. Zip Code / Town. 6. tic Diagnostics A. Analysis Requested 1. Test(s)/(s) 1.1 Single Sequencing 1.2 NGS Panel 1.3 NGS Panel Plus 1.4 NGS Panel Genomic 1.5 Deletion/Duplication Analysis B. Patient Name (Label) 1. Surname Promo

More information

Promo Code (if applicable) ... mutation description. 1. Name of Physician. 2. Clinic. 3. Department. 4. Street. 5. Zip Code / Town. 6.

Promo Code (if applicable) ... mutation description. 1. Name of Physician. 2. Clinic. 3. Department. 4. Street. 5. Zip Code / Town. 6. Genetic Diagnostics A. Analysis Requested 1. Test(s)/Gene(s) 1.1 Single Gene Sequencing 1.2 NGS Panel 1.3 NGS Panel Plus 1.4 NGS Panel Genomic 1.5 Deletion/Duplication Analysis 1.6 Repeat Expansion 1.7

More information

Committee to Review Adverse Effects of Vaccines An Institute of Medicine Workshop on the Safety of Vaccines. Mitochondrial Disorders

Committee to Review Adverse Effects of Vaccines An Institute of Medicine Workshop on the Safety of Vaccines. Mitochondrial Disorders Committee to Review Adverse Effects of Vaccines An Institute of Medicine Workshop on the Safety of Vaccines Mitochondrial Disorders Bruce H. Cohen, MD Cleveland Clinic August 26, 2009 special thanks to

More information

Genetics & CMT Q&A Questions from the CMTA Genetics & CMT Discussion Forum

Genetics & CMT Q&A Questions from the CMTA Genetics & CMT Discussion Forum Genetics & CMT Q&A Questions from the CMTA Genetics & CMT Discussion Forum Presented by : Shawna Feely, MS, CGC & Carly Siskind MS, LCGC Is CMT a type of Muscular Dystrophy (MD)? Myopathy: a disease of

More information

Intellectual Disability Exome Panel Requisition Form

Intellectual Disability Exome Panel Requisition Form Intellectual Disability Exome Panel Requisition Form The University of Chicago Genetic Services Laboratories 5841 South Maryland Avenue, Room G701/MC0077, Chicago, IL 60637 Toll Free: 888.824.3637 Local:

More information

MEDICAL GENOMICS LABORATORY. Next-Gen Sequencing and Deletion/Duplication Analysis of NF1 Only (NF1-NG)

MEDICAL GENOMICS LABORATORY. Next-Gen Sequencing and Deletion/Duplication Analysis of NF1 Only (NF1-NG) Next-Gen Sequencing and Deletion/Duplication Analysis of NF1 Only (NF1-NG) Ordering Information Acceptable specimen types: Fresh blood sample (3-6 ml EDTA; no time limitations associated with receipt)

More information

TRACKING CREATINE DEFICIENCY

TRACKING CREATINE DEFICIENCY TRACKING CREATINE DEFICIENCY Think your loved one may have a CCDS? Recently diagnosed with a CCDS? (Cerebral Creatine Deficiency Syndrome) This document is intended as educational information for patients

More information

IBMPFD Educational Information For Patients and Families

IBMPFD Educational Information For Patients and Families Page 1 of 5 CLIA # 05D1034314 CA State License: CLF 332383 IBMPFD Educational Information For What is IBMPFD? IBMPFD stands for Inclusion Body Myopathy associated with Paget s disease of bone and/or Frontotemporal

More information

No mutations were identified.

No mutations were identified. Hereditary High Cholesterol Test ORDERING PHYSICIAN PRIMARY CONTACT SPECIMEN Report date: Aug 1, 2017 Dr. Jenny Jones Sample Medical Group 123 Main St. Sample, CA Kelly Peters Sample Medical Group 123

More information

Clinical Spectrum and Genetic Mechanism of GLUT1-DS. Yasushi ITO (Tokyo Women s Medical University, Japan)

Clinical Spectrum and Genetic Mechanism of GLUT1-DS. Yasushi ITO (Tokyo Women s Medical University, Japan) Clinical Spectrum and Genetic Mechanism of GLUT1-DS Yasushi ITO (Tokyo Women s Medical University, Japan) Glucose transporter type 1 (GLUT1) deficiency syndrome Mutation in the SLC2A1 / GLUT1 gene Deficiency

More information

In the past 13 years, a new chapter of human genetics, mitochondrial genetics, has opened

In the past 13 years, a new chapter of human genetics, mitochondrial genetics, has opened ARTICLE The Other Human Genome Alan L. Shanske, MD; Sara Shanske, PhD; Salvatore DiMauro, MD In the past 13 years, a new chapter of human genetics, mitochondrial genetics, has opened up and is becoming

More information

Illumina Clinical Services Laboratory

Illumina Clinical Services Laboratory Illumina Clinical Services Laboratory Illumina, Inc. 5200 Illumina Way San Diego, CA 92122, USA Phone: 858.736.8080 Fax: 858.255.5285 everygenome@illumina.com CLIA Certificate No.: 05D1092911 Illumina

More information

Mitrochondrial Disease

Mitrochondrial Disease Mitrochondrial Disease - Information for patients, parents and families Neuromuscular and Neurometabolic Clinic McMaster University Medical Centre 1200 Main Street West Hamilton ON 905-521-7933 What is

More information

GeneticsNow TM. A Guide to Testing Hereditary Conditions in Women & Men. Patient & Physician Information

GeneticsNow TM. A Guide to Testing Hereditary Conditions in Women & Men. Patient & Physician Information GeneticsNow TM A Guide to Testing Hereditary Conditions in Women & Men Patient & Physician Information How can BRCA status affect your health? Everyone has BRCA1 and BRCA2 genes. However, sometimes the

More information

Enabling Informed Clinical Decisions with Deep Insights. Routine Multi-gene Testing for Inherited Neuromuscular Disorders

Enabling Informed Clinical Decisions with Deep Insights. Routine Multi-gene Testing for Inherited Neuromuscular Disorders Enabling Informed Clinical Decisions with Deep Insights Routine Multi-gene Testing for Inherited Neuromuscular Disorders Introduction Multi-gene Testing for Inherited Neuromuscular Disorders Inherited

More information

CNNH NeuroGenomics Program Peer-to-Peer Service Consent/Information Form

CNNH NeuroGenomics Program Peer-to-Peer Service Consent/Information Form CNNH NeuroGenomics Program Peer-to-Peer Service Consent/Information Form WHO WEARE The Center for Neurological and Neurodevelopmental Health (CNNH) is an innovative patient- and family-centered "Specialty

More information

Copyright and use of this thesis

Copyright and use of this thesis Copyright and use of this thesis This thesis must be used in accordance with the provisions of the Copyright Act 1968. Reproduction of material protected by copyright may be an infringement of copyright

More information

Gaucher disease 3/22/2009. Mendelian pedigree patterns. Autosomal-dominant inheritance

Gaucher disease 3/22/2009. Mendelian pedigree patterns. Autosomal-dominant inheritance Mendelian pedigree patterns Autosomal-dominant inheritance Autosomal dominant Autosomal recessive X-linked dominant X-linked recessive Y-linked Examples of AD inheritance Autosomal-recessive inheritance

More information

AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE ISSUE 01 APRIL 2011 REPRINTED WITH PERMISSION

AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE ISSUE 01 APRIL 2011 REPRINTED WITH PERMISSION FRAN KENDALL, MD, has extensive experience in the diagnosis and management of children and adults with a wide array of inborn errors of metabolism, specifically mitochondrial and metabolic disorders. She

More information

NGS Panel Plus. Sequencing Sequencing + NGS based CNVs Del/Dup with MLPA. Clinic. Department. Street. ZIP Code/Town. Country. . Billing.

NGS Panel Plus. Sequencing Sequencing + NGS based CNVs Del/Dup with MLPA. Clinic. Department. Street. ZIP Code/Town. Country.  . Billing. Promo Code (if applicable) Genetic Diagnostics (s)/gene(s)/panel(s): Analysis Requested Single Gene Sequencing Sequencing (Sanger) Sequencing (NGS) Sequencing + CNVs (with NGS) Del/Dup (MLPA or qpcr) Carrier

More information

Neurological Disorders

Neurological Disorders patient guide Neurological Disorders genetic testing Finding answers quickly to help guide patient care Know the Basics Over 6 million people in the U.S. are affected by a neurological disorder 1-2% of

More information

Supplemental Table 1. Cardiac mitochondrial acetyl proteoforms in mouse heart. Uniprot ID Gene Symbol Acetyl Proteoform Q8BWT1 Acaa2 K137 Q8BWT1

Supplemental Table 1. Cardiac mitochondrial acetyl proteoforms in mouse heart. Uniprot ID Gene Symbol Acetyl Proteoform Q8BWT1 Acaa2 K137 Q8BWT1 Supplemental Table 1. Cardiac mitochondrial acetyl proteoforms in mouse heart. Uniprot ID Gene Symbol Acetyl Proteoform Q8BWT1 Acaa2 K137 Q8BWT1 Acaa2 K171 Q8BWT1 Acaa2 K234 Q8BWT1 Acaa2 K240 D3Z7X0 Acad12

More information

Talking Genomes with Your Patients. Meagan Cochran, MS, CGC Certified Genetic Counselor HudsonAlpha Institute for Biotechnology

Talking Genomes with Your Patients. Meagan Cochran, MS, CGC Certified Genetic Counselor HudsonAlpha Institute for Biotechnology Talking Genomes with Your Patients Meagan Cochran, MS, CGC Certified Genetic Counselor HudsonAlpha Institute for Biotechnology Objectives Review the importance of physician familiarity with genomic testing

More information

BRCAnowTM It s Your Decision

BRCAnowTM It s Your Decision Hereditary Breast and Ovarian Cancer BRCAnowTM It s Your Decision Patient & Physician Information What is BRCA? The breast cancer genes BRCA1 and BRCA2 are found within an individual s normal genetic makeup;

More information

Genetics and Genomics: Applications to Developmental Disability

Genetics and Genomics: Applications to Developmental Disability Tuesday, 12:30 2:00, B1 Objective: Genetics and Genomics: Applications to Developmental Disability Helga Toriello 616-234-2712 toriello@msu.edu Identify advances in clinical assessment and management of

More information

Introduction to Evaluating Hereditary Risk. Mollie Hutton, MS, CGC Certified Genetic Counselor Roswell Park Comprehensive Cancer Center

Introduction to Evaluating Hereditary Risk. Mollie Hutton, MS, CGC Certified Genetic Counselor Roswell Park Comprehensive Cancer Center Introduction to Evaluating Hereditary Risk Mollie Hutton, MS, CGC Certified Genetic Counselor Roswell Park Comprehensive Cancer Center Objectives Describe genetic counseling and risk assessment Understand

More information

Biochemistry of cellular organelles

Biochemistry of cellular organelles Kontinkangas, L101A Biochemistry of cellular organelles Lectures: 1. Membrane channels; 2. Membrane transporters; 3. Soluble lipid/metabolite-transfer proteins; 4. Mitochondria as cellular organelles;

More information

EFNS guidelines on the molecular diagnosis of mitochondrial disorders

EFNS guidelines on the molecular diagnosis of mitochondrial disorders European Journal of Neurology 2009, 16: 1255 1264 EFNS GUIDELINES/CME ARTICLE doi:10.1111/j.1468-1331.2009.02811.x EFNS guidelines on the molecular diagnosis of mitochondrial disorders J. Finsterer a,

More information

SEX-LINKED INHERITANCE. Dr Rasime Kalkan

SEX-LINKED INHERITANCE. Dr Rasime Kalkan SEX-LINKED INHERITANCE Dr Rasime Kalkan Human Karyotype Picture of Human Chromosomes 22 Autosomes and 2 Sex Chromosomes Autosomal vs. Sex-Linked Traits can be either: Autosomal: traits (genes) are located

More information

Genetic Testing for Inherited Conditions

Genetic Testing for Inherited Conditions Genetic Testing for Inherited Conditions Policy Number: 2018-101 Effective Date: January 26, 2018 Review Date: January 26, 2018 Next Review Date: January 26, 2019 Important Information - Please Read Before

More information

GENETIC TESTING AND COUNSELING FOR HERITABLE DISORDERS

GENETIC TESTING AND COUNSELING FOR HERITABLE DISORDERS Status Active Medical and Behavioral Health Policy Section: Laboratory Policy Number: VI-09 Effective Date: 03/17/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

No mutations were identified.

No mutations were identified. Hereditary Heart Health Test DOB: May 25, 1977 ID: 123456 Sex: Female Requisition #: 123456 ORDERING PHYSICIAN Dr. Jenny Jones Sample Medical Group 123 Main St. Sample, CA SPECIMEN Type: Saliva Barcode:

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Invasive Prenatal (Fetal) Diagnostic Testing File Name: Origination: Last CAP Review: Next CAP Review: Last Review: invasive_prenatal_(fetal)_diagnostic_testing 12/2014 3/2018

More information

Targeted Genes and Methodology Details for Epilepsy/Seizure Genetic Panels

Targeted Genes and Methodology Details for Epilepsy/Seizure Genetic Panels Targeted s and Methodology Details for Epilepsy/Seizure tic Panels Reference transcripts based on build GRCh37 (hg19) interrogated by Epilepsy/Seizure tic Panels Epilepsy Expanded Panel Epilepsy Expanded

More information

A guide to understanding variant classification

A guide to understanding variant classification White paper A guide to understanding variant classification In a diagnostic setting, variant classification forms the basis for clinical judgment, making proper classification of variants critical to your

More information

SELECTIVE VULNERABILITY (HYPOXIA AND HYPOGLYCEMIA)

SELECTIVE VULNERABILITY (HYPOXIA AND HYPOGLYCEMIA) DEFICIENCY OF METABOLITE -HYPOXIA AND HYPOGLYCEMIA -HYPOVITAMINOSIS SELECTIVE VULNERABILITY (HYPOXIA AND HYPOGLYCEMIA) -SPECIFIC CELL TYPE NEURONS>OLIGODENDROCYTES>ASTROCYTES -SPECIFIC BRAIN REGION PYRAMIDAL

More information

The Pathogenesis of Dystonia: Past, Present and Future

The Pathogenesis of Dystonia: Past, Present and Future The Pathogenesis of Dystonia: Past, Present and Future NIH Grant Disclosures U54 TR001456, R21 NS096445, R56 NS102980 Private Foundation Disclosures Benign Essential Blepharospasm Research Foundation Cure

More information

What s New in Newborn Screening?

What s New in Newborn Screening? What s New in Newborn Screening? Funded by: Illinois Department of Public Health Information on Newborn Screening Newborn screening in Illinois is administered by the Illinois Department of Public Health.

More information

Robert Barski. Biochemical Genetics St James s University Hospital, Leeds. MetBioNet IEM Introductory Training

Robert Barski. Biochemical Genetics St James s University Hospital, Leeds. MetBioNet IEM Introductory Training Robert Barski Biochemical Genetics St James s University Hospital, Leeds Lactate is produced as the fate of anaerobic metabolism of pyruvate. It is an important intermediary metabolite especially with

More information

Mitochondrial diseases are

Mitochondrial diseases are Andre Mattman, MD, FRCPC, Sandra Sirrs, MD, FRCPC, Michelle M. Mezei, MDCM, FRCPC, Ramona Salvarinova-Zivkovic, MD, FRCPC, FCCMG, Majid Alfadhel, MHSc, MD, FCCMG, Yolanda Lillquist, MD, FRCPC Mitochondrial

More information

7 Medical Genetics. Hemoglobinopathies. Hemoglobinopathies. Protein and Gene Structure. and Biochemical Genetics

7 Medical Genetics. Hemoglobinopathies. Hemoglobinopathies. Protein and Gene Structure. and Biochemical Genetics SESSION 7 Medical Genetics Hemoglobinopathies and Biochemical Genetics J a v a d F a s a J a m s h i d i U n i v e r s i t y o f M e d i c a l S c i e n c e s, N o v e m b e r 2 0 1 7 Hemoglobinopathies

More information

Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier

Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier Test Disease Population Triad Disease name Amyotrophic Lateral Sclerosis 10 (ALS10) and Amyotrophic Lateral Sclerosis 6 (ALS6)

More information

The Patient Perspective: diagnostic Exome Sequencing

The Patient Perspective: diagnostic Exome Sequencing 1 2 Hello, I m Teresa Kruisselbrink, genetic counselor in the Center of Individualized Medicine. 3 I have nothing to disclose. 4 The title of my talk, The patient perspective; diagnostic whole exome sequencing,

More information

Riunione Regionale SIN Campania

Riunione Regionale SIN Campania Riunione Regionale SIN Campania Dott.ssa Maria Lieto Dipartimento di Neuroscienze, Università Federico II Napoli Salerno, 14 dicembre 2018 HEREDITARY ATAXIAS SCAs (35 genes) ARCAs (94 genes) Diagnosis?

More information

Exploding Genetic Knowledge in Developmental Disabilities. Disclosures. The Genetic Principle

Exploding Genetic Knowledge in Developmental Disabilities. Disclosures. The Genetic Principle Exploding Genetic Knowledge in Developmental Disabilities How to acquire the data and how to make use of it Elliott H. Sherr MD PhD Professor of Neurology & Pediatrics UCSF Disclosures InVitae: clinical

More information

Fran D. Kendall, M.D.

Fran D. Kendall, M.D. Fran D. Kendall, M.D. VMP, LLC Biochemical Genetics Metabolic, Mitochondrial & Inherited Disorders To provide basic background information on Mitochondrial Disease, its clinical features, diagnosis, treatment,

More information

PATIENT EDUCATION. carrier screening INFORMATION

PATIENT EDUCATION. carrier screening INFORMATION PATIENT EDUCATION carrier screening INFORMATION carrier screening AT A GLANCE Why is carrier screening recommended? Carrier screening is one of many tests that can help provide information to you and your

More information

Childhood mitochondrial encephalomyopathies: clinical course, diagnosis, neuroimaging findings, mtdna mutations and outcome in six children

Childhood mitochondrial encephalomyopathies: clinical course, diagnosis, neuroimaging findings, mtdna mutations and outcome in six children Lu and Huang Italian Journal of Pediatrics 2013, 39:60 ITALIAN JOURNAL OF PEDIATRICS CASE REPORT Open Access Childhood mitochondrial encephalomyopathies: clinical course, diagnosis, neuroimaging findings,

More information

Utility of Microarrays in Molecular Genetics

Utility of Microarrays in Molecular Genetics Utility of Microarrays in Molecular Genetics Madhuri Hegde, Ph.D., FACMG Associate Professor Senior Director Department of Human Genetics Emory Genetics Laboratory Emory University School of Medicine Atlanta,

More information

The benefit of. knowing. Genetic testing for hereditary cancer. A patient support guide

The benefit of. knowing. Genetic testing for hereditary cancer. A patient support guide The benefit of knowing Genetic testing for hereditary cancer A patient support guide Does cancer run in your family? Cancer is more common in some families. Sometimes cancer is caused by a change in a

More information

Introduction. Overview

Introduction. Overview Leigh syndrome Redi Rahmani BA ( Dr. Rahmani of Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth has no relevant financial relationships to disclose. ) Brandon Root MD ( Dr. Root

More information

panel tests assessing multiple genes at the same time for the diagnosis of one or more related disorders

panel tests assessing multiple genes at the same time for the diagnosis of one or more related disorders NGS tests panel tests assessing multiple genes at the same time for the diagnosis of one or more related disorders UKGTN website lists 13 laboratories offering a total of 56 panel test UKGTN listed panel

More information

Genetic testing for hereditary cancer. An overview for healthcare providers

Genetic testing for hereditary cancer. An overview for healthcare providers Genetic testing for hereditary cancer An overview for healthcare providers Specimen requirements Whole blood Two 4.5 ml EDTA tubes (lavender top) Please wait at least 2 weeks after a packed cell/platelet

More information

Genetic Counseling & Testing. Courtney Eddy, MS, LCGC, MT(ASCP) Licensed & Certified Genetic Counselor

Genetic Counseling & Testing. Courtney Eddy, MS, LCGC, MT(ASCP) Licensed & Certified Genetic Counselor Genetic Counseling & Testing Courtney Eddy, MS, LCGC, MT(ASCP) Licensed & Certified Genetic Counselor What will you hear today? Description of genetic counseling & genetic counselors Description of a typical

More information

Genetic Conditions and Services: An Introduction

Genetic Conditions and Services: An Introduction Genetic Conditions and Services: An Introduction Jennifer Roberts, MC, MS, CGC Laboratory Genetics Counselor The Children s Mercy Hospital, 2017 Goals Determine which children/families may benefit from

More information

Metabolic Muscle Diseases

Metabolic Muscle Diseases Metabolic Muscle Diseases Dr Tim Hutchin, Birmingham Children s Hospital Jan 13, 2012 Metabolic myopathies are heterogeneous conditions with defects of muscle energy metabolism that result in predominantly

More information

PALB2 c g>c is. VARIANT OF UNCERTAIN SIGNIFICANCE (VUS) CGI s summary of the available evidence is in Appendices A-C.

PALB2 c g>c is. VARIANT OF UNCERTAIN SIGNIFICANCE (VUS) CGI s summary of the available evidence is in Appendices A-C. Consultation sponsor (may not be the patient): First LastName [Patient identity withheld] Date received by CGI: 2 Sept 2017 Variant Fact Checker Report ID: 0000001.5 Date Variant Fact Checker issued: 12

More information