De Novo Mutations in PDE10A Cause Childhood-Onset Chorea with Bilateral Striatal Lesions  Niccolò E. Mencacci, Erik-Jan Kamsteeg, Kosuke Nakashima, Lea.

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De Novo Mutations in PDE10A Cause Childhood-Onset Chorea with Bilateral Striatal Lesions  Niccolò E. Mencacci, Erik-Jan Kamsteeg, Kosuke Nakashima, Lea R’Bibo, David S. Lynch, Bettina Balint, Michèl A.A.P. Willemsen, Matthew E. Adams, Sarah Wiethoff, Kazunori Suzuki, Ceri H. Davies, Joanne Ng, Esther Meyer, Liana Veneziano, Paola Giunti, Deborah Hughes, F. Lucy Raymond, Miryam Carecchio, Giovanna Zorzi, Nardo Nardocci, Chiara Barzaghi, Barbara Garavaglia, Vincenzo Salpietro, John Hardy, Alan M. Pittman, Henry Houlden, Manju A. Kurian, Haruhide Kimura, Lisenka E.L.M. Vissers, Nicholas W. Wood, Kailash P. Bhatia  The American Journal of Human Genetics  Volume 98, Issue 4, Pages 763-771 (April 2016) DOI: 10.1016/j.ajhg.2016.02.015 Copyright © 2016 The Authors Terms and Conditions

Figure 1 MRI Features Associated with Dominant PDE10A Mutations Axial MRI of individuals 1 (A–C) and 2 (D–F). T2-weighted imaging (A and D) and diffusion-weighted imaging (DWI; B and E) showed increased signal intensity within the striatum. In individual 1, the putamen and caudate nucleus appeared slightly swollen (A), and high signal on DWI (B) was confirmed to represent abnormal restricted diffusion on the ADC map (C). In individual 2, the abnormal signal was principally located in the postero-lateral putamina, which also appeared atrophic (D). There was no corresponding restriction of diffusion on the ADC map (F), and appearances suggested a more chronic disease stage. The American Journal of Human Genetics 2016 98, 763-771DOI: (10.1016/j.ajhg.2016.02.015) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Pedigrees, PDE10A Mutation Analysis, Interspecies Alignment, Schematic Representation of PDE10A, In Silico Modeling of the 3D Structure of the PDE10A GAF-B Domain, and Functional Studies of the Identified PDE10A Substitutions (A) Pedigrees of the three individuals carrying the de novo PDE10A mutations and Sanger sequencing confirmation of the mutations. The following abbreviations are used: WT, homozygous wild-type alleles; and M, heterozygous PDE10A mutations. (B) Interspecies alignment performed with Clustal Omega shows the complete conservation down to invertebrates of the amino acid residues affected by the substitutions. Asterisks indicate invariant residues (full conservation), whereas colons and periods represent strong and moderate similarities, respectively. (C) A schematic representation of PDE10A shows its organization in three domains: the regulatory GAF-A and GAF-B domains in the N-terminal portion of the protein and the catalytic domain in the C terminus. The p.Phe300Leu and p.Phe334Leu substitutions are both located in the GAF-B domain, which binds to cAMP. (D) In silico modeling of the 3D structure of the GAF-B domain binding pocket and its interaction with the cAMP (shown in blue) was generated with PDB: 2ZMF. The variant residues Phe300 and Phe334 and their aromatic side chains, located in the β1 and β3 sheets, respectively, forming the floor of the cAMP binding pocket, are shown in red and cyan, respectively. Both residues are located in very close proximity to the cAMP molecule and are therefore likely to play an essential role in nucleotide binding. (E) The p.Phe300Leu and p.Phe334Leu substitutions cause a loss of stimulatory effect of the GAF-B domain on PDE10A catalytic activity. The effect of cyclic nucleotides binding to the GAF-B domain on PDE activity was evaluated via measurement of the enzyme activity after WT and mutant PDE10As were incubated in the presence of various concentrations of 1-NO-cAMP and 70 nM [3H]cGMP. Each data point represents the mean ± SEM of three independent experiments. The American Journal of Human Genetics 2016 98, 763-771DOI: (10.1016/j.ajhg.2016.02.015) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Summary of PDE10A mRNA Expression in the Human and Mouse Brain (A) Boxplots of PDE10A mRNA expression levels in ten adult brain regions (source: BRAINEAC, see Web Resources). The expression levels are based on exon array experiments and are plotted on a log2 scale (y axis). This dataset was generated with Affymetrix Exon 1.0 ST arrays and brain tissue originating from 134 control individuals, collected by the Medical Research Council Sudden Death Brain and Tissue Bank and the Sun Health Research Institute, an affiliate of Sun Health Corporation.20 This plot shows significant variation in PDE10A expression across the ten brain regions analyzed, such that expression is higher in the putamen than in any other region. Abbreviations are as follows: PUTM, putamen; FCTX, frontal cortex; TCTX, temporal cortex; OCTX, occipital cortex; HIPP, hippocampus; SNIG, substantia nigra; MEDU, medulla (specifically the inferior olivary nucleus); WHMT, intralobular white matter; THAL, thalamus; CRBL, cerebellar cortex; and N, number of samples analyzed for each brain region. (B and C) PDE10A expression in the mouse brain in (B) sagittal and (C) coronal sections. PDE10A was very highly and selectively expressed in the striata and in the olfactory tubercula. Images were obtained from the Allen Mouse Brain Atlas (©2015 Allen Institute for Brain Science). Expression intensity is color coded and ranges from low (blue) to moderate (green, yellow) to high (red) intensity. The American Journal of Human Genetics 2016 98, 763-771DOI: (10.1016/j.ajhg.2016.02.015) Copyright © 2016 The Authors Terms and Conditions