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Chondroitin synthase 1 (CHSY1) is identified as a potential mediator of bone morphogenetic protein (BMP) effects and understand the loss of human CHSY1 function which causes autosomal-recessive Temtamy preaxial brachydactyly syndrome (TPBS), characterized by limb malformations, short stature, and hearing loss. The results confirmed that loss of human CHSY1 function causes autosomal-recessive TPBS and that antisense-mediated chsy1 knockdown in zebrafish causes similar defects in multiple developmental processes.

An autosomal-recessive frontonasal dysplasia (FND) characterized by bilateral extreme microphthalmia, bilateral oblique facial cleft, complete cleft palate, hypertelorism, wide nasal bridge with hypoplasia of the ala nasi, and low-set, posteriorly rotated ears in two distinct families is presented. The study expands the spectrum of the newly recognized autosomal-recessive ALX-related FND phenotypes.

Homozygosity-mapping approach was used to map the Cenani-Lenz syndrome (CLS) locus to chromosome 11p11.2-q13.1. The study results offer insight into the spectrum of congenital anomallies associated with abnormal lipoprotein receptor-dependent signaling.

A genome-wide homozygosity mapping study in a large consanguineous from Morocco is conducted to identify the genetic basis for a progressive form of autosomal-recessive nonsyndromic hearing loss (ARNSHL) affecting members of the family. Results reveal that mutations in the TPRN gene in the DFNB79 locus on chromosome 9q34, resulting from a causative homozygous deletion, are associated with progressive ARNSHL.

Noonan syndrome patients harboring causative variants in LZTR1 are particularly at risk to develop severe and early-onset hypertrophic cardiomyopathy. In this study, we investigate the mechanistic consequences of a homozygous variant LZTR1 L580P by using patient-specific and CRISPR-Cas9-corrected induced pluripotent stem cell (iPSC) cardiomyocytes. Molecular, cellular, and functional phenotyping in combination with in silico prediction identify an LZTR1 L580P -specific disease mechanism provoking cardiac hypertrophy. The variant is predicted to alter the binding affinity of the dimerization domains facilitating the formation of linear LZTR1 polymers. LZTR1 complex dysfunction results in the accumulation of RAS GTPases, thereby provoking global pathological changes of the proteomic landscape ultimately leading to cellular hypertrophy. Furthermore, our data show that cardiomyocyte-specific MRAS degradation is mediated by LZTR1 via non-proteasomal pathways, whereas RIT1 degradation is mediated by both LZTR1-dependent and LZTR1-independent pathways. Uni- or biallelic genetic correction of the LZTR1 L580P missense variant rescues the molecular and cellular disease phenotype, providing proof of concept for CRISPR-based therapies. [Display omitted] • LZTR1L580P in homozygosity is causative for Noonan syndrome and hypertrophic cardiomyopathy • LZTR1L580P fosters assembly of LZTR1 polymers, resulting in complex dysfunction • Pathological LZTR1 results in impaired RAS GTPase degradation, causing cellular hypertrophy • CRISPR correction of one allele is sufficient to normalize cardiac disease phenotype Using patient-specific and CRISPR-Cas9-corrected iPSC cardiomyocytes, Busley et al. describe an LZTR1 L580P -specific disease mechanism provoking Noonan syndrome-associated cardiac hypertrophy. Mutation-induced polymerization of LZTR1 complexes results in the accumulation of RAS GTPases, leading to molecular and cellular impairments associated with cardiac hypertrophy, whereas CRISPR correction of the missense variant rescues the disease phenotype. [ABSTRACT FROM AUTHOR]

We present a large Turkish family with autosomal dominant inherited ulnar-mammary syndrome in which 10 affected family members, spanning three generations, were diagnosed. The phenotypic expression of the disease was found to be highly variable among the affected family members showing posterior-limb deficiencies and/or duplications, mammary-gland hypoplasia, apocrine dysfunction, dental and genital abnormalities. Mutation analysis of the TBX3 gene showed a novel one base-pair insertion at position 89 (designated 88_89insA) in the coding region. The mutation leads to a shift of the open reading frame and causes a premature truncation of the protein (M30fsX110). The truncated protein lacks almost all functional important parts of TBX3, most likely leading to a complete loss of functional protein. Our findings indicate that ulnar-mammary syndrome shows a wide range of phenotypes even within the same family and provide further evidence that haploinsufficiency of TBX3 is the disease-causing mechanism. [Copyright &y& Elsevier]

The linkeropathies are a group of rare disorders, characterized by overlapping clinical features involving the skeletal and connective tissues. Each "linker" gene encodes an enzyme responsible for the addition of glycosaminoglycan chains to proteoglycans via a common tertrasaccharine linker region. The original descriptions of the autosomal recessive B3GALT6-related disorder showed that the associated clinical features are pleiotropic, spanning the skeletal dysplasia (Spondyloepimetaphyseal dysplasia with joint laxity) (SEMD-JL1) and connective tissue disorder (Ehlers-Danlos syndrome) (EDS spondylodysplastic Type 2) spectrum. Here, we describe three patients with biallelic B3GALT6 variants: each had different clinical presentations, and the two older patients initially received alternative clinical diagnoses (Larsen syndrome and Osteogenesis imperfecta, respectively). We describe the clinico-radiological features of these patients to highlight the spectrum of disease associated with the B3GALT6-linkeropathy. [ABSTRACT FROM AUTHOR]

MFSD2A, a member of the major facilitator superfamily (MFS), is a transmembrane transporter responsible for the uptake of specific essential fatty acids through the blood-brain barrier (BBB) to the brain. The transporter is crucial for early embryonic brain development and a major factor in the formation and maintenance of the BBB. Mfsd2a -knockout mice show a leakage of the BBB in early embryonic stages and develop a phenotype characterized by microcephaly, cognitive impairment, and anxiety. So far, homozygous or compound heterozygous MFSD2A mutations in humans have only been reported in 13 different families with a total of 28 affected individuals. The phenotypical spectrum of patients with MFSD2A variants is rather broad but all patients present with microcephaly and severe intellectual disability, absent or limited speech, and walking difficulties. Severely affected patients develop seizures and show brain malformations and have, above all, a profound developmental delay hardly reaching any developmental motor milestones. Here, we report on two unrelated individuals with novel homozygous variants in the MFSD2A gene, presenting with severe primary microcephaly, brain malformations, profound developmental delay, and epilepsy, including hypsarrhythmia. Our findings extend the mutational spectrum of the bi-allelic MFSD2A variants causing autosomal recessive primary microcephaly type 15 and broaden the phenotypic spectrum associated with these pathogenic variants emphasizing the role of MFSD2A in early brain development. [ABSTRACT FROM AUTHOR]

• MTX is one of the earliest cancer drugs to be developed, giving rise to seven decades of clinical experience. It is on the World Health Organization's List of Essential Medicines, can be administered orally or parenterally, and its costs are at single digit € or $ amounts/day for standard treatment. In case of its successful further preclinical evaluation for treating SARS-CoV-2 infections, its repurposing to treat COVID-19 would thus be feasible, especially under low-resource conditions. • Additional drugs exist to interfere with the synthesis of nucleotides, e.g. additional folate antagonists, inhibitors of GMP synthetase, or inhibitors of dihydroorotate dehydrogenase (DHODH). Such inhibitors have been approved as drugs for different purposes and might represent further therapeutic options against infections with SARS-CoV-2. • Remdesivir is in clinical trials for treating COVID-19. Our results argue that MTX and remdesivir, even at moderate concentrations, can act in a synergistic fashion to repress virus replication to a considerably greater extent than either drug alone. • COVID-19, in its severe forms, is characterized by pneumonia and acute respiratory distress syndrome, and additional organ involvements. These manifestations are not necessarily a direct consequence of virus replication and cytopathic effects, but rather a result of an uncontrolled inflammatory and immune response. Anti-inflammatory drugs such as glucocorticoids are thus being evaluated for treating COVID-19. However, this bears the risk of re-activating virus spread by suppressing a sufficient and specific immune response. In this situation, it is tempting to speculate that MTX might suppress both excessive inflammation as well as virus replication at the same time, thus limiting both the pathogenesis of pneumonia and also the spread of virus within a patient. The search for successful therapies of infections with the coronavirus SARS-CoV-2 is ongoing. We tested inhibition of host cell nucleotide synthesis as a promising strategy to decrease the replication of SARS-CoV-2-RNA, thus diminishing the formation of virus progeny. Methotrexate (MTX) is an established drug for cancer therapy and to induce immunosuppression. The drug inhibits dihydrofolate reductase and other enzymes required for the synthesis of nucleotides. Strikingly, the replication of SARS-CoV-2 was inhibited by MTX in therapeutic concentrations around 1 µM, leading to more than 1000-fold reductions in virus progeny in Vero C1008 (Vero E6) and ~100-fold reductions in Calu-3 cells. Virus replication was more sensitive to equivalent concentrations of MTX than of the established antiviral agent remdesivir. MTX strongly diminished the synthesis of viral structural proteins and the amount of released virus RNA. Virus replication and protein synthesis were rescued by folinic acid (leucovorin) and also by inosine, indicating that purine depletion is the principal mechanism that allows MTX to reduce virus RNA synthesis. The combination of MTX with remdesivir led to synergistic impairment of virus replication, even at 100 nM MTX. The use of MTX in treating SARS-CoV-2 infections still awaits further evaluation regarding toxicity and efficacy in infected organisms, rather than cultured cells. Within the frame of these caveats, however, our results raise the perspective of a two-fold benefit from repurposing MTX for treating COVID-19. Firstly, its previously known ability to reduce aberrant inflammatory responses might dampen respiratory distress. In addition, its direct antiviral activity described here would limit the dissemination of the virus. [ABSTRACT FROM AUTHOR]