Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism

Ghayda M. Mirzaa, Catarina D. Campbell, Nadia Solovieff, Carleton P. Goold, Laura A. Jansen, Suchithra Menon, Andrew E. Timms, Valerio Conti, Jonathan D. Biag, Carissa Olds, Evan August Boyle, Sarah Collins, Gisele Ishak, Sandra L. Poliachik, Katta M. Girisha, Kit San Yeung, Brian Hon Yin Chung, Elisa Rahikkala, Sonya A. Gunter, Sharon S. McDaniel & 25 others Colleen Forsyth Macmurdo, Jonathan A. Bernstein, Beth Martin, Rebecca J. Leary, Scott Mahan, Shanming Liu, Molly Weaver, Michael O. Dorschner, Shalini Jhangiani, Donna M. Muzny, Eric Boerwinkle, Richard A. Gibbs, James R. Lupski, Jay Shendure, Russell P. Saneto, Edward J. Novotny, Christopher J. Wilson, William R. Sellers, Michael P. Morrissey, Robert F. Hevner, Jeffrey G. Ojemann, Renzo Guerrini, Leon O. Murphy, Wendy Winckler, William B. Dobyns

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

IMPORTANCE Focal cortical dysplasia (FCD), hemimegalencephaly, and megalencephaly constitute a spectrum of malformations of cortical development with shared neuropathologic features. These disorders are associated with significant childhood morbidity and mortality. OBJECTIVE To identify the underlying molecular cause of FCD, hemimegalencephaly, and diffuse megalencephaly. DESIGN, SETTING, AND PARTICIPANTS Patients with FCD, hemimegalencephaly, or megalencephaly (mean age, 11.7 years; range, 2-32 years) were recruited from Pediatric Hospital A. Meyer, the University of Hong Kong, and Seattle Children's Research Institute from June 2012 to June 2014. Whole-exome sequencing (WES) was performed on 8 children with FCD or hemimegalencephaly using standard-depth (50-60X) sequencing in peripheral samples (blood, saliva, or skin) from the affected child and their parents and deep (150-180X) sequencing in affected brain tissue. Targeted sequencing and WES were used to screen 93 children with molecularly unexplained diffuse or focal brain overgrowth. Histopathologic and functional assays of phosphatidylinositol 3-kinase-AKT (serine/threonine kinase)-mammalian target of rapamycin (mTOR) pathway activity in resected brain tissue and cultured neurons were performed to validate mutations. MAIN OUTCOMES AND MEASURES Whole-exome sequencing and targeted sequencing identified variants associated with this spectrum of developmental brain disorders. RESULTS Low-level mosaic mutations of MTOR were identified in brain tissue in 4 children with FCD type 2a with alternative allele fractions ranging from 0.012 to 0.086. Intermediate-level mosaic mutation of MTOR (p.Thr1977Ile) was also identified in 3 unrelated children with diffuse megalencephaly and pigmentary mosaicism in skin. Finally, a constitutional de novo mutation of MTOR (p.Glu1799Lys) was identified in 3 unrelated children with diffuse megalencephaly and intellectual disability. Molecular and functional analysis in 2 children with FCD2a from whom multiple affected brain tissue samples were available revealed a mutation gradient with an epicenter in the most epileptogenic area. When expressed in cultured neurons, all MTOR mutations identified here drive constitutive activation of mTOR complex 1 and enlarged neuronal size. CONCLUSIONS AND RELEVANCE In this study, mutations of MTOR were associated with a spectrum of brain overgrowth phenotypes extending from FCD type 2a to diffuse megalencephaly, distinguished by different mutations and levels of mosaicism. These mutations may be sufficient to cause cellular hypertrophy in cultured neurons and may provide a demonstration of the pattern of mosaicism in brain and substantiate the link between mosaic mutations of MTOR and pigmentary mosaicism in skin.

Original languageEnglish
Pages (from-to)836-845
Number of pages10
JournalJAMA Neurology
Volume73
Issue number7
DOIs
Publication statusPublished - 01-07-2016

Fingerprint

Megalencephaly
Malformations of Cortical Development
Mosaicism
Brain Diseases
Mutation
Exome
Brain
Neurons
Skin
Phosphatidylinositol 3-Kinase
Pediatric Hospitals
Protein-Serine-Threonine Kinases
Hong Kong
Sirolimus
Saliva
Intellectual Disability
Hypertrophy
Parents
Alleles

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Mirzaa, Ghayda M. ; Campbell, Catarina D. ; Solovieff, Nadia ; Goold, Carleton P. ; Jansen, Laura A. ; Menon, Suchithra ; Timms, Andrew E. ; Conti, Valerio ; Biag, Jonathan D. ; Olds, Carissa ; Boyle, Evan August ; Collins, Sarah ; Ishak, Gisele ; Poliachik, Sandra L. ; Girisha, Katta M. ; Yeung, Kit San ; Chung, Brian Hon Yin ; Rahikkala, Elisa ; Gunter, Sonya A. ; McDaniel, Sharon S. ; Macmurdo, Colleen Forsyth ; Bernstein, Jonathan A. ; Martin, Beth ; Leary, Rebecca J. ; Mahan, Scott ; Liu, Shanming ; Weaver, Molly ; Dorschner, Michael O. ; Jhangiani, Shalini ; Muzny, Donna M. ; Boerwinkle, Eric ; Gibbs, Richard A. ; Lupski, James R. ; Shendure, Jay ; Saneto, Russell P. ; Novotny, Edward J. ; Wilson, Christopher J. ; Sellers, William R. ; Morrissey, Michael P. ; Hevner, Robert F. ; Ojemann, Jeffrey G. ; Guerrini, Renzo ; Murphy, Leon O. ; Winckler, Wendy ; Dobyns, William B. / Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism. In: JAMA Neurology. 2016 ; Vol. 73, No. 7. pp. 836-845.
@article{834192ba3a254bceab9f30137d5ae045,
title = "Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism",
abstract = "IMPORTANCE Focal cortical dysplasia (FCD), hemimegalencephaly, and megalencephaly constitute a spectrum of malformations of cortical development with shared neuropathologic features. These disorders are associated with significant childhood morbidity and mortality. OBJECTIVE To identify the underlying molecular cause of FCD, hemimegalencephaly, and diffuse megalencephaly. DESIGN, SETTING, AND PARTICIPANTS Patients with FCD, hemimegalencephaly, or megalencephaly (mean age, 11.7 years; range, 2-32 years) were recruited from Pediatric Hospital A. Meyer, the University of Hong Kong, and Seattle Children's Research Institute from June 2012 to June 2014. Whole-exome sequencing (WES) was performed on 8 children with FCD or hemimegalencephaly using standard-depth (50-60X) sequencing in peripheral samples (blood, saliva, or skin) from the affected child and their parents and deep (150-180X) sequencing in affected brain tissue. Targeted sequencing and WES were used to screen 93 children with molecularly unexplained diffuse or focal brain overgrowth. Histopathologic and functional assays of phosphatidylinositol 3-kinase-AKT (serine/threonine kinase)-mammalian target of rapamycin (mTOR) pathway activity in resected brain tissue and cultured neurons were performed to validate mutations. MAIN OUTCOMES AND MEASURES Whole-exome sequencing and targeted sequencing identified variants associated with this spectrum of developmental brain disorders. RESULTS Low-level mosaic mutations of MTOR were identified in brain tissue in 4 children with FCD type 2a with alternative allele fractions ranging from 0.012 to 0.086. Intermediate-level mosaic mutation of MTOR (p.Thr1977Ile) was also identified in 3 unrelated children with diffuse megalencephaly and pigmentary mosaicism in skin. Finally, a constitutional de novo mutation of MTOR (p.Glu1799Lys) was identified in 3 unrelated children with diffuse megalencephaly and intellectual disability. Molecular and functional analysis in 2 children with FCD2a from whom multiple affected brain tissue samples were available revealed a mutation gradient with an epicenter in the most epileptogenic area. When expressed in cultured neurons, all MTOR mutations identified here drive constitutive activation of mTOR complex 1 and enlarged neuronal size. CONCLUSIONS AND RELEVANCE In this study, mutations of MTOR were associated with a spectrum of brain overgrowth phenotypes extending from FCD type 2a to diffuse megalencephaly, distinguished by different mutations and levels of mosaicism. These mutations may be sufficient to cause cellular hypertrophy in cultured neurons and may provide a demonstration of the pattern of mosaicism in brain and substantiate the link between mosaic mutations of MTOR and pigmentary mosaicism in skin.",
author = "Mirzaa, {Ghayda M.} and Campbell, {Catarina D.} and Nadia Solovieff and Goold, {Carleton P.} and Jansen, {Laura A.} and Suchithra Menon and Timms, {Andrew E.} and Valerio Conti and Biag, {Jonathan D.} and Carissa Olds and Boyle, {Evan August} and Sarah Collins and Gisele Ishak and Poliachik, {Sandra L.} and Girisha, {Katta M.} and Yeung, {Kit San} and Chung, {Brian Hon Yin} and Elisa Rahikkala and Gunter, {Sonya A.} and McDaniel, {Sharon S.} and Macmurdo, {Colleen Forsyth} and Bernstein, {Jonathan A.} and Beth Martin and Leary, {Rebecca J.} and Scott Mahan and Shanming Liu and Molly Weaver and Dorschner, {Michael O.} and Shalini Jhangiani and Muzny, {Donna M.} and Eric Boerwinkle and Gibbs, {Richard A.} and Lupski, {James R.} and Jay Shendure and Saneto, {Russell P.} and Novotny, {Edward J.} and Wilson, {Christopher J.} and Sellers, {William R.} and Morrissey, {Michael P.} and Hevner, {Robert F.} and Ojemann, {Jeffrey G.} and Renzo Guerrini and Murphy, {Leon O.} and Wendy Winckler and Dobyns, {William B.}",
year = "2016",
month = "7",
day = "1",
doi = "10.1001/jamaneurol.2016.0363",
language = "English",
volume = "73",
pages = "836--845",
journal = "JAMA Neurology",
issn = "2168-6149",
publisher = "American Medical Association",
number = "7",

}

Mirzaa, GM, Campbell, CD, Solovieff, N, Goold, CP, Jansen, LA, Menon, S, Timms, AE, Conti, V, Biag, JD, Olds, C, Boyle, EA, Collins, S, Ishak, G, Poliachik, SL, Girisha, KM, Yeung, KS, Chung, BHY, Rahikkala, E, Gunter, SA, McDaniel, SS, Macmurdo, CF, Bernstein, JA, Martin, B, Leary, RJ, Mahan, S, Liu, S, Weaver, M, Dorschner, MO, Jhangiani, S, Muzny, DM, Boerwinkle, E, Gibbs, RA, Lupski, JR, Shendure, J, Saneto, RP, Novotny, EJ, Wilson, CJ, Sellers, WR, Morrissey, MP, Hevner, RF, Ojemann, JG, Guerrini, R, Murphy, LO, Winckler, W & Dobyns, WB 2016, 'Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism', JAMA Neurology, vol. 73, no. 7, pp. 836-845. https://doi.org/10.1001/jamaneurol.2016.0363

Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism. / Mirzaa, Ghayda M.; Campbell, Catarina D.; Solovieff, Nadia; Goold, Carleton P.; Jansen, Laura A.; Menon, Suchithra; Timms, Andrew E.; Conti, Valerio; Biag, Jonathan D.; Olds, Carissa; Boyle, Evan August; Collins, Sarah; Ishak, Gisele; Poliachik, Sandra L.; Girisha, Katta M.; Yeung, Kit San; Chung, Brian Hon Yin; Rahikkala, Elisa; Gunter, Sonya A.; McDaniel, Sharon S.; Macmurdo, Colleen Forsyth; Bernstein, Jonathan A.; Martin, Beth; Leary, Rebecca J.; Mahan, Scott; Liu, Shanming; Weaver, Molly; Dorschner, Michael O.; Jhangiani, Shalini; Muzny, Donna M.; Boerwinkle, Eric; Gibbs, Richard A.; Lupski, James R.; Shendure, Jay; Saneto, Russell P.; Novotny, Edward J.; Wilson, Christopher J.; Sellers, William R.; Morrissey, Michael P.; Hevner, Robert F.; Ojemann, Jeffrey G.; Guerrini, Renzo; Murphy, Leon O.; Winckler, Wendy; Dobyns, William B.

In: JAMA Neurology, Vol. 73, No. 7, 01.07.2016, p. 836-845.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of MTOR mutations with developmental brain disorders, including megalencephaly, focal cortical dysplasia, and pigmentary mosaicism

AU - Mirzaa, Ghayda M.

AU - Campbell, Catarina D.

AU - Solovieff, Nadia

AU - Goold, Carleton P.

AU - Jansen, Laura A.

AU - Menon, Suchithra

AU - Timms, Andrew E.

AU - Conti, Valerio

AU - Biag, Jonathan D.

AU - Olds, Carissa

AU - Boyle, Evan August

AU - Collins, Sarah

AU - Ishak, Gisele

AU - Poliachik, Sandra L.

AU - Girisha, Katta M.

AU - Yeung, Kit San

AU - Chung, Brian Hon Yin

AU - Rahikkala, Elisa

AU - Gunter, Sonya A.

AU - McDaniel, Sharon S.

AU - Macmurdo, Colleen Forsyth

AU - Bernstein, Jonathan A.

AU - Martin, Beth

AU - Leary, Rebecca J.

AU - Mahan, Scott

AU - Liu, Shanming

AU - Weaver, Molly

AU - Dorschner, Michael O.

AU - Jhangiani, Shalini

AU - Muzny, Donna M.

AU - Boerwinkle, Eric

AU - Gibbs, Richard A.

AU - Lupski, James R.

AU - Shendure, Jay

AU - Saneto, Russell P.

AU - Novotny, Edward J.

AU - Wilson, Christopher J.

AU - Sellers, William R.

AU - Morrissey, Michael P.

AU - Hevner, Robert F.

AU - Ojemann, Jeffrey G.

AU - Guerrini, Renzo

AU - Murphy, Leon O.

AU - Winckler, Wendy

AU - Dobyns, William B.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - IMPORTANCE Focal cortical dysplasia (FCD), hemimegalencephaly, and megalencephaly constitute a spectrum of malformations of cortical development with shared neuropathologic features. These disorders are associated with significant childhood morbidity and mortality. OBJECTIVE To identify the underlying molecular cause of FCD, hemimegalencephaly, and diffuse megalencephaly. DESIGN, SETTING, AND PARTICIPANTS Patients with FCD, hemimegalencephaly, or megalencephaly (mean age, 11.7 years; range, 2-32 years) were recruited from Pediatric Hospital A. Meyer, the University of Hong Kong, and Seattle Children's Research Institute from June 2012 to June 2014. Whole-exome sequencing (WES) was performed on 8 children with FCD or hemimegalencephaly using standard-depth (50-60X) sequencing in peripheral samples (blood, saliva, or skin) from the affected child and their parents and deep (150-180X) sequencing in affected brain tissue. Targeted sequencing and WES were used to screen 93 children with molecularly unexplained diffuse or focal brain overgrowth. Histopathologic and functional assays of phosphatidylinositol 3-kinase-AKT (serine/threonine kinase)-mammalian target of rapamycin (mTOR) pathway activity in resected brain tissue and cultured neurons were performed to validate mutations. MAIN OUTCOMES AND MEASURES Whole-exome sequencing and targeted sequencing identified variants associated with this spectrum of developmental brain disorders. RESULTS Low-level mosaic mutations of MTOR were identified in brain tissue in 4 children with FCD type 2a with alternative allele fractions ranging from 0.012 to 0.086. Intermediate-level mosaic mutation of MTOR (p.Thr1977Ile) was also identified in 3 unrelated children with diffuse megalencephaly and pigmentary mosaicism in skin. Finally, a constitutional de novo mutation of MTOR (p.Glu1799Lys) was identified in 3 unrelated children with diffuse megalencephaly and intellectual disability. Molecular and functional analysis in 2 children with FCD2a from whom multiple affected brain tissue samples were available revealed a mutation gradient with an epicenter in the most epileptogenic area. When expressed in cultured neurons, all MTOR mutations identified here drive constitutive activation of mTOR complex 1 and enlarged neuronal size. CONCLUSIONS AND RELEVANCE In this study, mutations of MTOR were associated with a spectrum of brain overgrowth phenotypes extending from FCD type 2a to diffuse megalencephaly, distinguished by different mutations and levels of mosaicism. These mutations may be sufficient to cause cellular hypertrophy in cultured neurons and may provide a demonstration of the pattern of mosaicism in brain and substantiate the link between mosaic mutations of MTOR and pigmentary mosaicism in skin.

AB - IMPORTANCE Focal cortical dysplasia (FCD), hemimegalencephaly, and megalencephaly constitute a spectrum of malformations of cortical development with shared neuropathologic features. These disorders are associated with significant childhood morbidity and mortality. OBJECTIVE To identify the underlying molecular cause of FCD, hemimegalencephaly, and diffuse megalencephaly. DESIGN, SETTING, AND PARTICIPANTS Patients with FCD, hemimegalencephaly, or megalencephaly (mean age, 11.7 years; range, 2-32 years) were recruited from Pediatric Hospital A. Meyer, the University of Hong Kong, and Seattle Children's Research Institute from June 2012 to June 2014. Whole-exome sequencing (WES) was performed on 8 children with FCD or hemimegalencephaly using standard-depth (50-60X) sequencing in peripheral samples (blood, saliva, or skin) from the affected child and their parents and deep (150-180X) sequencing in affected brain tissue. Targeted sequencing and WES were used to screen 93 children with molecularly unexplained diffuse or focal brain overgrowth. Histopathologic and functional assays of phosphatidylinositol 3-kinase-AKT (serine/threonine kinase)-mammalian target of rapamycin (mTOR) pathway activity in resected brain tissue and cultured neurons were performed to validate mutations. MAIN OUTCOMES AND MEASURES Whole-exome sequencing and targeted sequencing identified variants associated with this spectrum of developmental brain disorders. RESULTS Low-level mosaic mutations of MTOR were identified in brain tissue in 4 children with FCD type 2a with alternative allele fractions ranging from 0.012 to 0.086. Intermediate-level mosaic mutation of MTOR (p.Thr1977Ile) was also identified in 3 unrelated children with diffuse megalencephaly and pigmentary mosaicism in skin. Finally, a constitutional de novo mutation of MTOR (p.Glu1799Lys) was identified in 3 unrelated children with diffuse megalencephaly and intellectual disability. Molecular and functional analysis in 2 children with FCD2a from whom multiple affected brain tissue samples were available revealed a mutation gradient with an epicenter in the most epileptogenic area. When expressed in cultured neurons, all MTOR mutations identified here drive constitutive activation of mTOR complex 1 and enlarged neuronal size. CONCLUSIONS AND RELEVANCE In this study, mutations of MTOR were associated with a spectrum of brain overgrowth phenotypes extending from FCD type 2a to diffuse megalencephaly, distinguished by different mutations and levels of mosaicism. These mutations may be sufficient to cause cellular hypertrophy in cultured neurons and may provide a demonstration of the pattern of mosaicism in brain and substantiate the link between mosaic mutations of MTOR and pigmentary mosaicism in skin.

UR - http://www.scopus.com/inward/record.url?scp=84971484777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84971484777&partnerID=8YFLogxK

U2 - 10.1001/jamaneurol.2016.0363

DO - 10.1001/jamaneurol.2016.0363

M3 - Article

VL - 73

SP - 836

EP - 845

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 7

ER -