Scientific Letter
Sjögren-Larsson syndrome in Spain: Description of three new cases
Síndrome de Sjögren-Larsson en España; descripción de 3 nuevos casos
Cristina Villar-Veraa,
, Ana Cuesta Peredob, Lucía Monfort-Belenguera, María Rosario Abellán Sanchezc, Cecilia Martínez-Costad
Corresponding author
a Unidad de Neuropediatría, Servicio de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, Spain
b Laboratorio de Bioquímica y Patología Molecular, Hospital Clínico Universitario de Valencia, Valencia, Spain
c Unidad de Genotipado y Diagnóstico Genético, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
d Servicio de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, Spain
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array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 743 "Ancho" => 905 "Tamanyo" => 64448 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Changes in white matter at age 2 years, patient 1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sjögren-Larsson syndrome (OMIM #270200) is a neurocutaneous disorder characterised by congenital ichthyosis, intellectual disability and spasticity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is caused by changes in the <span class="elsevierStyleItalic">ALDH3A2</span> gene, which encodes the fatty aldehyde dehydrogenase (FALDH) enzyme, involved in the oxidation of aldehydes to fatty acids.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We described the different clinical and genetic characteristics of 3 cases diagnosed in our department.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient 1, a girl, was the first child of non-consanguineous parents with an unremarkable history. She was born at 36 weeks’ gestation, exhibiting mild erythroderma that progressed to ichthyosis vulgaris (based on the findings of the skin biopsy) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">She was referred to the paediatric neurology department at age 17 months due to severe axial hypotonia with instability in sitting and ichthyosis. The findings of the metabolic, neurophysiological and neuroimaging tests at the time were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the patient did not present with additional signs of syndromic ichthyosis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> comparative genomic hybridization testing was performed, which detected a 159.6 kb deletion in region 17p11.2, hg19 (chr17:19424245-19583843) that contained the <span class="elsevierStyleItalic">ALDH3A2</span> gene. Sequencing of the other <span class="elsevierStyleItalic">ALDH3A2</span> allele revealed a frameshift variant in exon 1 (c.86_96del, p.Ala29Aspfs*21) that gave rise to a truncated protein.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The segregation analysis of the family revealed that both changes were inherited (one from each parent).</p><p id="par0035" class="elsevierStylePara elsevierViewall">A magnetic resonance imaging (MRI) scan performed at age 2 years found myelination defects (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Currently, at age 6 years, the patient has mild intellectual disability and axial hypotonia with spasticity in the lower extremities that precludes independent walking.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The patient has experienced 5 episodes of typical febrile seizures that did not require antiepileptic medication. She has not developed vision abnormalities to date.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients 2 and 3 are sisters in a family with no known consanguinity. At birth, at 34 and 36 weeks’ gestation, respectively, both presented with moderate ichthyosis described as “lamellar”. They developed the ability to sit at around 9 months and independent walking between ages 4 and 6 years. Patient 2 retains independent walking at age 22 years. Both sisters developed signs of spasticity in the first 2 years of life, and Sjögren-Larsson syndrome was suspected due to the detection of myelination defects on neuroimaging.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Both patients developed typical febrile seizures, language delay and mild intellectual disability.</p><p id="par0055" class="elsevierStylePara elsevierViewall">At ages 14 and 16 years, respectively, inclusions were detected in the ocular fundus.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The diagnosis was based on enzyme activity assays in fibroblasts and sequencing of the <span class="elsevierStyleItalic">ALDH3A2</span> gene. Both patients were homozygous for the previously described variant c.471+1delG (NM_000382.2).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The family segregation analysis confirmed that both parents were carriers of the variant.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As of June 2020, there were 280 reported variants of the <span class="elsevierStyleItalic">ALDH3A2</span> gene in 182 individuals with Sjögren-Larsson syndrome (Leiden Open Variation Database [LOVD], PubMed). Some, like c.471+1delG, detected in patients 2 and 3, have been described in many European families. However, the variants detected in patient 1 were novel.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">A previous review of cases reported in Spain identified 4 cases diagnosed in adulthood after detection of the characteristic ocular or cutaneous lesions, and only 1 diagnosed in childhood.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The c.86_96del variant produces a shift in the reading frame and results in a truncated protein. However, the presence of another start codon downstream suggests the possibility of a protein missing the first 32 amino acids (of the 508 of the full protein) that could maintain some residual activity and result in an attenuated phenotype.</p><p id="par0085" class="elsevierStylePara elsevierViewall">We believe that it is important to be aware of the association of congenital ichthyosis with neurologic impairment as one of the known neuroichthyotic syndromes and of the presence of carriers of these variants in Spain to facilitate early diagnosis and the establishment of an accurate phenotype/genotype correlation. Patient 1, who had a deletion and a variant that had not been previously described presented with more severe axial hypotonia and milder ichthyosis compared to patients 2 and 3, who had a previously described variant.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villar-Vera C, Cuesta Peredo A, Monfort-Belenguer L, Abellán Sanchez MR, Martínez-Costa C. Síndrome de Sjögren-Larsson en España; descripción de 3 nuevos casos. An Pediatr (Barc). 2021;95:203–204.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 429 "Ancho" => 905 "Tamanyo" => 74692 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mild ichthyosis at age 5 years, patient 1.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 743 "Ancho" => 905 "Tamanyo" => 64448 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Changes in white matter at age 2 years, patient 1.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sjögren–Larsson syndrome in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 54 | 32 | 86 |
| 2024 September | 60 | 31 | 91 |
| 2024 August | 70 | 53 | 123 |
| 2024 July | 44 | 18 | 62 |
| 2024 June | 45 | 40 | 85 |
| 2024 May | 45 | 25 | 70 |
| 2024 April | 46 | 37 | 83 |
| 2024 March | 32 | 16 | 48 |
| 2024 February | 21 | 27 | 48 |
| 2024 January | 48 | 17 | 65 |
| 2023 December | 31 | 20 | 51 |
| 2023 November | 39 | 36 | 75 |
| 2023 October | 31 | 26 | 57 |
| 2023 September | 42 | 34 | 76 |
| 2023 August | 21 | 17 | 38 |
| 2023 July | 33 | 34 | 67 |
| 2023 June | 27 | 31 | 58 |
| 2023 May | 30 | 28 | 58 |
| 2023 April | 27 | 13 | 40 |
| 2023 March | 43 | 21 | 64 |
| 2023 February | 34 | 14 | 48 |
| 2023 January | 48 | 15 | 63 |
| 2022 December | 49 | 27 | 76 |
| 2022 November | 46 | 23 | 69 |
| 2022 October | 41 | 38 | 79 |
| 2022 September | 42 | 21 | 63 |
| 2022 August | 47 | 52 | 99 |
| 2022 July | 34 | 43 | 77 |
| 2022 June | 32 | 33 | 65 |
| 2022 May | 37 | 36 | 73 |
| 2022 April | 53 | 20 | 73 |
| 2022 March | 69 | 50 | 119 |
| 2022 February | 55 | 27 | 82 |
| 2022 January | 40 | 39 | 79 |
| 2021 December | 40 | 35 | 75 |
| 2021 November | 39 | 42 | 81 |
| 2021 October | 51 | 85 | 136 |
| 2021 September | 67 | 54 | 121 |
| 2021 August | 80 | 89 | 169 |
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