Publications by authors named "William Gahl"

Free sialic acid storage disorder (FSASD) is a rare, autosomal recessive, neurodegenerative disorder caused by biallelic mutations in SLC17A5, encoding the lysosomal transmembrane sialic acid exporter, SLC17A5. Defects in SLC17A5 lead to lysosomal accumulation of free sialic acid and other acid hexoses. The clinical spectrum of FSASD ranges from mild (Salla disease) to severe infantile forms.

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  • * A patient with compound heterozygous DDX41 variants exhibited symptoms including bone dysplasia and ichthyosis, and analysis of their skin cells showed reduced DDX41 levels and disruption of immune gene activation.
  • * Further studies revealed significant gene dysregulation and increased periostin mRNA in the patient’s cells, indicating that impaired DDX41 function and altered periostin expression likely contribute to the patient's complex disorder.
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GM1 gangliosidosis is an ultra-rare inherited neurodegenerative lysosomal storage disorder caused by biallelic mutations in the gene. GM1 is uniformly fatal and has no approved therapies, although clinical trials investigating gene therapy as a potential treatment for this condition are underway. Novel outcome measures or biomarkers demonstrating the longitudinal effects of GM1 and potential recovery due to therapeutic intervention are urgently needed to establish efficacy of potential therapeutics.

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  • APECED is a serious genetic autoimmune disorder linked to variants in the autoimmune regulator (AIRE) gene, with 16% of evaluated patients lacking known harmful variants, most of whom are of Puerto Rican descent.
  • Researchers discovered a deep intronic variant (c.1504-818 G>A) in these patients that causes a cryptic splice site leading to a dysfunctional protein through pseudoexon inclusion.
  • They developed an antisense oligonucleotide (ASO) that corrected this genetic issue, demonstrating the potential for targeted treatments in APECED patients.
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Purpose: To characterize brain MR imaging findings in a cohort of 58 patients with ECD and to evaluate relationship between these findings and the BRAF pathogenic variant.

Methods: ECD patients of any gender and ethnicity, aged 2-80 years, with biopsy-confirmed ECD were eligible to enroll in this study. Two radiologists experienced in evaluating ECD CNS disease activity reviewed MRI studies.

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Alkaptonuria is a rare disorder of tyrosine catabolism caused by deficiency of homogentisate 1,2-dioxygenase that leads to accumulation of homogentisic acid (HGA). Deposition of HGA-derived polymers in connective tissue causes progressive arthropathy of the spine and large joints, cardiac valvular disease, and genitourinary stones beginning in the fourth decade of life. Nitisinone, a potent inhibitor of the upstream enzyme, 4-hydroxyphenylpyruvate dioxygenase, dramatically reduces HGA production.

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  • DNA replication is crucial for cell division and maintaining genetic stability, with the RFC complex playing a key role by loading important proteins onto DNA.
  • While RFC1's involvement in certain disorders is recognized, the impact of RFC2-5 subunits, particularly RFC4, on human genetic diseases remains under-researched.
  • Our study identifies harmful variants in RFC4 linked to a new disorder marked by muscle weakness and hearing issues, showing how these variants disrupt RFC complex formation and ultimately affect DNA replication and cell cycle processes.
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N-Acetyl-D-mannosamine (ManNAc) is an endogenous monosaccharide and precursor of N-acetylneuraminic acid (Neu5Ac), a critical sialic acid. ManNAc is currently under clinical development to treat GNE myopathy, a rare muscle-wasting disease. In this randomized, open-label, 2-sequence, crossover study, 16 healthy women and men were administered a single oral dose of ManNAc under fasting and fed conditions.

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  • Hermansky-Pudlak syndrome (HPS) is a rare genetic condition linked to severe lung issues, particularly pulmonary fibrosis, with no effective treatments available.
  • The study analyzed endocannabinoids in blood samples from HPS patients and other groups to see if they could serve as early indicators of lung fibrosis, noting an increase in the endocannabinoid anandamide (AEA) in HPS-1 patients.
  • A treatment involving zevaquenabant was found to reduce elevated AEA levels and slow down lung fibrosis progression in mouse models, suggesting that AEA could be a potential blood biomarker for monitoring PF in HPS.
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Background: Cystine-depleting therapy in nephropathic cystinosis is currently monitored via the white blood cell cystine assay, although its application and usefulness are limited by practical and technical issues. Therefore, alternative biomarkers that are widely available, more economical and less technically demanding, while reliably reflecting long-term adherence to cysteamine treatment, are desirable. Recently, we proposed chitotriosidase enzyme activity as a potential novel biomarker for the therapeutic monitoring of cysteamine treatment in cystinosis.

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  • Arterial calcification due to CD73 deficiency (ACDC) is a rare genetic disorder that causes painful calcium deposits in arteries and joints, and there are currently no standard treatments available.
  • A study was conducted with seven adult ACDC patients to evaluate the safety and effectiveness of etidronate, a potential treatment, over three years, involving regular imaging and clinical assessments.
  • Results suggested that etidronate was safe and well-tolerated, and it may have slowed the progression of vascular calcification, although it did not reverse existing calcifications.
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POEMS Syndrome is a constellation of findings including Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, and Skin changes. Calciphylaxis, a microangiopathy involving vascular calcification and thrombotic occlusions, occurs rarely in POEMS. We present a case of prominent calciphylaxis that antedated the diagnosis of POEMS.

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  • RNA polymerase III (Pol III) is important for making tRNAs and small RNAs, and when it doesn't work right, it can cause health problems in people.
  • Scientists studied a specific problem in a gene that caused mistakes in how RNA is processed and led to changes in some proteins that Pol III needs.
  • They found that people with this mutation had different types of tRNA fragments in their cells, which could help scientists understand the Pol III system better and create new tests for related health issues.
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Neuronal ceroid lipofuscinosis (NCL), type 6 (CLN6) is a neurodegenerative disorder associated with progressive neurodegeneration leading to dementia, seizures, and retinopathy. encodes a resident-ER protein involved in trafficking lysosomal proteins to the Golgi. CLN6p deficiency results in lysosomal dysfunction and deposition of storage material comprised of Nile Red lipids/proteolipids that include subunit C of the mitochondrial ATP synthase (SUBC).

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Every year on February 28, the global community comes together to observe Rare Disease Day, a day dedicated to raising awareness and understanding for the millions of individuals who live with rare disorders. While individual rare diseases may seem uncommon, their collective impact is significant, affecting the lives of countless families and communities worldwide. This day serves as a crucial platform to amplify the voices of those affected, advocate for increased research and support, and inspire hope for a future where rare diseases can be prevented, diagnosed earlier, and effectively treated.

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Objective: The aim of this study was to characterize the distribution of skeletal involvement in Erdheim-Chester disease (ECD) by using radiography, computed tomography (CT), F-FDG positron emission tomography/computed tomography (PET/CT), and bone scans, as well as looking for associations with the BRAF mutation.

Material And Methods: Prospective study of 50 consecutive patients with biopsy-confirmed ECD who had radiographs, CT, F-FDG PET/CT, and Tc-99m MDP bone scans. At least two experienced radiologists with expertise in the relevant imaging studies analyzed the images.

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Background: XMEN (X-linked immunodeficiency with magnesium defect, Epstein-Barr virus (EBV), and N-linked glycosylation defect) disease results from loss-of-function mutations in MAGT1, a protein that serves as a magnesium transporter and a subunit of the oligosaccharyltransferase (OST) complex. MAGT1 deficiency disrupts N-linked glycosylation, a critical regulator of immune function. XMEN results in recurrent EBV infections and a propensity for EBV-driven malignancies.

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Background: Benign adult familial myoclonic epilepsy (BAFME) is an autosomal dominant disorder characterized by cortical tremors and seizures. Six types of BAFME, all caused by pentanucleotide repeat expansions in different genes, have been reported. However, several other BAFME cases remain with no molecular diagnosis.

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Over the last 15 years, Undiagnosed Diseases Programs have emerged to address the significant number of individuals with suspected but undiagnosed rare genetic diseases, integrating research and clinical care to optimize diagnostic outcomes. This narrative review summarizes the published literature surrounding Undiagnosed Diseases Programs worldwide, including thirteen studies that evaluate outcomes and two commentary papers. Commonalities in the diagnostic and research process of Undiagnosed Diseases Programs are explored through an appraisal of available literature.

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  • - The NIH Undiagnosed Diseases Program (UDP) helps patients who have not been diagnosed despite extensive testing by using deep phenotyping and genomic testing under procedural anesthesia.
  • - A review of cases from 2008 to 2020 revealed that 249 pediatric patients underwent anesthesia for diagnostic reasons, with serious systemic and neurological conditions being common among them.
  • - The study found that while some perioperative complications occurred, most patients recovered fully, and nearly half received a diagnosis, largely thanks to the insights gained from the procedures done under anesthesia.
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Background: Patients, families, the healthcare system, and society as a whole are all significantly impacted by rare diseases (RDs). According to various classifications, there are currently up to 9,000 different rare diseases that have been recognized, and new diseases are discovered every month. Although very few people are affected by each uncommon disease individually, millions of people are thought to be impacted globally when all these conditions are considered.

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  • - Chediak-Higashi syndrome (CHS) is a rare genetic disorder marked by symptoms like skin and eye color changes, bleeding issues, immune dysfunction, and neurological problems, caused by loss-of-function variants in a specific gene involved in lysosomal regulation.
  • - The study involved clinical evaluations of CHS patients and genomic analysis which led to the discovery of 11 new pathogenic variants, along with a review that compiled a total of 147 known variants, categorizing them based on their types and effects.
  • - The findings suggest a correlation between the type of genetic variants and disease severity, indicating that those with milder disease often have certain types of variants, while those with more severe symptoms have specific nonsense or frameshift mutations.*
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Background: KBG syndrome is caused by haploinsufficiency of and is characterised by macrodontia of upper central incisors, distinctive facial features, short stature, skeletal anomalies, developmental delay, brain malformations and seizures. The central nervous system (CNS) and skeletal features remain poorly defined.

Methods: CNS and/or skeletal imaging were collected from molecularly confirmed individuals with KBG syndrome through an international network.

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