The fragile X-associated tremor ataxia syndrome (FXTAS) in Indonesia

Fragile X-associated disorders caused by the premutation of the FMR1 gene, includes the fragile X-associated tremor/ataxia syndrome (FXTAS). FXTAS affects more than 40% of premutation males over the age of 50 and 75% over the age of 80. FMR1 molecular analysis was done using PCR and confirmed by Southern Blot. Three premutation males were diagnosed FXTAS using quantification based on the standard neurological examination. Cognitive impairment was assessed using Raven and WAIS-R test. MRI was done to identify the middle cerebellar peduncle (MCP) sign, white matter disease and/or cerebral atrophy. Three cases of FXTAS are identified, of five individuals older than 50 years in one family tree two met criteria for definite FXTAS and the third with sub-clinical symptoms, although cognitive and radiological criteria are met. These cases are the first identified FXTAS cases in rural Indonesia. In addition with lack of routine medical follow-up, complications of FXTAS, such as hypertension may go unrecognized and untreated, which may further exacerbate the central nervous system (CNS) findings of FXTAS

Increased PAI-1 plasma levels and risk of death from dengue: no association with the 4G/5G promoter polymorphism

BACKGROUND: Dengue virus infected patients have high plasminogen activator inhibitor type I (PAI-1) plasma concentrations. Whether the insertion/deletion (4G/5G) polymorphism in the promotor region of the PAI-1 gene is associated with increased PAI-1 plasma concentrations and with death from dengue is unknown. We, therefore, investigated the relationship between the 4G/5G polymorphism and PAI-1 plasma concentrations in dengue patients and risk of death from dengue. METHODS: A total of 194 patients admitted to the Dr. Kariadi Hospital in Semarang, Indonesia, with clinical suspected severe dengue virus infection were enrolled. Blood samples were obtained on day of admission, days 1, 2 and 7 after admission and at a 1-month follow-up visit. Plasma concentrations of PAI-1 were measured using a sandwich ELISA kit. The PAI-1 4G/5G polymorphism was typed by allele-specific PCR analysis. RESULTS: Concentrations of PAI-1 on admission and peak values of PAI-1 during admission were higher than the values measured in healthy controls. Survival was significantly worse in patients with PAI-1 concentrations in the highest tertile (at admission: OR 4.7 [95% CI 0.9–23.8], peak value during admission: OR 6.3 [95%CI 1.3–30.8]). No association was found between the PAI-1 4G/5G polymorphism, and PAI-1 plasma concentrations, dengue disease severity and mortality from dengue. CONCLUSION: These data suggest that the 4G/5G polymorphism has no significant influence on PAI-1 concentrations in dengue virus infected patients and is not associated with the risk of death from dengue. Other factors contributing to the variability of PAI-1 plasma concentrations in patients with dengue need to be explored

Lessons Learned from 17 Years of Multidisciplinary Care for DSD Patients at A Single Indonesian Center

Background: Our Multidisciplinary Team (MDT) is a large specialized team based in Semarang,Indonesia that cares for a wide variety of pediatric and adult individuals with Differences of SexDevelopment (DSD) from across Indonesia. Here we describe our work over the last 17 years.Methods: We analyzed phenotypic, hormonal and genetic findings from clinical records for allpatients referred to our MDT during the period 2004 to 2020.Results: Among 1184 DSD patients, 10% had sex chromosome DSD, 67% had 46,XY DSD and 23% had46,XX DSD. The most common sex chromosome anomaly was Turner syndrome (45,X) (55 cases). Forpatients with 46,XY DSD under-masculinization was the most common diagnosis (311 cases) and for46,XX DSD a defect of Müllerian development was most common (131 cases) followed by CongenitalAdrenal Hyperplasia (CAH) (116 cases). Sanger sequencing, MLPA and targeted gene sequencing ofDownloaded from http://karger.com/sxd/article-pdf/doi/10.1159/000534085/3998946/000534085.pdf by guest on 03 October 2023257 patients with 46,XY DSD found likely causative variants in 21% (55 cases), with 13 diagnosticgenes implicated. The most affected gene coded for the Androgen Receptor. Molecular analysisidentified a diagnosis for 69 of 116 patients with CAH, with 62 carrying variants in CYP21A2 includingfour novel variants, and seven patients carrying variants in CYP11B1. In many cases these geneticdiagnoses influenced the clinical management of patients and families.Conclusions: Our work has highlighted the occurrence of different DSDs in Indonesia. By applyingsequencing technologies as part of our clinical care, we have delivered a number of geneticdiagnoses and identified novel pathogenic variants in some genes, which may be clinically specific toIndonesia. Genetics can inform many aspects of DSD clinical management, and whilst many of ourpatients remain undiagnosed, we hope that future testing may provide answers for even more

Analysis of the androgen receptor (AR) gene in a cohort of Indonesian undermasculinized 46, XY DSD patients

Abstract Background Pathogenic variants in the androgen receptor (AR) gene located on chromosome Xq11-12, are known to cause varying degrees of undermasculinization in 46, XY individuals. The aim of this study was to investigate the frequency of pathogenic variants in the AR gene in a cohort of 46, XY undermasculinized individuals from Indonesia who were suspected of having androgen insensitivity syndrome (AIS). All patients with 46, XY DSD referred to our center between 1994 and 2019 were collected from our clinical database. All 46, XY DSD patients without a prior molecular diagnosis with an external masculinization score (EMS) ≤ 9 were included in this study. All exons and intron–exon boundaries of AR gene were analyzed using Sanger sequencing to identify pathogenic variants of the AR gene. Results A cohort of 75 undermasculinized patients were selected for the study. Direct Sanger sequencing of all eight exons of the AR gene led to a genetic diagnosis in 11 patients (14.67%). All of the variants identified (p.Arg841His; p.Ile604Asn; p.Val731Met; p.Pro672Ser; p.Gln739Arg; p.Ser302Glufs*3) have been previously reported in patients with AIS. Conclusions This is the first study in Indonesia that highlights the significance of molecular analysis in providing a definitive diagnosis of AIS for patients with 46, XY DSD undermasculinization. This is an uncommon finding in the Indonesian population presenting with 46, XY DSD undermasculinization. A genetic diagnosis allows optimal clinical management and genetic counseling for patients and their families. As 46, XY DSD can be caused by pathogenic variants in other genes involved in gonadal development and differentiation, further genetic analysis, such as whole exome sequencing, should be carried out on those patients that did not carry an AR variant