Prader–Willi syndrome: Symptoms and topiramate response in light of genetics
IntroductionPrader–Willi Syndrome (PWS) is a rare genetic condition, which affects one in 25,000 births and results in various phenotypes. It leads to a wide range of metabolic and endocrine disorders including growth delay, hypogonadism, narcolepsy, lack of satiety and compulsive eating, associated...
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| Format: | Article |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2023.1126970/full |
| _version_ | 1797854866860670976 |
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| author | Cécile Louveau Mimi-Caterina Turtulici Angèle Consoli Angèle Consoli Christine Poitou Muriel Coupaye Marie-Odile Krebs Marie-Odile Krebs Boris Chaumette Boris Chaumette Boris Chaumette Anton Iftimovici Anton Iftimovici |
| author_facet | Cécile Louveau Mimi-Caterina Turtulici Angèle Consoli Angèle Consoli Christine Poitou Muriel Coupaye Marie-Odile Krebs Marie-Odile Krebs Boris Chaumette Boris Chaumette Boris Chaumette Anton Iftimovici Anton Iftimovici |
| author_sort | Cécile Louveau |
| collection | DOAJ |
| description | IntroductionPrader–Willi Syndrome (PWS) is a rare genetic condition, which affects one in 25,000 births and results in various phenotypes. It leads to a wide range of metabolic and endocrine disorders including growth delay, hypogonadism, narcolepsy, lack of satiety and compulsive eating, associated with mild to moderate cognitive impairment. Prognosis is especially determined by the complications of obesity (diabetes, cardiorespiratory diseases) and by severe behavioral disorders marked by impulsivity and compulsion. This heterogeneous clinical picture may lead to mis- or delayed diagnosis of comorbidities. Moreover, when diagnosis is made, treatment remains limited, with high interindividual differences in drug response. This may be due to the underlying genetic variability of the syndrome, which can involve several different genetic mutations, notably deletion or uniparental disomy (UPD) in a region of chromosome 15. Here, we propose to determine whether subjects with PWS differ for clinical phenotype and treatment response depending on the underlying genetic anomaly.MethodsWe retrospectively included all 24 PWS patients who were referred to the Reference Center for Rare Psychiatric Disorders (GHU Paris Psychiatrie and Neurosciences) between November 2018 and July 2022, with either deletion (N = 8) or disomy (N = 16). The following socio-demographic and clinical characteristics were recorded: age, sex, psychiatric and non-psychiatric symptoms, the type of genetic defect, medication and treatment response to topiramate, which was evaluated in terms of eating compulsions and impulsive behaviors. We compared topiramate treatment doses and responses between PWS with deletion and those with disomy. Non-parametric tests were used with random permutations for p-value and bootstrap 95% confidence interval computations.ResultsFirst, we found that disomy was associated with a more severe clinical phenotype than deletion. Second, we observed that topiramate was less effective and less tolerated in disomy, compared to deletion.DiscussionThese results suggest that a pharmacogenomic-based approach may be relevant for the treatment of compulsions in PWS, thus highlighting the importance of personalized medicine for such complex heterogeneous disorders. |
| first_indexed | 2024-04-09T20:14:16Z |
| format | Article |
| id | doaj.art-65941c8d6c9c48a8a595e55791afcfda |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-04-09T20:14:16Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-65941c8d6c9c48a8a595e55791afcfda2023-03-31T12:02:49ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2023-02-011710.3389/fnins.2023.11269701126970Prader–Willi syndrome: Symptoms and topiramate response in light of geneticsCécile Louveau0Mimi-Caterina Turtulici1Angèle Consoli2Angèle Consoli3Christine Poitou4Muriel Coupaye5Marie-Odile Krebs6Marie-Odile Krebs7Boris Chaumette8Boris Chaumette9Boris Chaumette10Anton Iftimovici11Anton Iftimovici12Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, FranceCentre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, FranceDepartment of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, FranceGRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, Sorbonne Université, Paris, FranceNutrition Department, Rare Diseases Center of Reference “Prader–Willi Syndrome and Obesity With Eating Disorders” (PRADORT), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, INSERM, Nutriomics, Sorbonne Université, Paris, FranceNutrition Department, Rare Diseases Center of Reference “Prader–Willi Syndrome and Obesity With Eating Disorders” (PRADORT), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, INSERM, Nutriomics, Sorbonne Université, Paris, FranceCentre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, FranceInstitute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, FranceCentre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, FranceInstitute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, FranceDepartment of Psychiatry, McGill University, Montréal, QC, CanadaCentre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, FranceInstitute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, FranceIntroductionPrader–Willi Syndrome (PWS) is a rare genetic condition, which affects one in 25,000 births and results in various phenotypes. It leads to a wide range of metabolic and endocrine disorders including growth delay, hypogonadism, narcolepsy, lack of satiety and compulsive eating, associated with mild to moderate cognitive impairment. Prognosis is especially determined by the complications of obesity (diabetes, cardiorespiratory diseases) and by severe behavioral disorders marked by impulsivity and compulsion. This heterogeneous clinical picture may lead to mis- or delayed diagnosis of comorbidities. Moreover, when diagnosis is made, treatment remains limited, with high interindividual differences in drug response. This may be due to the underlying genetic variability of the syndrome, which can involve several different genetic mutations, notably deletion or uniparental disomy (UPD) in a region of chromosome 15. Here, we propose to determine whether subjects with PWS differ for clinical phenotype and treatment response depending on the underlying genetic anomaly.MethodsWe retrospectively included all 24 PWS patients who were referred to the Reference Center for Rare Psychiatric Disorders (GHU Paris Psychiatrie and Neurosciences) between November 2018 and July 2022, with either deletion (N = 8) or disomy (N = 16). The following socio-demographic and clinical characteristics were recorded: age, sex, psychiatric and non-psychiatric symptoms, the type of genetic defect, medication and treatment response to topiramate, which was evaluated in terms of eating compulsions and impulsive behaviors. We compared topiramate treatment doses and responses between PWS with deletion and those with disomy. Non-parametric tests were used with random permutations for p-value and bootstrap 95% confidence interval computations.ResultsFirst, we found that disomy was associated with a more severe clinical phenotype than deletion. Second, we observed that topiramate was less effective and less tolerated in disomy, compared to deletion.DiscussionThese results suggest that a pharmacogenomic-based approach may be relevant for the treatment of compulsions in PWS, thus highlighting the importance of personalized medicine for such complex heterogeneous disorders.https://www.frontiersin.org/articles/10.3389/fnins.2023.1126970/fullPrader–Willitopiramatetreatmentgeneticsdeletiondisomy |
| spellingShingle | Cécile Louveau Mimi-Caterina Turtulici Angèle Consoli Angèle Consoli Christine Poitou Muriel Coupaye Marie-Odile Krebs Marie-Odile Krebs Boris Chaumette Boris Chaumette Boris Chaumette Anton Iftimovici Anton Iftimovici Prader–Willi syndrome: Symptoms and topiramate response in light of genetics Frontiers in Neuroscience Prader–Willi topiramate treatment genetics deletion disomy |
| title | Prader–Willi syndrome: Symptoms and topiramate response in light of genetics |
| title_full | Prader–Willi syndrome: Symptoms and topiramate response in light of genetics |
| title_fullStr | Prader–Willi syndrome: Symptoms and topiramate response in light of genetics |
| title_full_unstemmed | Prader–Willi syndrome: Symptoms and topiramate response in light of genetics |
| title_short | Prader–Willi syndrome: Symptoms and topiramate response in light of genetics |
| title_sort | prader willi syndrome symptoms and topiramate response in light of genetics |
| topic | Prader–Willi topiramate treatment genetics deletion disomy |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2023.1126970/full |
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