Autosomal recessive VWA1-related disorder: comprehensive analysis of phenotypic variability and genetic mutations

• Published in: Brain communications 2024, Vol.6 (6), p.fcae377
• Main Authors: Nagy, Sara, Pagnamenta, Alistair T, Cali, Elisa, Braakman, Hilde M H, Wijntjes, Juerd, Kusters, Benno, Gotkine, Marc, Elpeleg, Orly, Meiner, Vardiella, Lenberg, Jerica, Wigby, Kristen, Friedman, Jennifer, Perry, Luke D, Rossor, Alexander M, Uhrova Meszarosova, Anna, Thomasova, Dana, Jacob, Saiju, O'Driscoll, Mary, De Simone, Lenika, Grange, Dorothy K, Sommerville, Richard, Firoozfar, Zahra, Alavi, Shahryar, Mazaheri, Mahta, Parmar, Jevin M, Lamont, Phillipa J, Pini, Veronica, Sarkozy, Anna, Muntoni, Francesco, Ravenscroft, Gianina, Jones, Eppie, O'Rourke, Declan, Nel, Melissa, Heckmann, Jeannine M, Kvalsund, Michelle, Kapapa, Musambo M, Wa Somwe, Somwe, Bearden, David R, Çakar, Arman, Childs, Anne-Marie, Horvath, Rita, Reilly, Mary M, Houlden, Henry, Maroofian, Reza
• Format: Article
• Language: English
• ISSN: 2632-1297; 2632-1297
• DOI: 10.1093/braincomms/fcae377

Abstract A newly identified subtype of hereditary axonal motor neuropathy, characterized by early proximal limb involvement, has been discovered in a cohort of 34 individuals with biallelic variants in von Willebrand factor A domain-containing 1 (VWA1). This study further delineates the disease characteristics in a cohort of 20 individuals diagnosed through genome or exome sequencing, incorporating neurophysiological, laboratory and imaging data, along with data from previously reported cases across three different studies. Newly reported clinical features include hypermobility/hyperlaxity, axial weakness, dysmorphic signs, asymmetric presentation, dystonic features and, notably, upper motor neuron signs. Foot drop, foot deformities and distal leg weakness followed by early proximal leg weakness are confirmed to be initial manifestations. Additionally, this study identified 11 novel VWA1 variants, reaffirming the 10 bp insertion-induced p.Gly25ArgfsTer74 as the most prevalent disease-causing allele, with a carrier frequency of ∼1 in 441 in the UK and Western European population. Importantly, VWA1-related pathology may mimic various neuromuscular conditions, advocating for its inclusion in diverse gene panels spanning hereditary neuropathies to muscular dystrophies. The study highlights the potential of lower quality control filters in exome analysis to enhance diagnostic yield of VWA1 disease that may account for up to 1% of unexplained hereditary neuropathies. Nagy et al. contributed to the better understanding of a recently described neuromuscular condition characterized by motor neuropathy and myopathic features due to recessive VWA1 variants. They introduced new clinical features as well as new variants in the so far biggest patient cohort including European, Middle Eastern and African families. Graphical Abstract Graphical Abstract