This prognostic study evaluates whether psychosis transition can be predicted in patients with clinical high-risk syndromes or recent-onset depression by multimodal machine learning that optimally integrates clinical and neurocognitive data, structural magnetic resonance imaging, and polygenic risk scores for schizophrenia.

BAYAT eT Al | INTRODUCTIONGlycosylphosphatidylinositol (GPI) is a glycolipid that is synthetized and transferred to proteins in the membrane of the endoplasmic reticulum. 1 Biogenesis of GPI-anchored proteins (GPI-APs) is a conserved posttranslational mechanism in eukaryotes and is important for attaching these proteins to the cell membrane and for protein sorting, trafficking, and dynamics. 1,2 GPI synthesis and GPI-AP modification are mediated by at least 31 genes, and pathogenic variants in 22 of these genes have been associated with human disease to date. 3 The X-linked phosphatidylinositol glycan class A protein gene (phosphatidylinositol glycan class A protein [PIGA]) is part of a heptameric enzyme complex catalyzing the transfer of N-acetylglucosamine (GlcNAc) to phosphatidylinositol as the first step in GPI anchor biosynthesis. [4][5][6] In contrast to other members of the GPI-GlcNAc transferase complex, PIGA is an integral membrane protein with only one transmembrane domain residing in the endoplasmic reticulum (ER). The large N-terminal cytoplasmic domain contains two Rossmann folds. 7 Pathogenic germline missense variants in PIGA are associated with multiple congenital anomalies-hypotonia-seizures syndrome 2 (OMIM 316818). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The affected

Among children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are typically mild. Here, we describe the case of a 3.5-year-old girl with an unusually severe presentation of coronavirus disease (COVID-19). The child had an autoinflammatory disorder of unknown etiology, which had been treated using prednisolone and methotrexate, and her parents were half cousins of Turkish descent. After 5 days of nonspecific viral infection symptoms, tonic-clonic seizures occurred followed by acute cardiac insufficiency, multi-organ insufficiency, and ultimate death. Trio exome sequencing identified a homozygous splice-variant in the gene TBK1, and a homozygous missense variant in the gene TNFRSF13B. Heterozygous deleterious variants in the TBK1 gene have been associated with severe COVID-19, and the variant in the TNFRSF13B gene has been associated with common variable immunodeficiency (CVID). We suggest that the identified variants, the autoinflammatory disorder and its treatment, or a combination of these factors probably predisposed to lethal COVID-19 in the present case.

Over a relatively short period of time, the clinical geneticist's ''toolbox'' has been expanded by machine-learning algorithms for image analysis, which can be applied to the task of syndrome identification on the basis of facial photographs, but these technologies harbor potential beyond the recognition of established phenotypes. Here, we comprehensively characterized two individuals with a hitherto unknown genetic disorder caused by the same de novo mutation in LEMD2 (c.1436C>T;p.Ser479Phe), the gene which encodes the nuclear envelope protein LEM domain-containing protein 2 (LEMD2). Despite different ages and ethnic backgrounds, both individuals share a progeria-like facial phenotype and a distinct combination of physical and neurologic anomalies, such as growth retardation; hypoplastic jaws crowded with multiple supernumerary, yet unerupted, teeth; and cerebellar intention tremor. Immunofluorescence analyses of patient fibroblasts revealed mutation-induced disturbance of nuclear architecture, recapitulating previously published data in LEMD2-deficient cell lines, and additional experiments suggested mislocalization of mutant LEMD2 protein within the nuclear lamina. Computational analysis of facial features with two different deep neural networks showed phenotypic proximity to other nuclear envelopathies. One of the algorithms, when trained to recognize syndromic similarity (rather than specific syndromes) in an unsupervised approach, clustered both individuals closely together, providing hypothesis-free hints for a common genetic etiology. We show that a recurrent de novo mutation in LEMD2 causes a nuclear envelopathy whose prognosis in adolescence is relatively good in comparison to that of classical Hutchinson-Gilford progeria syndrome, and we suggest that the application of artificial intelligence to the analysis of patient images can facilitate the discovery of new genetic disorders.

PIGT-CDG, an autosomal recessive syndromic form of a glycosylphosphatidylinositol biosynthesis defect (GPIBD) with intellectual disability, has so far only been described in seven independent families and all but one patient presented with an epileptic encephalopathy. PIGT encodes phosphatidylinositol-glycan biosynthesis class T, a subunit of the heteropentameric transamidase complex that facilitates the transfer of proteins to the GPI anchor. The GPI anchor links proteins to the cell membrane in all tissues.