Adults with intellectual or developmental disability (IDD) comprise 1–2% of the population worldw... more Adults with intellectual or developmental disability (IDD) comprise 1–2% of the population worldwide. IDD is a significant risk factor for premature morbidity or mortality. This is likely due in part to preventable health conditions, which are modifiable with the intervention of direct care providers in areas including nutrition, promotion of an active lifestyle and effective identification of health or functional deterioration. Adults with IDD are also at increased risk for neglect or mistreatment, a finding that has been documented across multiple countries and in a variety of care settings. Contributing factors include resource availability, lack of person-centered care, management culture and care worker training. Practical and economical interventions may address the known disparities and challenges facing the large community of adults with IDD. To promote person-centered care, improve record-keeping/documentation, and aid in protecting the health and safety of this vulnerable ...
Autism Spectrum Disorder (ASD) is a set of heterogeneous neurodevelopmental conditions defined by... more Autism Spectrum Disorder (ASD) is a set of heterogeneous neurodevelopmental conditions defined by impairments in social communication and restricted, repetitive behaviors, interests or activities. Only a minority of ASD cases are determined to have a definitive etiology and the pathogenesis of most ASD is poorly understood. We hypothesized that a global analysis of the proteomes of human ASD vs. control brain, heretofore not done, would provide important data with which to better understand the underlying neurobiology of autism. In this study, we characterized the proteomes of two brain regions, Brodmann area 19 (BA19) and posterior inferior cerebellum (CB), from carefully selected idiopathic ASD cases and matched controls using label-free HPLC-tandem mass spectrometry. The data revealed marked differences between ASD and control brain proteomes for both brain regions. Unlike earlier transcriptomic analyses using frontal and temporal cortex, however, our proteomic analysis did not s...
Intellectual disability (ID) affects approximately 1%-3% of humans with a gender bias toward male... more Intellectual disability (ID) affects approximately 1%-3% of humans with a gender bias toward males. Previous studies have identified mutations in more than 100 genes on the X chromosome in males with ID, but there is less evidence for de novo mutations on the X chromosome causing ID in females. In this study we present 35 unique deleterious de novo mutations in DDX3X identified by whole exome sequencing in 38 females with ID and various other features including hypotonia, movement disorders, behavior problems, corpus callosum hypoplasia, and epilepsy. Based on our findings, mutations in DDX3X are one of the more common causes of ID, accounting for 1%-3% of unexplained ID in females. Although no de novo DDX3X mutations were identified in males, we present three families with segregating missense mutations in DDX3X, suggestive of an X-linked recessive inheritance pattern. In these families, all males with the DDX3X variant had ID, whereas carrier females were unaffected. To explore th...
fragments, used in the treatmentof severedigitalis intoxication, cause a markedinterference withb... more fragments, used in the treatmentof severedigitalis intoxication, cause a markedinterference withboth fluorescence excitation transfer immunoassays and radioimmunoassays for digoxin. In addition, we describea rapidultrafJltration methodthatavoids the Fab-induced interference and affordsexcellentaccuracyand precision. This technique willprovidea usefuladjunctto the clinicalevaluation of patients withdigoxintoxicity who are recipients of antidigoxin immunotherapy by enablinga precisedetermination of theirserum digoxinconcentrations. By separating the free and protein-bound digoxinthis technique also may be useful in evaluating serumdigoxin concentrations in patientswithabnormalplasmaproteinconcentrations. DICPAnn Pharmacother 1991;25:739-41. A NARROW MARGIN EXISTS between therapeutic and toxic concentrations of digitalis glycosides. In addition, a large number of medical conditions and drug interactions can
Background Metabolic syndrome (MS) is a construct used to separate “healthy” from “unhealthy” obe... more Background Metabolic syndrome (MS) is a construct used to separate “healthy” from “unhealthy” obese patients, and is a major risk factor for type 2 diabetes (T2D) and cardiovascular disease. There is controversy over whether obese “metabolically well” persons have a higher morbidity and mortality than lean counterparts, suggesting that MS criteria do not completely describe physiologic risk factors or consequences of obesity. We hypothesized that metabolomic analysis of plasma would distinguish obese individuals with and without MS and T2D along a spectrum of obesity-associated metabolic derangements, supporting metabolomic analysis as a tool for a more detailed assessment of metabolic wellness than currently used MS criteria. Methods Fasting plasma samples from 90 adults were assigned to groups based on BMI and ATP III criteria for MS: (1) lean metabolically well (LMW; n = 24); (2) obese metabolically well (OBMW; n = 26); (3) obese metabolically unwell (OBMUW; n = 20); and (4) obes...
The major diseases affecting the thoracic aorta are aneurysms and acute dissections, and pathogen... more The major diseases affecting the thoracic aorta are aneurysms and acute dissections, and pathogenic variants in 11 genes are confirmed to lead to heritable thoracic aortic disease. However, many families in which multiple members have thoracic aortic disease do not have alterations in the known aortopathy genes. Genes highly expressed in the aorta were assessed for rare variants in exome sequencing data from such families, and compound rare heterozygous variants (p.Pro45Argfs25 and p.Glu750) in LTBP3 were identified in affected members of one family. A homozygous variant (p.Asn678_Gly681delinsThrCys) that introduces an additional cysteine into an epidermal growth factor (EGF)-like domain in the corresponding protein, latent TGF-β binding protein (LTBP-3), was identified in a second family. Individuals with compound heterozygous or homozygous variants in these families have aneurysms and dissections of the thoracic aorta, as well as aneurysms of the abdominal aorta and other arteries...
Whole exome sequencing (WES) has the potential of identifying secondary findings that are predict... more Whole exome sequencing (WES) has the potential of identifying secondary findings that are predictive of poor pharmacotherapy outcomes. The purpose of this study was to investigate patients' wishes regarding the reporting of secondary pharmacogenomic findings. WES results (n = 106 patients) were retrospectively reviewed to determine the number of patients electing to receive secondary pharmacogenomic results. Phenotypes were assigned based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. The percent of patients with a predicted phenotype associated with a gene-based CPIC dosing recommendation was determined. Ninety-nine patients (93.4%) elected to receive secondary pharmacogenomic findings. For each gene-drug pair analyzed, the number of patients with an actionable phenotype ranged from two (2%) to 43 patients (43.4%). Combining all gene-drug pairs, 84 unique patients (84.8%) had an actionable phenotype. A prospective multidisciplinary practice model was ...
ABSTRACT We demonstrate that digoxin-specific Fab antibody fragments, used in the treatment of se... more ABSTRACT We demonstrate that digoxin-specific Fab antibody fragments, used in the treatment of severe digitalis intoxication, cause a marked interference with both fluorescence excitation transfer immunoassays and radioimmunoassays for digoxin. In addition, we describe a rapid ultrafiltration method that avoids the Fab-induced interference and affords excellent accuracy and precision. This technique will provide a useful adjunct to the clinical evaluation of patients with digoxin toxicity who are recipients of antidigoxin immunotherapy by enabling a precise determination of their serum digoxin concentrations. By separating the free and protein-bound digoxin this technique also may be useful in evaluating serum digoxin concentrations in patients with abnormal plasma protein concentrations.
American Journal of Medical Genetics, Jan 30, 1997
RSH/Smith-Lemli-Opitz (RSH/SLO) syndrome is an autosomal recessive malformation syndrome recently... more RSH/Smith-Lemli-Opitz (RSH/SLO) syndrome is an autosomal recessive malformation syndrome recently shown to be associated with a severe deficiency of cholesterol biosynthesis and markedly elevated plasma and tissue levels of 7-dehydrocholesterol (7-DHC), the immediate ...
Tay-Sachs disease (TSD) is an autosomal recessive, neurodegenerative disorder caused by a deficie... more Tay-Sachs disease (TSD) is an autosomal recessive, neurodegenerative disorder caused by a deficiency of beta-hexosaminidase A activity. Mass screening for TSD heterozygotes has been routine in the Ashkenazi Jewish population since the early 1970s. Recent advances in the molecular genetics and epidemiology of TSD require a reevaluation of heterozygote screening practices. The use of DNA-based analyses for a panel of common mutations detects about 98% of TSD mutations found in the Ashkenazi Jews and about 50% of TSD mutations found in the general non-Jewish population; enzyme-based analysis has nearly 100% sensitivity for all populations. We recommend 1) that members of several ethnic groups and persons with a family history consistent with TSD be offered testing for TSD heterozygosity and 2) that assays of enzyme activity be used as the primary screening tool, with mutation analysis used as an adjunct tool in certain cases.
Alpha-glucosidase deficiency is a rare cause of muscle disease in adults. The diagnosis relies on... more Alpha-glucosidase deficiency is a rare cause of muscle disease in adults. The diagnosis relies on recognition of the salient clinical features and determination of significantly reduced alpha-glucosidase (GAA) activity. Lymphocytes are the usual tissue for diagnostic enzymology; discrepant results from analyses of different tissues are unusual. We report a patient with clinical, electromyographic, and biopsy findings indicative of alpha-glucosidase deficiency whose muscle and lymphocyte enzyme results were markedly discrepant on multiple analyses. As a result, we conclude that all patients with suspected alpha-glucosidase deficiency and a normal lymphocyte GAA assay should also have a determination of GAA activity in muscle or skin fibroblasts.
Adults with intellectual or developmental disability (IDD) comprise 1–2% of the population worldw... more Adults with intellectual or developmental disability (IDD) comprise 1–2% of the population worldwide. IDD is a significant risk factor for premature morbidity or mortality. This is likely due in part to preventable health conditions, which are modifiable with the intervention of direct care providers in areas including nutrition, promotion of an active lifestyle and effective identification of health or functional deterioration. Adults with IDD are also at increased risk for neglect or mistreatment, a finding that has been documented across multiple countries and in a variety of care settings. Contributing factors include resource availability, lack of person-centered care, management culture and care worker training. Practical and economical interventions may address the known disparities and challenges facing the large community of adults with IDD. To promote person-centered care, improve record-keeping/documentation, and aid in protecting the health and safety of this vulnerable ...
Autism Spectrum Disorder (ASD) is a set of heterogeneous neurodevelopmental conditions defined by... more Autism Spectrum Disorder (ASD) is a set of heterogeneous neurodevelopmental conditions defined by impairments in social communication and restricted, repetitive behaviors, interests or activities. Only a minority of ASD cases are determined to have a definitive etiology and the pathogenesis of most ASD is poorly understood. We hypothesized that a global analysis of the proteomes of human ASD vs. control brain, heretofore not done, would provide important data with which to better understand the underlying neurobiology of autism. In this study, we characterized the proteomes of two brain regions, Brodmann area 19 (BA19) and posterior inferior cerebellum (CB), from carefully selected idiopathic ASD cases and matched controls using label-free HPLC-tandem mass spectrometry. The data revealed marked differences between ASD and control brain proteomes for both brain regions. Unlike earlier transcriptomic analyses using frontal and temporal cortex, however, our proteomic analysis did not s...
Intellectual disability (ID) affects approximately 1%-3% of humans with a gender bias toward male... more Intellectual disability (ID) affects approximately 1%-3% of humans with a gender bias toward males. Previous studies have identified mutations in more than 100 genes on the X chromosome in males with ID, but there is less evidence for de novo mutations on the X chromosome causing ID in females. In this study we present 35 unique deleterious de novo mutations in DDX3X identified by whole exome sequencing in 38 females with ID and various other features including hypotonia, movement disorders, behavior problems, corpus callosum hypoplasia, and epilepsy. Based on our findings, mutations in DDX3X are one of the more common causes of ID, accounting for 1%-3% of unexplained ID in females. Although no de novo DDX3X mutations were identified in males, we present three families with segregating missense mutations in DDX3X, suggestive of an X-linked recessive inheritance pattern. In these families, all males with the DDX3X variant had ID, whereas carrier females were unaffected. To explore th...
fragments, used in the treatmentof severedigitalis intoxication, cause a markedinterference withb... more fragments, used in the treatmentof severedigitalis intoxication, cause a markedinterference withboth fluorescence excitation transfer immunoassays and radioimmunoassays for digoxin. In addition, we describea rapidultrafJltration methodthatavoids the Fab-induced interference and affordsexcellentaccuracyand precision. This technique willprovidea usefuladjunctto the clinicalevaluation of patients withdigoxintoxicity who are recipients of antidigoxin immunotherapy by enablinga precisedetermination of theirserum digoxinconcentrations. By separating the free and protein-bound digoxinthis technique also may be useful in evaluating serumdigoxin concentrations in patientswithabnormalplasmaproteinconcentrations. DICPAnn Pharmacother 1991;25:739-41. A NARROW MARGIN EXISTS between therapeutic and toxic concentrations of digitalis glycosides. In addition, a large number of medical conditions and drug interactions can
Background Metabolic syndrome (MS) is a construct used to separate “healthy” from “unhealthy” obe... more Background Metabolic syndrome (MS) is a construct used to separate “healthy” from “unhealthy” obese patients, and is a major risk factor for type 2 diabetes (T2D) and cardiovascular disease. There is controversy over whether obese “metabolically well” persons have a higher morbidity and mortality than lean counterparts, suggesting that MS criteria do not completely describe physiologic risk factors or consequences of obesity. We hypothesized that metabolomic analysis of plasma would distinguish obese individuals with and without MS and T2D along a spectrum of obesity-associated metabolic derangements, supporting metabolomic analysis as a tool for a more detailed assessment of metabolic wellness than currently used MS criteria. Methods Fasting plasma samples from 90 adults were assigned to groups based on BMI and ATP III criteria for MS: (1) lean metabolically well (LMW; n = 24); (2) obese metabolically well (OBMW; n = 26); (3) obese metabolically unwell (OBMUW; n = 20); and (4) obes...
The major diseases affecting the thoracic aorta are aneurysms and acute dissections, and pathogen... more The major diseases affecting the thoracic aorta are aneurysms and acute dissections, and pathogenic variants in 11 genes are confirmed to lead to heritable thoracic aortic disease. However, many families in which multiple members have thoracic aortic disease do not have alterations in the known aortopathy genes. Genes highly expressed in the aorta were assessed for rare variants in exome sequencing data from such families, and compound rare heterozygous variants (p.Pro45Argfs25 and p.Glu750) in LTBP3 were identified in affected members of one family. A homozygous variant (p.Asn678_Gly681delinsThrCys) that introduces an additional cysteine into an epidermal growth factor (EGF)-like domain in the corresponding protein, latent TGF-β binding protein (LTBP-3), was identified in a second family. Individuals with compound heterozygous or homozygous variants in these families have aneurysms and dissections of the thoracic aorta, as well as aneurysms of the abdominal aorta and other arteries...
Whole exome sequencing (WES) has the potential of identifying secondary findings that are predict... more Whole exome sequencing (WES) has the potential of identifying secondary findings that are predictive of poor pharmacotherapy outcomes. The purpose of this study was to investigate patients' wishes regarding the reporting of secondary pharmacogenomic findings. WES results (n = 106 patients) were retrospectively reviewed to determine the number of patients electing to receive secondary pharmacogenomic results. Phenotypes were assigned based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. The percent of patients with a predicted phenotype associated with a gene-based CPIC dosing recommendation was determined. Ninety-nine patients (93.4%) elected to receive secondary pharmacogenomic findings. For each gene-drug pair analyzed, the number of patients with an actionable phenotype ranged from two (2%) to 43 patients (43.4%). Combining all gene-drug pairs, 84 unique patients (84.8%) had an actionable phenotype. A prospective multidisciplinary practice model was ...
ABSTRACT We demonstrate that digoxin-specific Fab antibody fragments, used in the treatment of se... more ABSTRACT We demonstrate that digoxin-specific Fab antibody fragments, used in the treatment of severe digitalis intoxication, cause a marked interference with both fluorescence excitation transfer immunoassays and radioimmunoassays for digoxin. In addition, we describe a rapid ultrafiltration method that avoids the Fab-induced interference and affords excellent accuracy and precision. This technique will provide a useful adjunct to the clinical evaluation of patients with digoxin toxicity who are recipients of antidigoxin immunotherapy by enabling a precise determination of their serum digoxin concentrations. By separating the free and protein-bound digoxin this technique also may be useful in evaluating serum digoxin concentrations in patients with abnormal plasma protein concentrations.
American Journal of Medical Genetics, Jan 30, 1997
RSH/Smith-Lemli-Opitz (RSH/SLO) syndrome is an autosomal recessive malformation syndrome recently... more RSH/Smith-Lemli-Opitz (RSH/SLO) syndrome is an autosomal recessive malformation syndrome recently shown to be associated with a severe deficiency of cholesterol biosynthesis and markedly elevated plasma and tissue levels of 7-dehydrocholesterol (7-DHC), the immediate ...
Tay-Sachs disease (TSD) is an autosomal recessive, neurodegenerative disorder caused by a deficie... more Tay-Sachs disease (TSD) is an autosomal recessive, neurodegenerative disorder caused by a deficiency of beta-hexosaminidase A activity. Mass screening for TSD heterozygotes has been routine in the Ashkenazi Jewish population since the early 1970s. Recent advances in the molecular genetics and epidemiology of TSD require a reevaluation of heterozygote screening practices. The use of DNA-based analyses for a panel of common mutations detects about 98% of TSD mutations found in the Ashkenazi Jews and about 50% of TSD mutations found in the general non-Jewish population; enzyme-based analysis has nearly 100% sensitivity for all populations. We recommend 1) that members of several ethnic groups and persons with a family history consistent with TSD be offered testing for TSD heterozygosity and 2) that assays of enzyme activity be used as the primary screening tool, with mutation analysis used as an adjunct tool in certain cases.
Alpha-glucosidase deficiency is a rare cause of muscle disease in adults. The diagnosis relies on... more Alpha-glucosidase deficiency is a rare cause of muscle disease in adults. The diagnosis relies on recognition of the salient clinical features and determination of significantly reduced alpha-glucosidase (GAA) activity. Lymphocytes are the usual tissue for diagnostic enzymology; discrepant results from analyses of different tissues are unusual. We report a patient with clinical, electromyographic, and biopsy findings indicative of alpha-glucosidase deficiency whose muscle and lymphocyte enzyme results were markedly discrepant on multiple analyses. As a result, we conclude that all patients with suspected alpha-glucosidase deficiency and a normal lymphocyte GAA assay should also have a determination of GAA activity in muscle or skin fibroblasts.
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Papers by Marvin Natowicz