Hum Mutat. 2025 Feb 27;2025:6096758. doi: 10.1155/humu/6096758. eCollection 2025.

ABSTRACT

Affecting fewer than 20,000 people as defined in South Korea, rare diseases pose significant diagnostic challenges due to their diverse manifestations and genetic heterogeneity. Genome sequencing (GS) offers a promising solution by enabling simultaneous screening for thousands of rare genetic disorders. This study explores the diagnostic utility and necessity of GS within the government-funded Korean Regional Rare Disease Diagnostic Support Program (KR-RDSP), a collaborative initiative involving 11 regional rare disease centers across Korea. The program was launched as a proof-of-concept study in 2023 to equip the genetic clinics with a diagnostic tool to expedite the diagnoses for rare disease patients who reside outside the urban Seoul region where diagnostic resources are limited. The study leveraged GS to diagnose a cohort of 400 patients exhibiting a wide spectrum of symptoms. The overall diagnostic yield was 36.3% (145/400), with 4.8% (7/145) of the diagnosed patients being reported with variants that could not have been identified by chromosomal microarray or exome sequencing (ES), highlighting the added value of comprehensive genomic analysis. The implementation of a centralized GS analysis system streamlined the diagnostic process, enabling timely reporting within a reasonable turnaround time of ≤ 35 days. Segregation analysis by Sanger sequencing played a crucial role in confirming or reclassifying variant pathogenicity by elucidating inheritance patterns. Here, we summarize diagnostic statistics from the 400 GS dataset gathered from June 2023 to December 2023 and show interesting and informative case examples that illustrate the diagnostic efficacy of GS, highlighting its ability to uncover elusive genetic etiologies and provide personalized treatment insights. The study also highlights the successful implementation of the program for the 11 regional rare disease centers across Korea with a practical workflow, comprehensive testing, comparable diagnostic yield to previous reports, and, most importantly, reasonable turnaround time.

PMID:40226308 | PMC:PMC11987077 | DOI:10.1155/humu/6096758

Hum Mutat. 2024 Apr 29;2024:6411444. doi: 10.1155/2024/6411444. eCollection 2024.

ABSTRACT

Clinical exome and genome sequencing (ES/GS) have become indispensable diagnostic tools for rare genetic diseases (RGD). However, the interpretation of ES/GS presents a substantial operational challenge in clinical settings. Test interpretation requires the review of hundreds of genetic variants, a task that has become increasingly challenging given the rising use of ES/GS. In response, we present Clinical Assessment of Variants by Likelihood Ratios (CAVaLRi), which employ a modified likelihood ratio (LR) framework to assign diagnostic probabilities to candidate germline disease genes. CAVaLRi models aspects of the clinical variant assessment process, taking into consideration the predicted impact of the variant, the proband and parental genotypes, and the proband's clinical characteristics. It also factors in computational phenotype noise and weighs the relative significance of genotype, phenotype, and variant segregation information. We trained and tested CAVaLRi on variant and phenotype data from an internal cohort of 655 clinical ES cases. For validation, CAVaLRi's performance was benchmarked against four leading gene prioritization algorithms (Exomiser's hiPHIVE and PhenIX prioritizers, LIRICAL, and XRare) using a distinct cohort of 12,832 ES cases. Our findings reveal that CAVaLRi significantly outperforms its counterparts when clinician-curated phenotype sets are used, as evidenced by its superior precision-recall curve (PR AUC: 0.701) and average diagnostic gene rank (1.59). Notably, even when substituting highly focused clinician-curated phenotype sets with large and potentially nonspecific computationally derived phenotypes, CAVaLRi retains its precision (PR AUC: 0.658; diagnostic gene average rank: 1.68) and markedly outperforms other tools. In a large, heterogeneous validation cohort, CAVaLRi stood out as the most precise prioritization algorithm (PR AUC: 0.335; average diagnostic rank: 1.91). In conclusion, CAVaLRi presents a robust solution for prioritizing diagnostic genes, surpassing current methods. It demonstrates resilience to noisy, computationally-derived phenotypes, providing a scalable strategy to help labs focus on the most diagnostically relevant variants, thus addressing the growing demand for ES/GS interpretation.

PMID:40225936 | PMC:PMC11918498 | DOI:10.1155/2024/6411444

Hum Mutat. 2024 Apr 18;2024:9920230. doi: 10.1155/2024/9920230. eCollection 2024.

ABSTRACT

Although around 6% of the world's population is affected by rare diseases, only a small number of disease-modifying therapies are available. In recent years, antisense oligonucleotides (ASOs) have emerged as one option for the development of therapeutics for orphan diseases. In particular, ASOs can be utilized for individualized genetic treatments, addressing patients with a known disease-causing genetic variant, who would otherwise not be able to receive therapy. Careful prioritization of genetic variants amenable to an ASO approach is crucial to increase chances for successful treatments and reduce costs and time for drug development. At present, there is no consensus on how to systematically approach this selection procedure. Here, we present practical guidelines to evaluate disease-causing variants and standardize the process of selecting n-of-1 cases. We focus on variants leading to a loss of function in monogenic disorders and consider which splice-switching ASO-mediated treatments are applicable in each case. To ease the understanding and application of our guidelines, we created a hypothetical transcript covering different pathogenic variants and explained their evaluation in detail. We support our recommendations with real-life examples and add further considerations to be applied to specific cases to provide a comprehensive framework for selecting eligible variants.

PMID:40225926 | PMC:PMC11919232 | DOI:10.1155/2024/9920230

BMJ Paediatr Open. 2025 Apr 10;9(1):e003286. doi: 10.1136/bmjpo-2024-003286.

ABSTRACT

BACKGROUND: The National Health Service in the UK is the first national healthcare system to offer genomic sequencing for rare disease diagnosis as routine care. Non-genetic medical specialists, including paediatricians, can now request genomic testing for certain clinical indications. The primary purpose of this study was to evaluate the preparedness and confidence of paediatricians providing genomic sequencing in England. In addition, we assessed current practice, perceived utility of testing, barriers and enablers, prior genomics education and training preferences.

METHODS: A 26-item electronic survey for completion by paediatric specialists. Participants were recruited through national associations and a conference. Quantitative items were analysed using descriptive and inferential statistics. Open-ended question responses were analysed by qualitative content analysis.

RESULTS: 157 responses were included in the analysis. Only 49.0% reported feeling prepared for mainstreaming despite 75.0% reporting they had requested testing in the past 12 months, 47.7% indicating they had returned genomic sequencing results and 67.1% feeling genomic testing was useful. Mean confidence scores were lowest for tasks including using human phenotype ontology terminology on test request forms (3.9/10), interpreting genomic test results (4.8/10), discussing complex genomic results with patients and families (4.3/10) and integrating test results into patient care (4.7/10). Significantly higher average ranked genomic confidence was identified among those who had requested testing in the last 12 months compared with those who had not (Z=5.063, p<0.001, r=0.412). The most frequent barriers to mainstreaming were lack of training and knowledge (43.3%), determining patient eligibility (28.0%), lack of time (27.4%) and confidence (25.5%). Webinars (48.4%), followed by continued professional development meetings and/or conferences (38.9%), were the preferred mode of training.

CONCLUSIONS: Our data suggest that preparedness and confidence among paediatricians in genomics is currently lacking. Support from clinical genetics services, simplified referral forms and webinar training sessions could improve current practice.

PMID:40216446 | DOI:10.1136/bmjpo-2024-003286

Cell Mol Life Sci. 2025 Apr 10;82(1):156. doi: 10.1007/s00018-025-05652-6.

ABSTRACT

Rare disorders often represent a molecular deviation from hi-fidelity genomic integrity networks and are often perceived as too difficult or unimportant for further mechanistic studies. Here, we synthesize evidence demonstrating how valuable knowledge of biochemical pathways related to rare disorders can be for biomedicine. To this end, we describe several rare congenital lipid, protein, organic acid, and glycan metabolism disorders and discuss how rare phenotypes (such as "extreme responders") and case reports (such as the lenalidomide cases) have provided clues for drug discovery or repurposing. We also discuss how rare disorders such as Gaucher disease and ultra-rare genetic syndromes can provide insights into cancer and mTOR-driven metabolism, respectively. Our discussion highlights the continued value of biochemical pathways and studies in understanding human pathophysiology and drug discovery even in the genomics era.

PMID:40210765 | DOI:10.1007/s00018-025-05652-6

J Clin Transl Hepatol. 2025 Apr 28;13(4):339-357. doi: 10.14218/JCTH.2024.00402. Epub 2025 Jan 17.

ABSTRACT

Liver injury in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is a multifaceted disorder, lacking cohort homogeneity due to a variety of potential causes, including drugs, arsenic and other heavy metals, glyphosate, infections, and ultraviolet radiation. The goals of this review were (1) to analyze the role of diagnostic algorithms in assessing causality for potential culprits involved in the development of liver injury associated with immune-mediated SJS and TEN, which represent immune-based variant disorders within a continuous spectrum. Milder forms are classified as SJS or SJS/TEN overlap, while TEN is known as the most serious form; and (2) to interpret the findings that allow for the characterization of the different types of these disorders. The manuscript is based on an extensive literature search for single case reports, case cohorts, and review articles. Search terms included: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, and specific diagnostic algorithms such as the Roussel Uclaf Causality Assessment Method (RUCAM) and the Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN). For the purpose of basic feature description, the uniform term SJS/TEN is used in the current analysis. SJS/TEN presents with five different cohort types: SJS/TEN type (1), which refers to a cohort of SJS/TEN caused by drugs, as assessed by both ALDEN and RUCAM; type (2), representing SJS/TEN due to drugs and assessed by ALDEN only, but not by RUCAM; type (3), which includes a cohort of SJS/TEN caused by drugs, assessed by non-ALDEN and non-RUCAM tools; type (4), which focuses on a cohort of SJS/TEN caused by non-drug culprits, assessed by various tools; and type (5), which considers a cohort of SJS/TEN caused by unknown culprits. Using this new SJS/TEN typology will help better characterize individual features, personalize treatment, and clarify pathogenetic specifics for each of the five disease types. This new SJS/TEN typology provides clarity by replacing issues of inhomogeneity with cohort homogeneity.

PMID:40206276 | PMC:PMC11976437 | DOI:10.14218/JCTH.2024.00402

Pharm Stat. 2025 May-Jun;24(3):e70011. doi: 10.1002/pst.70011.

ABSTRACT

Patient enrollment can be a substantial burden in rare disease trials. One potential approach is to incorporate external control (EC) into concurrent randomized trials, or EC borrowing, to reduce such burden. Extensive research has been conducted to explore statistical methodologies. As in all designs, type I error control is essential. Conditional type I error rate has been used in the literature as the de facto metrics for type I error rate. However, research has shown that controlling the conditional type I error rate at the alpha level will disallow EC borrowing. Therefore, EC borrowing is practically at an impasse. Kopp-Schneider et al. concluded that a more appropriate metrics for type I error is necessary. We show that a trial with EC borrowing can be considered as a two-stage adaptive design. With this perspective, we propose to define type I error as the weighted averages of conditional type I error rate in trials with EC borrowing. Dynamic borrowing methods for controlling type I error are proposed.

PMID:40205746 | DOI:10.1002/pst.70011

Orphanet J Rare Dis. 2025 Apr 10;20(1):169. doi: 10.1186/s13023-025-03673-9.

ABSTRACT

BACKGROUND: Individuals living with rare congenital malformations and/or intellectual disability often face challenges in accessing appropriate healthcare. Clinical practice guidelines (CPGs) may serve as a tool to provide evidence-based care for rare diseases, but their development is complex, and the views of affected individuals and families often remain unknown.

METHODS: Patient advocates of the European Reference Network ITHACA (Intellectual disability, TeleHealth, Autism and Congenital Anomalies) participated in focus groups in which their experiences with and perspectives on CPG use and development were discussed.

RESULTS: Patient advocates considered CPGs relevant to address information and care needs and support advocacy efforts. Important characteristics included representation of heterogeneity within conditions, a holistic approach in which and how topics are addressed, user-friendly availability for individuals and families, and reliability of information. Guideline development and implementation were described as challenging, iterative processes in which effective partnership between clinicians, patient advocates, and other stakeholders is essential.

CONCLUSIONS: Understanding the perspectives of patient advocates is essential to develop CPGs that meet the life-long and complex care needs of individuals and families living with rare conditions. Identified challenges include balancing the urgency of information needs with thorough guideline development processes, as well as the integration and interpretation of different types of knowledge.

PMID:40205602 | DOI:10.1186/s13023-025-03673-9

Front Public Health. 2025 Mar 24;13:1531583. doi: 10.3389/fpubh.2025.1531583. eCollection 2025.

ABSTRACT

Rare diseases, also known as orphan diseases, are a group of disorders that affect a small percentage of the population. Despite individually affecting a small number of people, collectively, they impact millions worldwide. This is particularly significant in paediatric patients, highlighting the global scale of the issue. This review delves into the exact prevalence of rare diseases among children and adolescents and their diverse impact on the quality of life of patients and their families. The review sheds light on the complex interplay of genetic and environmental factors contributing to these conditions and the diagnostic challenges and delays often encountered in identifying and categorising these diseases. It is noted that although there have been significant strides in the field of genomic medicine and the development of orphan drugs, effective treatments remain limited. This necessitates a comprehensive, multidisciplinary approach to management involving various specialities working closely together to provide holistic care. Furthermore, the review addresses the psychosocial and economic burdens faced by families with paediatric patients suffering from rare diseases, highlighting the urgent need for enhanced support mechanisms. Recent technological and therapeutic advancements, including genomic sequencing and personalized medicine, offer promising avenues for improving patient outcomes. Additionally, the review underscores the role of policy and advocacy in advancing research, ensuring healthcare access, and supporting affected families. It emphasises the importance of increased awareness, education, and collaboration among healthcare providers, researchers, policymakers, and patient advocacy groups. It stresses the pivotal role each group plays in improving the diagnosis, treatment, and overall quality of life for paediatric patients with rare diseases.

PMID:40196857 | PMC:PMC11973084 | DOI:10.3389/fpubh.2025.1531583

Orphanet J Rare Dis. 2025 Apr 8;20(1):166. doi: 10.1186/s13023-025-03629-z.

ABSTRACT

BACKGROUND: Rare diseases (RDs) clinical care and research face several challenges. Patients are dispersed over large geographic areas, their number per disease is limited, just like the number of researchers involved. Current databases as well as biological collections, when existing, are generally local, of modest size, incomplete, of uneven quality, heterogeneous in format and content, and rarely accessible or standardised to support interoperability. Most disease phenotypes are complex corresponding to multi-systemic conditions, with insufficient interdisciplinary cooperation. Thus emerged the need to generate, within a coordinated, mutualised, secure and interoperable framework, high-quality data from national or international RD cohorts, based on deep phenotyping, including molecular analysis data, notably genotypic. The RaDiCo program objective was to create, under the umbrella of Inserm, a national operational platform dedicated to the development of RD e-cohorts. Its Information System (IS) is presented here.

MATERIAL AND METHODS: Constructed on the cloud computing principle, the RaDiCo platform was designed to promote mutualization and factorization of processes and services, for both clinical epidemiology support and IS. RaDiCo IS is based on an interoperability framework combining a unique RD identifier, data standardisation, FAIR principles, data exchange flows/processes and data security principles compliant with the European GDPR.

RESULTS: RaDiCo IS favours a secure, open-source web application in order to implement and manage online databases and give patients themselves the opportunity to collect their data. It ensures a continuous monitoring of data quality and consistency over time. RaDiCo IS proved to be efficient, currently hosting 13 e-cohorts, covering 67 distinct RDs. As of April 2024, 8063 patients were recruited from 180 specialised RD sites spread across the national territory.

DISCUSSION: The RaDiCo operational platform is equivalent to a national infrastructure. Its IS enables RD e-cohorts to be developed on a shared platform with no limit on size or number. Compliant with the GDPR, it is compatible with the French National Health Data Hub and can be extended to the RDs European Reference Networks (ERNs).

CONCLUSION: RaDiCo provides a robust IS, compatible with the French Data Hub and RDs ERNs, integrated on a RD platform that enables e-cohorts creation, monitoring and analysis.

PMID:40200372 | DOI:10.1186/s13023-025-03629-z

Orphanet J Rare Dis. 2025 Apr 8;20(1):163. doi: 10.1186/s13023-025-03704-5.

ABSTRACT

BACKGROUND: Rare neurological diseases (RNDs) result in severe health burdens worldwide. Data from China are limited. We aimed to investigate the health burden of 20 RNDs in Guangdong Province (GD), which contains two-thirds of the population of South China.

METHODS: The hospitalization data of 20 RNDs were described using hospital-based front sheet data from 3,037 hospitals of GD from 2016 to 2022. The 20 RNDs included amyotrophic lateral sclerosis (ALS), Charcot-Marie-Tooth Disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, congenital myotonia, congenital myasthenic syndrome, Dravet syndrome, Fabry disease, hereditary spastic paraplegia, Huntington disease, Leber hereditary optic neuropathy, mitochondrial encephalopathy (ME), multi-focal motor neuropathy, myotonic dystrophy, primary hereditary dystonia, progressive muscular dystrophy (PMD), spinal and bulbar muscular atrophy, spinal muscular atrophy (SMA), spinocerebellar ataxia, Wilson disease (WD) and X-linked adrenoleukodystrophy. Age were presented as mean and standard deviation while length of hospital stay as median and interquartile range (25th and 75th percentiles). The other variables were described as number and percentage. The data were analyzed by Joinpoint regression.

RESULTS: There were 9,351 cases, including 330 ICU and 155 death cases. The average age was 33.7 ± 22.0 y, and 63.8% of patients were male. From 2016 to 2022, the number of RND (and juvenile RND) cases were 1034 (184), 1174 (293), 1443 (374), 1422 (320), 1331 (337), 1432 (409) to 1515 (515). ICU (and juvenile ICU) cases rose from 28 (3), 34 (6), 24 (4), 38 (11), 46 (13), 54 (24) to 106 (56). Joinpoint regression showed significant upward trend in percentages of juvenile and juvenile ICU cases (APC = 8.13, P< 0.05; APC = 28.42, P< 0.05). The fop five RNDs were WD, ASL, PMD, ME, and SMA, which accounted for 79.7% of all, 99.1% of ICU, and 94.8% of death cases.

CONCLUSIONS: We demonstrated that the increase in health burden of RNDs was mainly evident in juveniles in South China from 2016 to 2022. The top 5 RNDs accounted for majority of the critical patients.

PMID:40200352 | DOI:10.1186/s13023-025-03704-5

Neurology. 2025 Apr 8;104(7_Supplement_1):3899. doi: 10.1212/WNL.0000000000211311. Epub 2025 Apr 7.

ABSTRACT

OBJECTIVE: This study aims to evaluate condition-specific knowledge among patients with rare neuroimmune disorders.

BACKGROUND: Rare neuroimmune disorders (RNDs) include conditions such as neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD), acute disseminated encephalomyelitis (ADEM), idiopathic optic neuritis (ON) and transverse myelitis (TM). These conditions share significant phenotypic overlap, which makes communication of the diagnosis and relapse risk challenging for neurologists. This may predispose patients to have an incomplete understanding of their condition and long-term prognosis. In this study, we sought to understand the condition-specific knowledge in patients with RNDs.

DESIGN/METHODS: A questionnaire was developed to assess condition-specific knowledge in patients with RNDs by a group of neuroimmunologists. An initial version of the test was administered to five individuals with RNDs, who provided feedback via semistructured interviews. The final version of the test included fifteen questions covering localization, symptoms, etiology, and relapse risk. The test was administered virtually to subjects via a Redcap survey. Subjects also completed a demographic questionnaire, the Medical Term Recognition Test (METER) for health literacy assessment, and the Patient Determined Disease Steps (PDDS).

RESULTS: Ninety-two subjects completed the test of knowledge, and eighty-nine completed all procedures. The study population was largely female (73%), and 68% completed 16+ years of education. Individuals with MOGAD and NMOSD (n=45) scored higher on the test (median score 87%) compared to individuals with idiopathic conditions (n=45; median score 73%). Analysis for the correlation of test scores with age, duration since diagnosis, health literacy, and self-reported disability are ongoing.

CONCLUSIONS: Individuals with idiopathic conditions (TM, ON, ADEM) scored lower on our test when compared to the better-characterized conditions of NMOSD and MOGAD. Individuals with idiopathic conditions may benefit from targeted education about their diagnosis and relapse risk. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Ms. Mahale has nothing to disclose. Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Sguigna has received research support from Genentech. The institution of Dr. Sguigna has received research support from Clene Nanomedicine. The institution of Dr. Sguigna has received research support from The International Progressive Multiple Sclerosis Alliance through the National Multiple Sclerosis Society. The institution of Dr. Sguigna has received research support from PCORI. The institution of Dr. Sguigna has received research support from DOD/CDMRP. The institution of Dr. Sguigna has received research support from Alexion. Dr. Sguigna has received intellectual property interests from a discovery or technology relating to health care. Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for NeurologyLive. Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving as a Panel member with CanDoMS. Dr. Tardo has a non-compensated relationship as a Tardo with The MOG Project that is relevant to AAN interests or activities. Dr. Nguyen has nothing to disclose. Dr. DeFiebre has received personal compensation for serving as an employee of Siegel Rare Neuroimmune Association. Dr. Blackburn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics.

PMID:40194445 | DOI:10.1212/WNL.0000000000211311

Fam Cancer. 2025 Apr 7;24(2):35. doi: 10.1007/s10689-025-00462-y.

ABSTRACT

Recent updated management guidelines for Familial Adenomatous Polyposis (FAP) have been published by professional bodies internationally. These recommendations reflect the diverse needs and capabilities of varying health systems worldwide, including thresholds for intervention and population health priorities. Whilst guidelines are closely aligned in many regards, there are areas of disparity. However, alongside discrepancies in guideline recommendations, common challenges also face professional bodies across the globe. Generation of a robust evidence-base in the environment of limited data is difficult in rare diseases such as FAP, underscored by the fact that expert consensus opinion underpins virtually all guidelines. The presence of a wide phenotypic spectrum in FAP and the other hereditary gastrointestinal polyposis syndromes, whilst now well recognised, further complicates the creation of universal recommendations. In this review we draw comparison between the various international guidelines for the management of FAP, using examples to focus on thematic areas of agreement and divergence. However, beyond this, we also wish to highlight the persisting evidence gaps in clinical management, and any areas of ongoing debate among clinicians, where we are yet to establish the optimal approach.

PMID:40192835 | DOI:10.1007/s10689-025-00462-y

NAR Genom Bioinform. 2025 Apr 4;7(2):lqaf033. doi: 10.1093/nargab/lqaf033. eCollection 2025 Jun.

ABSTRACT

We describe FoundHaplo, an identity-by-descent algorithm that can be used to screen untyped disease-causing variants using single nucleotide polymorphism (SNP) array data. FoundHaplo leverages knowledge of shared disease haplotypes for inherited variants to identify those who share the disease haplotype and are, therefore, likely to carry the rare [minor allele frequency (MAF) ≤ 0.01%] variant. We performed a simulation study to evaluate the performance of FoundHaplo across 33 disease-harbouring loci. FoundHaplo was used to infer the presence of two rare (MAF ≤ 0.01%) pathogenic variants, SCN1B c.363C>G (p.Cys121Trp) and WWOX c.49G>A (p.E17K), which can cause mild dominant and severe recessive epilepsy, respectively, in the Epi25 cohort and the UK Biobank. FoundHaplo demonstrated substantially better sensitivity at inferring the presence of these rare variants than existing genome-wide imputation. FoundHaplo is a valuable screening tool for searching disease-causing variants with known founder effects using only SNP genotyping data. It is also applicable to nonhuman applications and nondisease-causing traits, including rare-variant drivers of quantitative traits. The FoundHaplo algorithm is available at https://github.com/bahlolab/FoundHaplo (DOI:10.5281/zenodo.8058286).

PMID:40191585 | PMC:PMC11970371 | DOI:10.1093/nargab/lqaf033

Eur J Pediatr. 2025 Apr 5;184(5):281. doi: 10.1007/s00431-025-06101-z.

ABSTRACT

The diagnosis and treatment of rare diseases present significant global challenges. This study aimed to identify the difficulties faced by specialists in the diagnosis and management of rare diseases, as well as to gather their recommendations for potential solutions. An expert committee specializing in inborn metabolic disease and genetics developed a comprehensive survey, which was then distributed online to professionals working with rare diseases. A total of 21 specialists actively engaged in the management of rare diseases participated in the survey. All participants acknowledged the substanstial significant diagnostic challenges associated with rare diseases, with 86% indicating that these diagnostic challenges negatively affect their clinical practice. The primary obstacles encountered in the diagnosis and follow-up of rare diseases were low awareness, a lack of a multidisciplinary approach, insufficient numbers of specialists and inadequate infrastructure, limited newborn screening programs, challenges in accessing treatment, and insufficient psychosocial support. All participants emphasized the need for a multidisciplinary approach in the management of rare diseases. Proposed solutions included enhanced training for healthcare professionals, the establishment of multidisciplinary teams and diagnostic algorithms, the regular convening of councils and meetings, and the establishment of robust registries. While all participants rated their own clinical experience as proficient in diagnosing and treating rare diseases, the establishment of multidisciplinary teams was the most frequently suggested area for improvement.

CONCLUSION: Addressing the challenges in the diagnosis, treatment, and monitoring of rare diseases requires a multifaceted approach, including raising awareness, enhancing patient services, developing robust research and improving the infrastructure, establishing multidisciplinary care frameworks, and implementing preventive medicine and social policies.

WHAT IS KNOWN: • It is estimated that over 300 million people globally are living with one or more rare diseases. The process of diagnosis, treatment, and follow-up of rare diseases involves significant global challenges.

WHAT IS NEW: • In our study, the difficulties encountered by specialists in the diagnosis and treatment of rare diseases in Türkiye and solution suggestions are presented. This is the first study on this subject in Türkiye.

PMID:40186762 | DOI:10.1007/s00431-025-06101-z

Front Public Health. 2025 Mar 20;13:1450625. doi: 10.3389/fpubh.2025.1450625. eCollection 2025.

ABSTRACT

INTRODUCTION: The role of public health has evolved from addressing infectious diseases to encompass non-communicable diseases. Individuals with genetic disorders and rare diseases constitute a particularly vulnerable population, requiring tailored public health policies, practical implementation strategies, and a long-term vision to ensure sustainable support. Given the prolonged duration and significant costs often associated with these conditions, comprehensive, patient-centered, and cost-effective approaches are essential to safeguard their physical and mental well-being.

AIMS: To summarize definitions and concepts related to health, public health, rare diseases, and to highlight the role of integrating public health interventions into routine care in improving patient outcomes. Hemophilia was selected as an exemplary rare disease due to its significant lifetime treatment costs and the recent approval and pricing of its gene therapy as the world's most expensive drug, highlighting the critical importance of public health policies in ensuring equitable access to care and treatment.

METHODS: A narrative literature review was conducted between July 2023 and December 2024, searching PubMed, Google Scholar, and Google for various topics related to rare diseases, public health, and hemophilia.

RESULTS: Public health can play an important role in improving the health outcomes of people with rare diseases by implementing conceptual and applied models to accomplish a set of objectives. Over the past two decades, legislative and regulatory support in high income countries (HICs) has facilitated the development and approval of diagnostics and treatments for several rare diseases leading to important advancements. In contrast, many low- and middle-income countries (LMICs) face obstacles in enacting legislation, developing regulations, and implementing policies to support rare disease diagnosis and treatment. More investment and innovation in drug discovery and market access pathways are still needed in both LMICs and HICs. Ensuring the translation of public health policies into regulatory measures, and in turn implementing, and regularly evaluating these measures to assess their effectiveness is crucial. In the case of hemophilia, public health can play a pivotal role.

CONCLUSION: Enhancing public health surveillance, policies, and interventions in hemophilia and other rare diseases can bridge data gaps, support access to equitable treatment, promote evidence-based care, and improve outcomes across the socioeconomic spectrum.

PMID:40182514 | PMC:PMC11965367 | DOI:10.3389/fpubh.2025.1450625

Pathologie (Heidelb). 2025 May;46(3):142-151. doi: 10.1007/s00292-025-01426-w. Epub 2025 Apr 3.

ABSTRACT

Molecular methods have improved the diagnosis of many rare tumors but have also revealed their limitations. Gene fusions that originally appeared specific occur "promiscuously" in biologically distinct mesenchymal and epithelial tumors, underscoring the importance of integrated morphologic-molecular diagnostics. By contrast, similar tumor biology-which is difficult to prove in rare tumors-supports the concept of entity-defining gene fusions for a spectrum of morphologically diverse tumors. Still other rare tumors have no diagnostically or prognostically helpful molecular profile, and their rarity and lack of authentic tumor models are obstacles to the use of, for example, new single-cell-based molecular or AI-assisted morphological methods and preclinical functional analyses. These peculiarities of rare tumors are illustrated by thymic, testicular, salivary gland, and soft tissue neoplasms.

PMID:40178563 | DOI:10.1007/s00292-025-01426-w

Neurogenetics. 2025 Apr 3;26(1):41. doi: 10.1007/s10048-025-00822-x.

ABSTRACT

Neurodevelopmental, jaw, eye, and digital syndrome (NEDJED) is a rare autosomal dominant condition that has demonstrated diverse phenotypes. This is the second case report published on this condition, covering the disease history of an 8 year old patient with a severe manifestation of the disease. The patient was born with hydrocephalus, and demonstrated major developmental delay as he aged. Whole-genome sequencing of the patient and his parents was conducted, detecting a de novo variant, NM_001378974.1:c.1220 A > T [p.Lys407Ile], located in the conserved WD4 region of the WD40 domain of FBXW11, which is consistent with all previously reported patients. The phenotype of the patient is presented with a focus on MRI and EEG features, including images and detailed description for both. While the patient's phenotype is overall consistent with previous findings, there are a number of major factors we believe are caused by the FBXW11 variant that have not been previously described, such as the patient's complete inability to walk.

PMID:40178747 | DOI:10.1007/s10048-025-00822-x

Brain Commun. 2025 Mar 17;7(2):fcaf113. doi: 10.1093/braincomms/fcaf113. eCollection 2025.

ABSTRACT

Somatic mosaic variants contribute to focal epilepsy, with variants often present only in brain tissue and not in blood or other samples typically assayed for genetic testing. Thus, genetic analysis for mosaic variants in focal epilepsy has been limited to patients with drug-resistant epilepsy who undergo surgical resection and have resected brain tissue samples available. Stereo-EEG (sEEG) has become part of the evaluation for many patients with focal drug-resistant epilepsy, and sEEG electrodes provide a potential source of small amounts of brain-derived DNA. We aimed to identify, validate, and assess the distribution of deleterious mosaic variants in epilepsy-associated genes in DNA extracted from trace brain tissue on individual sEEG electrodes. We enrolled a prospective cohort of 10 paediatric patients with drug-resistant epilepsy who had sEEG electrodes implanted for invasive monitoring. We extracted unamplified DNA and in parallel performed whole-genome amplification from trace brain tissue on each sEEG electrode. We also extracted DNA from resected brain tissue and blood/saliva samples where available. We performed deep sequencing (panel and exome) and analysis for candidate germline and mosaic variants. We validated candidate mosaic variants and assessed the variant allele fraction in amplified and unamplified electrode-derived DNA and across electrodes. We extracted unamplified DNA and performed whole-genome amplification from >150 individual electrodes from 10 individuals. Immunohistochemistry confirmed the presence of neurons in the brain tissue on electrodes. Deep sequencing and analysis demonstrated similar depth of coverage between amplified and unamplified DNA samples but significantly more potential mosaic variants in amplified samples. We validated four deleterious mosaic variants in epilepsy-associated genes in electrode-derived DNA in three patients who underwent laser ablation and did not have resected brain tissue samples available. Three of the four variants were detected in both amplified and unamplified electrode-derived DNA, with higher variant allele fraction observed in DNA from electrodes in closest proximity to the electrical seizure focus in one case. We demonstrate that mosaic variants can be identified and validated from DNA extracted from trace brain tissue on individual sEEG electrodes in patients with drug-resistant focal epilepsy, from both unamplified and amplified electrode-derived DNA. Our findings support a relationship between the extent of regional genetic abnormality and electrophysiology and suggest that with further optimization, this minimally invasive diagnostic approach holds promise for advancing precision medicine for patients with drug-resistant epilepsy as part of the surgical evaluation.

PMID:40177531 | PMC:PMC11961356 | DOI:10.1093/braincomms/fcaf113

J Health Popul Nutr. 2025 Apr 2;44(1):103. doi: 10.1186/s41043-025-00845-y.

ABSTRACT

Sturge-Weber Syndrome (SWS), is a rare neuro-oculo-cutaneous disorder that presents unique diagnostic and management challenges, particularly in resource-limited settings. This editorial reflects on a recent case of an undiagnosed SWS in an Ethiopian refugee patient in Sudan, highlighting systemic barriers to healthcare access during a time of war and the importance of clinical vigilance. We advocate for local and global initiatives to further enhance diagnostic capabilities, develop integrated care systems in recognition and management of such a rare and complex condition.

PMID:40176099 | DOI:10.1186/s41043-025-00845-y