TY - JOUR EP - 2312 Y1 - 2022/07// SP - 2301 IS - 7 VL - 145 N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. JF - Brain UR - https://doi.org/10.1093/brain/awac116 PB - Oxford University Press (OUP) N2 - Pathogenic variants in A Disintegrin And Metalloproteinase (ADAM) 22, the postsynaptic cell membrane receptor for the glycoprotein leucine-rich repeat glioma-inactivated protein 1 (LGI1), have been recently associated with recessive developmental and epileptic encephalopathy. However, so far, only two affected individuals have been described and many features of this disorder are unknown. We refine the phenotype and report 19 additional individuals harboring compound heterozygous or homozygous inactivating ADAM22 variants, of whom 18 had clinical data available. Additionally, we provide follow-up data from two previously reported cases. All affected individuals exhibited infantile-onset, treatment-resistant epilepsy. Additional clinical features included moderate to profound global developmental delay/intellectual disability (20/20), hypotonia (12/20), delayed motor development (19/20). Brain MRI findings included cerebral atrophy (13/20), supported by post-mortem histological examination in patient-derived brain tissue, cerebellar vermis atrophy (5/20), and callosal hypoplasia (4/20). Functional studies in transfected cell lines confirmed the deleteriousness of all identified variants and indicated at least three distinct pathological mechanisms: defective cell membrane expression (1), impaired LGI1-binding (2), and/or impaired interaction with the postsynaptic density protein PSD-95 (3). We reveal novel clinical and molecular hallmarks of ADAM22 deficiency and provide knowledge that might inform clinical management and early diagnostics. A1 - van der Knoop, Marieke M A1 - Maroofian, Reza A1 - Fukata, Yuko A1 - van Ierland, Yvette A1 - Karimiani, Ehsan G A1 - Lehesjoki, Anna-Elina A1 - Muona, Mikko A1 - Paetau, Anders A1 - Miyazaki, Yuri A1 - Hirano, Yoko A1 - Selim, Laila A1 - de França, Marina A1 - Fock, Rodrigo Ambrosio A1 - Beetz, Christian A1 - Ruivenkamp, Claudia AL A1 - Eaton, Alison J A1 - Morneau-Jacob, Francois D A1 - Sagi-Dain, Lena A1 - Shemer-Meiri, Lilach A1 - Peleg, Amir A1 - Haddad-Halloun, Jumana A1 - Kamphuis, Daan J A1 - Peeters-Scholte, Cacha MPCD A1 - Hiz Kurul, Semra A1 - Horvath, Rita A1 - Lochmüller, Hanns A1 - Murphy, David A1 - Waldmüller, Stephan A1 - Spranger, Stephanie A1 - Overberg, David A1 - Muir, Alison M A1 - Rad, Aboulfazl A1 - Vona, Barbara A1 - Abdulwahad, Firdous A1 - Maddirevula, Sateesh A1 - Povolotskaya, Inna S A1 - Voinova, Victoria Y A1 - Gowda, Vykuntaraju K A1 - Srinivasan, Varunvenkat M A1 - Alkuraya, Fowzan S A1 - Mefford, Heather C A1 - Alfadhel, Majid A1 - Haack, Tobias B A1 - Striano, Pasquale A1 - Severino, Mariasavina A1 - Fukata, Masaki A1 - Hilhorst-Hofstee, Yvonne A1 - Houlden, Henry TI - Biallelic ADAM22 pathogenic variants cause progressive encephalopathy and infantile-onset refractory epilepsy AV - public KW - ADAM22 KW - LGI1 KW - developmental and epileptic encephalopathy KW - refractory seizures ID - discovery10146747 ER -