4.7 Review

Neuromuscular and Neuromuscular Junction Manifestations of the PURA-NDD: A Systematic Review of the Reported Symptoms and Potential Treatment Options

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Summary: This study evaluated 25 Mainland China patients and identified new PURA variants. The study suggests that PURA gene is a major contributor to 5q31.3 microdeletion syndrome and indicates the involvement of other genes as well.

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Summary: PURA syndrome, caused by heterozygous de novo pathogenic variants in PURA, is characterized by moderate to severe neurodevelopmental disability with a wide clinical spectrum and evolving phenotype. This study presents two genetically confirmed cases of PURA syndrome with severe neonatal signs and symptoms, showing a novel phenotype suggestive of neuromuscular junction pathology. The study demonstrates that PURA syndrome shares features consistent with congenital myasthenic syndrome, suggesting the need for electrodiagnostic study and consideration of salbutamol as a therapeutic option in neonates and infants with PURA syndrome.

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Yuya Fukuda et al.

Summary: This report presents a case of a 15-year-old Japanese female patient with hypotonia and global developmental delay since the neonatal period. Whole-exome sequencing revealed that she carries a known pathogenic PURA variant, and she also exhibited previously unreported clinical features.

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Shan-Ju Lin et al.

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Roberta Solazzi et al.

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Three Individuals with PURA Syndrome in a Cohort of Patients with Neuromuscular Disease

Magdalena Mroczek et al.

Summary: PURA syndrome presents with core features such as neurodevelopmental and speech delay, feeding difficulties, epilepsy, and hypotonia at birth, with muscular weakness being a prominent symptom. Two novel variants in conservative domains PUR-I and PUR-II were reported, and muscle biopsies of PURA syndrome patients showed myopathic changes and fast fiber atrophy. PURA syndrome should be considered as a differential diagnosis in pediatric patients with unexplained muscle weakness.

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Ying Liu et al.

Summary: The study retrospectively analyzed the clinical characteristics of a case of PURA syndrome and 72 cases reported in ten studies, finding that most patients exhibited symptoms such as hypotonia, feeding difficulties, and epilepsy. Therefore, other symptoms should be considered in newborns and targeted gene detection should be completed for early diagnosis and intervention.

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The Molecular Function of PURA and Its Implications in Neurological Diseases

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Summary: In recent years, genome-wide analyses have led to the identification of neurodevelopmental disorders caused by mutations in genes encoding RNA-binding proteins. This review focuses on PURA and its involvement in neuropathological abnormalities, exploring its molecular and cellular functions in various neuronal disorders, including PURA syndrome.

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PURA-Related Developmental and Epileptic Encephalopathy

Katrine M. Johannesen et al.

Summary: The study aimed to define and expand the phenotypic spectrum of PURA syndrome by collecting data from a large cohort of affected patients. Neonatal hypotonia, feeding difficulties, and respiratory distress were common characteristics, with 60% of patients developing epilepsy. Sixty percent of patients had drug-resistant epilepsy with focal or generalized seizures, and Lennox-Gastaut syndrome was the most common. Over 90 pathogenic variants in the PURA gene were found without clear genotype-phenotype associations.

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Sun Ah Choi et al.

Summary: PURA-NDDs are neurodevelopmental disorders characterized by neonatal hypotonia, global developmental delay/intellectual disability, facial dysmorphism, epileptic seizures, and ophthalmological problems. Diagnosis of PURA-NDDs is challenging and requires consideration as a differential diagnosis in individuals with severe hypotonia and distinctive facial and ophthalmological features. Next-generation sequencing methods based on detailed phenotypic evaluation can help shorten the diagnostic delay for this rare disorder.

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