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Early onset or syndromic epilepsy v2.364 RPIA Arina Puzriakova Phenotypes for gene: RPIA were changed from ?Ribose 5-phosphate isomerase deficiency 608611 to Ribose 5-phosphate isomerase deficiency, OMIM:608611
Early onset or syndromic epilepsy v1.191 RPIA Rebecca Foulger Source Wessex and West Midlands GLH was added to RPIA.
Early onset or syndromic epilepsy v1.190 RPIA Rebecca Foulger Source NHS GMS was added to RPIA.
Early onset or syndromic epilepsy v1.189 RPIA Rebecca Foulger reviewed gene: RPIA: Rating: AMBER; Mode of pathogenicity: ; Publications: ; Phenotypes: ; Mode of inheritance:
Early onset or syndromic epilepsy v1.188 RPIA Tracy Lester reviewed gene: RPIA: Rating: RED; Mode of pathogenicity: ; Publications: ; Phenotypes: ?Ribose 5-phosphate isomerase deficiency, 608611; Mode of inheritance: BIALLELIC, autosomal or pseudoautosomal
Early onset or syndromic epilepsy v0.1520 RPIA Sarah Leigh Marked gene: RPIA as ready
Early onset or syndromic epilepsy v0.1520 RPIA Sarah Leigh Added comment: Comment when marking as ready: Associated with phenotype in OMIM and not in Gen2Phen. At least five variants identified in three unrelated cases, with seizures as a phenotypic feature in two of these cases.
Early onset or syndromic epilepsy v0.1520 RPIA Sarah Leigh Gene: rpia has been classified as Amber List (Moderate Evidence).
Early onset or syndromic epilepsy v0.1519 RPIA Sarah Leigh Phenotypes for gene: RPIA were changed from Ribose 5-phosphate isomerase deficiency, MIM 608611 to ?Ribose 5-phosphate isomerase deficiency 608611
Early onset or syndromic epilepsy v0.1518 RPIA Sarah Leigh Classified gene: RPIA as Amber List (moderate evidence)
Early onset or syndromic epilepsy v0.1518 RPIA Sarah Leigh Added comment: Comment on list classification: Based on reviewers' comments and number of cases reported.
Early onset or syndromic epilepsy v0.1518 RPIA Sarah Leigh Gene: rpia has been classified as Amber List (Moderate Evidence).
Early onset or syndromic epilepsy v0.1488 RPIA Konstantinos Varvagiannis gene: RPIA was added
gene: RPIA was added to Genetic epilepsy syndromes. Sources: Literature
Mode of inheritance for gene: RPIA was set to BIALLELIC, autosomal or pseudoautosomal
Publications for gene: RPIA were set to 14988808; 20499043; 28801340; 30088433
Phenotypes for gene: RPIA were set to Ribose 5-phosphate isomerase deficiency, MIM 608611
Penetrance for gene: RPIA were set to unknown
Review for gene: RPIA was set to AMBER
Added comment: Biallelic pathogenic variants in RPIA cause Ribose 5-phosphate isomerase deficiency, MIM 608611.

PMID: 14988808 is the first report on the disorder with molecular (incl. genetic) confirmation of the diagnosis. A patient initially investigated for early developmental delay, leukoencephalopathy, seizures with onset at 4 years, with subsequent neurologic regression and peripheral neuropathy at the age of 7, was suspected to have a disorder of the pentose phosphate pathway on the basis of highly elevated polyols on brain MRS and body fluid analysis. Reduced ribose 5-phosphate isomerase activity was shown in fibroblasts. Genetic testing demonstrated the presence of a missense (NM_144563.2:c.404C>T / NP_653164.2:p.Ala135Val - previously referred to as A61V) as well as a frameshift variant (NM_144563.2:c.762delG / NP_653164.2:p.Asn255Ilefs). Additional extensive supportive functional studies were published a few years later (PMID: 20499043). [This patient was initially described in PMID: 10589548].

PMID: 28801340 is a report on a second patient. This individual presented with delayed early development (independent walking and speech achieved at 2 and 5 years respectively), seizures and regression at the age of 7 with MRI white matter abnormalities. Review of magnetic resonance spectroscopy (MRS) was suggestive of elevated polyols (arabitol and ribitol). In line with this, genetic testing revealed a homozygous missense variant in RPIA (NM_144563.2:c.592T>C or p.Phe198Leu). Urine analysis confirmed elevated excretion of polyols, thus confirming the diagnosis.

PMID: 30088433 reports on a boy with neonatal onset leukoencephalopathy and developmental delay having undergone early metabolic testing and aCGH (the latter at the age of 16 months). Persistance of his delay motivated exome sequencing at the age of approx. 4.5 years which demonstrated 2 RPIA variants (NM_144563.2:c.253G>A or p.Ala85Thr and NM_144563.2:c.347-1G>A). Measurement of ribitol and arabitol in urine demonstrated significant elevations (>20x) consistent with this diagnosis.

2 of the 3 patients described in the literature presented seizures.

As a result this gene can be considered for inclusion in this panel as amber.
Sources: Literature