@article {966, title = {Successful treatment of intractable epilepsy with ketogenic diet therapy in twins with ALG3-CDG.}, journal = {Brain Dev}, volume = {42}, year = {2020}, month = {2020 Aug}, pages = {539-545}, abstract = {

BACKGROUND: Congenital disorders of glycosylation (CDG) is a heterogeneous group of congenital metabolic diseases with multisystem clinical involvement. ALG3-CDG is a very rare subtype with only 24 cases reported so far.

CASE: Here, we report two siblings with dysmorphic features, growth retardation, microcephaly, intractable epilepsy, and hemangioma in the frontal, occipital and lumbosacral regions.

RESULTS: We studied two siblings by whole exome sequencing. A pathogenic variant in ALG3 (NM_005787.6: c.165C~>~T; p.Gly55=) that had been previously associated with congenital glycolysis defect type 1d was identified. Their intractable seizures were controlled by ketogenic diet.

CONCLUSION: Although prominent findings of growth retardation and microcephaly seen in our patients have been extensively reported before, presence of hemangioma is a novel finding that may be used as an indication for ALG3-CDG diagnosis. Our patients are the first reported cases whose intractable seizures were controlled with ketogenic diet. This report adds ketogenic diet as an option for treatment of intractable epilepsy in ALG3-CDG.

}, keywords = {Central Nervous System Neoplasms, Congenital Disorders of Glycosylation, Craniofacial Abnormalities, Developmental Disabilities, Diet, Ketogenic, Drug Resistant Epilepsy, Female, Hemangioma, Humans, Infant, Male, Mannosyltransferases, Twins, Whole Exome Sequencing}, issn = {1872-7131}, doi = {10.1016/j.braindev.2020.04.008}, author = {Paketci, C and Edem, P and Hiz, S and Sonmezler, E and Soydemir, D and Sarikaya Uzan, G and Oktay, Y and O{\textquoteright}Heir, E and Beltran, S and Laurie, S and T{\"o}pf, A and Lochmuller, H and Horvath, R and Yis, U} } @article {125, title = {Somatic p.T771R KDR (VEGFR2) Mutation Arising in a Sporadic Angioma During Ramucirumab Therapy.}, journal = {JAMA Dermatol}, volume = {151}, year = {2015}, month = {2015 Nov}, pages = {1240-3}, abstract = {

IMPORTANCE: Inhibition of angiogenesis is an effective anticancer strategy because neoplasms require a rich blood supply. Ramucirumab, approved by the US Food and Drug Administration in 2014 to treat gastric adenocarcinomas and non-small cell lung carcinomas, targets vascular endothelial growth factor 2 (VEGFR2). We identified a patient prescribed a regimen of irinotecan hydrochloride, cetuximab, and ramucirumab for metastatic rectal cancer (diagnosed in November 2013 and treated through early January 2015) who developed a new-onset, expanding vascular lesion on his right leg. Via exome sequencing, we found that the lesion contained a single somatic mutation in KDR (encodes VEGFR2), possibly in response to ramucirumab. Vascular tumors are not a known complication of antiangiogenic therapeutics.

OBSERVATIONS: Exome sequencing of the well-demarcated, blanching vascular lesion on the lateral right shin revealed a somatic p.T771R mutation in KDR, without evidence of other somatic mutations or loss of heterozygosity. Histological features included lobules of small vessels within the dermis, resembling a tufted angioma.

CONCLUSIONS AND RELEVANCE: A potential adverse effect of ramucirumab in combination therapy is the development of sporadic angiomas. The p.T771R mutation was previously implicated in autophosphorylation of VEGFR2 and reported in angiosarcomas alongside other driver mutations. Our observations suggest that this mutation confers a proliferative advantage in the setting of ramucirumab therapy. Patients receiving ramucirumab should be monitored for the development of new vascular lesions.

}, keywords = {Adult, Angiogenesis Inhibitors, Antibodies, Monoclonal, Antineoplastic Combined Chemotherapy Protocols, Camptothecin, Cetuximab, Hemangioma, Humans, Irinotecan, Male, Mutation, Rectal Neoplasms, Skin Neoplasms, Vascular Endothelial Growth Factor Receptor-2}, issn = {2168-6084}, doi = {10.1001/jamadermatol.2015.1925}, author = {Lim, Young H and Odell, Ian D and Ko, Christine J and Choate, Keith A} }