FINCA syndrome beyond pulmonary affection: biallelic NHLRC2 variants in eight families with intellectual disability and epilepsy
Bibliographic record
Abstract
Abstract FINCA syndrome is an autosomal recessive inherited multisystemic disorder characterized by pulmonary fibrosis, neurodegeneration and cerebral angiomatosis. So far, 13 patients from nine families with biallelic NHLRC2 variants have been published. In all of them, the recurrent missense variant p.(Asp148Tyr) was detected at least on one allele. Common manifestations comprised pulmonary fibrosis, respiratory distress, developmental delay, muscular hypotonia, dystonia, seizures and brain atrophy, followed mostly by early demise due to progression of disease. Here, we present ten individuals from eight families with an overlapping but static phenotype with much longer survival, associated with seven novel NHLRC2 variants identified by exome analysis. All of the here described patients presented with severe global developmental delay. While seizures and EEG abnormalities were observed as frequent manifestations, eight individuals did not show any signs of pulmonary involvement or distinct MRI abnormalities. Notably, we also present the first seven cases in which the recurrent p.(Asp148Tyr) variant was not detected, neither in homozygous nor in compound heterozygous state. Interestingly, none of these cases presented with the classic FINCA phenotype. However, bioinformatic modeling and analyses could not establish a distinct genotype phenotype correlation. Taken together, our findings broaden the known phenotypic and molecular spectrum and propose that NHLRC2 related disease should also be considered in patients presenting with intellectual disability, movement disorders, neuroregression and epilepsy without pulmonary findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".