• Test Code:
    1400
  • Department:
  • Test Synonyms:
    FAHNFA2HNBIA
  • CPT Code(s):
    81479
Background:

Fatty acid hydroxylase-associated neurodegeneration (FAHN) is an autosomal recessive disorder characterized by spastic paraplegia or quadriplegia, pyramidal tract signs, dystonia, ataxia, and brain MRI findings that include T2 hypointensity in the globus pallidus, progressive atrophy of the cerebellum, pons, medulla and spinal cord, thinning of the corpus callosum, and variable T2 hyperintensities in the periventricular and/or subcortical white matter.  Mutations in the fatty acid 2-hydroxylase gene (FA2H; OMIM 611026) are found in patients clinically diagnosed with FAHN (Evardson et al. 2008; Dick et al. 2008; Dick et al. 2010; Kruer et al. 2010).  Onset occurs in the first to second decade and the disorder is progressive.

Reasons for Referral:

  • Confirmation of a suspected clinical diagnosis in patients with the hallmark findings of FAHN.
  • Further assessment of patients with clinical diagnosis of idiopathic Neurodegeneration with Brain Iron Accumulation (NBIA) who have had mutations ruled out in PANK2 and/or PLA2G6.
  • Carrier testing of family members of FAHN patients with known mutations.

Methodology:

Sequencing can be performed by either Sanger Sequencing or Next-Generation Sequencing.

Sanger Sequencing: Sequencing of FA2H is carried out by amplification of all exons and intron/exon boundaries followed by bi-directional Sanger sequencing. The sensitivity of full gene sequencing is estimated to be approximately 99% for single nucleotide substitutions and small insertions/deletions. All nucleotide changes are analyzed within the context of current databases and literature to predict pathogenicity.

NGS: Next generation sequencing will analyze the exons or coding regions of FA2H using
Illumina NextSeq 500 technology. Samples are prepared using hybridization probes to enrich exonic regions. Promoter, intronic, etc. regions are not assessed on our assay, but may contain variants that impact gene function.Test reporting follows the ACMG Standards & Guidelines for Clinical Genetics Laboratories, Ultra-Rare Disorders Guidelines, and Interpretation of Sequence Variants Guidelines.

Specimen Requirements:

Blood: EDTA or ACD (Solution A or B):

    • Adult: 5mL
    • Child: 5mL
    • Infant: 2-3mL

Prenatal:

    • Direct Amniotic Fluid (10-20mL)
    • Direct CVS
    • Cultured Amnio or CVS (2-T25 flasks)

DNA: 10µg at a minimum of 100ng/µL

Notice Regarding Molecular Genetic Testing on CVS or Amniotic Fluid Specimens:

  • Maternal cell rule-out testing will be performed on all prenatal specimens received.Please provide maternal blood in addition to the fetal specimen.Additional charges apply for the maternal cell rule-out test.
  • All genetic testing performed on Direct CVS or Amniotic Fluid specimens will be confirmed on cell cultures prepared by Knight Diagnostic Laboratories.Cell cultures will be prepared from the specimen received.Additional charges apply for confirmatory testing.

A REQUISITION FORM MUST ACCOMPANY ALL SAMPLES.  Please include detailed clinical information, including ethnicity, clinical history, and family history.

Test Performed (Days):

Weekly

Turn Around Time:

14 – 21 Days

Shipment Sensitivity Requirements:

  • Package and ship specimen to remain cold, but not frozen. 
  • Ship via overnight express, using the FedEx priority overnight label provided. 
  • Contact Client Services for shipping kits and instructions at (855) 535-1522.

References:

  1. Kruer, M. et al.  Fatty Acid Hydroxylase-Associated Neurodegeneration. Synonym: FAHN. Includes: Dysmyelinating Leukodystrophy and Spastic Paraparesis with or without Dystonia, Spastic Paraplegia 35.  Gene Reviews. http://www.ncbi.nlm.nih.gov/books/NBK56080/.  Initial Posting: June 28, 2011.
  2. Edvardson et al. Am J Hum Genet. 2008 Nov;83(5):643-8.
  3. Dick et al. Neurology. 2008 Jul 22;71(4):248-52.
  4. Dick et al. Hum Mutat. 2010 Apr;31(4):E1251-60.
  5. Kruer et al. Ann Neurol. 2010 Nov;68(5):611-8.

Additional Info:

The Knight Cancer Institute at Oregon Health & Science University is a pioneer in the field of precision cancer medicine. The institute's director, Brian Druker, M.D., helped prove it was possible to shut down just the cells that enable cancer to grow. This breakthrough has made once-fatal forms of the disease manageable and transformed how cancer is treated. The OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle – an honor earned only by the nation's top cancer centers. It is headquarters for one of the National Cancer Institute's largest research collaboratives, SWOG, in addition to offering the latest treatments and technologies as well as hundreds of research studies and clinical trials.

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