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October 16, 2002

Members
Joubert Syndrome Foundation

Re: Breaking Research News


Dear Friends:

It is a pleasure for me to report that scientists from the University of Missouri (Drs. Braddock, Farmer, Maria, and Miles) and the University of California San Diego (Dr. Wynshaw-Boris) have teamed up to study Joubert syndrome. Importantly, the National Institutes of Health (NIH) will fund the proposed research.

Dr. Wynshaw-Boris is investigating the genetic and biochemical pathways that are important in brain development. A major effort is to study the role of genes in the development of the junction between the midbrain and hindbrain (isthmus), and cerebellum. Specific tools have been developed to inactivate genes in these brain regions and to study the consequences. Dr. Wynshaw-Boris and University of Missouri investigators were recently awarded a grant from NIH to extend research in the mouse to attempt to model Joubert syndrome, and to better define features of the disease in humans.

Common clinical features of Joubert syndrome are low muscle tone, delay in development, balance problems, and the molar tooth sign detected on MRI of the brain. Other associated abnormalities include breathing problems, eye problems, and kidney disease. Uncommon abnormalities include polydactyly, macrocephaly, soft tissue tongue tumors, and many others. In 1998 and 2002, Dr. Maria chaired scientific symposia on Joubert syndrome that were funded by the NIH and co-sponsored by the National Institute of Neurologic Disorders and Stroke, the Office of Rare Diseases, and the Joubert Syndrome Foundation. The expert panels in both workshops produced specific recommendations and defined future research directions that our research proposes to address.

The role of genetics in Joubert syndrome is indisputable; however, the location of the relevant genes, their contribution to disease onset and progression and the possible associated role of epigenetic factors is as yet unknown. In addition, a number of related disorders of hindbrain development such as Arima-Dekaban, Senior-Loken Syndrome, Varadi syndrome, or COACH have made the study of Joubert syndrome problematic. Lack of animal models, incomplete characterization of clinical features, as well as limitations resulting from geographic distribution of the study population, staffing, funding, and the feasibility of collecting a large number of families have hampered previous investigations.

The overall goal of our research is to expand the understanding of the cause, diagnosis, and management of Joubert syndrome. Our specific aims are:

Specific Aim 1 will produce mouse mutants with inactivation of genes that participate in several aspects of midbrain-hindbrain development. It is anticipated that some of these mutants will share neuropathological features with Joubert syndrome. If so, such animal models and mutant mice will help focus the search for candidate genes for Joubert syndrome.

Specific Aim 2 will establish a national Registry to inform research studies in Joubert syndrome. Collection of data for a sufficient number of families should provide adequate power of analysis for studies of clinical features and of genetic etiology. The Registry will: (a) identify and recruit affected individuals with Joubert syndrome; (b) collect clinical and radiological data including pedigree information, medical records concerning diagnosis and treatment, clinical features, and MRI data; (c) ensure that blood samples are forwarded to the Genetics Core directed by Dr. Phil Chance at the University of Washington in Seattle; and (d) analyze clinical data as a means to stratify the sample for linkage analyses in candidate regions.

Specific Aim 3 will clarify the heterogeneity within the Joubert syndrome diagnosis by characterizing the physical phenotype, family history, language and neuro-psychological features. We will determine the relative frequencies of system involvement in Joubert syndrome and what clinical (eye, face, brain, kidney, liver, finger, behavioral, neuropsychological) and radiological features cluster in affected sibs. Studies in Aim 3 will assist with the development of practice guidelines in the evaluation and monitoring of children with Joubert syndrome and related conditions.

In summary, we have secured Federal funding to advance our understanding of Joubert syndrome and to establish a national registry that you will be hearing more about from the Foundation in coming months. I am especially grateful to all families who have actively participated in past clinical studies and I look forward to keeping you updated on progress with our research.

Sincerely yours,

Bernard L. Maria, MD, MBA
Children's Miracle Network Distinguished Professor of Child Health
Professor of Pediatrics, Neurology, and Neuroscience
Chairman, Department of Child Health
Pediatrician-in-Chief of Children's Hospital
University of Missouri Health Care

cc. Dr. Wynshaw-Boris
Principal Investigator

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