This study aims to document the first genetically confirmed cases of WS1 in Ecuador. A Cross-Sectional study was conducted among individuals with early-onset insulin-dependent diabetes, residing in Santa Elena Province, Ecuador. A detailed clinical history and family tree were obtained along with laboratory and imaging diagnostics. A genetic whole exome sequencing was performed to confirm WS1 or not (NWS). This Ecuadorian cohort included 38 participants (19 males) aged < 35 years with an average diabetes onset at 3 years old. Approximately 50% of the patients are related by consanguinity. Genetic studies tested positive for WS1 in 26 (69%) patients, which yields a prevalence of 1/12,000 inhabitants and the presence of two previously undescribed variants located in exon 8. Twenty-three were homozygous. Positive antibody testing was reported in 3/26 WS1 and in 4/11 NWS patients. High prevalence of severe and early neurological complications: optic atrophy, deafness and urinary disorders were documented. No patient had diabetes insipidus. Findings suggest the highest WS1 prevalence worldwide and two novel WS1 variants. There is high consanguinity and frequency of severe, early clinical complications among WS1 patients. In addition, only 11% were diagnosed with type 1 diabetes, suggesting that younger patients with early-onset, non-autoimmune diabetes should undergo comprehensive genetic testing. We identified a cohort of young people with type 1 diabetes and severe and early neurodegenerative complications. Could these neurodegenerative complications be linked to Wolfram syndrome? We identified two new variants of WS1. All patients presented with early-onset diabetes, with an average age of onset of three years. There was a high prevalence of severe and early neurological complications, including optic atrophy (92%), deafness (80%), and urinary disorders (72%). Ecuadorian patients under the age of 16 with non-autoimmune diabetes and optic atrophy should be investigated for WS1 to ensure they receive appropriate treatment.
Palacio et al. (Fri,) studied this question.