In Kazakhstan, there is insufficient data on genetic epilepsy, which has its own clinical and management implications. Thus, this study aimed to use whole genome sequencing to identify and evaluate genetic variants and genetic structure of early onset epilepsy in the Kazakhstani pediatric population. In this study, for the first time in Kazakhstan, whole genome sequencing was carried out among epilepsy diagnosed children. The study involved 20 pediatric patients with early onset epilepsy and no established cause of the disease during the July–December, 2021. The average age at enrolment was 34.5 months, with a mean age at seizure onset of 6 months. Six patients (30%) were male, and 7 were familial cases. We identified pathogenic and likely pathogenic variants in 14 (70%) cases, among them, 6 novel disease gene variants (KCNQ2, CASK, WWOX, MT-CO3, GRIN2D, and SLC12A5). Other genes associated with the disease were SCN1A (x2), SLC2A1, ARX, CACNA1B, PCDH19, KCNT1, and CHRNA2. Identification of the genetic causes in 70% of cases confirms the general structure of the etiology of early onset epilepsy and the necessity of using NGS in diagnostics. Moreover, the study describes new genotype-phenotypic correlations in genetic epilepsy. Despite certain limitations of the study, it can be concluded that the genetic etiology of pediatric epilepsy in Kazakhstan is very broad and requires further research.

Perrault syndrome (PRLTS) is a rare autosomal recessive disorder which is associated with pathogenic variants in HSD17B4, HARS2, CLPP, LARS2, GGPS1, RMND1, TWNK, ERAL1, and PRORP genes. The disease is characterized by sensorineural hearing loss, sometimes with neurological signs, including progressive sensory and motor peripheral neuropathy, cerebellar ataxia, mild mental retardation, and ovarian dysgenesis in females. In this article, we report a case of a child diagnosed with spastic diplegic cerebral palsy. Determination of the segregation status of the parents of a proband with a rare compound heterozygote in the gene HSD17B4 will help the genetic counselling for the prognosis of Perrault syndrome in the family.

Introduction: Kidney transplantation is recognized as the most effective treatment for children with end-stage renal disease (ESRD), providing significant improvements in quality of life and long-term survival. Traditional methods to detect involve after allograft rejection AR primarily invasive biopsy procedures that, while diagnostic, carry significant risks, especially in pediatric patients. Therefore, there is an urgent need for safer, less invasive, and more patient-friendly methods to monitor graft health. Metabolomics, the comprehensive analysis of small-molecule metabolites within a biological sample, offers a promising solution. Materials and Methods: This paper is a non-systematic review. PubMed and Scopus-indexed journals were used to collect articles for research. In general, 6 papers were included. Results: Our findings indicate that specific urinary metabolites can serve as sensitive and specific indicators of AR, offering a safer alternative to biopsies. Metabolomic profiling not only provides real-time insights into graft health, but also supports personalized management strategies to improve patient outcomes. This study contributes to the evolving field of transplant diagnostics, demonstrating how non-invasive methods such as metabolomics could revolutionize the monitoring and treatment of pediatric kidney transplant recipients.

This study investigates the genetic landscape and phenotypic spectrum of osteogenesis imperfecta (OI) in the Kazakhstani pediatric population, focusing on 40 children diagnosed and treated at the “University Medical Center” Corporate Fund from July 2021 to June 2023. Genetic analysis was conducted using whole-genome sequencing for 22 participants at the “National Laboratory Astana” (Nazarbayev University, Astana, Kazakhstan) and whole-exome sequencing for 18 participants in private laboratories. Clinically significant genetic variants were found in 35 cases (87.5%). Mutations in the COL1A1 and COL1A2 genes were detected in 24 cases (68.6%), among them 5 variants were described for the first time. Among the rare cases of OI, variants in the IFITM5 (n = 2), SERPINF1 (n = 7), and SERPINH1 (n = 1) genes were identified. At the same time, seven unrelated cases had identical variants in the SERPINF1 gene (c.907C > T, 6 of which in the homozygous and 1 in the compound heterozygous state) and two cases in the IFITM1 gene (c.-14C > T). Novel disease-causing variants were identified in 17% of cases, and a higher proportion of collagen defects were seen. The relatively high proportion of autosomal recessive inherited OI determined in the current study should be investigated at the population level in Kazakhstan and in the countries of Central Asia. Moreover, this study described the genotype–phenotype correlation, which complements and expands the existing knowledge about the OI.

Kidney transplantation stands as the ultimate recourse for restoring vital organ functions, particularly in cases of end-stage kidney disease where alternative treatments, such as dialysis, prove less effective. With over 102,000 kidney transplants conducted globally in 2022, the demand for organ transplantation is ever-increasing, fueled by a rising incidence of end-stage renal disease attributed to causes like diabetes and hypertension. Despite significant advancements in kidney transplantation, immunosuppressive therapy remains crucial to preventing graft rejection. Tacrolimus (TAC), a calcineurin inhibitor, plays a pivotal role in this regard. Discovered in 1984, TAC inhibits T-lymphocyte activation, preventing acute rejection by disrupting the transcription of crucial genes involved in early T-cell activation. However, the use of TAC is not without challenges. The drug exhibits serious side effects, a narrow therapeutic index, and unpredictable pharmacokinetics. Therapeutic drug monitoring (TDM) becomes imperative in daily practice to maintain TAC blood concentrations within the therapeutic range. This literature review delves into the genetic aspects influencing TAC metabolism, focusing on key polymorphisms in CYP3A5, CYP3A4, and ABCB1 genes. Genetic variations in CYP3A5, a major enzyme in TAC metabolism, impact enzyme activity, necessitating personalized dosing strategies. CYP3A4 polymorphisms, especially CYP3A4*22, demonstrate associations with altered TAC clearance and dose requirements. The ABCB1 gene, encoding P-glycoprotein, another player in TAC pharmacokinetics, also exhibits polymorphisms influencing drug absorption and distribution. The ABCB1 3435C>T variant, in particular, shows potential implications on Tacrolimus bioavailability. Understanding these genetic variations aids in the development of personalized dosing regimens. Studies suggest that tailoring TAC doses based on CYP3A5 genotypes significantly improves the proportion of patients achieving therapeutic concentrations. Additionally, incorporating genetic information, particularly CYP3A4*22, into dosing strategies enhances the precision of TAC therapy, reducing the risk of adverse effects.

Genetic profiling and molecular biology methods have made it possible to study the etiology of the end-stage organ disease that led to transplantation, the genetic factors of compatibility and tolerance of the transplant, and the pharmacogenetics of immunosuppressive drugs and allowed for the development of monitoring methods for the early assessment of allograft rejection. This study aims to report the design and baseline characteristics of an integrated personalized genetic approach in solid organ transplantation, including whole-exome sequencing (WES) and the monitoring of dd-cfDNA by dPCR. Preliminary results reported female recipients with male donors undergoing two pediatric and five adult kidney and three heart transplantations. WES revealed a pathogenic mutation in RBM20 and VUS in TTN and PKP2 in heart recipients, while kidney donors presented mutations in UMOD and APOL1 associated with autosomal-dominant kidney diseases, highlighting the risks requiring the long-term monitoring of recipients, donors, and their family members. %dd-cfDNA levels were generally stable but elevated in cadaveric kidney recipient and one pediatric patient with infectious complications and genetic variants in the ABCB1 and ABCC2 genes. These findings highlight the potential of combining genetic and molecular biomarker-based approaches to improve donor–recipient matching, predict complications, and personalize post-transplant care, paving the way for precision medicine in transplantation.