Elyn Y-L Tzen, Jiin Yin Lim, Sue Mei Cheah, Jonathan T L Choo, Sylvia Kam, Zhi Min Ng, Biju Thomas, Saumya Jamuar, Ai Ling Koh, Ene-Choo Tan
{"title":"Diverse Clinical Manifestations of Cardiofaciocutaneous Syndrome Type 3 in Two Patients from South East Asia.","authors":"Elyn Y-L Tzen, Jiin Yin Lim, Sue Mei Cheah, Jonathan T L Choo, Sylvia Kam, Zhi Min Ng, Biju Thomas, Saumya Jamuar, Ai Ling Koh, Ene-Choo Tan","doi":"10.1159/000525434","DOIUrl":"https://doi.org/10.1159/000525434","url":null,"abstract":"<p><strong>Background: </strong>Cardiofaciocutaneous syndrome (CFCS) is a rare genetic condition caused by mutations in <i>BRAF</i>, <i>KRAS</i>, <i>MAP2K1,</i> or <i>MAP2K2</i>. It is characterized by ectodermal abnormalities, cardiac defects, intellectual disability, and distinct craniofacial features. CFCS falls under a group of conditions caused by mutations in the RAS/MAPK pathway called RASopathies which share many features. In particular, CFCS has significant phenotypic overlaps with Costello syndrome (CS) and Noonan syndrome (NS).</p><p><strong>Objective: </strong>The aim of this study was to assess the patients‧ phenotypic features for syndromic disorders and evaluate the use of molecular testing to clarify the clinical diagnosis.</p><p><strong>Method: </strong>The patients were recruited for genetic testing with written informed consent. Genomic DNA from venous blood was sequenced and potential variants were identified via targeted next-generation sequencing. Their phenotypic features were compared with other CFCS cases carrying pathogenic variants in the same gene.</p><p><strong>Results and discussion: </strong>One patient had a de novo variant (c.370C>T; p.P124S) in <i>MAP2K1</i> and presented with mild and typical features which do not significantly affect her quality of life. The second patient presented with severe features, including failure to thrive, feeding difficulties, epileptic spasms, septal hypertrophy, and global developmental delay, and developed chronic lung disease and sequelae from multiple infections. She had a severe disease course and severe global developmental delay. The discovery of a de novo variant (c.371C>A; p.P124Q) in <i>MAP2K1,</i> which had been reported in another patient with a similar phenotype, clarifies her clinical diagnosis. Her presentations add to existing reports that support expanding the CFCS phenotype to include features previously thought to be more suggestive of CS.</p><p><strong>Conclusion: </strong>The genetic findings for the 2 patients affirm the use of identified gene mutations to confirm the clinical diagnosis of syndromic disorders and add to the phenotypic spectrum of CFCS.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"21-29"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911993/pdf/msy-0014-0021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maiara A Floriani, Andressa S Santos, Bruna L Diniz, Andressa B Glaeser, Paulo R Gazzola Zen, Rafael F Machado Rosa
{"title":"22q11 Copy Number Variations in a Brazilian Cohort of Children with Congenital Heart Disorders.","authors":"Maiara A Floriani, Andressa S Santos, Bruna L Diniz, Andressa B Glaeser, Paulo R Gazzola Zen, Rafael F Machado Rosa","doi":"10.1159/000525247","DOIUrl":"https://doi.org/10.1159/000525247","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital heart disease (CHD) is the most common type of congenital defect reported to be one of the leading causes of mortality in the first year of life. Microdeletion and microduplication syndromes (MMS) are associated with cardiac malformations. Understanding which genetic factors are involved in these conditions directly impacts treatment decisions. We aimed to identify the occurrence of genetic alterations and their association with MMS in CHD pediatric patients evaluated in a reference service of Southern Brazil.</p><p><strong>Methods: </strong>Participants were recruited during 2010 in the intensive care unit of a pediatric hospital. MMs and regions of chromosome 22 were screened by SALSA MLPA Probemix P245 Microdeletion Syndromes-1A kit for detection of copy number variations (CNVs).</p><p><strong>Results: </strong>MMS were detected in 11 from 207 patients (5.3%). Heterozygous deletion in the 22q11.2 chromosome region was the most prevalent CNV (5 from 11 patients). Also, atypical <i>RTDR1</i> deletion and 22q11.2 duplication were detected. MLPA was able to reveal microdeletions in <i>SNRPN</i> and <i>NF1</i> genes in patients with a normal karyotype and FISH.</p><p><strong>Conclusion: </strong>Our study reports the prevalence and variability of genomic alterations associated with MMS in CHD pediatric patients. The results by MLPA are of great help in planning and specialized care.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"1-10"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911999/pdf/msy-0014-0001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prenatal Diagnosis of Intragenic <i>HNF1B</i> Variant-Associated Renal Disease by Exome Sequencing.","authors":"Qiu-Xia Yu, Xiang-Yi Jing, Dong-Zhi Li","doi":"10.1159/000526394","DOIUrl":"https://doi.org/10.1159/000526394","url":null,"abstract":"<p><strong>Introduction: </strong><i>HNF1B</i>-associated diseases are a group of genetic conditions that affect the kidney as well as other organ systems. Kidney anomalies are the most common symptoms. Other defects may include early-onset diabetes, genital abnormalities, and abnormalities of pancreas and liver function. Renal involvement has emerged as the earliest finding in <i>HNF1B</i> disease, even in prenatal life, with the most common feature being hyperechogenic kidneys.</p><p><strong>Case presentation: </strong>In this study, we present 3 fetuses with bilateral renal hyperechogenicity identified by ultrasound in the second trimester. No pathogenic copy number variations were revealed by amniocentesis with chromosomal microarray analysis (CMA). Heterozygous variants in <i>HNF1B</i> were detected in all 3 fetuses by further investigation with exome sequencing (ES). Two pregnancies were terminated, and one was continued to term.</p><p><strong>Discussion and conclusion: </strong>Because of the known high frequency of <i>HNF1B</i> aberrations in fetal hyperechogenic kidneys, <i>HNF1B</i> screening should be an integral part of prenatal diagnosis for such fetuses. ES should be recommended following or concurrently with CMA for rapid prenatal detection. The ES results would improve the diagnostic yield and are beneficial in guiding counseling and management.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"59-64"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911988/pdf/msy-0014-0059.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9906680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Çiğdem Seher Kasapkara, Ahmet Cevdet Ceylan, Deniz Yılmaz, Oya Kıreker Köylü, Burak Yürek, Burcu Civelek Ürey, Mehmet Gündüz
{"title":"<i>CLN3</i>-Associated NCL Case with a Preliminary Diagnosis of Niemann Pick Type C.","authors":"Çiğdem Seher Kasapkara, Ahmet Cevdet Ceylan, Deniz Yılmaz, Oya Kıreker Köylü, Burak Yürek, Burcu Civelek Ürey, Mehmet Gündüz","doi":"10.1159/000525100","DOIUrl":"https://doi.org/10.1159/000525100","url":null,"abstract":"<p><strong>Introduction: </strong>Neuronal ceroid lipofuscinoses (NCLs) are a broad class of inherited lysosomal storage disorders. Known mutations in at least 13 different genes can result in NCL with variable ages of onset, symptoms, and pathologic findings. Generally, these patients experience cognitive and motor decline, seizures, visual impairment, and premature death. Pathologically, NCL patients display heterogeneous histologic abnormalities, but consistently exhibit neuronal loss, reactive gliosis, and lysosomal accumulation of autofluorescent storage material or lipopigment. Juvenile-onset NCL has been classically referred to as Batten disease. By far the most prevalent NCL is <i>CLN3</i>-associated disease. It is an autosomal recessive condition that is usually caused by mutations in the ceroid-lipofuscinosis, neuronal 3 (<i>CLN3</i>) gene. <i>CLN3</i> encodes battenin, a ubiquitously expressed transmembrane protein of unknown function that is associated with cellular homeostasis and neuronal survival. The initial clinical symptom of <i>CLN3</i>-associated NCL is central vision loss, which is usually detected between 4 and 9 years of age. Seizures typically begin early in the second decade of life, and affected individuals rarely live beyond their mid-20ies.</p><p><strong>Case presentation: </strong>Herein, we describe a 16-year-old patient with <i>CLN3-</i>related juvenile NCL with a preliminary diagnosis of Niemann Pick Type C disease. The proband showed characteristic clinical signs, including epilepsy, ataxia, psychomotor regression, dementia, and visual impairment with an unusual elevation of lyso-sphingomyelin-509 (Lyso-SM-509; 812 nmol/L, normal 1-33 nmol/L). A homozygous NM_001042432.2(CLN3):c.233dup (p.Thr80fs) variant was detected at exon 4 of <i>CLN3.</i> Diagnosis of NCL was difficult due to the pronounced elevation of LysoSM-509.</p><p><strong>Discussion: </strong>LysoSM-509 is a biomarker which is elevated especially in Niemann Pick Type C. We can consider that a high LysoSM-509 level might be also an indicator of NCL, especially NCL type 3.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"30-34"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911989/pdf/msy-0014-0030.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Younus, Memoona Rasheed, Zhaohan Lin, Saeed A Asiri, Ibrahim A Almazni, Mohammed Ali Alshehri, Sarfraz Shafiq, Imran Iqbal, Amjad Khan, Hanif Ullah, Muhammad Umair, Ahmed Waqas
{"title":"Homozygous Missense Variant in the N-Terminal Region of ANK3 Gene Is Associated with Developmental Delay, Seizures, Speech Abnormality, and Aggressive Behavior.","authors":"Muhammad Younus, Memoona Rasheed, Zhaohan Lin, Saeed A Asiri, Ibrahim A Almazni, Mohammed Ali Alshehri, Sarfraz Shafiq, Imran Iqbal, Amjad Khan, Hanif Ullah, Muhammad Umair, Ahmed Waqas","doi":"10.1159/000526381","DOIUrl":"https://doi.org/10.1159/000526381","url":null,"abstract":"<p><strong>Introduction: </strong>Intellectual disability (ID) is a lifelong disability that affects an individual‧s learning capacity and adaptive behavior. Such individuals depend on their families for day-to-day survival and pose a significant challenge to the healthcare system, especially in developing countries. ID is a heterogeneous condition, and genetic studies are essential to unravel the underlying cellular pathway for brain development and functioning.</p><p><strong>Methods: </strong>Here we studied a female index patient, born to a consanguineous Pakistani couple, showing clinical symptoms of ID, ataxia, hypotonia, developmental delay, seizures, speech abnormality, and aggressive behavior. Whole exome sequencing (WES) coupled with Sanger sequencing was performed for molecular diagnosis. Further, 3D protein modeling was performed to see the effect of variant on protein structure.</p><p><strong>Results: </strong>WES identified a novel homozygous missense variant (c.178T>C; p.Tyr60His) in the <i>ANK3</i> gene. In silico analysis and 3-dimensional (3D) protein modeling supports the deleterious impact of this variant on the encoding protein, which compromises the protein‧s overall structure and function.</p><p><strong>Conclusion: </strong>Our finding supports the clinical and genetic diversity of the <i>ANK3</i> gene as a plausible candidate gene for ID syndrome. Intelligence is a complex polygenic human trait, and understanding molecular and biological pathways involved in learning and memory can solve the complex puzzle of how cognition develops. Intellectual disability (ID) is defined as a deficit in an individual‧s learning and adaptive behavior at an early age of onset [American Psychiatric Association, 2013]. It is one of the major medical, and cognitive disorders with a prevalence of 1-3% in the population worldwide [Leonard and Wen, 2002]. ID often exists with other disabling mental conditions such as autism, attention deficit hyperactivity disorder, epilepsy, schizophrenia, bipolar disorder, or depression. Almost half of the cases appear to have a genetic explanation that ranges from cytogenetically visible abnormalities to monogenic defects [Flint, 2001; Ropers, 2010; Tucker-Drob et al., 2013]. Intellectual disability is a genetically heterogeneous condition, and more than 700 genes have been identified to cause ID alone or as a part of the syndrome. Research in X-linked ID has identified more than 100 disease-causing genes on the X chromosome that play a role in cognition; however, research into autosomal causes of ID is still ongoing [Vissers et al., 2016].</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"11-20"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912002/pdf/msy-0014-0011.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9915949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Left Ventricular Systolic Dysfunction Related to Adrenal Insufficiency in a Case due to Autoimmune Polyendocrine Syndrome Type 1 with a Novel Variant.","authors":"Yavuz Özer, Hande Turan, Aydilek Dağdeviren Çakır, Selman Gökalp, Zeynep Ocak, Oya Ercan, Olcay Evliyaoğlu","doi":"10.1159/000526221","DOIUrl":"https://doi.org/10.1159/000526221","url":null,"abstract":"<p><strong>Introduction: </strong>Primary adrenal insufficiency associated with cardiomyopathy has been rarely reported in children. We report a case of left ventricular (LV) systolic dysfunction related to adrenal insufficiency with autoimmune polyendocrine syndrome type 1 (APS1).</p><p><strong>Case presentation: </strong>A 7-year-old girl presented with a loss of consciousness. She had hyperpigmentation over joints and enamel hypoplasia. Laboratory tests showed hypoglycemia, hyponatremia, hypocalcemia, and hyperphosphatemia. Endocrine evaluations revealed low serum parathyroid hormone, low cortisol, and high ACTH. Echocardiography showed moderate to severe mitral regurgitation and LV systolic dysfunction. Serum pro-brain natriuretic peptide (pro-BNP) level was high (2,348 pg/mL). Adrenal insufficiency, hypoparathyroidism, and enamel dysplasia suggested APS1. A novel homozygous variant in the <i>AIRE</i> gene, NM_000383, p.Cys322Arg (c.964T>C) confirmed the diagnosis. Calcium, calcitriol, and hydrocortisone treatments were started. Serum pro-BNP level returned to normal, and LV systolic function improved.</p><p><strong>Conclusion: </strong>Here, we present a case of adrenal insufficiency and hypoparathyroidism associated with LV systolic dysfunction whose cardiac findings improved completely with hydrocortisone and calcitriol treatments. Our case is the second reported case of APS1 presenting with LV dysfunction.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"65-70"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911995/pdf/msy-0014-0065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Koji Obara, Erika Abe, Shigeo Mamiya, Itaru Toyoshima
{"title":"Cerebellar Hypoperfusion in Two Patients with Cornelia de Lange Syndrome with Novel <i>NIPBL</i> Variants.","authors":"Koji Obara, Erika Abe, Shigeo Mamiya, Itaru Toyoshima","doi":"10.1159/000525681","DOIUrl":"https://doi.org/10.1159/000525681","url":null,"abstract":"<p><strong>Introduction: </strong>Cornelia de Lange syndrome (CdLS) is a rare congenital malformation characterized by distinctive facial features, short stature, and limb defects. In addition, half of the patients with CdLS exhibit repetitive self-injurious behaviors (SIBs) related to intellectual disability with autistic traits. CdLS is caused by pathogenic variants of genes encoding the cohesin complex pathway, with 70% of these variants identified in the nipped-B-like (<i>NIPBL</i>) gene.</p><p><strong>Case presentation: </strong>We report 2 patients with CdLS who exhibited repetitive SIBs. Patient 1, a 40-year-old male, carried a novel heterozygous duplication variant, c.1458dup, p.(Glu487*), in exon 9 of the <i>NIPBL</i> gene. Patient 2, a 49-year-old female, carried a novel heterozygous insertion variant, c.1751_1752ins[A;1652_1751], p.(Asp584Glufs*8), in exon 10 of the <i>NIPBL</i> gene. These variants were predicted to confer loss of function to the protein because of a premature stop codon. In both patients, single-photon emission computed tomography using <i>N</i>-isopropyl-p-[123I] iodoamphetamine (IMP-SPECT) revealed diffuse hypoperfusion in the cerebellum.</p><p><strong>Discussion: </strong>This report identified 2 novel pathogenic variants in the <i>NIPBL</i> gene and the relationship between SIBs and cerebellar hypoperfusion in patients with CdLS. The cerebellar hypoperfusion might have been caused by the dysfunction of the cohesin complex via the downregulation of the <i>NIPBL</i> gene products. Further studies should be conducted to elucidate the contribution of the <i>NIPBL</i> gene to the development of the cerebello-cerebral cortical circuits associated with behavioral disorders.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"51-58"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911990/pdf/msy-0014-0051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"<i>FBLN5</i>-Related Cutis Laxa Syndrome: A Case with a Novel Variant and Review of the Literature.","authors":"Aysel Tekmenuray-Unal, Ceren Damla Durmaz","doi":"10.1159/000525215","DOIUrl":"https://doi.org/10.1159/000525215","url":null,"abstract":"<p><strong>Introduction: </strong><i>FBLN5</i>-related cutis laxa is a very rare, autosomal recessive syndrome that is characterized by loose, wrinkled, and redundant skin, sagging cheeks, emphysema, aortic or pulmonary artery abnormalities, inguinal hernia, and diverticula of the gastrointestinal and urinary tract.</p><p><strong>Case presentation: </strong>In this study, we report an 8-year-old Turkish girl with a novel homozygous missense variant in the <i>FBLN5</i> gene, c.862G>T, p.(Asp288Tyr). Her unaffected parents were carriers of the same variant. The patient had loose skin, short stature, broad eyebrows, large ears, inguinal hernia, frequent respiratory tract infections, a history of peripheral pulmonary artery stenosis, and fourth finger contractures on both hands.</p><p><strong>Discussion: </strong>To our knowledge, 8 families have been reported to date, and this family is the third Turkish family with <i>FBLN5</i>-related cutis laxa. In addition to the classical findings of cutis laxa, the patient had fourth finger contractures on both hands. This report contributes to the ongoing clinical and genetic characterization of <i>FBLN5</i>-related cutis laxa.</p>","PeriodicalId":48566,"journal":{"name":"Molecular Syndromology","volume":"14 1","pages":"80-87"},"PeriodicalIF":1.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912000/pdf/msy-0014-0080.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9915948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}