与 SOX17 相关的儿童肺动脉高压:一种独特的发育和临床综合征

IF 3.9 2区 医学 Q1 PEDIATRICS
Mary P Mullen, D Dunbar Ivy, Nidhy P Varghese, Abbey J Winant, Nahir Cortes-Santiago, Sara O Vargas, Diego Porres, Nicola Maschietto, Paul J Critser, Russel Hirsch, Catherine M Avitabile, Rachel K Hopper, Benjamin S Frank, Ryan D Coleman, Pankaj B Agrawal, Jill A Madden, Amy E Roberts, Shane L Collins, J Usha Raj, Eric D Austin, Wendy K Chung, Steven H Abman
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引用次数: 0

摘要

目的研究旨在描述肺动脉高压(PAH)患儿的临床、血流动力学、影像学和病理学结果,以及与遗传性和先天性心脏病相关的 PAH 的新型风险基因 SOX17 的变异情况:研究设计:我们组建了一个多机构队列,其中包括在儿科肺动脉高压网络(PPHNet)和其他登记处登记的患有 PAH 和 SOX17 变异的儿童。受试者是通过外显子组和 PAH 基因组测序确定的。数据来自登记处和回顾性病历审查:我们发现了13名诊断时年龄在1.6岁至16岁之间、患有SOX17变异和PAH的儿童(8名女性,5名男性)。七名患者患有房间隔缺损(ASD),两名患者患有动脉导管未闭。在诊断性心导管检查时,患者的平均肺动脉压严重升高(平均 78,范围 47-124 mmHg),肺血管阻力指数明显升高(平均 25.9,范围 4.9-55 WU*m2)。没有患者对急性血管扩张剂测试有反应。导管和 CT 血管造影成像显示肺动脉解剖结构不典型,包括主肺动脉严重扩张、三阶和四阶肺动脉缺乏锥度、肺动脉 "螺旋状 "迂曲以及毛细血管 "脸红 "异常。多名患儿肺动脉狭窄,两名患儿全身动脉异常。对三名患者的肺部进行组织学检查后发现,丛状动脉病变和肺泡间隔毛细血管广泛的动脉瘤扩张:结论:SOX17相关性PAH是一种独特的遗传综合征,其特点是早发重度PAH、广泛的肺血管异常以及伴有心内分流和动脉间分流的先天性心脏病的高患病率,这表明SOX17在肺血管发育中发挥作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
SOX17-Associated Pulmonary Hypertension in Children: A Distinct Developmental and Clinical Syndrome.

Objective: To characterize clinical, hemodynamic, imaging, and pathologic findings in children with pulmonary arterial hypertension (PAH) and variants in SRY-box transcription factor 17 (SOX17), a novel risk gene linked to heritable and congenital heart disease-associated PAH.

Study design: We assembled a multi-institutional cohort of children with PAH and SOX17 variants enrolled in the Pediatric Pulmonary Hypertension Network (PPHNet) and other registries. Subjects were identified through exome and PAH gene panel sequencing. Data were collected from registries and retrospective chart review.

Results: We identified 13 children (8 female, 5 male) aged 1.6-16 years at diagnosis with SOX17 variants and PAH. Seven patients had atrial septal defects and 2 had patent ductus arteriosus. At diagnostic cardiac catheterization, patients had severely elevated mean pulmonary artery (PA) pressure (mean 78, range 47-124 mmHg) and markedly elevated indexed pulmonary vascular resistance (mean 25.9, range 4.9-55 WU∗m2). No patients responded to acute vasodilator testing. Catheter and computed tomography angiography imaging demonstrated atypical PA anatomy including severely dilated main pulmonary arteries, lack of tapering in third and fourth order pulmonary arteries, tortuous 'corkscrewing' pulmonary arteries, and abnormal capillary 'blush.' Several children had PA stenoses and 2 had systemic arterial abnormalities. Histologic examination of explanted lungs from 3 patients disclosed plexiform arteriopathy and extensive aneurysmal dilation of alveolar septal capillaries.

Conclusions: SOX17-associated PAH is a distinctive genetic syndrome characterized by early onset severe PAH, extensive pulmonary vascular abnormalities, and high prevalence of congenital heart disease with intracardiac and interarterial shunts, suggesting a role for SOX17 in pulmonary vascular development.

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来源期刊
Journal of Pediatrics
Journal of Pediatrics 医学-小儿科
CiteScore
6.00
自引率
2.00%
发文量
696
审稿时长
31 days
期刊介绍: The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.
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