epi_classify_test.csv

Evolution of the Friedreich's ataxia trinucleotide repeat expansion: founder effect and premutations. Friedreich's ataxia the most frequent inherited ataxia is caused in the vast majority of cases by large GAA repeat expansions in the first intron of the frataxin gene. The normal sequence corresponds to a moderately polymorphic trinucleotide repeat with bimodal size distribution. Small normal alleles have approximately eight to nine repeats whereas a more heterogeneous mode of large normal alleles ranges from 16 to 34 GAA. The latter class accounts for approximately 17% of normal alleles. To identify the origin of the expansion mutation we analyzed linkage disequilibrium between expansion mutations or normal alleles and a haplotype of five polymorphic markers within or close to the frataxin gene; 51% of the expansions were associated with a single haplotype and the other expansions were associated with haplotypes that could be related to the major one by mutation at a polymorphic marker or by ancient recombination. Of interest the major haplotype associated with expansion is also the major haplotype associated with the larger alleles in the normal size range and was almost never found associated with the smaller normal alleles. The results indicate that most if not all large normal alleles derive from a single founder chromosome and that they represent a reservoir for larger expansion events possibly through "premutation" intermediates. Indeed we found two such alleles (42 and 60 GAA) that underwent cataclysmic expansion to pathological range in a single generation. This stepwise evolution to large trinucleotide expansions already was suggested for myotonic dystrophy and fragile X syndrome and may relate to a common mutational mechanism despite sequence motif differences.,1
Cleft palate lateral synechia syndrome: an opportunity for unique surgical closure. OBJECTIVES: To report two cases of cleft palate lateral synechia (CPLS) syndrome in a single family and describe surgical closure using the synechia. STUDY DESIGN: Case report and literature review. METHODS: A case report is presented with a review of the literature of cleft palate in conjunction with lateral synechia. Clinical presentation with photographic images of surgical repair is presented as well as a genetic workup with pedigree. RESULTS: A 6-week-old male presented for evaluation of a cleft palate. Mucosa-lined fibromuscular tissue bands were noted connecting the floor of mouth and the free edges of a bilateral complete secondary cleft palate. No other craniofacial digital genital or limb defects were noted. The patient's 13-month-old sister had similar synechial bands and cleft palate at birth. Another older sibling had cleft palate without synechia. The patient's mother and maternal great grandmother had cleft palates at birth without synechia. The three children share a common mother but have three different fathers. Genetic analysis failed to reveal chromosomal defects or a mutation in the interferon regulatory factor 6 (IRF6) gene a locus linked to Van der Woude syndrome. At 2 years of age the index patient was growing and feeding well. His intra-oral bands remained intact and were incorporated in the surgical repair using a novel approach. CONCLUSIONS: Since more otolaryngologists are performing cleft surgeries the awareness of the differential diagnoses associated with a cleft palate is important. CPLS is an extremely rare condition. The report of this family supports the suspected pattern of autosomal dominant inheritance with variable expressivity. The unusual surgical approach will be discussed.,0
Craniofacial conodysplasia. A family with dominant inheritance of a previously unreported syndrome of craniofacial dysplasia and cone-shaped physes of the hands and feet is described. Hydrocephalus and spinal cord compression at the craniocervical junction causes neurological complications and mimics cerebral palsy. Early diagnosis and treatment may prevent progression of neurological changes.,0
Cardiomyopathy familial dilated. Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic function. Patients with DCM suffer from heart failure arrhythmia and are at risk of premature death. DCM has a prevalence of one case out of 2500 individuals with an incidence of 7/100000/year (but may be under diagnosed). In many cases the disease is inherited and is termed familial DCM (FDC). FDC may account for 20-48% of DCM. FDC is principally caused by genetic mutations in FDC genes that encode for cytoskeletal and sarcomeric proteins in the cardiac myocyte. Family history analysis is an important tool for identifying families affected by FDC. Standard criteria for evaluating FDC families have been published and the use of such criteria is increasing. Clinical genetic testing has been developed for some FDC genes and will be increasingly utilized for evaluating FDC families. Through the use of family screening by pedigree analysis and/or genetic testing it is possible to identify patients at earlier or even presymptomatic stages of their disease. This presents an opportunity to invoke lifestyle changes and to provide pharmacological therapy earlier in the course of disease. Genetic counseling is used to identify additional asymptomatic family members who are at risk of developing symptoms allowing for regular screening of these individuals. The management of FDC focuses on limiting the progression of heart failure and controlling arrhythmia and is based on currently accepted treatment guidelines for DCM. It includes general measures (salt and fluid restriction treatment of hypertension limitation of alcohol intake control of body weight moderate exercise) and pharmacotherapy. Cardiac resynchronization implantable cardioverter defibrillators and left ventricular assist devices have progressively expanding usage. Patients with severe heart failure severe reduction of the functional capacity and depressed left ventricular ejection fraction have a low survival rate and may require heart transplant.,1
Autosomal dominant antecubital pterygium: syndromic status substantiated. An autosomal dominant (AD) antecubital pterygium syndrome has been documented on the Indian Ocean Island of Rodrigues and 11 affected family members in five generations have been studied over four decades. The consistent features include a fleshy web extending across the anterior aspect of the cubital fossa absence of the long head of the triceps limitation of full elbow extension and missing skin creases over the terminal inter-phalangeal joints of the fingers. On the basis of our observations we consider that this condition warrants acceptance as an autonomous AD entity.,0
Chromosome 1p36 deletions: the clinical phenotype and molecular characterization of a common newly delineated syndrome. Deletions of the distal short arm of chromosome 1 (1p36) represent a common newly delineated deletion syndrome characterized by moderate to severe psychomotor retardation seizures growth delay and dysmorphic features. Previous cytogenetic underascertainment of this chromosomal deletion has made it difficult to characterize the clinical and molecular aspects of the syndrome. Recent advances in cytogenetic technology particularly FISH have greatly improved the ability to identify 1p36 deletions and have allowed a clearer definition of the clinical phenotype and molecular characteristics of this syndrome. We have identified 14 patients with chromosome 1p36 deletions and have assessed the frequency of each phenotypic feature and clinical manifestation in the 13 patients with pure 1p36 deletions. The physical extent and parental origin of each deletion were determined by use of FISH probes on cytogenetic preparations and by analysis of polymorphic DNA markers in the patients and their available parents. Clinical examinations revealed that the most common features and medical problems in patients with this deletion syndrome include large anterior fontanelle (100%) motor delay/hypotonia (92%) moderate to severe mental retardation (92%) growth delay (85%) pointed chin (80%) eye/vision problems (75%) seizures (72%) flat nasal bridge (65%) clinodactyly and/or short fifth finger(s) (64%) low-set ear(s) (59%) ear asymmetry (57%) hearing deficits (56%) abusive behavior (56%) thickened ear helices (53%) and deep-set eyes (50%). FISH and DNA polymorphism analysis showed that there is no uniform region of deletion but rather a spectrum of different deletion sizes with a common minimal region of deletion overlap.,1
Mutations in the tail domain of DYNC1H1 cause dominant spinal muscular atrophy. To identify the gene responsible for 14q32-linked dominant spinal muscular atrophy with lower extremity predominance (SMA-LED OMIM 158600).Target exon capture and next generation sequencing was used to analyze the 73 genes in the 14q32 linkage interval in 3 SMA-LED family members. Candidate gene sequencing in additional dominant SMA families used PCR and pooled target capture methods. Patient fibroblasts were biochemically analyzed.Regional exome sequencing of all candidate genes in the 14q32 interval in the original SMA-LED family identified only one missense mutation that segregated with disease state-a mutation in the tail domain of DYNC1H1 (I584L). Sequencing of DYNC1H1 in 32 additional probands with lower extremity predominant SMA found 2 additional heterozygous tail domain mutations (K671E and Y970C) confirming that multiple different mutations in the same domain can cause a similar phenotype. Biochemical analysis of dynein purified from patient-derived fibroblasts demonstrated that the I584L mutation dominantly disrupted dynein complex stability and function.We demonstrate that mutations in the tail domain of the heavy chain of cytoplasmic dynein (DYNC1H1) cause spinal muscular atrophy and provide experimental evidence that a human DYNC1H1 mutation disrupts dynein complex assembly and function. DYNC1H1 mutations were recently found in a family with Charcot-Marie-Tooth disease (type 2O) and in a child with mental retardation. Both of these phenotypes show partial overlap with the spinal muscular atrophy patients described here indicating that dynein dysfunction is associated with a range of phenotypes in humans involving neuronal development and maintenance.,0
Contemporary epidemiology of bladder exstrophy in the United States. PURPOSE: Although bladder exstrophy is much discussed in the urology literature there are few population based epidemiological data available for this rare condition. The purpose of this study was to use a large nationwide database to collect contemporary data on the incidence and demographics of bladder exstrophy. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample is a 20% sample of nonfederal United States hospitals containing data on 5 million to 7 million inpatient stays per year. The sample was limited to newborns and International Classification of Disease-9 codes were used to identify cases of bladder exstrophy. We then determined nationally weighted incidence through time and performed multivariate analyses to identify factors associated with exstrophy. RESULTS: We identified 205 patients with exstrophy among 9452110 newborns. The overall weighted incidence of exstrophy was 2.15 per 100000 live births. The male-to-female ratio was almost even (OR 0.989 95% CI 0.88 to 1.12). White infants were significantly more likely to present with exstrophy than nonwhites (incidence 2.63 vs 1.54 per 100000 p <0.0001). Exstrophy incidence also varied by geographic region socioeconomic status (SES) and insurance status. On multivariate analysis the racial variation in exstrophy incidence persisted even after adjustment for geographic region SES and insurance status. Conditions such as spina bifida cleft palate preterm birth and gastrointestinal anomalies were more common in newborns with exstrophy. CONCLUSIONS: Bladder exstrophy is rare occurs in equal numbers of live male and female newborns and is associated with certain co-morbid conditions. Incidence appears to be stable through time. Nonwhite race uninsured status high or low SES and Western geographic region are associated with lower exstrophy incidence.,1
Takayasu arteritis. A study of 32 North American patients. Thirty-two patients (26 female 6 male) with angiographically diagnosed Takayasu arteritis were seen at the Mayo Clinic between 1971 and 1982. Racial composition of this group was 23 North American Caucasians 4 Mexicans 3 Orientals 1 Native American and 1 patient of Middle Eastern origin. Incidence of the disease in Olmsted County Minnesota was 2.6/million/year. Diagnosis was often delayed for long periods of time with a median delay of 18 months. Patients had both non-vascular symptoms (arthralgias in 56% fever in 44% weight loss in 38%) and symptoms of vascular stenosis such as arm claudication (47%) and hypertension due to renal artery stenosis (41%). All patients had either multiple vascular bruits (94%) or absent pulses (50%). Laboratory findings included anemia (44%) and elevations of erythrocyte sedimentation rate (78%). Almost all patients had multiple sites of arterial involvement documented by angiogram with various combinations of stenosis luminal irregularity and aneurysm formation. Response to corticosteroid treatment was usually very good with dramatic improvement in non-vascular symptoms and return of pulses in 8 of the 16 patients with absent pulses prior to treatment. Five-year survival rate from time of diagnosis was 94%. Twelve patients underwent surgical procedures involving the carotid arteries (5 cases) subclavian artery (4 cases) and renal arteries (3 cases). Three aneurysms were resected one had aortic valve replacement for severe aortic regurgitation and two patients underwent transluminal angioplasty. Pathologic changes were restricted to the media and adventitial layers of the vessel wall and were indistinguishable from those of giant-cell or temporal arteritis. Takayasu arteritis is more common than previously suspected in North America is not restricted to any one racial group and is readily treatable with corticosteroids and surgical vascular reconstruction.,1
Mutations in KANSL1 cause the 17q21.31 microdeletion syndrome phenotype. The chromosome 17q21.31 deletion syndrome is a genomic disorder characterized by highly distinctive facial features moderate-to-severe intellectual disability hypotonia and friendly behavior. Here we show that de novo loss-of-function mutations in KANSL1 (also called KIAA1267) cause a full del(17q21.31) phenotype in two unrelated individuals that lack deletion at 17q21.31. These findings indicate that 17q21.31 deletion syndrome is a monogenic disorder caused by haploinsufficiency of KANSL1.,1
Clinical biochemical and molecular findings in three patients with 3-hydroxyisobutyric aciduria. 3-Hydroxyisobutyric aciduria is a rare entity and affected individuals display a range of clinical manifestations including dysmorphic features and neurodevelopmental problems in the majority of patients. Here we present two novel patients with 3-hydroxyisobutyric aciduria. To our knowledge these are the 11th and 12th cases of 3-hydroxyisobutyic aciduria reported. It is believed that a deficiency in 3-hydroxyisobutyrate dehydrogenase is the most likely cause of this disorder. Measurement of 3-hydroxyisobutyrate dehydrogenase activity in fibroblasts homogenates of the two newly identified patients and a previously reported patient however revealed similar activities as in control fibroblasts. Since other enzymes with overlapping substrate specificity could conceal abnormal 3-hydroxyisobutyrate dehydrogenase activity we cloned a candidate human cDNA for 3-hydroxyisobutyrate dehydrogenase (HIBADH). By heterologous expression in Escherichia coli we showed that the product of the HIBADH gene indeed displays 3-hydroxyisobutyrate dehydrogenase activity. Mutation analysis of the corresponding gene in the patients suffering from 3-hydroxyisobutyric aciduria revealed no mutations. We conclude that HIBADH is not the causative gene in 3-hydroxyisobutyric aciduria.,1
Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admissions. Six thousand three hundred and six cases of achalasia were admitted to hospital in Britain and Ireland over a 10-year period. The majority (4920) came from England. The disease was significantly more common in Eire than England Wales Scotland or Northern Ireland. The prevalence in a 10-year period of 13.4/10(5) in Eire was based on 453 cases. Checks on the accuracy of prevalences collected in this manner showed them to be within 2.5 per cent of the actual figure. Studies of age-specific incidence in Scotland and Oxford showed a close correlation between the regions and between men and women. Achalasia is most common in Eire and its incidence increases with age.,1
Recurrent fever associated with progesterone action and persistently elevated serum levels of immunoreactive tumor necrosis factor-alpha and interleukin-6. We describe two women who suffer from recurrent fever up to 40 C in association with progesterone action and who have continuously elevated serum levels of immunoreactive tumor necrosis factor-alpha (TNF alpha) and interleukin-6 (IL-6). In patient 1 recurrent fever began at age 17 yr and has now continued for 11 yr. The patient has had three early pregnancy terminations because of continuous fever and thereafter three early pregnancy losses associated with fever. In patient 2 fever first appeared at age 18 yr and the attacks have now continued for 3 yr. The association between fever and progesterone action is supported by the following facts. 1) The episodes of fever appear in the midluteal phase of the menstrual cycle concomitantly with the highest concentration of serum progesterone. 2) Fever is further exaggerated in early pregnancy. 3) Synthetic progestins induce fever regardless of the day of the menstrual cycle. 4) The progesterone antagonist RU 486 and an agonist of GnRH nafarelin are capable of preventing the fever with no effect on serum cytokine levels. Although the underlying mechanism of elevated TNF alpha and IL-6 levels in our patients remains unknown the data suggest that these cytokines cooperate with progesterone in exerting a pyrogenic response in the hypothalamic thermoregulatory center.,0
Hallermann-Streiff syndrome: experience with 15 patients and review of the literature. Hallermann-Streiff syndrome is rare with approximately 150 case reports in the world literature. The syndrome consists of proportionate nanism; hypotrichosis; atrophy and extreme thinness of the skin particularly over the facial area; an unusual "bird-like" face with mandibular hypoplasia; a prominent thin pointed nose; congenital cataracts; and severe dental abnormalities. This appears to be a sporadic mutation and the inheritance pattern is unknown. Clinical management must focus on the more life-threatening and developmental issues early on and aesthetic deformities can be addressed after the adolescent growth period is complete. Surgical correction of cataracts should be undertaken early in life to preserve vision. Airway issues need to be addressed early. Other reconstructive procedures including rhinoplasty facial augmentation and mandibular surgery have been successful and can be performed later in life. We report on our clinical findings in 15 patients with this condition our attempts at reconstruction and complications we have encountered in treating this patient population. Five of our patients had produced normal chromosome studies and none have had similarly affected siblings. Four have had normal unaffected children. Most of our patients have undergone multiple reconstructive procedures and have done relatively well. Eleven of our patients however have encountered significant intermittent respiratory difficulty manifested as early feeding difficulty recurrent upper respiratory tract infection sleep apnea and respiratory arrest. Three patients required tracheostomy because of respiratory difficulty and one child died of postoperative respiratory compromise. The management of these complicated and difficult patients is discussed.,1
Association between maternal chronic conditions and congenital heart defects: a population-based cohort study. BACKGROUND: This study quantifies the association between maternal medical conditions/illnesses and congenital heart defects (CHDs) among infants. METHODS AND RESULTS: We carried out a population-based study of all mother-infant pairs (n=2278838) in Canada (excluding Quebec) from 2002 to 2010 using data from the Canadian Institute for Health Information. CHDs among infants were classified phenotypically through a hierarchical grouping of International Statistical Classification of Diseases and Related Health Problems 10th Revision Canada codes. Maternal conditions such as multifetal pregnancy diabetes mellitus hypertension and congenital heart disease were defined by use of diagnosis codes. The association between maternal conditions and CHDs and its subtypes was modeled using logistic regression with adjustment for maternal age parity residence and other factors. There were 26 488 infants diagnosed with CHDs at birth or at rehospitalization in infancy; the overall CHD prevalence was 116.2 per 10000 live births of which the severe CHD rate was 22.3 per 10000. Risk factors for CHD included maternal age ≥40 years (adjusted odds ratio [aOR] 1.48; 95% confidence interval [CI] 1.39-1.58) multifetal pregnancy (aOR 4.53; 95% CI 4.28-4.80) diabetes mellitus (type 1: aOR 4.65; 95% CI 4.13-5.24; type 2: aOR 4.12; 95% CI 3.69-4.60) hypertension (aOR 1.81; 95% CI 1.61-2.03) thyroid disorders (aOR 1.45; 95% CI 1.26-1.67) congenital heart disease (aOR 9.92; 95% CI 8.36-11.8) systemic connective tissue disorders (aOR 3.01; 95% CI 2.23-4.06) and epilepsy and mood disorders (aOR 1.41; 95% CI 1.16-1.72). Specific CHD subtypes were associated with different maternal risk factors. CONCLUSIONS: Several chronic maternal medical conditions including diabetes mellitus hypertension connective tissue disorders and congenital heart disease confer an increased risk of CHD in the offspring.,1
A multiplex human syndrome implicates a key role for intestinal cell kinase in development of central nervous skeletal and endocrine systems. Six infants in an Old Order Amish pedigree were observed to be affected with endocrine-cerebro-osteodysplasia (ECO). ECO is a previously unidentified neonatal lethal recessive disorder with multiple anomalies involving the endocrine cerebral and skeletal systems. Autozygosity mapping and sequencing identified a previously unknown missense mutation R272Q in ICK encoding intestinal cell kinase (ICK). Our results established that R272 is conserved across species and among ethnicities and three-dimensional analysis of the protein structure suggests protein instability due to the R272Q mutation. We also demonstrate that the R272Q mutant fails to localize at the nucleus and has diminished kinase activity. These findings suggest that ICK plays a key role in the development of multiple organ systems.,0
A new syndrome with noncompaction cardiomyopathy bradycardia pulmonary stenosis atrial septal defect and heterotaxy with suggestive linkage to chromosome 6p. We report a three-generation family with nine patients affected by a combination of cardiac abnormalities and left isomerism which to our knowledge has not been described before. The cardiac anomalies include non-compaction of the ventricular myocardium bradycardia pulmonary valve stenosis and secundum atrial septal defect. The laterality sequence anomalies include left bronchial isomerism azygous continuation of the inferior vena cava polysplenia and intestinal malrotation all compatible with left isomerism. This new syndrome is inherited in an autosomal dominant pattern. A genome-wide linkage analysis suggested linkage to chromosome 6p24.3-21.2 with a maximum LOD score of 2.7 at marker D6S276. The linkage interval is located between markers D6S470 (telomeric side) and D6S1610 (centromeric side) and overlaps with the linkage interval in another family with heterotaxy reported previously. Taken together the genomic region could be reduced to 9.4 cM (12 Mb) containing several functional candidate genes for this complex heterotaxy phenotype.,0
Marfan's syndrome. Marfan's syndrome is a systemic disorder of connective tissue caused by mutations in the extracellular matrix protein fibrillin 1. Cardinal manifestations include proximal aortic aneurysm dislocation of the ocular lens and long-bone overgrowth. Important advances have been made in the diagnosis and medical and surgical care of affected individuals yet substantial morbidity and premature mortality remain associated with this disorder. Progress has been made with genetically defined mouse models to elucidate the pathogenetic sequence that is initiated by fibrillin-1 deficiency. The new understanding is that many aspects of the disease are caused by altered regulation of transforming growth factor beta (TGFbeta) a family of cytokines that affect cellular performance highlighting the potential therapeutic application of TGFbeta antagonists. Insights derived from studying this mendelian disorder are anticipated to have relevance for more common and non-syndromic presentations of selected aspects of the Marfan phenotype.,1
Further Delineation of the ALG9-CDG Phenotype. ALG9-CDG is one of the less frequently reported types of CDG. Here we summarize the features of six patients with ALG9-CDG reported in the literature and report the features of four additional patients. The patients presented with drug-resistant infantile epilepsy hypotonia dysmorphic features failure to thrive global developmental disability and skeletal dysplasia. One patient presented with nonimmune hydrops fetalis. A brain MRI revealed global atrophy with delayed myelination. Exome sequencing identified a novel homozygous mutation c.1075G>A p.E359K of the ALG9 gene. The results of our analysis of these patients expand the knowledge of ALG9-CDG phenotype.,1
Onychomatricoma: a case report with literature review. Onychomatricoma (OM) is a fibroepithelial tumor of nail matrix that occurs in the digits of both the hands and feet. This was first reported by Baran and Kint. They initially described 3 cases all of which demonstrated a filamentous tumor of matrix tissue that resulted in a thickened funnel-shaped nail. Although apparently benign it is subject to recurrence and long-term follow-up is recommended because it is not known whether there is a conversion to malignancy. Even though this neoplasm was first described more than 18 years ago there remains a dearth of case reports (currently fewer than 50) in the literature. This is a single case report and literature review.                                  Levels of Evidence               : Therapeutic Level IV.,1
Male neonatal death and progressive weakness and immune deficiency in females: an unknown X linked condition. We report a family with an undiagnosed X linked condition. The grandmother two of her three daughters and one of her grand-daughters have a slowly progressive proximal weakness brisk reflexes poor bladder function static reduced night vision and IgG2 deficiency. The diagnosis of the three living symptomatic females was "hereditary spastic paraplegia plus". They have lost five male children who died in the neonatal period of severe hypotonia and were of low birth weight. Investigations have not led to a unifying diagnosis: myotonic dystrophy NARP and X linked hyper IgM were specifically eliminated. Using the hypothesis that the condition is X linked dominant haplotype analysis of the family suggests that the disease locus is within Xq26-qter. This entity should be considered in the differential diagnosis of families presenting with severe neonatal hypotonia in males and females with symptoms suggestive of complex hereditary spastic paraplegia.,0
Familial arhinia choanal atresia and microphthalmia. We describe two females (aunt and niece) with variable manifestations of arhinia choanal atresia microphthalmia and hypertelorism. In the literature there is only one report on this syndrome in sibs. We hypothesize autosomal dominant inheritance with reduced penetrance.,0
Novel mutation in the myelin protein zero gene in a family with intermediate hereditary motor and sensory neuropathy. OBJECTIVES:To determine the molecular basis for autosomal dominant intermediate hereditary motor and sensory neuropathy (HMSN) in a four generation family. The gene defects in families with intermediate HMSN are not known but it has been suggested that most have X linked HMSN. METHODS:All participating family members were examined clinically. Genomic DNA was obtained from 10 affected and seven unaffected members. Linkage analysis for the known HMSN loci was first performed. Mutations in the peripheral myelin protein zero gene (PMP0) were sought in two affected members using one unaffected member for comparison by amplification of the six exons of the gene followed by single strand conformation polymorphism (SSCP) analysis dideoxy fingerprinting (ddF) and sequencing. Subsequently the mutation was screened for in all affected and unaffected members in the family using Alu I digestion and in 100 unrelated control subjects using "snap back" SSCP analysis. Sequencing of cDNA from a sural nerve biopsy from an affected member was also performed. RESULTS:The clinical phenotype was of variable severity with motor nerve conduction velocities in the intermediate range. Linkage to PMP0 was demonstrated. Analysis of genomic DNA and cDNA for PMP0 identified a novel codon 35 GAC to TAC mutation. The mutation produces an inferred amino acid change of aspartate to tyrosine at codon six of the processed protein (Asp6Tyr) in the extracellular domain and was present in all affected family members but not in 100 unrelated controls. CONCLUSIONS:The present findings further extend the range of phenotypes associated with PMP0 mutations and indicate that families with "intermediate" HMSN need not necessarily be X-linked as previously suggested.,0
Prevalence and distribution of selected developmental dental anomalies in an Indian population. The purpose of this study was to determine the prevalence of developmental dental anomalies in an Indian population and to statistically analyze the distribution of these anomalies. The study was based on clinical examination evaluation of dental casts and panoramic radiographs of 1123 Indian subjects (572 males 551 females) who visited the outpatient clinic at Government Dental College Indore between November 2009 and September 2010 after obtaining their informed consent. These patients were examined for the following developmental dental anomalies: shape anomalies (microdontia talon cusp dens evaginatus fusion taurodontism) number anomalies (hypodontia oligodontia anodontia) structural anomalies (amelogenesis imperfecta dentinogenesis imperfecta) and positional anomalies (ectopic eruption rotation impaction). The percentages of these anomalies were assessed for the whole group and compared using statistical analysis. Among the 1123 subjects a total of 385 individuals (34.28%) presented with the selected developmental dental anomalies. The distribution by sex was 197 males (34.44%) and 188 females (34.06%). Out of the total 1123 individuals 351 (31.26%) exhibited at least one anomaly 28 (2.49 %) showed two anomalies and 6 (0.53%) displayed more than two anomalies. P values indicated that the dental anomalies were statistically independent of sex. On intergroup comparison positional anomalies were significantly most prevalent (P < 0.05) in the Indian population. The most common developmental dental anomaly was rotation (10.24%) followed by ectopic eruption (7.93%). The next common group was number anomalies. The most common number anomaly was hypodontia (4.19%) which had a higher frequency than hyperdontia (2.40%). Analyzing the next prevalent group of shape anomalies microdontia (2.58%) was found to be the most common followed by taurodontism (2.49%) dens evaginatus (2.40%) and talon cusp (0.97%). Dentinogenesis imperfecta (0.09%) was the rarest followed by amelogenesis imperfecta (0.27%) and fusion (0.27%).,1
Zellweger Spectrum Disorder CLINICAL CHARACTERISTICS:Zellweger spectrum disorder (ZSD) is a phenotypic continuum ranging from severe to mild. While individual phenotypes (e.g. Zellweger syndrome [ZS] neonatal adrenoleukodystrophy [NALD] and infantile Refsum disease [IRD]) were described in the past before the biochemical and molecular bases of this spectrum were fully determined the term "ZSD" is now used to refer to all individuals with a PEX gene defect regardless of phenotype. Individuals with ZSD usually come to clinical attention in the newborn period or later in childhood. Affected newborns are hypotonic and feed poorly. They have distinctive facies congenital malformations (neuronal migration defects associated with neonatal-onset seizures renal cysts and bony stippling [chondrodysplasia punctata] of the patella[e] and other long bones) and liver disease that can be severe. Infants with severe ZSD are significantly impaired and typically die during the first year of life usually having made no developmental progress. Individuals with intermediate/milder ZSD do not have congenital malformations but rather progressive peroxisome dysfunction variably manifest as sensory loss (secondary to retinal dystrophy and sensorineural hearing loss); neurologic involvement (ataxia polyneuropathy and leukodystrophy); liver dysfunction; adrenal insufficiency; and renal oxalate stones. While hypotonia and developmental delays are typical intellect can be normal. Some have osteopenia; almost all have ameleogenesis imperfecta in the secondary teeth. DIAGNOSIS/TESTING:The diagnosis of ZSD is established in a proband with the suggestive clinical and biochemical findings above and identification of biallelic pathogenic variants in one of the 13 known ZSD-PEX genes. MANAGEMENT:Treatment of manifestations: The focus is on symptomatic therapy and may include gastrostomy to provide adequate calories hearing aids cataract removal in infancy glasses vitamin supplementation primary bile acid therapy adrenal replacement antiepileptic drugs and possibly monitoring for hyperoxaluria. Surveillance: Annual hearing and ophthalmologic evaluations monitoring of liver function and coagulation factors ACTH/cortisol. A baseline brain MRI is recommended; a loss of motor and cognitive milestones could indicate a leukodystrophy. GENETIC COUNSELING:ZSD is inherited in an autosomal recessive manner. At conception each sib of an affected individual has a 25% chance of being affected a 50% chance of being an asymptomatic carrier and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk relatives and prenatal diagnosis for pregnancies at increased risk are possible if both ZSD-related pathogenic variants have been identified in an affected family member. Prenatal diagnosis by biochemical testing is also possible; however the biochemical defects in cultured fibroblasts from an affected family member must be confirmed first since the biochemical defects present in body fluids or liver may not be detectable in cultured cells (a phenomenon called "peroxisomal mosaicism").,1
Localization of the gene for X-linked calvarial hyperostosis to chromosome Xq27.3-Xqter. X-linked calvarial hyperostosis is a rare disorder characterized by isolated calvarial thickening. Symptoms are prominent frontoparietal bones a flat nasal root and a short upturned nose a high forehead with ridging of the metopic and sagittal sutures and lateral frontal prominences. The mandible is normal as are the clavicles pelvis and long bones. The thickened bone in the skull appears to be softer than normal bone. Despite calvarial hyperostosis increased intracranial pressure and cranial nerve entrapment do not occur. The major disability seems to be cosmetic. The disease segregates with an X-linked recessive mode of inheritance. Female carriers do not show any clinical symptoms. To date only one family has been described with X-linked calvarial hyperostosis including three affected individuals. In order to localize the disease causing gene 31 polymorphic microsatellite markers that spread across the X-chromosome were analyzed. Genotypes were combined in haplotypes to delineate the region. A chromosomal region spanning from Xq27.3 to Xqter cosegregates with the disorder. This region encompasses 23.53cM or 8.2Mb according to the deCODE map and contains 165 genes. CNV-analysis did not show small duplications or deletions in this region. Exome sequencing was performed on a male patient in this family. However this did not reveal any putative mutation. These results indicate that a non-coding regulatory sequence might be involved in the pathogenesis of this disorder.,1
Congenital Cataracts Facial Dysmorphism and Neuropathy CLINICAL CHARACTERISTICS:Congenital cataracts facial dysmorphism and neuropathy (CCFDN) is characterized by abnormalities of the eye (bilateral congenital cataracts microcornea microphthalmia micropupils); mildly dysmorphic facial features apparent in late childhood; and a hypo/demyelinating symmetric distal peripheral neuropathy. The neuropathy is predominantly motor at the onset and results in delays in early motor development progressing to severe disability by the third decade. Secondary scoliosis and foot deformities are common. Sensory neuropathy develops after age ten years. Most affected individuals have a mild non-progressive intellectual deficit and cerebellar involvement including ataxia nystagmus intention tremor and dysmetria. All have short stature and subnormal weight. Adults have hypogonadotropic hypogonadism. Parainfectious rhabdomyolysis (profound muscle weakness myoglobinuria and excessively elevated serum concentration of creatine kinase usually following a viral infection) is a potentially life-threatening complication. To date all affected individuals and carriers identified have been from the Roma/Gypsy population. DIAGNOSIS/TESTING:The diagnosis of CCFDN is based on clinical findings. CTDP1 is the only gene in which pathogenic variants are known to cause CCFDN. Targeted analysis identifies the pathogenic variant IVS6+389C>T in intron 6 the CTDP1 founder variant in the Roma/Gypsy population. MANAGEMENT:Treatment of manifestations: Cataracts are treated surgically; exaggerated inflammatory response and foreign-body reaction to contact lenses and intraocular lenses warrant close postoperative follow up. Peripheral neuropathy is managed symptomatically in the usual manner. Secondary spine and foot deformities may require surgical intervention. Hormone replacement therapy for hypogonadotropic hypogonadism may help prevent osteoporosis. Prevention of secondary complications: Close monitoring during and after anesthesia for potentially life-threatening complications (pulmonary edema inspiratory stridor malignant hyperthermia and epileptic seizures). Awareness of rhabdomyolysis as a potential complication following viral infections in order to seek medical attention with the first recognizable symptoms and to provide oral corticosteroid treatment (for 2-3 weeks for optimal recovery). Surveillance: Annual examinations for possible ophthalmologic neurologic and endocrine manifestations. Evaluation of relatives at risk: It is appropriate to evaluate the older and younger sibs of a proband in order to identify as early as possible those who would benefit from early initiation of treatment and preventive measures. GENETIC COUNSELING:CCFDN is inherited in an autosomal recessive manner. At conception each sib of an affected individual has a 25% chance of being affected a 50% chance of being an asymptomatic carrier and a 25% chance of being unaffected and not a carrier. If the pathogenic variants in the family are known carrier testing for at-risk family members prenatal diagnosis for pregnancies at increased risk and preimplantation genetic diagnosis are possible.,1
Mutations in the autoinflammatory cryopyrin-associated periodic syndrome gene: epidemiological study and lessons from eight years of genetic analysis in France. Cryopyrin-associated periodic syndromes (CAPS) consist of a continuum of autoinflammatory diseases caused by a defect in interleukin 1β regulation. Although symptoms may vary widely the discovery in 2001 of the gene involved (NLRP3) has dramatically helped diagnosis.To define the spectrum and prevalence of NLRP3 mutations in France and to delineate initial criteria before molecular analysis.Retrospective review (2001-9) of genetic analysis data and request forms of patients living in France with an NLRP3 mutation since the set up of CAPS molecular diagnosis by the three French laboratories providing this test (GenMAI network).Over 800 analyses of this gene have been conducted identifying 135 cases with an NLRP3 mutation (55 probands; 33 multiplex families); the estimated prevalence in France was equal to 1/360 000. A total of 21 different sequence variants were detected among which four are common and nine are new mutations.Although the number of NLRP3 test requests has doubled over the past 5 years genetic screening has not contributed to enhanced detection of new index cases each year. There are two possible reasons for this: (i) no clinical prerequisite for genetic diagnosis and (ii) few new large families are now identified (unlike the initial study based on a selection by linkage). A set of initial clinical criteria have been drawn up which it is recommended should be fulfilled before a patient is tested: at least three recurrent bouts age at disease onset < 20 years and elevated levels of C-reactive protein especially in individuals with urticaria and moderate fever.,1
Mutations in γ adducin are associated with inherited cerebral palsy. OBJECTIVE:Cerebral palsy is estimated to affect nearly 1 in 500 children and although prenatal and perinatal contributors have been well characterized at least 20% of cases are believed to be inherited. Previous studies have identified mutations in the actin-capping protein KANK1 and the adaptor protein-4 complex in forms of inherited cerebral palsy suggesting a role for components of the dynamic cytoskeleton in the genesis of the disease. METHODS:We studied a multiplex consanguineous Jordanian family by homozygosity mapping and exome sequencing then used patient-derived fibroblasts to examine functional consequences of the mutation we identified in vitro. We subsequently studied the effects of adducin loss of function in Drosophila. RESULTS:We identified a homozygous c.1100G>A (p.G367D) mutation in ADD3 encoding gamma adducin in all affected members of the index family. Follow-up experiments in patient fibroblasts found that the p.G367D mutation which occurs within the putative oligomerization critical region impairs the ability of gamma adducin to associate with the alpha subunit. This mutation impairs the normal actin-capping function of adducin leading to both abnormal proliferation and migration in cultured patient fibroblasts. Loss of function studies of the Drosophila adducin ortholog hts confirmed a critical role for adducin in locomotion. INTERPRETATION:Although likely a rare cause of cerebral palsy our findings indicate a critical role for adducins in regulating the activity of the actin cytoskeleton suggesting that impaired adducin function may lead to neuromotor impairment and further implicating abnormalities of the dynamic cytoskeleton as a pathogenic mechanism contributing to cerebral palsy.,1
Warsaw breakage syndrome a cohesinopathy associated with mutations in the XPD helicase family member DDX11/ChlR1. The iron-sulfur-containing DNA helicases XPD FANCJ DDX11 and RTEL represent a small subclass of superfamily 2 helicases. XPD and FANCJ have been connected to the genetic instability syndromes xeroderma pigmentosum and Fanconi anemia. Here we report a human individual with biallelic mutations in DDX11. Defective DDX11 is associated with a unique cellular phenotype in which features of Fanconi anemia (drug-induced chromosomal breakage) and Roberts syndrome (sister chromatid cohesion defects) coexist. The DDX11-deficient patient represents another cohesinopathy besides Cornelia de Lange syndrome and Roberts syndrome and shows that DDX11 functions at the interface between DNA repair and sister chromatid cohesion.,0
Twenty-year birth prevalence of Down syndrome in Cape Town South Africa. The 20-year birth prevalence of Down syndrome in Cape Town South Africa was determined. All cases delivered to mothers in Cape Town plus terminations following prenatal diagnosis between 1 January 1974 and 31 December 1993 were ascertained. There were 784 Down syndrome pregnancies of which 95% were trisomies. The 32 terminations comprised 18.3% of the white 5.8% of the coloured (mixed race) and 1.4% of the black cases. The overall prevalence rate was 1.49 per 1000 (white 1.88 coloured 1.54 and black 1.29 per 1000). Analysis for linear trends showed a significant decline in rates for the total population and for whites a downward trend for coloureds but no decline for blacks. Over the last 5-year period the prevalence rates in all three population groups were 1.3 per 1000. An increasing risk with advancing maternal age was confirmed but no maternal age-specific differences in rates by race were demonstrated.,?
Nationwide population-based epidemiological study of myasthenia gravis in taiwan. BACKGROUND: The purpose of this study is to investigate the epidemiology and medical expenses of myasthenia gravis (MG) in Taiwan. METHODS: Cases of MG were identified from the National Health Insurance Research Database with corresponding codes of the International Classification of Diseases ninth revision (ICD-9) from January 2000 to December 2007. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics Ministry of the Interior. RESULTS: During the study period 5211 cases were identified. The incidence ratio of males to females was 0.68. The average annual incidence rate was 2.1/100000. MG occurred in all age groups with a higher incidence in older individuals and the lowest incidence in the 10- to 14-year-olds for both sexes. Among the 5211 cases 615 (12%) had a neoplasm of the thymus. The prevalence increased steadily during the study period from 8.4/100000 in 2000 to 14.0/ 100000 in 2007. CONCLUSIONS: This is the first population-based epidemiological study of MG in Taiwan. The incidence rate and prevalence were higher than in most published studies especially in old age groups.,?
Biallelic Mutations in DNM1L are Associated with a Slowly Progressive Infantile Encephalopathy. Mitochondria are highly dynamic organelles undergoing continuous fission and fusion and mitochondrial dynamics is important for several cellular functions. DNM1L is the most important mediator of mitochondrial fission with a role also in peroxisome division. Few reports of patients with genetic defects in DNM1L have been published most of them describing de novo dominant mutations. We identified compound heterozygous DNM1L variants in two brothers presenting with an infantile slowly progressive neurological impairment. One variant was a frame-shift mutation the other was a missense change the pathogenicity of which was validated in a yeast model. Fluorescence microscopy revealed abnormally elongated mitochondria and aberrant peroxisomes in mutant fibroblasts indicating impaired fission of these organelles. In conclusion we described a recessive disease caused by DNM1L mutations with a clinical phenotype resembling mitochondrial disorders but without any biochemical features typical of these syndromes (lactic acidosis respiratory chain complex deficiency) or indicating a peroxisomal disorder.,0
Autosomal dominant painful plantar callosities. We describe large kindred with an autosomal dominant condition characterized by painful callosities that develop over the pressure points of the soles. These callosities are not congenital; they arise with upright ambulation.,0
Myosin binding protein C1: a novel gene for autosomal dominant distal arthrogryposis type 1. Distal arthrogryposis type I (DA1) is a disorder characterized by congenital contractures of the hands and feet for which few genes have been identified. Here we describe a five-generation family with DA1 segregating as an autosomal dominant disorder with complete penetrance. Genome-wide linkage analysis using Affymetrix GeneChip Mapping 10K data from 12 affected members of this family revealed a multipoint LOD(max) of 3.27 on chromosome 12q. Sequencing of the slow-twitch skeletal muscle myosin binding protein C1 (MYBPC1) located within the linkage interval revealed a missense mutation (c.706T>C) that segregated with disease in this family and causes a W236R amino acid substitution. A second MYBPC1 missense mutation was identified (c.2566T>C)(Y856H) in another family with DA1 accounting for an MYBPC1 mutation frequency of 13% (two of 15). Skeletal muscle biopsies from affected patients showed type I (slow-twitch) fibers were smaller than type II fibers. Expression of a green fluorescent protein (GFP)-tagged MYBPC1 construct containing WT and DA1 mutations in mouse skeletal muscle revealed robust sarcomeric localization. In contrast a more diffuse localization was seen when non-fused GFP and MYBPC1 proteins containing corresponding MYBPC3 amino acid substitutions (R326Q E334K) that cause hypertrophic cardiomyopathy were expressed. These findings reveal that the MYBPC1 is a novel gene responsible for DA1 though the mechanism of disease may differ from how some cardiac MYBPC3 mutations cause hypertrophic cardiomyopathy.,1
Neuropathy target esterase impairments cause Oliver-McFarlane and Laurence-Moon syndromes. Oliver-McFarlane syndrome is characterised by trichomegaly congenital hypopituitarism and retinal degeneration with choroidal atrophy. Laurence-Moon syndrome presents similarly though with progressive spinocerebellar ataxia and spastic paraplegia and without trichomegaly. Both recessively inherited disorders have no known genetic cause.Whole-exome sequencing was performed to identify the genetic causes of these disorders. Mutations were functionally validated in zebrafish pnpla6 morphants. Embryonic expression was evaluated via in situ hybridisation in human embryonic sections. Human neurohistopathology was performed to characterise cerebellar degeneration. Enzymatic activities were measured in patient-derived fibroblast cell lines.Eight mutations in six families with Oliver-McFarlane or Laurence-Moon syndrome were identified in the PNPLA6 gene which encodes neuropathy target esterase (NTE). PNPLA6 expression was found in the developing human eye pituitary and brain. In zebrafish the pnpla6 curly-tailed morphant phenotype was fully rescued by wild-type human PNPLA6 mRNA and not by mutation-harbouring mRNAs. NTE enzymatic activity was significantly reduced in fibroblast cells derived from individuals with Oliver-McFarlane syndrome. Intriguingly adult brain histology from a patient with highly overlapping features of Oliver-McFarlane and Laurence-Moon syndromes revealed extensive cerebellar degeneration and atrophy.Previously PNPLA6 mutations have been associated with spastic paraplegia type 39 Gordon-Holmes syndrome and Boucher-Neuhäuser syndromes. Discovery of these additional PNPLA6-opathies further elucidates a spectrum of neurodevelopmental and neurodegenerative disorders associated with NTE impairment and suggests a unifying mechanism with diagnostic and prognostic importance.,0
Homozygosity mapping and candidate prioritization identify mutations missed by whole-exome sequencing in SMOC2 causing major dental developmental defects. Inherited dental malformations constitute a clinically and genetically heterogeneous group of disorders. Here we report on a severe developmental dental defect that results in a dentin dysplasia phenotype with major microdontia oligodontia and shape abnormalities in a highly consanguineous family. Homozygosity mapping revealed a unique zone on 6q27-ter. The two affected children were found to carry a homozygous mutation in SMOC2. Knockdown of smoc2 in zebrafish showed pharyngeal teeth that had abnormalities reminiscent of the human phenotype. Moreover smoc2 depletion in zebrafish affected the expression of three major odontogenesis genes: dlx2 bmp2 and pitx2.,0
Inherited ring chromosome 8 without loss of subtelomeric sequences. We report the first case of inherited ring chromosome 8 syndrome without loss of subtelomeric sequences. The proband is a 6 1/2-year-old boy with short stature microcephaly mild mental retardation and behavioral problems including hyperactivity and attention deficit. His mother presented the same physical features but intelligence was normal. Family history also revealed an uncle and a grandmother with short stature and microcephaly. Moderate mental retardation was reported in the uncle. Karyotypes and fluorescence in situ hybridization (FISH) analyses were performed on peripheral blood lymphocytes for both child and mother. The child's karyotype was reported as 46XYr(8)(p23q24.3)[24]/45XY-8[2] and the mother's karyotype 46XXr(8)(p23q24.3)[22]/45XX-8[2]/47XXr(8)(p23q24.3) +r(8)(p23q24.3)[1]. FISH studies showed no deletion of subtelomeric sequences for both child and mother indicating that no or little chromosomal euchromatic material has been deleted. These findings indicate that ring chromosome 8 without loss of subtelomeric sequences can be inherited and that carriers in a same family present with cognitive function ranging from mild mental retardation to normal intelligence.,1
Prevalence of eosinophilic esophagitis in the United States. Eosinophilic esophagitis (EoE) has become a major cause of upper gastrointestinal morbidity in children and adults. However there are few data on the nationwide prevalence of EoE. We aimed to estimate the prevalence of EoE in the United States.We collected health insurance claims from a large database that represented the U.S. commercially insured population. We analyzed data from 2008 to 2011 identifying cases of EoE by using a previously validated definition and calculated a period prevalence by using data from 2009 to 2011. EoE was defined as any instance of the International Classification of Diseases 9th revision code 530.13. We calculated the prevalence of the code in the database and standardized the estimate to the U.S. population.Of 35575388 individuals in this database 16405 had at least 1 code for EoE. The mean age was 33.5 years 65% were male 55.8% had dysphagia and 52.8% had a diagnostic code for at least 1 allergic condition. Among 11569217 individuals with continuous insurance coverage between mid-2009 and mid-2011 6513 had at least 1 code for EoE. When standardized to the U.S. population the estimated period prevalence of EoE was 56.7/100000 persons translating to approximately 152152 cases in the U.S. Prevalence peaked in men 35-39 years old with a rate of 114.6/100000 persons.Despite its relatively recent description EoE is frequently diagnosed in the United States with an estimated prevalence of 56.7/100000 persons. This estimate depends on the accuracy of the International Classification of Diseases 9th revision code but it could be an underestimate because knowledge of the code and recognition of EoE are increasing.,1
KIF1A missense mutations in SPG30 an autosomal recessive spastic paraplegia: distinct phenotypes according to the nature of the mutations. The hereditary spastic paraplegias (HSPs) are a clinically and genetically heterogeneous group of neurodegenerative diseases characterised by progressive spasticity in the lower limbs. The nosology of autosomal recessive forms is complex as most mapped loci have been identified in only one or a few families and account for only a small percentage of patients. We used next-generation sequencing focused on the SPG30 chromosomal region on chromosome 2q37.3 in two patients from the original linked family. In addition wide genome scan and candidate gene analysis were performed in a second family of Palestinian origin. We identified a single homozygous mutation p.R350G that was found to cosegregate with the disease in the SPG30 kindred and was absent in 970 control chromosomes while affecting a strongly conserved amino acid at the end of the motor domain of KIF1A. Homozygosity and linkage mapping followed by mutation screening of KIF1A allowed us to identify a second mutation p.A255V in the second family. Comparison of the clinical features with the nature of the mutations of all reported KIF1A families including those reported recently with hereditary sensory and autonomic neuropathy suggests phenotype-genotype correlations that may help to understand the mechanisms involved in motor neuron degeneration. We have shown that mutations in the KIF1A gene are responsible for SPG30 in two autosomal recessive HSP families. In published families the nature of the KIF1A mutations seems to be of good predictor of the underlying phenotype and vice versa.,0
[Major birth defects in a third-level hospital in Cali Colombia 2004-2008]. OBJECTIVE: Determining the prevalence of infant birth defects and describing sociodemographic factors associated with the occurrence of these diseases in a tertiary hospital in the city of Cali in Colombia. METHODOLOGY: Data from the Valle Teaching Hospital's surveillance system was analysed covering March 2004 to October 2008. The methodology proposed by the Collaborative Study of Congenital Malformations in Latin-America (ECLAMC) was followed for determining birth defect occurrence. Tables and graphs were constructed for describing the characteristics of the new-born their parents and the resulting pregnancies. RESULTS: There were 32995 births during the study period (4 years and 7 months); there was at least one birth defect in 735 of them giving a 2.22 per 10000 births prevalence. The major birth defects having the highest prevalence were polydactyly (22.1 per 10000 births) clubfoot (17.6) hydrocephalus (16.4) neural tube defects (16.7) limb reduction defects (8.2) cleft lip or cleft palate (10.9) heart defects (14.6) hydronephrosis (11.5) gastroschisis (7.3) cyclopia (2.4) and sirenomelia (1.2) DISCUSSION: The prevalence of birth defects related to environmental factors such as hydrocephalus limb reduction defects clubfoot hydronephrosis gastroschisis cyclopia and sirenomelia showed higher prevalence compared to those reported in the pertinent literature. Some hypotheses which could explain such increase are reported.,1
A dedicated surveillance network for congenital toxoplasmosis in Greece 2006-2009: assessment of the results. BACKGROUND: Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Acute infections in pregnant women may be transmitted to the fetus and cause severe illness. The purpose of this study was to establish a dedicated surveillance network (DSN) for congenital toxoplasmosis (CT) in Greece in order to assess the birth prevalence of CT. METHODS: A DSN of thirty clinicians was established for reporting CT cases from hospitals throughout Greece. The clinicians were selected on the basis that there was a high possibility the suspected cases would be referred to them from district hospitals or private clinics. Suspected cases of CT were reported on a monthly basis with a zero reporting card during a surveillance period from April 2006 to December 2009. A questionnaire was sent for any suspected case to record information including demographic parameters clinical signs and symptoms and laboratory results. Serological and molecular confirmation of cases was performed by the Pasteur Hellenic Institute. All newborns suspected of CT received treatment and were serologically and clinically followed up for one year. RESULTS: The monthly response rate reached 100% although only after reminders sent to 65% of the participant physicians. Sixty-three suspected CT cases were recorded by the DSN during the study period including fourteen confirmed and seven probable cases. Ten cases (47.6%) presented with symptoms at birth. Chorioretinitis was the most prominent manifestation occurring in five symptomatic CT cases (50%). No other symptoms appeared by the end of the one year clinical follow up. No case was recorded by the existing surveillance system of the Hellenic Center of Disease Control and Prevention (HCDCP) during the same time period. Birth prevalence was estimated at 0.45 0.51 and 0.51 per 10000 births for 2007 2008 and 2009 respectively. The incidence rate of symptomatic CT at birth was estimated at 0.10 cases per 10000 births per year in Greece (for the period 2007-2009). CONCLUSION: The DSN for CT proved to be more sensitive than the classical notification system easy in application and very efficient in reporting rare diseases such as CT. Similar DSNs could be used to provide useful information on other rare diseases.,1
Hereditary leukonychia totalis acanthosis-nigricans-like lesions and hair dysplasia: a new syndrome? Leukonychia is an ungueal discoloration or dyschromia. The hereditary form is rare. In the observations reported in the literature leukonychia was total or sub-total and was sometimes associated to other various symptoms. We report an original observation of hereditary leukonychia totalis in a father and two of his children associated with acanthosis-nigricans-like lesions and hair dysplasia. These symptoms were also present in eight other members of the same family.,0
De novo mutations in NALCN cause a syndrome characterized by congenital contractures of the limbs and face hypotonia and developmental delay. Freeman-Sheldon syndrome or distal arthrogryposis type 2A (DA2A) is an autosomal-dominant condition caused by mutations in MYH3 and characterized by multiple congenital contractures of the face and limbs and normal cognitive development. We identified a subset of five individuals who had been putatively diagnosed with "DA2A with severe neurological abnormalities" and for whom congenital contractures of the limbs and face hypotonia and global developmental delay had resulted in early death in three cases; this is a unique condition that we now refer to as CLIFAHDD syndrome. Exome sequencing identified missense mutations in the sodium leak channel non-selective (NALCN) in four families affected by CLIFAHDD syndrome. We used molecular-inversion probes to screen for NALCN in a cohort of 202 distal arthrogryposis (DA)-affected individuals as well as concurrent exome sequencing of six other DA-affected individuals thus revealing NALCN mutations in ten additional families with "atypical" forms of DA. All 14 mutations were missense variants predicted to alter amino acid residues in or near the S5 and S6 pore-forming segments of NALCN highlighting the functional importance of these segments. In vitro functional studies demonstrated that NALCN alterations nearly abolished the expression of wild-type NALCN suggesting that alterations that cause CLIFAHDD syndrome have a dominant-negative effect. In contrast homozygosity for mutations in other regions of NALCN has been reported in three families affected by an autosomal-recessive condition characterized mainly by hypotonia and severe intellectual disability. Accordingly mutations in NALCN can cause either a recessive or dominant condition characterized by varied though overlapping phenotypic features perhaps based on the type of mutation and affected protein domain(s).,0
Mutations in the cyclin family member FAM58A cause an X-linked dominant disorder characterized by syndactyly telecanthus and anogenital and renal malformations. We identified four girls with a consistent constellation of facial dysmorphism and malformations previously reported in a single mother-daughter pair. Toe syndactyly telecanthus and anogenital and renal malformations were present in all affected individuals; thus we propose the name 'STAR syndrome' for this disorder. Using array CGH qPCR and sequence analysis we found causative mutations in FAM58A on Xq28 in all affected individuals suggesting an X-linked dominant inheritance pattern for this recognizable syndrome.,0
MORC2 mutations cause axonal Charcot-Marie-Tooth disease with pyramidal signs. OBJECTIVE:To use linkage analysis and whole exome sequencing to identify the genetic mutation in a multigenerational Australian family with Charcot-Marie-Tooth disease type 2 (CMT2) and pyramidal signs. METHODS:Genome-wide linkage analysis was performed to map the locus. Whole exome sequencing was undertaken on selected individuals (3 affected 1 normal) and segregation analysis and mutation screening were carried out using high-resolution melt analysis. The GEM.app database was queried to identify additional families with mutations. RESULTS:Significant linkage (2-point LOD score‚Äâ‚â•‚Äâ+3) and haplotype analysis mapped a new locus for CMT2 and pyramidal signs to a 6.6Mb interval on chromosome 22q12.1-q12.3. Whole exome sequencing identified a novel mutation (p.R252W) in the microrchidia CW-type zinc finger 2 (MORC2) gene mapping within the linkage region. The mutation fully segregated with the disease phenotype in the family. Screening additional families and querying unsolved CMT2 exomes we identified the p.R252W mutation in 2 unrelated early onset CMT2 families and a second mutation p.E236G in 2 unrelated CMT2 families. Both the mutations occurred at highly conserved amino acid residues and were absent in the normal population. INTERPRETATION:We have identified a new locus in which MORC2 mutations are the likely pathogenic cause of CMT2 and pyramidal signs in these families. MORC2 encodes the human CW-type zinc finger 2 protein which is a chromatin modifier involved in the regulation of DNA repair as well as gene transcription.,0
Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: a prospective comparison of effectiveness and costs. Immune Thrombocytopenia Working Group. A prospective study was conducted in three maternity wards to compare the medical outcomes and the costs of two screening strategies for the detection of fetal/neonatal alloimmune thrombocytopenia (FMAIT). A total of 2066 primiparas and 6081 newborns were included. Fifty-two primiparous women with HPA-1b phenotype were found and 45 were followed during pregnancy. Four women developed antibodies and two fetuses exhibited FMAIT; therefore the prevalence of anti-HPA-1a was 2 per 1000 and the prevalence of FMAIT 1 per 1000. Forty-eight thrombocytopenic newborns were found out of a total of 5632 blood samples. Five were HPA-1a children whose mothers were HPA-1b. The cost-effectiveness of screening all primiparous women was $45000 and of screening all newborns is $18000-per anti-HPA-1a alloimmunization diagnosed. Costs per fetal death or disability averted were $500000 for the primiparous strategy and $225000 for the newborn strategy. In conclusion screening newborns for neonatal alloimmune thrombocytopenia is more cost-effective than screening primiparous women.,1
Autopsy case of the C12orf65 mutation in a patient with signs of mitochondrial dysfunction. To describe the autopsy case of a patient with a homozygous 2-base deletion c171_172delGA (p.N58fs) in the C12orf65 gene.We described the clinical history neuroimaging data neuropathology and genetic analysis of the patients with C12orf65 mutations.The patient was a Japanese woman with a history of delayed psychomotor development primary amenorrhea and gait disturbance in her 20s. She was hospitalized because of respiratory failure at the age of 60. Pectus excavatum long fingers and toes and pes cavus were revealed by physical examination. Her IQ score was 44. Neurologic examination revealed ophthalmoplegia optic atrophy dysphagia distal dominant muscle weakness and atrophy hyperreflexia at patellar tendon reflex hyporeflexia at Achilles tendon reflex and extensor plantar reflexes. At age 60 she died of pneumonia. Lactate levels were elevated in the patient's serum and CSF. T2-weighted brain MRI showed symmetrical hyperintense brainstem lesions. At autopsy axial sections exposed symmetrical cyst formation with brownish lesions in the upper spinal cord ventral medulla pons dorsal midbrain and medial hypothalamus. Microscopic analysis of these areas demonstrated mild gliosis with rarefaction. Cell bodies in the choroid plexuses were eosinophilic and swollen. Electron microscopic examination revealed that these cells contained numerous abnormal mitochondria. Whole-exome sequencing revealed the 2-base deletion in C12orf65.We report an autopsy case of the C12orf65 mutation and findings suggest that mitochondrial dysfunction may underlie the unique clinical presentations.,0
Familial occurrence of agonadism and multiple internal malformations in phenotypically normal girls with 46XY and 46XX karyotypes respectively: a new autosomal recessive syndrome. We report on 2 phenotypic sisters one with 46XY; the other with 46XX. The 2 girls had similar related internal malformations including agonadism hypoplasia of the right pulmonary artery hypoplasia of the right lung isolated dextrocardia with complex vitium cordis and diaphragmatic hernia (only sib 1) or omphalocele (only sib 2). This combination of malformations did not fit into any of the previously described syndromes. For this syndrome we suggest the acronym PAGOD ([hypoplasia of the] pulmo and pulmonary artery agonadism omphalocele/diaphragmatic defect dextrocardia). The occurrence of a basically similar set of malformations in 2 unlike sex is interpreted as evidence for autosomal recessive inheritance. The different gonosomal status excludes the Y chromosome as a responsible factor. The peculiar finding of a 46XX sex chromosome constitution combined with agonadism and an intact urogenitral tract emphasizes the concept of secondary regression of Wolffian and Müllerian structures. The associated malformations of mesodermal structures can be interpreted as midline defects. We suggest that from the developmental field perspective secondary regression of midline structures including the gonadal anlage explains the pathogenesis reasonably well.,0
Jancar syndrome: mental retardation spasticity and distal transverse limbs defects. We report on a child with mental retardation spasticity and distal transverse defects of the limbs born to healthy parents related as first cousin. This is the third child reported to be affected with the syndrome described by Jancar. We confirm the existence of the syndrome as a separate entity and raise possibility that it may be inherited as an autosomal recessive trait.,0
A new distal arthrogryposis syndrome characterized by plantar flexion contractures. The distal arthrogryposis (DA) syndromes are a distinct group of disorders characterized by contractures of two or more different body areas. More than a decade ago we revised the classification of DAs and distinguished several new syndromes. This revision has facilitated the identification of five genes (i.e. TNNI2 TNNT3 MYH3 MYH8 and TPM2) that encode components of the contractile apparatus of fast-twitch myofibers and cause DA syndromes. We now report on the phenotypic features of a novel DA disorder characterized primarily by plantar flexion contractures in a large five-generation Utah family. Contractures of hips elbows wrists and fingers were much milder though they varied in severity among affected individuals. All affected individuals had normal neurological examinations; electromyography and creatinine kinase levels were normal on selected individuals. We have tentatively labeled this condition distal arthrogryposis type 10 (DA10).,0
A novel mutation in two Hmong families broadens the range of STRA6-related malformations to include contractures and camptodactyly. PDAC (also termed Matthew Wood) syndrome is a rare autosomal recessive disorder characterized by pulmonary hypoplasia/aplasia diaphragmatic defects bilateral anophthalmia and cardiac malformations. The disorder is caused by mutations in STRA6 an important regulator of vitamin A and retinoic acid metabolism. We describe six cases from four families of Hmong ancestry seen over a 30 years period in California. These include: (i) consanguineous siblings with a combination of bilateral anophthalmia diaphragmatic abnormalities truncus arteriosus and/or pulmonary agenesis/hypoplasia; (ii) a singleton fetus with bilateral anophthalmia pulmonary agenesis cardiac malformation and renal hypoplasia; (iii) a sibling pair with a combination of antenatal contractures camptodactyly fused palpebral fissures pulmonary agenesis and/or truncus arteriosus; (iv) a fetus with bilateral anophthalmia bushy eyebrows pulmonary agenesis heart malformation and abnormal hand positioning. The phenotypic spectrum of PDAC syndrome has until now not included contractures or camptodactyly. Sequencing of STRA6 in unrelated members of families three and four identified a novel shared homozygous splice site alteration (c.113‚Äâ+‚Äâ3_4delAA) that is predicted to be pathogenic. We hypothesize this may represent a unique disease allele in the Hmong. We also provide a focused review of all published PDAC syndrome cases with confirmed or inferred STRA6 mutations illustrating the phenotypic and molecular variability that characterizes this disorder.,0
Benign infantile convulsions associated with mild gastroenteritis: an electroclinical study of 34 patients. PURPOSE: To analyze the electroclinical features and evolution of patients diagnosed with convulsions with mild gastroenteritis (CwG) from southwest China. METHODS: We reviewed and analyzed the medical records of 34 patients (13 males) diagnosed with CwG and followed-up for at least 12 months. RESULTS: The age of onset was 6-29 months and the female/male ratio 1.62. Seizures were generalized in 32 cases. Single seizures in 15 cases were <5 min and multiple seizures 24-48 h after seizure onset were seen in 18 cases. Seizure duration was <1 min in 32.35% between 1 and 5 min in 55.88% and between 5 and 10 min in 8.82% of seizures. The average interval between the onset of gastroenteritis and seizures was 2.47 days. Rotavirus antigen was positive in stools in 26.47% of cases. During the acute phase diazepam and phenobarbital as first-line treatment were effective in 25% and 83.33% of cases respectively. Fourteen patients showed non-specific anomalies in the interictal electroencephalography. During 12-36 months follow-up 33 cases showed normal psychomotor development and no seizures. CONCLUSIONS: CwG occurred mostly in toddlers. During the acute phase phenobarbital is more effective in controlling seizures. For a good prognosis it is unnecessary to administrate long-term anticonvulsants.,0
Expanding the spectrum of PEX10-related peroxisomal biogenesis disorders: slowly progressive recessive ataxia. Peroxisomal biogenesis disorders (PBDs) consist of a heterogeneous group of autosomal recessive diseases in which peroxisome assembly and proliferation are impaired leading to severe multisystem disease and early death. PBDs include Zellweger spectrum disorders (ZSDs) with a relatively mild clinical phenotype caused by PEX1 (MIM# 602136) PEX2 (MIM# 170993) PEX6 (MIM# 601498) PEX10 (MIM# 602859) PEX12 (MIM# 601758) and PEX16 (MIM# 603360) mutations. Three adult patients are reported belonging to a non-consanguineous French family affected with slowly progressive cerebellar ataxia axonal neuropathy and pyramidal signs. Mental retardation and diabetes mellitus were optional. The age at onset was in childhood or in adolescence (3-15 years). Brain MRI showed marked cerebellar atrophy. Biochemical blood analyses suggested a mild peroxisomal defect. With whole exome sequencing two mutations in PEX10 were found in the three patients: c.827G>T (novel) causing the missense change p.Cys276Phe and c.932G>A causing the missense change p.Arg311Gln. The phenotypic spectrum related to PEX10 mutations includes slowly progressive syndromic recessive ataxia.,0
Positive newborn screen for methylmalonic aciduria identifies the first mutation in TCblR/CD320 the gene for cellular uptake of transcobalamin-bound vitamin B(12). Elevated methylmalonic acid in five asymptomatic newborns whose fibroblasts showed decreased uptake of transcobalamin-bound cobalamin (holo-TC) suggested a defect in the cellular uptake of cobalamin. Analysis of TCblR/CD320 the gene for the receptor for cellular uptake of holo-TC identified a homozygous single codon deletion c.262_264GAG (p.E88del) resulting in the loss of a glutamic acid residue in the low-density lipoprotein receptor type A-like domain. Inserting the codon by site-directed mutagenesis fully restored TCblR function.,0
Genealogical study of oculopharyngeal muscular dystrophy in France. This work is based on 54 probands affected by oculopharyngeal muscular dystrophy (OPMD). The muscle biopsy of all these patients showed the presence of the intranuclear inclusions specific of this disease. The residence of the probands is concentrated in three clusters: the Paris Marseilles and Bordeaux regions. The genealogical study was carried out on 43 probands 10 of which did not have any ascendance in France for more than two generations. The geographic origin of the 33 patients of French descent was distributed over numerous regions not including the Paris and Marseilles regions where many patients lived. This geographic dispersion and the rarity of common genealogies of the probands did not suggest the existence of a recent founder effect in contrast to what is observed in the French-Canadian community. The existence of a link between French and French-Canadian families is currently being investigated.,0
Cleft lip and palate hypertelorism brachycephaly flat facial profile and congenital heart disease in three brothers. A "new" syndrome was identified by McPherson and Clemens [1996: Am J Med Genet 62:58-60] in a brother and sister with bilateral cleft lip and palate hypertelorism flat facial profile flat occiput and complex heart defects. The brother also had a bilobed tongue and the sister had malrotation of the intestine and bifid thumbs. We describe three brothers with similar anomalies apart from the bilobed tongue malrotation of the intestine and bifid thumbs. McPherson and Clemens [1996: Am J Med Genet 62:58-60] suggested autosomal recessive inheritance. Our observation of three affected brothers also raises the possibility of X-linked recessive inheritance.,0
CADASIL: a common form of hereditary arteriopathy causing brain infarcts and dementia. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disease leading to cognitive decline and dementia. CADASIL usually begins with migraine in about one third of the patients. More severe manifestations transient ischemic attacks or recurrent strokes appear between 30 and 50 years of age. CADASIL however may be diagnosed well before the first stroke on the basis of characteristic white matter hyperintensities upon magnetic resonance imaging and presence of pathognomonic granular osmiophilic material in arterial walls including dermal arteries since the arteriopathy is generalized. Gradual destruction of vascular smooth muscle cells (VSMC) leads to progressive wall thickening and fibrosis and luminal narrowing in small and medium-sized penetrating arteries. The reduced cerebral blood flow finally causes lacunar infarcts mainly in the basal ganglia and fronto-temporal white matter which lead to cognitive deficits and dementia of the subcortical vascular type. CADASIL is caused by single missense mutations or small deletions in Notch3 gene encoding a transmembrane receptor Notch3 of which upon ligand binding a nuclear signaling protein is generated by regulated intramembrane proteolysis. Notch signaling is essential during development regulating cellular differentiation. In adults Notch3 is expressed only in VSMCs and it may promote cell survival by inhibiting apoptosis but its exact function is unknown. Mutations result in either a gain or loss of one (or rarely 3) cysteine residue(s) in one of the 34 epidermal growth factor-like repeats in the extracellular amino-terminal region of Notch3. It is as yet unclear which disturbance in the Notch signaling pathway leads to the characteristic vascular pathology of CADASIL.,1
Origin and diffusion of the myotonic dystrophy gene in the Saguenay region (Quebec). A very high prevalence (approximately 1/475 in 1985) of myotonic dystrophy (Steinert disease) is observed in the Saguenay region which is located in the north-east part of the Province of Quebec. For various reasons however the literature on the subject generally associates a high degree of selective disadvantage with this gene which seems to contradict the Saguenay data. Using a computerized regional population register we have reconstituted patients' genealogies and family biographies. We have thus been able to study the origin of the gene and to compare the demographic behavior of patients and controls. On the whole patients seem to be very little disadvantaged compared to controls in terms of reproduction as well as of geographical and occupational mobility.,1
Filippi Syndrome: Report of a Rare Case. Filippi syndrome is an autosomal recessive condition characterized by syndactyly of fingers and toes microcephaly growth retardation and abnormal facies. We are describing a boy who presented with syndactyly mental retardation microcephaly depressed nasal bridge and growth retardation. In addition he had some dental abnormalities like missing bilateral lateral incisors and delayed eruption of teeth. We concluded it to be Filippi syndrome by studying pathognomic clinical features and reviewed the literature. This is the second case report from India.,0
Minimum prevalence birth incidence and cause of death for Prader-Willi syndrome in Flanders. The identification of all people with a diagnosis of Prader-Willi syndrome (PWS) confirmed by DNA methylation analysis living in Flanders was attempted through contact with the four genetic centres and the PWS Association. The birth incidence for the period 1993-2001 was 1:26 676 the minimum prevalence at 31 December 2001 was 1:76 574. A decreasing number of cases with age was found which can be explained by a number of missing cases in the older population a higher neonatal mortality in the past and an increasing mortality with age. Childhood death is usually sudden and associated with respiratory infection and high temperature while the cause of death in adults is considered to be circulatory or respiratory in origin.,1
Incidence of classical 21-hydroxylase deficiency and distribution of CYP21A2 mutations in Estonia. To determine the incidence of classical 21-hydroxylase deficiency (21-OHD) in Estonia from 1978 to 2004 and describe their phenotype and genotype.All Estonian endocrinologists informed us about their patients with 21-OHD. The diagnosis was confirmed in 20 patients who were all screened for 8 common mutations of the CYP21A2 gene.The 27-year period incidence was 1:25500. The incidence from 1992 was 1:16100 which more accurately reflects the real situation in Estonia. The salt-wasting form (SW) was diagnosed in 14 (7 males) and the simple virilizing form in 6 patients (1 male). The median age at diagnosis of the SW form was 30 days in males and 2 days in females. The investigation of 34 unrelated alleles showed that a common deletion/conversion was the most frequent mutation in our group (7/34). Six other mutations were present: p.Ile172Asn (5/34) 8-bp deletion (3/34) intron-2 splice mutation (3/34) p.Arg356Trp (3/34) p.Gln318X (3/34) and a small conversion (2/34). Mutations in 8 alleles remained uncertain.The incidence of classical 21-OHD in Estonia in 1992-2004 was 1:16100. The genotype of our patients is similar to those from other Caucasian populations. The relatively late age at diagnosis and the skewed female:male ratio supports the need for newborn screening for 21-OHD.,1
Study of hemoglobinopathies in Oman through a national register. OBJECTIVES: A national register of symptomatic hemoglobinopathies has been developed in Oman to facilitate the development of the National Program for the control of genetic blood disorders. METHODS: The information was initially collected retrospectively through hospital records and was refined prospectively with data collected through a survey of pediatricians. The percentages of heterozygotes in different population groups and geographical locations birth prevalence age distribution of cases and factors determining frequencies of Hemoglobinopathies in different regions of the country were studied from the register. RESULTS: The register has identified 1757 cases of homozygous Sickle Cell Anemia and 243 cases of beta-thalassemia major in a population of 1.5 million in 1995. Register based national figures of heterozygote carriers approximate 10% for Sickle Cell Anemia and 4% for beta-thalassemia major. CONCLUSION: Defining regional and tribal variations can assist efficient targeting of health resources. This approach provides a simple model for other countries or regions to follow providing there is a health care system that facilitates registration.,1
Endocrine phenotype of 6q16.1-q21 deletion involving SIM1 and Prader-Willi syndrome-like features. Proximal interstitial 6q deletion involving Single-minded 1 (SIM1) gene causes a syndromic form of obesity mimicking Prader-Willi syndrome. In addition to obesity Prader-Willi syndrome includes several other endocrinopathies such as hypothyroidism growth hormone deficiency and hypogonadotropic hypogonadism. The endocrine phenotype of interstitial 6q deletion remains largely unknown although clinical similarities between Prader-Willi syndrome and interstitial 6q deletion suggest endocrine abnormalities also may contribute to the interstitial 6q deletion phenotype. This report describes the endocrine phenotype in a propositus with the Prader-Willi-like syndrome associated with an interstitial 6q deletion including the SIM1 gene. Detailed endocrine evaluation of the propositus during childhood and adolescence revealed hypopituitarism though initial endocrine evaluations during infancy were unremarkable. Our patient raises the possibility that hypopituitarism may be part of the phenotype especially short stature caused by interstitial 6q deletion. SIM1 plays an important role in the development of neuroendocrine lineage cells implicating SIM1 haploinsufficiency in the pathophysiology of hypopituitarism seen in our propositus. Early identification of endocrine abnormalities can improve clinical outcome by allowing timely introduction of hormone replacement therapy. Hence we suggest that detailed endocrine evaluation and longitudinal endocrine follow up be performed in individuals with proximal interstitial 6q deletion involving SIM1.,0
Inclusion Body Myopathy with Paget Disease of Bone and/or Frontotemporal Dementia CLINICAL CHARACTERISTICS:Inclusion body myopathy associated with Paget disease of bone (PDB) and/or frontotemporal dementia (IBMPFD) is characterized by adult-onset proximal and distal muscle weakness (clinically resembling a limb-girdle muscular dystrophy syndrome) early-onset PDB and premature frontotemporal dementia (FTD). Muscle weakness progresses to involve other limb and respiratory muscles. PDB involves focal areas of increased bone turnover that typically lead to spine and/or hip pain and localized enlargement and deformity of the long bones; pathologic fractures occur on occasion. Early stages of FTD are characterized by dysnomia dyscalculia comprehension deficits and paraphasic errors with minimal impairment of episodic memory; later stages are characterized by inability to speak auditory comprehension deficits for even one-step commands alexia and agraphia. Mean age at diagnosis for muscle disease and PDB is 42 years; for FTD 56 years. Dilated cardiomyopathy amyotrophic lateral sclerosis and Parkinson disease are now known to be part of the spectrum of findings associated with IBMPFD. DIAGNOSIS/TESTING:The diagnosis of IBMPFD is established in a proband with typical clinical findings and a heterozygous pathogenic variant in HNRNPA1 HNRNPA2B1 or VCP identified by molecular genetic testing. MANAGEMENT:Treatment of manifestations: Weight control to avoid obesity; physical therapy and stretching exercises to promote mobility and prevent contractures; mechanical aids (canes walkers orthotics wheelchairs) for ambulation/mobility; surgical intervention for foot deformity and scoliosis; respiratory aids when indicated; social and emotional support; assisted living arrangements for muscle weakness and/or dementia; bisphosphonates to relieve pain and disability from PDB. Surveillance: At periodic intervals: echocardiogram and ECG to monitor for evidence of cardiomyopathy; pulmonary function studies; sleep study; alkaline phosphatase skeletal x-rays and bone scans to monitor for PDB onset and effectiveness of therapy; assessment of behavior and mental status. GENETIC COUNSELING:IBMPFD is inherited in an autosomal dominant manner. An estimated 80% of affected individuals have an affected parent; approximately 20% have the disorder as a result of a de novo pathogenic variant. Each child of an individual with IBMPFD has a 50% chance of inheriting the pathogenic variant. Once the IBMPFD-causing pathogenic variant has been identified in an affected family member prenatal testing for a pregnancy at increased risk and preimplantation genetic diagnosis are possible.,1
IVIC syndrome is caused by a c.2607delA mutation in the SALL4 locus. The IVIC syndrome described in 1980 in a large Venezuelan family is an autosomal dominant condition characterized by upper limbs anomalies (radial ray defects carpal bones fusion) extraocular motor disturbances congenital bilateral non-progressive mixed hearing loss; other less consistent malformations include heart involvement mild thrombocytopenia and leukocytosis (before age 50) shoulder girdle hypoplasia imperforate anus kidney malrotation or rectovaginal fistula. Since 2002 mutations in the SALL4 locus have been reported producing phenotypic features quite similar to those in IVIC syndrome; this gene was thus proposed as a candidate for the condition. A segregation analysis of four SNPs in exon 2 (c.1520T > G c.1860A > G c.2037C > T and c.2392A > C) was carried out in 14 affected and in 15 normal family members. Haplotype T;A;C;A was found to always segregate with the disease. Sequencing the whole coding regions revealed one heterozygous base deletion in exon 3 (c.2607delA) causing a premature stop signal 44 codons downstream (p.Q869fsX44) which segregates with the phenotype being absent in controls. The large number of affected individuals presumably carrying the same mutation (n = 26) with quite different degrees of involvement allowed a discussion about possible mechanisms for the SALL4 action. The finding of a SALL4 mutation in a family with such a wide pleiotropic spectrum proves that at least Okihiro acro-renal-ocular and IVIC syndromes are allelic entities.,0
X-linked recessive Charcot-Marie-Tooth neuropathy: clinical and genetic study. We describe three families with X-linked recessive Charcot-Marie-Tooth (CMT) neuropathies. The disease phenotype in family 1 was characterized by infantile onset weakness of lower legs areflexia pes cavus and mental retardation (2 of 5 patients). The disease phenotype in families 2 and 3 was characterized by late onset distal weakness and normal intelligence. Hereditary spastic paraparesis was also present in the CMT patients of family 2. Thirty X-linked DNA markers were used for linkage studies. A maximum lod score of +3.48 was obtained by multipoint linkage analysis for the DXS16 locus mapped at Xp22.2 in family 1. In families 2 and 3 there was suggestion of linkage of Xq26 markers; the peak multipoint lod score for these 2 CMT families was 1.81 at DXS144. These results were suggestive of heterogeneity. The joint analysis including both regions (Xp22.2 and Xq26) provided evidence against homogeneity (chi 2 = 9.12 P less than 0.005).,0
Atypical Meigs' syndrome in a neonate with ovarian torsion associated with an ovarian dermoid cyst. We describe a female neonate with ovarian torsion ovarian follicular and dermoid cysts congenital ascites pleural effusions and respiratory distress. Her symptoms were consistent with atypical Meigs' syndrome and resolved after unilateral oophorectomy. This is the first report in a neonate of this syndrome in association with congenital ovarian disease.,0
Bartter's syndrome in Arabic children: review of 13 cases. BACKGROUND:Bartter's syndrome (BS) is an inherited disease of renal potassium wasting characterized by hypokalemic alkalosis normal blood pressure vascular insensitivity to pressor agents and elevated plasma concentrations of renin and aldosterone. It is caused by generalized hyperplasia of the juxtaglomerular apparatus at the site of renin production caused by mutations in the Na-K-2Cl cotransporter gene NKCC2. The objective of our study is to establish the prevalence and incidence of BS in Kuwait and to assess treatment modalities for it. METHODS AND RESULTS:Bartter's syndrome was diagnosed in 13 Kuwaiti children over a 14 year period (1981-1995) with the estimated incidence of 1.7/100000 live births. The mean age at diagnosis was 9.3 months (range 2-32 months). There were five males and eight females (ratio 1:1.6). The mean duration of follow up was 5.6 years (1-14 years). Both consanguinity and familial history among our patients were high (69 and 54% respectively). All patients had hypokalemia hypochloremia with metabolic alkalosis hyperreninemia and were normotensive. Clinical presentation was essentially similar to that in other series. Eleven patients (85%) had growth failure two had nephrocalcinosis (15%) and one had renal failure. All patients were treated with supplemental potassium an aldosterone antagonist (spironolactone) and a prostaglandin synthetase inhibitor (indomethacin or aspirin) sequentially. Significant catch-up of growth (four patients) and increases in serum potassium (eight patients) were recorded after administration of indomethacin therapy. One patient died of severe pneumonia with respiratory failure from hypokalemic myopathy. Clinical presentation inheritance complications and therapy of BS are briefly discussed. CONCLUSION:Bartter's syndrome is a rare disease but should be considered in the differential diagnosis of other disorders with growth failure and/or hypokalemia. Early diagnosis close follow up and compliance with treatment may lead to appropriate growth and development.,1
Amyotrophic lateral sclerosis in Catalonia: a population based study. Our objective was to determine the incidence and clinical-epidemiological characteristics of an ALS cohort patient in Catalonia (Spain). We conducted a population based registry for a three-year period (1999-2001) in Catalonia (6361365 inhabitants) using several sources of information. The original El Escorial diagnostic criteria (1994) for ALS were applied for the classification of patients. New cases diagnosed between 1 January 1999 and 31 December 2001 were 215 (118 males and 97 females) with an annual crude incidence rate of 1.4/100000 (95% CI 1.3-1.8). This rate showed a peak age between 75 and 79 years. The incidence rate was 1.6 (95% CI 1.5-2.2) in males and 1.2 (95% CI 1.1-1.7) in females. Prevalence at the end of the period was 5.4/100000 of the total population. Median age at onset was 64.3 years. Onset of symptoms was bulbar or generalized in 38% of cases. Mean disease duration at diagnosis was 11.0 months. Median time of survival from onset was 30.8 months. In conclusion ALS incidence in Catalonia is within the range of other countries across Europe with different geographic environmental and socioeconomic situations. However as in other studies conducted in the Mediterranean area Catalonia incidence is in the lower range of rates in Europe.,1
De Novo Mutations in SON Disrupt RNA Splicing of Genes Essential for Brain Development and Metabolism Causing an Intellectual-Disability Syndrome. The overall understanding of the molecular etiologies of intellectual disability (ID) and developmental delay (DD) is increasing as next-generation sequencing technologies identify genetic variants in individuals with such disorders. However detailed analyses conclusively confirming these variants as well as the underlying molecular mechanisms explaining the diseases are often lacking. Here we report on an ID syndrome caused by de novo heterozygous loss-of-function (LoF) mutations in SON. The syndrome is characterized by ID and/or DD malformations of the cerebral cortex epilepsy vision problems musculoskeletal abnormalities and congenital malformations. Knockdown of son in zebrafish resulted in severe malformation of the spine brain and eyes. Importantly analyses of RNA from affected individuals revealed that genes critical for neuronal migration and cortex organization (TUBG1 FLNA PNKP WDR62 PSMD3 and HDAC6) and metabolism (PCK2 PFKL IDH2 ACY1 and ADA) are significantly downregulated because of the accumulation of mis-spliced transcripts resulting from erroneous SON-mediated RNA splicing. Our data highlight SON as a master regulator governing neurodevelopment and demonstrate the importance of SON-mediated RNA splicing in human development.,0
Hirschsprung's disease in Oman. The incidence of Hirschsprung's disease (HD) was studied retrospectively in Oman using hospital-based data. In Oman there is a single pediatric surgery unit where a register has been kept from 1989 to 1994 and because all cases are referred to this unit a national survey could be carried out. There were 85 children with HD born between 1989 and 1994 and during the period there were 261000 livebirths among Omani nationals. The population frequency in Oman is 1 in 3070 (0.3/1000). Eighty percent of cases presented in the first 6 months. The incidence in different regions and within different tribes of Oman was also studied. The highest frequency (1 in 1800) is in the North Sharqiya region. There was not a significant seasonal influence in spite of the very high temperatures seen in the desert summer. The ratio of male to female cases was 2.9:1 overall but less for longer-segment involvement. The consanguinity rate (first and second cousins) was 75% which is higher than the level of consanguinity in the Omani population. Down's syndrome was observed in nine cases (11%) and a variety of other malformations were seen including piebaldism deafness and HD in two sibships.,1
Autosomal recessive gingival fibromatosis with distinctive facies. Hereditary gingival fibromatosis is a rare condition occurring as an isolated anomaly or as part of a genetic syndrome. The isolated or syndromic disorders are usually inherited in an autosomal dominant manner but an autosomal recessive form has been suggested. We report on male and female siblings who have gingival fibromatosis in association with specific facial dysmorphism. Their phenotype is depicted and described to document this hitherto unreported autosomal recessive gingival fibromatosis syndrome.,0
Heart-hand syndrome. III. A new syndrome in three generations. We have studied members of three generations of the same family affected by brachydactyly which is accompanied by intraventricular conduction defects in three cases (proband's father and two of his sons) and sick sinus syndrome in the proband. The brachydactyly described affects mainly the middle phalanges of both hands; the index and fifth fingers are more severely affected than the other fingers. It also includes a rare variant with an ossicle on the proximal phalanx of both index fingers which reduces them in length and causes them to deviate towards the ulnar border of the hand. The feet also tend to be affected but to a lesser degree. No other pathological findings were recorded. It is therefore suggested that the anomalies detected in this family are transmitted by an autosomal dominant mode of inheritance thus forming a syndrome.,0
The epidemiology of Wegener's granulomatosis and microscopic polyangiitis in a Southern Hemisphere region. OBJECTIVE: To determine the prevalence of Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) in the province of Canterbury New Zealand. METHOD: Three hospital clinical databases and the immunology laboratory database were searched and case notes reviewed for patients fulfilling either the 1990 American College of Rheumatology (ACR) criteria for WG or a modification of those criteria that allowed for antineutrophil cytoplasmic antibody (ANCA) positivity in the absence of granulomatous vasculitis. MPA was defined by the Chapel Hill consensus definition; however in the absence of histological evidence of pauci-immune glomerulonephritis ANCA positivity in association with evidence of active glomerular disease was included as a criterion. The point prevalence at 31 December 2003 and the 5-yr period prevalence for the interval 1 January 1999 to 31 December 2003 were calculated. RESULTS: Seventy-three patients with WG and 28 patients with MPA fulfilled the inclusion criteria. A 5-yr period prevalence of 152 WG cases/million [95% confidence interval (CI) 117-186] and 58 MPA cases/million (95% CI 37-80) was calculated using 2001 census data as denominator. Nineteen patients with WG died and 10 patients with MPA died during the study period resulting in a point prevalence for survivors at 31 December 2003 of 112 cases/million (95% CI 82-142) and 37 cases/million (95% CI 20-55) respectively. Using unmodified ACR criteria the 5-yr period and point prevalence for WG were 131/million (95% CI 99-163) and 93.5/million (95% CI 66-121) respectively. Apart from respiratory tract involvement which formed part of the case definition of WG organ involvement was similar in both diseases. CONCLUSION: The prevalence of WG and MPA in Canterbury is the highest reported to date. Restricting the case definition of WG to the ACR classification criteria we found a prevalence equivalent to that described in northern Norway. The clinical severity and serological characteristics were similar to descriptions in other WG and MPA patient cohorts. Studies of disease prevalence in other Southern Hemisphere centres will determine if the observed north-south negative disease gradient in the Northern Hemisphere is reciprocated.,1
Mass spectrometry-based proteomic diagnosis of renal immunoglobulin heavy chain amyloidosis. BACKGROUND AND OBJECTIVES: Amyloidosis is a group of disorders characterized by accumulation of extracellular deposition of proteins as insoluble aggregates. The clinical management of amyloidosis is based on identifying the underlying etiology and accurate typing of the amyloid. Ig heavy chain amyloid involving the kidney is poorly recognized and often poses a diagnostic dilemma. DESIGN SETTING PARTICIPANTS & MEASURES: In this study we describe the use of laser microdissection (LMD) and mass spectrometry (MS)-based proteomic analysis for the accurate typing of 14 cases of amyloidosis. We also describe the clinicopathologic findings of four problematic cases of renal Ig heavy chain amyloidosis that required LMD/MS proteomic analysis for accurate typing of the amyloid. RESULTS: LMD/MS proteomic data of four cases of Ig heavy chain renal amyloidosis showed Ig heavy chains with or without light chains. The break up of the Ig heavy chains was as follows: one case showed Igγ1 chain constant region and λ light chains one case showed Igα chain constant region and κ light chains variable and constant regions whereas two cases showed Igγ3 chain constant region and heavy chains variable region I and/or III without light chains. We compare the LMD/MS proteomic data of Ig heavy chain renal amyloid with that of other types of amyloid including Ig light chains serum amyloid A fibrinogen A-α chain renal amyloid and transthyretin amyloid. CONCLUSIONS: We conclude that LMD/MS is a sensitive and specific tool for diagnosis and accurate typing of renal amyloidosis including Ig heavy chain amyloid.,0
Postnatal microcephaly and pain insensitivity due to a de novo heterozygous DNM1L mutation causing impaired mitochondrial fission and function. An emerging class of mitochondrial disorders is caused by mutations in nuclear genes affecting mitochondrial dynamics and function. One of these is the DNM1L gene encoding the dynamin-related protein 1 (DRP1) which is pivotal in the mitochondrial fission process. Here we describe a patient with a novel dominant-negative de novo DNM1L mutation which expands the clinical spectrum. The patient reported here exhibits a chronic neurological disorder characterized by postnatal microcephaly developmental delay and pain insensitivity. Muscle biopsy disclosed decreased respiratory chain complex IV activity. Exome sequencing showed a de novo heterozygous c.1084G>A (p.G362S) mutation. Subsequent studies of patient skin fibroblasts showed markedly impaired mitochondrial fission and a partial respiratory chain defect while peroxisomal morphology remained intact. Human foreskin fibroblasts over-expressing the mutant DNM1L gene displayed aberrant mitochondrial morphology. © 2016 Wiley Periodicals Inc.,0
A syndromic form of Pierre Robin sequence is caused by 5q23 deletions encompassing FBN2 and PHAX. Pierre Robin sequence (PRS) is an aetiologically distinct subgroup of cleft palate. We aimed to define the critical genomic interval from five different 5q22-5q31 deletions associated with PRS or PRS-associated features and assess each gene within the region as a candidate for the PRS component of the phenotype. Clinical array-based comparative genome hybridisation (aCGH) data were used to define a 2.08 Mb minimum region of overlap among four de novo deletions and one mother-son inherited deletion associated with at least one component of PRS. Commonly associated anomalies were talipes equinovarus (TEV) finger contractures and crumpled ear helices. Expression analysis of the orthologous genes within the PRS critical region in embryonic mice showed that the strongest candidate genes were FBN2 and PHAX. Targeted aCGH of the critical region and sequencing of these genes in a cohort of 25 PRS patients revealed no plausible disease-causing mutations. In conclusion deletion of ∼2 Mb on 5q23 region causes a clinically recognisable subtype of PRS. Haploinsufficiency for FBN2 accounts for the digital and auricular features. A possible critical region for TEV is distinct and telomeric to the PRS region. The molecular basis of PRS in these cases remains undetermined but haploinsufficiency for PHAX is a plausible mechanism.,0
[Persistent polyclonal B-cell lymphocytosis: study of 35 cases]. BACKGROUND AND OBJECTIVES: Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare entity presenting especially in adult smoker women. It is characterized by an increase of serum IgM DR7-HLA haplotype cytogenetic abnormalities and multiple IgH/BCL-2 rearrangements. To date it has not been elucidated whether this is a benign or premalignant disorder. We analyzed the PPBL characteristics with especial attention to its evolution. PATIENTS AND METHODS: Thirty-five PPBL patients from 5 hospitals in Catalonia were retrospectively analyzed. A simultaneous morphologic review of the blood smears was performed by members of the GCCH in a 16 multiple-observer optic microscope. Clinical and biological data were also analyzed. RESULTS: PPBL presents in the majority of cases with persistent polyclonal B-cell lymphocytosis and affects primarily smoker women. The morphologic hallmark in absence of viral infections is the presence of activated lymphocytes with bilobulated and/or cleaved nuclei and nuclear pockets in the ultrastructural study. Increased serum IgM HLA-DR7 haplotype chromosomal abnormalities such as i(3)(q10) and multiple IgH/BCL-2 rearrangements were detected. Thirty-four out of 35 patients are alive after a median follow up of 70.7 months. One patient died because of lung adenocarcinoma and another developed a follicular lymphoma without relation to PPBL. CONCLUSIONS: PPBL has an asymptomatic and stable evolution although it frequently presents genetic abnormalities. It remains unknown whether it is a premalignant entity similar to monoclonal gammopathies of unknown significance. Hence accurate cytologic diagnosis and follow-up are essential.,0
Whole exome sequencing reveals de novo pathogenic variants in KAT6A as a cause of a neurodevelopmental disorder. Neurodevelopmental disorders (NDD) are common with 1-3% of general population being affected but the etiology is unknown in most individuals. Clinical whole-exome sequencing (WES) has proven to be a powerful tool for the identification of pathogenic variants leading to Mendelian disorders among which NDD represent a significant percentage. Performing WES with a trio-approach has proven to be extremely effective in identifying de novo pathogenic variants as a common cause of NDD. Here we report six unrelated individuals with a common phenotype consisting of NDD with severe speech delay hypotonia and facial dysmorphism. These patients underwent WES with a trio approach and de novo heterozygous predicted pathogenic novel variants in the KAT6A gene were identified. The KAT6A gene encodes a histone acetyltransfrease protein and it has long been known for its structural involvement in acute myeloid leukemia; however it has not previously been associated with any congenital disorder. In animal models the KAT6A ortholog is involved in transcriptional regulation during development. Given the similar findings in animal models and our patient's phenotypes we hypothesize that KAT6A could play a role in development of the brain face and heart in humans. © 2016 Wiley Periodicals Inc.,0
An assessment of efficiency in potential screening for Wilson's disease. The efficiency of screening for Wilson's disease by serum caeruloplasmin determination was assessed by analysing the epidemiologic data of 289 affected families in Japan. The estimated gene frequency was 5.2 x 10(-3). The sensitivity of the screening test was 93% at a proposed cut-off level of 120 mg/l and the specificity was 99.83%. In Japan 1 500 000 children are born every year of whom 50 would be expected to have Wilson's disease. The present analysis of potential screening for all children would grade three of them as false-negatives and identify 2621 as false-positives. An analysis for children only from consanguineous marriages produced a more efficient result with a much higher predictive value of the positive and case-finding rate. Although the number of patients identified in this latter high-risk screening group was small it is worth considering as a pilot study.,1
Increase in congenital hypothyroidism in New York State and in the United States. Mandated screening of newborns for congenital hypothyroidism (CH) in NYS was initiated in l978. Currently every newborn screening program in the U.S. includes CH in its panel. Between 1978 and 2005 7.4 million newborns were screened for CH in NYS. In NYS between 1978 and 2005 the incidence of CH has increased by 138%. Nationwide (excluding NYS data) with nearly 58 million infants screened between 1987 and 2002 the incidence has increased 73% between 1987 and 2002. These data and possible reasons for the increases are discussed though no definitive causes are identified.,1
Congenital hydrocephalus and cerebellar agenesis. In a sibship of three brothers two expired shortly after birth with congenital hydrocephalus and necropsy of one revealed cerebellar agenesis and absence of the foramina of Luschka and Magendie. The non-specificity of the Dandy-Walker anomaly is discussed and it is suggested that the present patients demonstrate another form of heritable hydrocephalus possibly on an X-linked recessive basis.,0
Fifteen dorsal vertebrae and rib pairs in two siblings. Born to consanguionous parents two siblings were each found to have fifteen dorsal vertebrae and rib pairs: one had Hirschsprung's disease the other had a low type of anal atresia.,0
NK-cell enteropathy: a benign NK-cell lymphoproliferative disease mimicking intestinal lymphoma: clinicopathologic features and follow-up in a unique case series. Intestinal T-cell and natural killer (NK)-cell lymphomas are clinically aggressive and can be challenging to diagnose in small endoscopic biopsies. We describe 8 patients in whom atypical NK-cell lymphoproliferative lesions mimicked NK- or T-cell lymphoma. The patients (2 men; 6 women; ages 27-68 years) presented with vague gastrointestinal symptoms with lesions involving stomach duodenum small intestine and colon. At endoscopy the lesions exhibited superficial ulceration edema and hemorrhage. Biopsies revealed a mucosal infiltrate of atypical cells with an NK-cell phenotype (CD56(+)/TIA-1(+)/Granzyme B(+)/cCD3(+)) which displaced but did not invade the glandular epithelium. Epstein-Barr virus-encoded RNA in situ hybridization was negative and T-cell receptor-γ gene rearrangement showed no evidence of a clonal process. Based on an original diagnosis of lymphoma 3 patients received aggressive chemotherapy followed by autologous bone marrow transplantation in 2. Five patients were followed without treatment. However no patient developed progressive disease or died of lymphoma (median follow-up 30 months). Repeat endoscopies in 6 of 8 patients showed persistence or recurrence of superficial gastrointestinal lesions. This unique entity mimics intestinal and NK-/T-cell lymphomas on endoscopic biopsies and can result in erroneous diagnosis leading to aggressive chemotherapy. We propose the term "NK-cell enteropathy" for this syndrome of as yet unknown etiology.,0
Epidemiological and clinical features of Moyamoya disease in Nanjing China. OBJECTIVE: The epidemiology of Moyamoya disease in mainland China has not been documented. Therefore the present study was designed to examine the epidemiological and clinical features of Moyamoya disease in Nanjing a provincial capital in China. METHODS: Patient records from multiple hospitals in Nanjing from January 2000 to December 2007 were collected. The clinical features of Moyamoya disease were retrospectively analyzed. RESULTS: A total of 202 patients were identified. There were 94 males and 108 females with ages ranging from 2 to 78 years. There was a dual age peak one in the group of patients 5-9 years of age and another in the group of patients 35-39 years of age. The initial symptoms included cerebral ischemia (81 patients 40%) cerebral hemorrhage (113 patients 55.9%) and asymptomatic disease (8 patients 3.9%). An increasing incidence rate of Moyamoya disease was observed during the period of 2000-2007 with an average detection rate of 0.43cases/100000 persons/year (prevalence 3.92/100000 persons). The incidence of ischemia associated with the disease was 0.16cases/100000 people-years and the incidence of hemorrhage was 0.22cases/100000 people-years. CONCLUSION: This first study on the epidemiological and clinical features of Moyamoya disease in mainland China indicated an increasing incidence of Moyamoya disease with bimodal incidence distribution appearing more frequently in adults.,1
a Novel Y152C KCNJ5 mutation responsible for familial hyperaldosteronism type III. Primary aldosteronism is a heterogeneous group of disorders comprising both sporadic and familial forms. Mutations in the KCNJ5 gene which encodes the inward rectifier K(+) channel 4 (G protein-activated inward rectifier K(+) channel 4 Kir3.4) cause familial hyperaldosteronism type III (FH-III) and are involved in the pathogenesis of sporadic aldosterone-producing adenomas.The objective of the study was to characterize the effects of a newly described KCNJ5 mutation in vitro.The index case is a 62-year-old woman affected by primary aldosteronism who underwent left adrenalectomy after workup for adrenal adenoma. Exon 1 of KCNJ5 was PCR amplified from adrenal tissue and peripheral blood and sequenced. Electrophysiological and gene expression studies were performed to establish the functional effects of the new mutation on the membrane potential and adrenal cell CYP11B2 expression.KCNJ5 sequencing in the index case revealed a new p.Y152C germline mutation; interestingly the phenotype of the patient was milder than most of the previously described FH-III families. The tyrosine-to-cysteine substitution resulted in pathological Na(+) permeability cell membrane depolarization and disturbed intracellular Ca(2+) homeostasis effects similar albeit smaller to the ones demonstrated for other KCNJ5 mutations. Gene expression studies revealed an increased expression of CYP11B2 and its transcriptional regulator NR4A2 in HAC15 adrenal cells overexpressing KCNJ5(Y152C) compared to the wild-type channel. The effect was clearly Ca(2+)-dependent because it was abolished by the calcium channel blocker nifedipine.Herein we describe a new germline mutation in KCNJ5 responsible for FH-III.,0
TK2-Related Mitochondrial DNA Maintenance Defect Myopathic Form CLINICAL CHARACTERISTICS:TK2-related mitochondrial DNA (mtDNA) maintenance defect is a phenotypic continuum that ranges from severe to mild. To date approximately 107 individuals with a molecularly confirmed diagnosis have been reported. Three main subtypes of presentation have been described: Infantile-onset myopathy with neurologic involvement and rapid progression to early death. Affected individuals experience progressive muscle weakness leading to respiratory failure. Some individuals develop dysarthria dysphagia and/or hearing loss. Cognitive function is typically spared. Juvenile/childhood onset with generalized proximal weakness and survival to at least 13 years. Late-/adult-onset myopathy with facial and limb weakness and mtDNA deletions. Some affected individuals develop respiratory insufficiency chronic progressive external ophthalmoplegia dysphagia and dysarthria. DIAGNOSIS/TESTING:The diagnosis of TK2-related mtDNA maintenance defect is established in a proband with infantile onset of disease with severely reduced (typically <20% of age- and tissue-matched healthy controls) mtDNA content in skeletal muscle. The diagnosis of TK2-related mtDNA maintenance defect is established in a proband older than age two years with reduced mtDNA content or multiple mtDNA deletions ragged red fibers and/or COX-deficient fibers in skeletal muscle. The diagnosis is confirmed by the identification of biallelic pathogenic variants in TK2 by molecular genetic testing. MANAGEMENT:Treatment of manifestations: Management should involve a multidisciplinary team. Feeding difficulties should be managed aggressively including use of a nasogastric tube or gastrostomy tube when the risk for aspiration is high. Physical therapy can help maintain muscle function; a physical medicine and rehabilitation (PM&R) specialist can help those who have difficulty walking. A pulmonologist can oversee chest physiotherapy to improve pulmonary function reduce the risk of pulmonary infection and manage respiratory insufficiency if present. Hearing loss and seizures are managed in a standard manner. Prevention of secondary complications: Chest physiotherapy can help reduce the risk of pulmonary infection; physical therapy can help prevent joint contractures. Surveillance: No clinical guidelines are available. Treating physicians should consider: routine evaluation of growth and weight pulmonary function tests with consideration of blood gases neurodevelopmental assessments at each visit and at least annual audiology evaluations in those with infantile-onset disease. GENETIC COUNSELING:TK2-related mtDNA maintenance defect is inherited in an autosomal recessive manner. Each sib of an affected individual has a 25% chance of being affected a 50% chance of being an asymptomatic carrier and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk family members and prenatal testing for a pregnancy at increased risk are possible if the pathogenic variants in the family have been identified.,1
Infantile cerebellar-retinal degeneration associated with a mutation in mitochondrial aconitase ACO2. Degeneration of the cerebrum cerebellum and retina in infancy is part of the clinical spectrum of lysosomal storage disorders mitochondrial respiratory chain defects carbohydrate glycosylation defects and infantile neuroaxonal dystrophy. We studied eight individuals from two unrelated families who presented at 2-6 months of age with truncal hypotonia and athetosis seizure disorder and ophthalmologic abnormalities. Their course was characterized by failure to acquire developmental milestones and culminated in profound psychomotor retardation and progressive visual loss including optic nerve and retinal atrophy. Despite their debilitating state the disease was compatible with survival of up to 18 years. Laboratory investigations were normal but the oxidation of glutamate by muscle mitochondria was slightly reduced. Serial brain MRI displayed progressive prominent cerebellar atrophy accompanied by thinning of the corpus callosum dysmyelination and frontal and temporal cortical atrophy. Homozygosity mapping followed by whole-exome sequencing disclosed a Ser112Arg mutation in ACO2 encoding mitochondrial aconitase a component of the Krebs cycle. Specific aconitase activity in the individuals' lymphoblasts was severely reduced. Under restrictive conditions the mutant human ACO2 failed to complement a yeast ACO1 deletion strain whereas the wild-type human ACO2 succeeded indicating that this mutation is pathogenic. Thus a defect in mitochondrial aconitase is associated with an infantile neurodegenerative disorder affecting mainly the cerebellum and retina. In the absence of noninvasive biomarkers determination of the ACO2 sequence or of aconitase activity in lymphoblasts are warranted in similarly affected individuals based on clinical and neuroradiologic grounds.,0
Updating on primary fallopian tube carcinoma. Primary fallopian tube carcinoma (PFTC) is rare constituting about 1% of female genital tract malignancies and little is known about its etiological protective risk or prognostic factors. Earlier such factors were thought to be similar to those seen in ovarian cancer. The incidence of PFTC has been rising during the last decades especially in higher social classes and among women in certain occupations. Parity is a strong protective factor for PFTC with a lower incidence associated with an increasing number of deliveries. Previous sterilisation seems to offer some protection. Earlier suggestions of previous genital infections as risk factors appear not to hold. Previous cancers are frequent among PFTC patients especially breast cancer. Second primary cancers after PFTC are also frequent especially non-lymphoid leukemia colorectal breast bladder and lung cancer. Only 4% of primary fallopian carcinomas are correctly diagnosed before operation. Treatment consists of aggressive cytoreductive surgery and adjuvant chemotherapy with a platinum-taxane combination. A high preoperative serum hCGss is a strong prognostic factor for worse prognosis. The 5-year survival rates vary between 22 and 57%.,1
Familial spastic paraplegia mental retardation and precocious puberty. Two brothers had progressive spastic paraplegia and precocious puberty develop due to Leydig's cell hyperplasia when they were 2 years old. Both later had moderate mental retardation. Family members displayed brisk lower-extremity reflexes and dysarthria in a pedigree that suggested autosomal dominant inheritance with variable expression. Precocious puberty has been associated with other neurologic syndromes. Its occurrence in two brothers with spastic paraplegia has not to our knowledge been previously reported.,0
Association of a Novel Nonsense Mutation in KIAA1279 with Goldberg-Shprintzen Syndrome. Goldberg-Shprintzen syndrome (OMIM 609460) (GOSHS) is an autosomal recessive multiple congenital anomaly syndrome distinguished by intellectual disability microcephaly and dysmorphic facial characteristics. Most affected individuals also have Hirschsprung disease and/or gyral abnormalities of the brain. This syndrome has been associated with KIAA1279 gene mutations at 10q22.1. Here we report a 16 yr old male patient referred to Center for Comprehensive Genetic Services Tehran Iran in 2015 with cardinal features of GOSHS in addition to refractory seizures. Whole exome sequencing in the patient revealed a novel nonsense (stop gain) homozygous mutation in KIAA1279 gene (KIAA1279: NM_015634:exon6:c.C976T:p.Q326X). Considering the wide range of phenotypic variations in GOSHS relying on phenotypic characteristics for discrimination of GOSH from similar syndromes may lead to misdiagnosis. Consequently molecular diagnostic tools would help in accurate diagnosis of such overlapping phenotypes.,0
Phenotypic variability in human embryonic holoprosencephaly in the Kyoto Collection. BACKGROUND: Holoprosencephaly (HPE) is one of the most common developmental disorders of the brain associated with specific craniofacial dysmorphogenesis. Although numerous postnatal cases have been reported early phases of its pathogenesis are not well understood. We examined over 200 cases of HPE human embryos both grossly and histologically and studied their phenotypic variability and stage-specific characteristics. METHODS: Among over 44000 human embryos in the Kyoto Collection of Human Embryos 221 embryos have been diagnosed as HPE. Their developmental stages ranged from Carnegie stage (CS) 13 to CS 23. They were examined grossly and were also serially sectioned for detailed histological analysis. RESULTS: HPE embryos after CS 18 were classified into complete (true) cyclopia synophthalmia (partially fused eyes in a single eye fissure) closely apposed separate eyes (possible forerunners of ethmocephaly and cebocephaly) and milder HPE with median cleft lip (premaxillary agenesis). At CS 13-17 when facial morphogenesis is not completed HPE embryos had some facial characteristics that are specific to these stages and different from those in older HPE embryos. The midline structures of the brain including the pituitary gland were lacking or seriously hypoplastic in HPE embryos. Complete cyclopia was found in two cases after CS 18 but none at earlier stages. CONCLUSIONS: The early development of HPE in human embryos was systematically studied for the first time. The pathogenesis of craniofacial abnormalities especially eye anomalies in HPE was discussed in the light of recent studies with mutant laboratory animals.,1
Dual T cell- and B cell-intrinsic deficiency in humans with biallelic RLTPR mutations. Combined immunodeficiency (CID) refers to inborn errors of human T cells that also affect B cells because of the T cell deficit or an additional B cell-intrinsic deficit. In this study we report six patients from three unrelated families with biallelic loss-of-function mutations in RLTPR the mouse orthologue of which is essential for CD28 signaling. The patients have cutaneous and pulmonary allergy as well as a variety of bacterial and fungal infectious diseases including invasive tuberculosis and mucocutaneous candidiasis. Proportions of circulating regulatory T cells and memory CD4+ T cells are reduced. Their CD4+ T cells do not respond to CD28 stimulation. Their CD4+ T cells exhibit a "Th2" cell bias ex vivo and when cultured in vitro contrasting with the paucity of "Th1" "Th17" and T follicular helper cells. The patients also display few memory B cells and poor antibody responses. This B cell phenotype does not result solely from the T cell deficiency as the patients' B cells fail to activate NF-κB upon B cell receptor (BCR) stimulation. Human RLTPR deficiency is a CID affecting at least the CD28-responsive pathway in T cells and the BCR-responsive pathway in B cells.,0
Mutation of SLC9A1 encoding the major Na⁺/H⁺ exchanger causes ataxia-deafness Lichtenstein-Knorr syndrome. Lichtenstein-Knorr syndrome is an autosomal recessive condition that associates sensorineural hearing loss and cerebellar ataxia. Here we report the first identification of a gene involved in Lichtenstein-Knorr syndrome. By using a combination of homozygosity mapping and whole-exome sequencing we identified the homozygous p.Gly305Arg missense mutation in SLC9A1 that segregates with the disease in a large consanguineous family. Mutant glycine 305 is a highly conserved amino acid present in the eighth transmembrane segment of all metazoan orthologues of NHE1 the Na(+)/H(+) exchanger 1 encoded by SLC9A1. We demonstrate that the p.Gly305Arg mutation causes the near complete de-glycosylation mis-targeting and loss of proton pumping activity of NHE1. The comparison of our family with the phenotypes of spontaneous and knockout Slc9a1 murine models demonstrates that the association between ataxia and hearing loss is caused by complete or near complete loss of function of NHE1 and altered regulation of pHi in the central nervous system.,0
Hereditary neurocutaneous angiomatosis. Report of four cases. The authors report the coexistence of vascular nevi (hemangiomas and arteriovenous malformations (AVMs) of the skin) with AVMs and venous malformations of the brain in male siblings from two related but nonconsanguineous families of three generations. The proband his siblings parents aunts uncles and cousins were examined underwent magnetic resonance (MR) imaging and MR angiography and when appropriate cerebral angiography. A father had vascular nevi and a mother his sister had an azygos anterior cerebral artery. No other cutaneous or cerebrovascular malformations were present in the parents. Each of the two families had two boys and one girl 9 to 18 years of age. All the children had vascular nevi and all of the boys had coexisting cerebrovascular malformations: AVMs in three and a venous malformation in another. One boy had three cerebral AVMs. Two boys had a cerebral hemorrhage and one also had focal motor seizures. The skin lesions were not those of the Sturge-Weber-Dimitri Rendu-Osler-Weber or Wybum-Mason syndromes. The association of cutaneous and cerebrovascular malformations was seen only in males in these families. but females have also been reported in the literature. The results obtained in these families and three other families reported from Western and Central Europe indicate that the association of cerebral and cutaneous vascular hamartomas constitutes a distinct hereditary clinicopathological entity with autosomal dominant inheritance and variable penetrance. The clinical manifestations of this syndrome are visible painful vascular nevi epilepsy cerebral hemorrhage and focal neurological deficits. The preponderance of male patients with the full expression of the syndrome suggests a possible hormonal influence on the expression of the gene.,0
Acromegaly incidence prevalence complications and long-term prognosis: a nationwide cohort study. Valid data on acromegaly incidence complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence prevalence complications and mortality in a population-based cohort study.All incident cases of acromegaly in Denmark (1991-2010) were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10(6) person-years (py) with 95% confidence intervals (95% CIs). For every patient 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used.Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10(6) persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)) heart failure (HR: 2.5 (95% CI: 1.4-4.5)) venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)) sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality.(i) The incidence rate and age at diagnosis of acromegaly have been stable over decades and the prevalence is higher than previously reported. (ii) The risk of complications is very high even before the diagnosis. (iii) Mortality risk remains elevated but uninfluenced by mode of treatment.,1
Newborn screening for Krabbe disease in New York State: the first eight years' experience. Krabbe disease (KD) results from galactocerebrosidase (GALC) deficiency. Infantile KD symptoms include irritability progressive stiffness developmental delay and death. The only potential treatment is hematopoietic stem cell transplantation. New York State (NYS) implemented newborn screening for KD in 2006.Dried blood spots from newborns were assayed for GALC enzyme activity using mass spectrometry followed by molecular analysis for those with low activity (≤12% of the daily mean). Infants with low enzyme activity and one or more mutations were referred for follow-up diagnostic testing and neurological examination.Of >1.9 million screened 620 infants were subjected to molecular analysis and 348 were referred for diagnostic testing. Five had enzyme activities and mutations consistent with infantile KD and manifested clinical/neurodiagnostic abnormalities. Four underwent transplantation two are surviving with moderate to severe handicaps and two died from transplant-related complications. The significance of many sequence variants identified is unknown. Forty-six asymptomatic infants were found to be at moderate to high risk for disease.The positive predictive value of KD screening in NYS is 1.4% (5/346) considering confirmed infantile cases. The incidence of infantile KD in NYS is approximately 1 in 394000 but it may be higher for later-onset forms.,1
Idiopathic pulmonary fibrosis in Taiwan - a population-based study. BACKGROUND: This study took advantage of a large population-based database of the Taiwan National Health Insurance (NHI) to investigate the epidemiology of idiopathic pulmonary fibrosis (IPF) in Taiwan. METHODS: This is a retrospective cohort study based on secondary analysis of prospectively collected data in the NHI system and governmental data on death registry in Taiwan during 1997-2007. By using the broad and narrow definitions for IPF we estimated incidence and prevalence rates of IPF and its associated clinical outcomes. RESULTS: The estimates of annual IPF incidence rates became more stable after 2000 ranging between 0.9 and 1.6 cases per 100000 persons. The prevalence rates became more than twofold from 2000 to 2007 (from 2.8 to 6.4 cases per 100000 persons for the broad definition and from 2.0 to 4.9 cases per 100000 persons for the narrow definition). Men of age older than 75 years had markedly higher incidence and prevalence rates than other groups. Around 40% of all incidences and about 30% of prevalent cases occurred in this population group. The median survival time after IPF diagnosis was 0.9 year (interquartile range (IQR) 0.2-2.5 years) and 0.7 year (IQR 0.1-2.3 years) for the broad and narrow definitions respectively. Progression of IPF was the leading cause of death followed by cancer. CONCLUSIONS: In Taiwan elderly men were the major group suffering from IPF. Survival time was short after IPF diagnosis and the poor survival was largely attributable to quick IPF progression after diagnosis.,1