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Boussion S, Escande F, Jourdain AS, Smol T, Brunelle P, Duhamel C, Alembik Y, Attié-Bitach T, Baujat G, Bazin A, Bonnière M, Carassou P, Carles D, Devisme L, Goizet C, Goldenberg A, Grotto S, Guichet A, Jouk PS, Loeuillet L, Mechler C, Michot C, Pelluard F, Putoux A, Whalen S, Ghoumid J, Manouvrier-Hanu S, Petit F. TAR syndrome: Clinical and molecular characterization of a cohort of 26 patients and description of novel noncoding variants of RBM8A. Hum Mutat 2020; 41:1220-1225. [PMID: 32227665 DOI: 10.1002/humu.24021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/18/2020] [Accepted: 03/22/2020] [Indexed: 11/07/2022]
Abstract
Thrombocytopenia-absent radius (TAR) syndrome is characterized by radial defect and neonatal thrombocytopenia. It is caused by biallelic variants of RBM8A gene (1q21.1) with the association of a null allele and a hypomorphic noncoding variant. RBM8A encodes Y14, a core protein of the exon junction complex involved in messenger RNA maturation. To date, only two hypomorphic variants have been identified. We report on a cohort of 26 patients affected with TAR syndrome and carrying biallelic variants in RBM8A. Half patients carried a 1q21.1 deletion and one of the two known hypomorphic variants. Four novel noncoding variants of RBM8A were identified in the remaining patients. We developed experimental models enabling their functional characterization in vitro. Two variants, located respectively in the 5'-untranslated region (5'-UTR) and 3'-UTR regions, are responsible for a diminished expression whereas two intronic variants alter splicing. Our results bring new insights into the molecular knowledge of TAR syndrome and enabled us to propose genetic counseling for patients' families.
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Affiliation(s)
- Simon Boussion
- Clinical Genetics Department, Reference Center for Developmental Anomalies, CHU Lille, Lille, France
- EA7364-RADEME, Lille University, Lille, France
| | - Fabienne Escande
- EA7364-RADEME, Lille University, Lille, France
- Biochemistry and Molecular Oncology Laboratory, CHU Lille, Lille, France
| | - Anne-Sophie Jourdain
- EA7364-RADEME, Lille University, Lille, France
- Biochemistry and Molecular Oncology Laboratory, CHU Lille, Lille, France
| | - Thomas Smol
- EA7364-RADEME, Lille University, Lille, France
- Medical Genetics Department, CHU Lille, Lille, France
| | - Perrine Brunelle
- EA7364-RADEME, Lille University, Lille, France
- Biochemistry and Molecular Oncology Laboratory, CHU Lille, Lille, France
| | | | - Yves Alembik
- Medical Genetics Department, CHU Strasbourg, Strasbourg, France
| | - Tania Attié-Bitach
- Histology, Embryology and Cytogenetics Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Geneviève Baujat
- Clinical Genetics Department, Necker-Enfants Malades Hospital, AP-HP, INSERM UMR, IMAGINE Institute, Paris, France
| | - Anne Bazin
- Antenatal Diagnosis Department, René Dubois Hospital, Pontoise, France
| | - Maryse Bonnière
- Histology, Embryology and Cytogenetics Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | | | | | - Louise Devisme
- EA7364-RADEME, Lille University, Lille, France
- Anatomo-Pathology Institute, CHU Lille, Lille, France
| | - Cyril Goizet
- Medical Genetics Department, CHU Bordeaux, MRGM Laboratory, INSERM, Bordeaux University, Bordeaux, France
| | - Alice Goldenberg
- Genetics Department, Reference Center for Developmental Anomalies, CHU Rouen, Rouen, France
| | - Sarah Grotto
- Genetics Department, Robert Debré Hospital, AP-HP, Paris, France
| | | | | | | | - Charlotte Mechler
- Foetopathology Department, Robert Debré Hospital, AP-HP, Paris, France
| | - Caroline Michot
- Clinical Genetics Department, Necker-Enfants Malades Hospital, AP-HP, INSERM UMR, IMAGINE Institute, Paris, France
| | - Fanny Pelluard
- INSERM U1053-UMR BaRITOn, Foetopathology Department, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | - Audrey Putoux
- Genetics Department, Hospices Civils de Lyon, Lyon, France
- GENDEV Team, CRNL, INSERM U1028, CNRS UMR 5292, UCBL1, Lyon, France
| | - Sandra Whalen
- Clinical Genetics, Reference Center for Developmental Anomalies, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Jamal Ghoumid
- Clinical Genetics Department, Reference Center for Developmental Anomalies, CHU Lille, Lille, France
- EA7364-RADEME, Lille University, Lille, France
| | - Sylvie Manouvrier-Hanu
- Clinical Genetics Department, Reference Center for Developmental Anomalies, CHU Lille, Lille, France
- EA7364-RADEME, Lille University, Lille, France
| | - Florence Petit
- Clinical Genetics Department, Reference Center for Developmental Anomalies, CHU Lille, Lille, France
- EA7364-RADEME, Lille University, Lille, France
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Abstract
The inherited bone marrow failure syndromes (IBMFS) are a set of clinically related yet heterogeneous disorders in which at least one hematopoietic cell lineage is significantly reduced. Many of the IBMFS have notably increased cancer risks, as well as other physical findings. Highly penetrant germline mutations in key pathways, such as DNA repair, telomere biology, or ribosomal biogenesis, are causative of Fanconi anemia (FA), dyskeratosis congenita (DC), and Diamond-Blackfan anemia (DBA), respectively. Next-generation sequencing (NGS) generally refers to high-throughput, large-scale sequencing technologies and is being used more frequently to understand disease etiology. In the IBMFS, NGS has facilitated the discovery of germline mutations that cause thrombocytopenia absent radii syndrome (TAR), a subset of DC and DBA, and other uncharacterized, but related, disorders. Panels of large numbers of genes are being used to molecularly characterize patients with IBMFS, such as FA and DBA. NGS is also accelerating the discovery of the genetic etiology of previously unclassified IBMFS. In this review, we will highlight recent studies that have employed NGS to ascertain the genetic etiology of IBMFS, namely, FA, DC, DBA, and TAR, and discuss the translational utility of these findings.
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Affiliation(s)
- Payal P. Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Children’s National Medical Center, Washington, DC
| | - Sharon A. Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Bottillo I, Castori M, De Bernardo C, Fabbri R, Grammatico B, Preziosi N, Scassellati GS, Silvestri E, Spagnuolo A, Laino L, Grammatico P. Prenatal diagnosis and post-mortem examination in a fetus with thrombocytopenia-absent radius (TAR) syndrome due to compound heterozygosity for a 1q21.1 microdeletion and a RBM8A hypomorphic allele: a case report. BMC Res Notes 2013; 6:376. [PMID: 24053387 PMCID: PMC3849061 DOI: 10.1186/1756-0500-6-376] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/17/2013] [Indexed: 11/14/2022] Open
Abstract
Background Thrombocytopenia–absent radius syndrome is a rare autosomal recessive disorder characterized by megakaryocytic thrombocytopenia and longitudinal limb deficiencies mostly affecting the radial ray. Most patients are compound heterozygotes for a 200 kb interstitial microdeletion in 1q21.1 and a hypomorphic allele in RBM8A, mapping in the deleted segment. At the moment, the complete molecular characterization of thrombocytopenia–absent radius syndrome is limited to a handful of patients mostly ascertained in the pediatric age Case presentation We report on a fetus with bilateral upper limb deficiency found at standard prenatal ultrasound examination. The fetus had bilateral radial agenesis and humeral hypo/aplasia with intact thumbs, micrognathia and urinary anomalies, indicating thrombocytopenia–absent radius syndrome. Molecular studies demonstrated compound heterozygosity for the 1q21.1 microdeletion and the RBM8A rs139428292 variant at the hemizygous state, inherited from the mother and father, respectively Conclusion The molecular information allowed prenatal diagnosis in the following pregnancy resulting in the birth of a healthy carrier female. A review was carried out with the attempt to the trace the fetal ultrasound presentation of thrombocytopenia–absent radius syndrome and discussing opportunities for second-tier molecular studies within a multidisciplinary setting.
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Affiliation(s)
- Irene Bottillo
- Department of Molecular Medicine, Medical Genetics, San Camillo-Forlanini Hospital, Sapienza University, Rome, Italy.
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Houeijeh A, Andrieux J, Saugier-Veber P, David A, Goldenberg A, Bonneau D, Fouassier M, Journel H, Martinovic J, Escande F, Devisme L, Bisiaux S, Chaffiotte C, Baux M, Kerckaert JP, Holder-Espinasse M, Manouvrier-Hanu S. Thrombocytopenia-absent radius (TAR) syndrome: a clinical genetic series of 14 further cases. impact of the associated 1q21.1 deletion on the genetic counselling. Eur J Med Genet 2011; 54:e471-7. [PMID: 21635976 DOI: 10.1016/j.ejmg.2011.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
Thrombocytopenia-absent radius Syndrome (TAR) is a rare congenital malformation syndrome of complicated transmission. 1q21.1 deletion is necessary but not sufficient for its expression. We report the result of a French multicentric clinical study, and we emphasized on the role of the associated 1q21.1 deletion in the diagnosis and the genetic counselling of our patients. We gathered information on 14 patients presenting with TAR syndrome and referred for genetic counselling in six different university hospitals (8 foetuses, 1 child and 5 adults). Clinical or pathology details, as well as skeletal X-rays were analyzed. Genetic studies were performed by Array-CGH, and Quantitative Multiplex PCR. We demonstrated the very variable phenotypes of TAR syndrome. Female:male ratio was ∼2:1. All patients presented with bilateral radial aplasia/hypoplasia with preserved thumbs. Phocomelia and lower limb anomalies were present in 28% of the cases. We reported the first case of cystic hygroma on affected foetus. 1q21.1 deletions ranging from 330 to 1100 kb were identified in all affected patients. Most of them were inherited from one healthy parent (80%). The identification of a 1q21.1 deletion allowed confirmation of TAR syndrome diagnosis, particularly in foetuses and in atypical phenotypes. Additionally, it allowed accurate genetic counselling, especially when it occurred de novo. These findings allowed discussing the diagnostic criteria and management towards TAR syndrome.
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Affiliation(s)
- Ali Houeijeh
- Service de Génétique clinique Guy Fontaine, CHRU Lille, France
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Klopocki E, Schulze H, Strauss G, Ott CE, Hall J, Trotier F, Fleischhauer S, Greenhalgh L, Newbury-Ecob RA, Neumann LM, Habenicht R, König R, Seemanova E, Megarbane A, Ropers HH, Ullmann R, Horn D, Mundlos S. Complex inheritance pattern resembling autosomal recessive inheritance involving a microdeletion in thrombocytopenia-absent radius syndrome. Am J Hum Genet 2007; 80:232-40. [PMID: 17236129 PMCID: PMC1785342 DOI: 10.1086/510919] [Citation(s) in RCA: 251] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/14/2006] [Indexed: 11/03/2022] Open
Abstract
Thrombocytopenia-absent radius (TAR) syndrome is characterized by hypomegakaryocytic thrombocytopenia and bilateral radial aplasia in the presence of both thumbs. Other frequent associations are congenital heart disease and a high incidence of cow's milk intolerance. Evidence for autosomal recessive inheritance comes from families with several affected individuals born to unaffected parents, but several other observations argue for a more complex pattern of inheritance. In this study, we describe a common interstitial microdeletion of 200 kb on chromosome 1q21.1 in all 30 investigated patients with TAR syndrome, detected by microarray-based comparative genomic hybridization. Analysis of the parents revealed that this deletion occurred de novo in 25% of affected individuals. Intriguingly, inheritance of the deletion along the maternal line as well as the paternal line was observed. The absence of this deletion in a cohort of control individuals argues for a specific role played by the microdeletion in the pathogenesis of TAR syndrome. We hypothesize that TAR syndrome is associated with a deletion on chromosome 1q21.1 but that the phenotype develops only in the presence of an additional as-yet-unknown modifier (mTAR).
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Affiliation(s)
- Eva Klopocki
- Institut für Medizinische Genetik, Charité Universitätsmedizin Berlin, Berlin, Germany
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Lubinsky MS. Explaining certain human limb anomalies and the limb-hematopoiesis community of syndromes using a model of determination. TERATOLOGY 1991; 43:295-9. [PMID: 2048037 DOI: 10.1002/tera.1420430403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Disturbances of determination, the process of limitation of developmental potential, can cause structural as well as histologic anomalies. A polar coordinate model (PCM) developed from studies in animals, in which determination depends upon positional information arranged along polar coordinates, can be used to explain certain classes of human limb anomalies. Under the model, interference with this system primarily affects distal patterning. If the radial area is distal to the zone of polarizing activity in embryological development, as it appears to be, the PCM explains the teratologic equivalence of preaxial duplications and deficiencies in certain circumstances and the prevalence of ulnar dimelias in forearm duplications. Also, failures of hematopoiesis can be considered late problems with determination and may be markers for abnormalities of a determinative process that also has earlier developmental consequences. Abnormalities of retinoic acid morphogen receptors would be one possible mechanism. This would provide a rationale for the known association of postnatal hematologic problems with developmental anomalies preferentially affecting the radial area. Syndromes with limb and hematopoietic problems may well be a community of determinative disorders.
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Affiliation(s)
- M S Lubinsky
- Division of Genetics, Children's Hospital of Wisconsin, Milwaukee 53201
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