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Kemezyte A, Gegieckiene R, Burnyte B. Genotype-phenotype spectrum and prognosis of early-onset Marfan syndrome. BMC Pediatr 2023; 23:539. [PMID: 37891508 PMCID: PMC10612290 DOI: 10.1186/s12887-023-04357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Marfan syndrome is a genetic connective tissue disorder affecting skeletal, ocular, and cardiovascular organ systems. Previous research found that pathogenic variants clustered in exons 24-32 of fibrillin-1 (FBN1) gene result in more severe clinical phenotypes. Furthermore, genotype-phenotype correlation studies suggested that more severe cardiovascular phenotypes were related to variants held responsible for haploinsufficiency. Our objective was to analyze the differences in clinical manifestations and genotypes of individuals with early-onset Marfan syndrome and to assess their impact on management strategies. METHODS We analyzed clinical and genetic data of a new patient with early-onset Marfan syndrome together with 51 previously reported ones in the PubMed database between 1991 and 2022. RESULTS Analysis showed 94% (49/52) of pathogenic variants clustered in exons 24-32 of the FBN1. The most common skeletal features were arachnodactyly (98%), reduced elbow extension (48%), pectus deformity (40%), and scoliosis (39%). Haploinsufficiency variants were reported as having poor outcome in 87.5% of the cases. Among patients carrying variants that substitute a cysteine for another amino acid and those that do not change cysteine content, cardiac intervention was found to be associated with a better outcome (p = 0.035 vs. p = 0.002). Variants that create an extra cysteine residue were found to be associated with a higher risk of ectopia lentis. Additionally, children up to 36-months-old were more often reported as still alive at the time of publication compared to newborns (p < 0.01). CONCLUSIONS Our findings have implications for prognosis, because different genotype groups and their resulting phenotype may require personalized care and management.
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Affiliation(s)
- Aurelija Kemezyte
- Faculty of Medicine, Vilnius University, M.K. Ciurlionio st. 21, Vilnius, Lithuania
| | - Ruta Gegieckiene
- Center of Cardiothoracic Surgery, Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu St. 2, Vilnius, Lithuania
| | - Birute Burnyte
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu st. 2, LT-08661, Vilnius, Lithuania.
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Motonaga T, Ohnishi Y, Okada S, Suzuki Y, Furuta T, Kawamura M, Okayama N, Suehiro Y, Hasegawa S. Successful Mitral Valve Replacement in an Infant with Neonatal Marfan Syndrome due to a Novel Missense Mutation of the FBN1 Gene. Int Heart J 2022; 63:777-781. [PMID: 35831148 DOI: 10.1536/ihj.21-821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Marfan syndrome is an autosomal dominant genetic disorder of the fibrous connective tissue caused by pathogenic mutations in the fibrillin-1 gene. Neonatal Marfan syndrome is a rare type of Marfan syndrome that is genotypically and phenotypically different from classical Marfan syndrome and has a poor prognosis. Most patients with neonatal Marfan syndrome die during infancy due to severe and rapidly progressive cardiovascular disorders. Here, we present a case of an 11-year-old girl with neonatal Marfan syndrome due to a novel missense mutation in exon 27 of the fibrillin-1 gene. Her condition was critical due to progressive mitral and tricuspid regurgitation. Mitral valve replacement, performed at the age of 6 months, improved her critical condition. Our case suggests that early mitral valve replacement may lead to better outcomes in patients with neonatal Marfan syndrome.
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Affiliation(s)
- Takahiro Motonaga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine.,Department of Pediatrics, Yamaguchi-ken Saiseikai Shimonoseki General Hospital
| | - Yuji Ohnishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Takashi Furuta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Mai Kawamura
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine.,Department of Pediatrics, Yamaguchi-ken Saiseikai Shimonoseki General Hospital
| | - Naoko Okayama
- Division of Laboratory, Yamaguchi University Graduate School of Medicine
| | - Yutaka Suehiro
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
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Azmanov DN, Dimitrova S, Florez L, Cherninkova S, Draganov D, Morar B, Saat R, Juan M, Arostegui JI, Ganguly S, Soodyall H, Chakrabarti S, Padh H, López-Nevot MA, Chernodrinska V, Anguelov B, Majumder P, Angelova L, Kaneva R, Mackey DA, Tournev I, Kalaydjieva L. LTBP2 and CYP1B1 mutations and associated ocular phenotypes in the Roma/Gypsy founder population. Eur J Hum Genet 2011; 19:326-33. [PMID: 21081970 PMCID: PMC3062003 DOI: 10.1038/ejhg.2010.181] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/28/2010] [Accepted: 10/08/2010] [Indexed: 12/19/2022] Open
Abstract
Primary congenital glaucoma (PCG) is a genetically heterogeneous autosomal recessive disorder, which is an important cause of blindness in childhood. The first known gene, CYP1B1, accounts for a variable proportion of cases in most populations. A second gene, LTBP2, was recently reported in association with a syndrome, in which glaucoma is secondary to lens dislocation. We report on the molecular and clinical profile of 34 families diagnosed as PCG, all originating from the Roma/Gypsy founder population. Comprehensive sequencing analysis revealed a level of heterogeneity unusual for this population, with five CYP1B1 and one ancestral LTBP2 mutation accounting for ∼70% of patients (25 out of 37) and the remainder still unexplained. Homozygosity for the founder LTBP2 p.R299X mutation resulted in a more severe clinical phenotype and poorer outcome despite a markedly higher number of surgical interventions. The genetically homogeneous group of p.R299X homozygotes showed variable phenotypes (presumably also underlying pathogenetic mechanisms), wherein PCG proper with primary dysgenesis of the trabecular meshwork, and Marfan syndrome-like zonular disease with ectopia lentis and later onset secondary glaucoma are two extremes. The spectrum manifestations may occur in different combinations and have a different evolution even within the same sibship or a single patient. Preliminary observations on compounds with mutations in both CYP1B1-LTBP2 suggest that the observed combinations are of no clinical significance and digenic inheritance is unlikely. We provide a population genetics perspective to explain the allelic heterogeneity, comparing the history and geographic distribution of the two major founder mutations--p.R299X/LTBP2 and p.E387K/CYP1B1.
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Affiliation(s)
- Dimitar N Azmanov
- Laboratory for Molecular Genetics, Centre for Medical Research and Western Australian Institute for Medical Research, QEII Medical Centre, University of Western Australia, Perth, Western Australia, Australia
| | | | - Laura Florez
- Laboratory for Molecular Genetics, Centre for Medical Research and Western Australian Institute for Medical Research, QEII Medical Centre, University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Bharti Morar
- Laboratory for Molecular Genetics, Centre for Medical Research and Western Australian Institute for Medical Research, QEII Medical Centre, University of Western Australia, Perth, Western Australia, Australia
| | - Rosmawati Saat
- Laboratory for Molecular Genetics, Centre for Medical Research and Western Australian Institute for Medical Research, QEII Medical Centre, University of Western Australia, Perth, Western Australia, Australia
| | - Manel Juan
- Servei d'Immunologia, IDIBAPS-Hospital Clínic, Barcelona, Spain
| | | | - Sriparna Ganguly
- Human Genetics Unit, Indian Statistical Institute, Kolkata, India
| | - Himla Soodyall
- National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Harish Padh
- BV Patel Pharmaceutical Education and Research Development Centre, Thaltej, Ahmedabad, India
| | - Miguel A López-Nevot
- Servicio de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
| | | | - Botio Anguelov
- Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | - Partha Majumder
- Human Genetics Unit, Indian Statistical Institute, Kolkata, India
- National Institute of Biomedical Genomics, Kalyani, India
| | - Lyudmila Angelova
- Department of Paediatrics and Medical Genetics, Medical University, Varna, Bulgaria
| | - Radka Kaneva
- Molecular Medicine Centre, Medical University, Sofia, Bulgaria
| | - David A Mackey
- Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Ivailo Tournev
- Department of Neurology, Medical University, Sofia, Bulgaria
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Luba Kalaydjieva
- Laboratory for Molecular Genetics, Centre for Medical Research and Western Australian Institute for Medical Research, QEII Medical Centre, University of Western Australia, Perth, Western Australia, Australia
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Chen JM, Férec C, Cooper DN. Closely spaced multiple mutations as potential signatures of transient hypermutability in human genes. Hum Mutat 2009; 30:1435-48. [PMID: 19685533 DOI: 10.1002/humu.21088] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Data from diverse organisms suggests that transient hypermutability is a general mutational mechanism with the potential to generate multiple synchronous mutations, a phenomenon probably best exemplified by closely spaced multiple mutations (CSMMs). Here we have attempted to extend the concept of transient hypermutability from somatic cells to the germline, using human inherited disease-causing multiple mutations as a model system. Employing stringent criteria for data inclusion, we have retrospectively identified numerous potential examples of pathogenic CSMMs that exhibit marked similarities to the CSMMs reported in other systems. These examples include (1) eight multiple mutations, each comprising three or more components within a sequence tract of <100 bp; (2) three possible instances of "mutation showers"; and (3) numerous highly informative "homocoordinate" mutations. Using the proportion of CpG substitution as a crude indicator of the relative likelihood of transient hypermutability, we present evidence to suggest that CSMMs comprising at least one pair of mutations separated by < or =100 bp may constitute signatures of transient hypermutability in human genes. Although this analysis extends the generality of the concept of transient hypermutability and provides new insights into what may be considered a novel mechanism of mutagenesis underlying human inherited disease, it has raised serious concerns regarding current practices in mutation screening.
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Affiliation(s)
- Jian-Min Chen
- Institut National de la Santé et de la Recherche Médicale, U613, Brest, France.
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