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Koutra E, Lusmöller E, Fischer J, Komlosi K, Stadler R, Gutzmer R. [Focal dermal hypoplasia associated with pathogenic PORCN gene variant in postzygotic, unilateral mosaic form]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:486-491. [PMID: 38366244 DOI: 10.1007/s00105-024-05308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
We report a case of a 29-year-old woman with subtle partial erythematous, partial hyperpigmented streaks along the Blaschko's lines on the right side of the body since early childhood. Primary DNA results of the skin and blood assay diagnosed focal dermal hypoplasia in mosaic form. The postzygotic mutation in the PORCN gene was only detectable in the affected skin and not in the blood assay. This article illustrates that clinically very discrete hypopigmentation and poikiloderma along Blaschko lines should raise awareness for robust diagnostic analysis in order to recognize this variable multisystem disease and to ensure an appropriate search for extracutaneous abnormalities and human genetic counseling, ideally before pregnancy. Careful correlation of clinical, histological, and genetic features along with close multidisciplinary cooperation of specialists from the fields of human genetics, dermatology, pediatrics, orthopedics and ophthalmology is crucial for final diagnosis, assessment of the prognosis and targeted genetic counseling of affected individuals.
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Affiliation(s)
- Eleni Koutra
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - Elke Lusmöller
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
| | - Judith Fischer
- Institut für Humangenetik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Katalin Komlosi
- Institut für Humangenetik, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
| | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
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Park JG, Xu CL, Boyd A, Aghajanova L, Mahajan VB, Wood EH. REPRODUCTIVE OPHTHALMOLOGY: The Intersection of Inherited Eye Diseases and Reproductive Technologies. Retina 2022; 42:2025-2030. [PMID: 35963004 PMCID: PMC10593127 DOI: 10.1097/iae.0000000000003591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To propose a working framework for patients with inherited eye diseases presenting to ophthalmologists who are interested in assisted reproductive technology and preimplantation genetic testing. METHODS Retrospective chart review and case series of three families with inherited eye diseases who successfully underwent preimplantation genetic testing, in vitro fertilization, and birth of unaffected children. RESULTS Preimplantation genetic testing was performed for three families with different inherited eye diseases, which included autosomal dominant retinitis pigmentosa, autosomal recessive achromatopsia, and X-linked Goltz syndrome. Preimplantation genetic testing led to the identification of unaffected embryos, which were then selected for in vitro fertilization and resulted in the birth of unaffected children. CONCLUSION A close collaboration between patients, families, ophthalmologists, reproductive genetic counselors, and reproductive endocrinology and infertility specialists is the ideal model for taking care of patients interested in preimplantation genetic testing for preventing the transmission of inherited eye diseases.
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Affiliation(s)
- Jong G Park
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; and
| | - Christine L Xu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; and
| | - Allison Boyd
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Sunnyvale, California
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Sunnyvale, California
| | - Vinit B Mahajan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; and
| | - Edward H Wood
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; and
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Fuhrmann S, Ramirez S, Mina Abouda M, Campbell CD. Porcn is essential for growth and invagination of the mammalian optic cup. Front Cell Dev Biol 2022; 10:1016182. [PMID: 36393832 PMCID: PMC9661423 DOI: 10.3389/fcell.2022.1016182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Microphthalmia, anophthalmia, and coloboma (MAC) are congenital ocular malformations causing 25% of childhood blindness. The X-linked disorder Focal Dermal Hypoplasia (FDH) is frequently associated with MAC and results from mutations in Porcn, a membrane bound O-acyl transferase required for palmitoylation of Wnts to activate multiple Wnt-dependent pathways. Wnt/β-catenin signaling is suppressed in the anterior neural plate for initiation of eye formation and is subsequently required during differentiation of the retinal pigment epithelium (RPE). Non-canonical Wnts are critical for early eye formation in frog and zebrafish. However, it is unclear whether this also applies to mammals. We performed ubiquitous conditional inactivation of Porcn in mouse around the eye field stage. In Porcn CKO , optic vesicles (OV) arrest in growth and fail to form an optic cup. Ventral proliferation is significantly decreased in the mutant OV, with a concomitant increase in apoptotic cell death. While pan-ocular transcription factors such as PAX6, SIX3, LHX2, and PAX2 are present, indicative of maintenance of OV identity, regional expression of VSX2, MITF, OTX2, and NR2F2 is downregulated. Failure of RPE differentiation in Porcn CKO is consistent with downregulation of the Wnt/β-catenin effector LEF1, starting around 2.5 days after inactivation. This suggests that Porcn inactivation affects signaling later than a potential requirement for Wnts to promote eye field formation. Altogether, our data shows a novel requirement for Porcn in regulating growth and morphogenesis of the OV, likely by controlling proliferation and survival. In FDH patients with ocular manifestations, growth deficiency during early ocular morphogenesis may be the underlying cause for microphthalmia.
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Affiliation(s)
- Sabine Fuhrmann
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Cell and Developmental Biology, Vanderbilt University Medical School, Nashville, TN, United States
| | - Sara Ramirez
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Cell and Developmental Biology, Vanderbilt University Medical School, Nashville, TN, United States
| | - Mirna Mina Abouda
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Clorissa D. Campbell
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
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Tefon Arıbaş AB, Aktaş Z, Özdek Ş. Neonatal Onset Glaucoma in a Case with Gorlin-Goltz Syndrome: An Unusual Association. J Curr Glaucoma Pract 2021; 15:99-101. [PMID: 34720501 PMCID: PMC8543741 DOI: 10.5005/jp-journals-10078-1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To report a unique presentation of Gorlin–Goltz syndrome (GGS) with congenital glaucoma. Materials and methods We report a case of a 3-month-old female patient with bilateral uncontrolled intraocular pressures (IOP), who was already diagnosed with GGS. Examination under anesthesia demonstrated microcornea, iris coloboma, lens subluxation in both eyes, and edematous cornea in the left eye. Intraocular pressure was 17 mm Hg in OD and 35 mm Hg in OS with Icare (Icare® PRO) tonometer on repetitive measurements. On dilated fundus examination, a large chorioretinal coloboma was seen on both eyes. Results On physical examination, cutaneous, dental, and skeletal anomalies associated with the GGS were found. As previously reported ocular abnormalities associated with the GGS; coloboma and microphthalmia were noted. In addition, congenital glaucoma which is not one of the known associations of GGS was also detected. For treatment, 270° transscleral diode cyclophotoablation was performed for the left eye and medical treatment was reorganized for both eyes. Conclusion Neonatal-onset glaucoma might be one of the important ocular manifestations of GGS. How to cite this article Tefon Arıbaş AB, Aktaş Z, Özdek Ş. Neonatal Onset Glaucoma in a Case with Gorlin–Goltz Syndrome: An Unusual Association. J Curr Glaucoma Pract 2021;15(2):99–101.
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Affiliation(s)
- A B Tefon Arıbaş
- Department of Ophthalmology, Gaziantep Abdulkadir Yüksel State Hospital, Gaziantep, Turkey
| | - Zeynep Aktaş
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | - Şengül Özdek
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
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Wawrocka A, Walczak-Sztulpa J, Pawlak M, Gotz-Wieckowska A, Krawczynski MR. Non-syndromic anophthalmia/microphthalmia can be caused by a PORCN variant inherited in X-linked recessive manner. Am J Med Genet A 2020; 185:250-255. [PMID: 33111437 DOI: 10.1002/ajmg.a.61938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
Anophthalmia and microphthalmia (A/M) represent severe developmental ocular malformations, corresponding, respectively, to absent eyeball or reduced size of the eye. Both anophthalmia and microphthalmia may occur in isolation or as part of a syndrome. Genetic heterogeneity has been demonstrated, and many genes have been reported to be associated with A/M. The advances in high-throughput sequencing have proven highly effective in defining the molecular basis of A/M. Nevertheless, there are still many patients with unsolved genetic background of the disease, who pose a significant challenge in the molecular diagnostics of A/M. Here we describe a family, with three males affected with the non-syndromic A/M. Whole exome-sequencing performed in Patient 1, revealed the presence of a novel probably pathogenic variant c.734A>G, (p.[Tyr245Cys]) in the PORCN gene. Pedigree analysis and segregation of the identified variant in the family confirmed the X-linked recessive pattern of inheritance. This is the first report of X-linked recessive non-syndromic A/M. Until now, pathogenic variants in the PORCN gene have been identified in the patients with Goltz syndrome, but they were inherited in X-linked dominant mode. The ocular phenotype is the only finding observed in the patients, which allows to exclude the diagnosis of Goltz syndrome.
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Affiliation(s)
- Anna Wawrocka
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Marta Pawlak
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Gotz-Wieckowska
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej R Krawczynski
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland.,Centers for Medical Genetics GENESIS, Poznan, Poland
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Freethy A, Acharya V, Iacovidou A, Taghi A. Rare and unusual case of familial focal dermal hypoplasia (Goltz syndrome) presenting to otolaryngology in the UK. BMJ Case Rep 2019; 12:e231809. [PMID: 31811108 PMCID: PMC6904200 DOI: 10.1136/bcr-2019-231809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/03/2022] Open
Abstract
Goltz syndrome or focal dermal hypoplasia (FDH), is an X-linked dominant condition which predominantly involves the skin, limbs and eyes. In otolaryngology, FDH has been poorly described, but can result in increased symptoms of obstructive sleep apnoea requiring surgery. There have also been documented cases of mixed severe hearing loss secondary to congenital ossicular anomalies. More frequently, patients present to the ear-nose-throat clinic with symptoms of dysphagia, secondary to papillomatosis. A 36-year-old woman presented with pain, irritation and dysphagia with a known diagnosis of FDH. She was subsequently investigated with an oesophago-gastro-duodenoscopy, Barium Swallow and an MRI neck scan with contrast. Lymphoid hyperplasia was found on investigation and the patient underwent a panendoscopy with CO2 laser to the lesion with good clinical outcome. This case report highlights the need for multidisciplinary team involvement to ensure full consideration of management options.
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Affiliation(s)
- Alexander Freethy
- Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Vikas Acharya
- Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Aphrodite Iacovidou
- Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Taghi
- Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
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Ruzicki J, Nair GS, Wang A, Farmer J, Strube YNJ. Papillomas in Goltz syndrome: case report, anaesthetic considerations, and review of the literature. Can J Ophthalmol 2019; 54:e227-e230. [PMID: 31564361 DOI: 10.1016/j.jcjo.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Ami Wang
- Queen's University, Kingston, Ont
| | - James Farmer
- Queen's University, Kingston, Ont; University of Ottawa, Ottawa, Ont
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Rishi E, Sodhi P, Swaminathan M, Rishi P. Goltz syndrome: Primary diagnosis by an ophthalmologist. Indian J Ophthalmol 2019; 67:1467-1468. [PMID: 31436196 PMCID: PMC6727721 DOI: 10.4103/ijo.ijo_724_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Preet Sodhi
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Meenakshi Swaminathan
- Pediatric Ophthalmology Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
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Yesodharan D, Büschenfelde UMZ, Kutsche K, Mohandas Nair K, Nampoothiri S. Goltz-Gorlin Syndrome: Revisiting the Clinical Spectrum. Indian J Pediatr 2018; 85:1067-1072. [PMID: 29383603 DOI: 10.1007/s12098-018-2632-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the varying phenotypic spectrum of Focal Dermal Hypoplasia (FDH) and to emphasize the need for identifying the condition in mildly affected females which is crucial for offering a prenatal diagnosis in subsequent pregnancy owing to the risk of having a severely affected baby. METHODS The phenotype-genotype correlation of 4 patients with FDH, over a period of 11 y from the genetic clinic in a tertiary care centre from Kerala, India was done. RESULTS All four mutation proven patients were females (2 adults and 2 children). One of the adult female subjects were mildly affected, though she had a history of having a severely affected female child who expired on day six. Among the 2 affected children, one of them had an unaffected mother and the other had an affected mother. CONCLUSIONS FDH has a wide clinical spectrum from very subtle findings to severe manifestations. The lethality of the condition in males and the disfigurement and multisystem involvement in females highlights the importance of confirmation of diagnosis by molecular analysis so that the family can be offered prenatal diagnosis in subsequent pregnancy.
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Affiliation(s)
- Dhanya Yesodharan
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Center, Aims Ponekkara PO, Kochi, Kerala, 682041, India
| | | | - Kerstin Kutsche
- Institute of Human Genetics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - K Mohandas Nair
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Center, Aims Ponekkara PO, Kochi, Kerala, 682041, India.
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Frisk S, Grandpeix‐Guyodo C, Popovic Silwerfeldt K, Hjartarson HT, Chatzianastassiou D, Magnusson I, Laurell T, Nordgren A. Goltz syndrome in males: A clinical report of a male patient carrying a novel PORCN variant and a review of the literature. Clin Case Rep 2018; 6:2103-2110. [PMID: 30455901 PMCID: PMC6230642 DOI: 10.1002/ccr3.1783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/04/2018] [Accepted: 07/31/2018] [Indexed: 12/26/2022] Open
Abstract
Here, we report a novel mosaic mutation in the PORCN gene in a male Goltz syndrome patient. We also compare the phenotypes of all reported males with a confirmed molecular diagnosis. This report serves to further clarify the phenotype of Goltz syndrome and suggests that expression in males varies.
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Affiliation(s)
- Sofia Frisk
- Department of Molecular Medicine and SurgeryCenter of Molecular MedicineKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | | | | | | | | | | | - Tobias Laurell
- Department of Molecular Medicine and SurgeryCenter of Molecular MedicineKarolinska InstitutetStockholmSweden
- Department of Hand SurgerySödersjukhusetStockholmSweden
| | - Ann Nordgren
- Department of Molecular Medicine and SurgeryCenter of Molecular MedicineKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University LaboratoryKarolinska University HospitalStockholmSweden
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Escudero-Góngora MDM, Jiménez V, Martín-Santiago A. Erosions and vesicles following the lines of Blaschko in a neonate. Pediatr Dermatol 2018; 35:519-520. [PMID: 29984856 DOI: 10.1111/pde.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Victoria Jiménez
- Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Ana Martín-Santiago
- Departments of Dermatology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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