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Grosse G, Hilger A, Ludwig M, Reutter H, Lorenzen F, Even G, Holterhus PM, Woelfle J. Targeted Resequencing of Putative Growth-Related Genes Using Whole Exome Sequencing in Patients with Severe Primary IGF-I Deficiency. Horm Res Paediatr 2018; 88:408-417. [PMID: 29073591 DOI: 10.1159/000480505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/21/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS To elucidate the genetic causes of severe primary insulin-like growth factor-I deficiency (SPIGFD) by systematic, targeted, next-generation sequencing (NGS)-based resequencing of growth-related genes. METHODS Clinical phenotyping followed by NGS in 17 families including 6 affected sib pairs. RESULTS We identified disease-causing, heterozygous, de novo variants in HRAS (p.Gly13Cys) and FAM111A (p.Arg569His) in 2 male patients with syndromic SPIGFD. A previously described homozygous GHR nonsense variant was detected in 2 siblings of a consanguineous family (p.Glu198*). Furthermore, we identified an inherited novel variant in the IGF2 gene (p.Arg156Cys) of a maternally imprinted gene in a less severely affected father and his affected daughter. We detected 2 other novel missense variants in SH2B1 and SOCS2, both were inherited from an unaffected parent. CONCLUSIONS Screening of growth-related genes using NGS-based, large-scale, targeted resequencing identified disease-causing variants in HRAS, FAM111A, and GHR. Considering the increased risk of subjects with HRAS mutations for neoplasms, close clinical monitoring and a thorough discussion of the risk/benefit ratio of the treatment with recombinant IGF-I is mandatory. Segregation analysis proved to be critical in the interpretation of potential SPIGFD-associated gene variations.
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Affiliation(s)
- Greta Grosse
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Alina Hilger
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Children's Hospital, Department of Pediatrics, University of Bonn, Bonn, Germany
| | | | - Gertrud Even
- Children's Hospital, Pediatric Endocrinology Division, University of Cologne, Cologne, Germany
| | - Paul-Martin Holterhus
- Children's Hospital, Pediatric Endocrinology Division, University of Kiel, Kiel, Germany
| | - Joachim Woelfle
- Children's Hospital, Department of Pediatrics, University of Bonn, Bonn, Germany,
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Sheffield BS, Yip S, Ruchelli ED, Dunham CP, Sherwin E, Brooks PA, Sur A, Singh A, Human DG, Patel MS, Lee AF. Fatal congenital hypertrophic cardiomyopathy and a pancreatic nodule morphologically identical to focal lesion of congenital hyperinsulinism in an infant with costello syndrome: case report and review of the literature. Pediatr Dev Pathol 2015; 18:237-44. [PMID: 25668678 DOI: 10.2350/14-07-1525-cr.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Costello syndrome is characterized by constitutional mutations in the proto-oncogene HRAS, causing dysmorphic features, multiple cardiac problems, intellectual disability, and an increased risk of neoplasia. We report a male infant with dysmorphic features, born prematurely at 32 weeks, who, during his 3-month life span, had an unusually severe and ultimately fatal manifestation of hypertrophic cardiomyopathy and hyperinsulinemic hypoglycemia. Molecular studies in this patient demonstrated the uncommon Q22K mutation in the HRAS gene, diagnostic of Costello syndrome. The major autopsy findings revealed hypertrophic cardiomyopathy, congenital myopathy, and a 1.4-cm pancreatic nodule that was positive for insulin expression and morphologically identical to a focal lesion of congenital hyperinsulinism. Sequencing of KCNJ11 and ABCC8, the 2 most commonly mutated genes in focal lesion of congenital hyperinsulinism, revealed no mutations. While hyperinsulinism is a recognized feature of RASopathies, a focal proliferation of endocrine cells similar to a focal lesion of hyperinsulinism is a novel pathologic finding in Costello syndrome.
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Affiliation(s)
- Brandon S. Sheffield
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
| | - Stephen Yip
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Centre for Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V6H3V4, Canada
| | - Eduardo D. Ruchelli
- Division of Anatomical Pathology, The Children's Hospital of Philadelphia. 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Christopher P. Dunham
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
| | - Elizabeth Sherwin
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Paul A. Brooks
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Amitava Sur
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Neonatal Perinatal Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC V6H3V4, Canada
| | - Avash Singh
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Neonatal Perinatal Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC V6H3V4, Canada
| | - Derek G. Human
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Millan S. Patel
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Medical Genetics and Child and Family Research Institute, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room C234, Vancouver, BC V6H3V4, Canada
| | - Anna F. Lee
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
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Myers A, Bernstein JA, Brennan ML, Curry C, Esplin ED, Fisher J, Homeyer M, Manning MA, Muller EA, Niemi AK, Seaver LH, Hintz SR, Hudgins L. Perinatal features of the RASopathies: Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome. Am J Med Genet A 2014; 164A:2814-21. [PMID: 25250515 DOI: 10.1002/ajmg.a.36737] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/24/2014] [Indexed: 11/08/2022]
Abstract
The RASopathies are a family of developmental disorders caused by heritable defects of the RAS/MAPK signaling pathway. While the postnatal presentation of this group of disorders is well known, the prenatal and neonatal findings are less widely recognized. We report on the perinatal presentation of 10 patients with Noonan syndrome (NS), nine with Cardiofaciocutaneous syndrome (CFCS) and three with Costello syndrome (CS), in conjunction with the results of a comprehensive literature review. The majority of perinatal findings in NS, CS, and CFCS are shared: polyhydramnios; prematurity; lymphatic dysplasia; macrosomia; relative macrocephaly; respiratory distress; hypotonia, as well as cardiac and renal anomalies. In contrast, fetal arrhythmia and neonatal hypoglycemia are relatively specific to CS. NS, CS, and CFCS should all be considered as a possible diagnosis in pregnancies with a normal karyotype and ultrasound findings of a RASopathy. Recognition of the common perinatal findings of these disorders should facilitate both their prenatal and neonatal diagnosis.
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Affiliation(s)
- Angela Myers
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, California
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Abstract
PURPOSE OF REVIEW Costello syndrome is a rare congenital disorder affecting multiple organ systems, encompassing severe failure to thrive, cardiac anomalies including hypertrophic cardiomyopathy and atrial tachycardia, tumor predisposition, and cognitive impairment. Costello syndrome shares findings with cardio-facio-cutaneous syndrome and the diagnosis can be challenging. The discovery of gene mutations underlying these and other closely related disorders allows for molecular confirmation of a clinical diagnosis. RECENT FINDINGS The identification of germline HRAS mutations in Costello syndrome, and mutations in BRAF, MEK1 and MEK2 in cardio-facio-cutaneous syndrome, uncovered the biologic mechanism for the shared phenotypic findings based on the close interaction of the gene products within the Ras-mitogen-activated protein kinase pathway. Changes in other genes encoding mitogen-activated protein kinase pathway proteins are responsible for Noonan syndrome and the KRAS mutation phenotype. SUMMARY Costello syndrome is caused by heterozygous de-novo point mutations in HRAS, resulting in increased activation of the mitogen-activated protein kinase pathway. Despite their overlapping presentation, Costello syndrome and its related disorders are distinct, and the phenotypes become more distinctive with age. Molecular testing is available and a clinical diagnosis should be reconsidered if it is inconsistent with the molecular result.
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Affiliation(s)
- Emilio Quezada
- Division of Medical Genetics, A.I. duPont Hospital for Children, Wilmington, Delaware 19803, USA
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