1
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Nelson AT, Vasta LM, Watson D, Kim J, Harris AK, Best AF, Harney LA, Carr AG, Frederickson N, Dehner LP, Kratz CP, Hagedorn KN, Mize WA, Ling A, Messinger YH, Hill DA, Schultz KAP, Stewart DR. Prevalence of lung cysts in adolescents and adults with a germline DICER1 pathogenic/likely pathogenic variant: a report from the National Institutes of Health and International Pleuropulmonary Blastoma/ DICER1 Registry. Thorax 2024:thorax-2023-221024. [PMID: 38508719 DOI: 10.1136/thorax-2023-221024] [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: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB), the hallmark tumour associated with DICER1-related tumour predisposition, is characterised by an age-related progression from a cystic lesion (type I) to a high-grade sarcoma with mixed cystic and solid features (type II) or purely solid lesion (type III). Not all cystic PPBs progress; type Ir (regressed), hypothesised to represent regressed or non-progressed type I PPB, is an air-filled, cystic lesion lacking a primitive sarcomatous component. This study aims to evaluate the prevalence of non-progressed lung cysts detected by CT scan in adolescents and adults with germline DICER1 pathogenic/likely pathogenic (P/LP) variants. METHODS Individuals were enrolled in the National Cancer Institute Natural History of DICER1 Syndrome study, the International PPB/DICER1 Registry and/or the International Ovarian and Testicular Stromal Tumor Registry. Individuals with a germline DICER1 P/LP variant with first chest CT at 12 years of age or older were selected for this analysis. RESULTS In the combined databases, 110 individuals with a germline DICER1 P/LP variant who underwent first chest CT at or after the age of 12 were identified. Cystic lung lesions were identified in 38% (42/110) with a total of 72 cystic lesions detected. No demographic differences were noted between those with lung cysts and those without lung cysts. Five cysts were resected with four centrally reviewed as type Ir PPB. CONCLUSION Lung cysts are common in adolescents and adults with germline DICER1 variation. Further study is needed to understand the mechanism of non-progression or regression of lung cysts in childhood to guide judicious intervention.
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Affiliation(s)
- Alexander T Nelson
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Lauren M Vasta
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Dave Watson
- Research Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Jung Kim
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Anne K Harris
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Ana F Best
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Nicole Frederickson
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Kelly N Hagedorn
- Department of Radiology, Children's Minnesota, Minneapolis, Minnesota, USA
| | - William A Mize
- Department of Radiology, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Alexander Ling
- Department of Radiology, NIH Clinical Center, Bethesda, Maryland, USA
| | - Yoav H Messinger
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - D Ashley Hill
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
- ResourcePath LLC, Sterling, Virginia, USA
| | - Kris Ann P Schultz
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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2
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Khera S, Jauhari S, Pattanayak S, Choubey M. Filamin A gene mutation in an infant with progressive pulmonary emphysema, periventricular nodular heterotopia and congenital heart disease. BMJ Case Rep 2024; 17:e257676. [PMID: 38176754 PMCID: PMC10773292 DOI: 10.1136/bcr-2023-257676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- Sanjeev Khera
- Pediatrics, Army Hospital Research and Referral, New Delhi, India
| | | | - Somali Pattanayak
- Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India
| | - Mrigank Choubey
- Pediatrics, Command Hospital Kolkata, Kolkata, West Bengal, India
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3
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Lavoie PM, Rayment JH. Genetics of bronchopulmonary dysplasia: An update. Semin Perinatol 2023; 47:151811. [PMID: 37775368 DOI: 10.1016/j.semperi.2023.151811] [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] [Indexed: 10/01/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a multi-factorial disease that results from multiple clinical factors, including lung immaturity, mechanical ventilation, oxidative stress, pulmonary congestion due to increasing cardiac blood shunting, nutritional and immunological factors. Twin studies have indicated that susceptibility to BPD can be strongly inherited in some settings. Studies have reported associations between common genetic variants and BPD in preterm infants. Recent genomic studies have highlighted a potential role for molecular pathways involved in inflammation and lung development in affected infants. Rare mutations in genes encoding the lipid transporter ATP-binding cassette, sub-family A, member 3 (ABCA3 gene) which is involved in surfactant synthesis in alveolar type II cells, as well as surfactant protein B (SFTPB) and C (SFTPC) can also result in severe form of neonatal-onset interstitial lung diseases and may also potentially affect the course of BPD. This chapter summarizes the current state of knowledge on the genetics of BPD.
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Affiliation(s)
- Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada.
| | - Jonathan H Rayment
- BC Children's Hospital Research Institute, Vancouver, Canada; Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine, BC Children's Hospital, Vancouver, Canada
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4
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Popler J, Vece TJ, Liptzin DR, Gower WA. Pediatric pulmonology 2021 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:374-381. [PMID: 36426677 DOI: 10.1002/ppul.26227] [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] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022]
Abstract
The field of rare and diffuse pediatric lung disease is experiencing rapid progress as diagnostic and therapeutic options continue to expand. In this annual review, we discuss manuscripts published in Pediatric Pulmonology in 2021 in (1) children's interstitial and diffuse lung disease, (2) congenital airway and lung malformations, and (3) noncystic fibrosis bronchiectasis including primary ciliary dyskinesia. These include case reports, descriptive cohorts, trials of therapies, animal model studies, and review articles. The results are put into the context of other literature in the field. Each furthers the field in important ways, while also highlighting the continued need for further studies.
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Affiliation(s)
- Jonathan Popler
- Children's Physician Group-Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah R Liptzin
- School of Public and Community Health, University of Montana, Missoula, Montana, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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5
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Zheng Y, Ma H, Yan Y, Ye P, Yu W, Lin S, Chen SL. Deficiency of filamin A in smooth muscle cells protects against hypoxia‑mediated pulmonary hypertension in mice. Int J Mol Med 2023; 51:22. [PMID: 36704846 PMCID: PMC9911089 DOI: 10.3892/ijmm.2023.5225] [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] [Received: 08/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023] Open
Abstract
Filamin A (FLNA) is a high molecular weight cytoskeleton protein important for cell locomotion. A relationship between FLNA mutations and pulmonary arterial hypertension (PAH) has previously been reported; however, the detailed mechanism remains unclear. The present study aimed to explore the role of FLNA in vascular smooth muscle cells during the development of PAH. Smooth muscle cell (SMC)‑specific FLNA‑deficient mice were generated and the mice were then exposed to hypoxia for 28 days to build the mouse model of PAH. Human pulmonary arterial smooth muscle cells (PASMCs) were also cultured and transfected with FLNA small interfering RNA or overexpression plasmids to investigate the effects of FLNA on PASMC proliferation and migration. Notably, compared with control individuals, the expression levels of FLNA were increased in lung tissues from patients with PAH, and it was obviously expressed in the PASMCs of pulmonary arterioles. FLNA deficiency in SMCs attenuated hypoxia‑induced pulmonary hypertension and pulmonary vascular remodeling. In vitro studies suggested that absence of FLNA impaired PASMC proliferation and migration, and produced lower levels of phosphorylated (p)‑PAK‑1 and RAC1 activity. However, FLNA overexpression promoted PASMC proliferation and migration, and increased the expression levels of p‑PAK‑1 and RAC1 activity. The present study highlights the role of FLNA in pulmonary vascular remodeling; therefore, it could serve as a potential target for the treatment of PAH.
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Affiliation(s)
- Yaguo Zheng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Hong Ma
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yufeng Yan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Peng Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Wande Yu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China,Correspondence to: Dr Song Lin or Dr Shao-Liang Chen, Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai, Nanjing, Jiangsu 210008, P.R. China, E-mail: , E-mail:
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China,Correspondence to: Dr Song Lin or Dr Shao-Liang Chen, Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai, Nanjing, Jiangsu 210008, P.R. China, E-mail: , E-mail:
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6
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West T, Williamson N, Akhter J. Case report: Filamin A mutation lung disease recognized in an 11-year-old child. Pediatr Pulmonol 2023; 58:61-65. [PMID: 36174535 DOI: 10.1002/ppul.26156] [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] [Received: 04/11/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
The loss of function (LOF) due to mutations in the Filamin A (FLNA) gene may result in abnormality of the FLNA protein. Of the many clinical syndromes, this condition may produce chronic lung disease, which usually presents and is diagnosed in the infant/toddler age group. Its clinical pattern may mimic broncho-pulmonary dysplasia. It is part of the entities included in childhood interstitial lung disease group of disorders. We are herein reporting a patient that was diagnosed with FLNA-associated lung disease at 11 years of age. This case provides a unique insight into the long-term course of lung disease in this illness and broadens our understanding of the spectrum of its presentation. Although the patient had symptoms early in life, the diagnosis was not entertained because of the rarity of the disorder, its atypical and clinically mild presentation, and discontinuous care due to parents moving to different cities for employment reasons. Her presentation to our institution was for pneumonia. Due to highly unusual chest X-ray images, asthenia, and early clubbing, an extensive workup included further imaging and a lung biopsy. The final diagnosis was confirmed by the detection of FLNA LOF gene mutation.
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Affiliation(s)
- Tahira West
- Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | | | - Javeed Akhter
- Advocate Children's Hospital, Oak Lawn, Illinois, USA
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7
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Heterogenous Disease Course and Long-Term Outcome of Children's Interstitial Lung Disease Related to Filamin A Gene Variants. Ann Am Thorac Soc 2022; 19:2021-2030. [PMID: 35767027 DOI: 10.1513/annalsats.202202-142oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Variable disease course and outcomes have been reported in children's interstitial lung disease associated with FLNA (Filamin A gene) variants. Objectives: To further delineate long-term respiratory outcomes and identify potential contributing factors to severe disease course. Methods: We retrospectively collected longitudinal data from three centers on nine cases (one male) with FLNA variants and early respiratory disease onset (within the first 24 mo of life). Clinical, radiographic, and histopathologic data were analyzed, focusing on cardiorespiratory disease course. Results: All required early respiratory support (three invasive ventilation, three noninvasive ventilation, three supplemental oxygen), and all experienced frequent severe infective respiratory exacerbations. Three died in infancy from refractory respiratory failure and pulmonary hypertension (PH). The six surviving individuals were 3, 10, 11, 15, 18, and 33 years old at time of reporting. The extent of functional respiratory impairment decreased with age; at last follow-up, there were no individuals on home invasive ventilation, one on nocturnal noninvasive ventilation, four on oxygen, and one on no respiratory support. Spirometry consistently demonstrated moderate to severe obstructive defects (forced expiratory volume in 1 s/forced vital capacity [FVC] z-score, -3.76 to -1.77; percent predicted FVC, 31.5% to 92.1%). Seven required PH treatment in early childhood (7/9), and three of the survivors (3/6) still receive treatment. Radiologic and histopathologic findings were consistent among cases. Conclusions: Early mortality was common, but many survivors stabilized even after severe symptoms in infancy. All survivors had persistent obstructive defects on spirometry, and half have persistent or recurrent PH. These typical findings are suggestive of this rare diagnosis and should prompt consideration of genetic testing.
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8
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Johnson B, Dobkin SL, Josephson M. Extracorporeal membrane oxygenation as a bridge to transplant in neonates with fatal pulmonary conditions: A review. Paediatr Respir Rev 2022; 44:31-39. [PMID: 36464576 DOI: 10.1016/j.prrv.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
Neonates with progressive respiratory failure should be referred early for subspecialty evaluation and lung transplantation consideration. ECMO should be considered for patients with severe cardiopulmonary dysfunction and a high likelihood of death while on maximal medical therapy, either in the setting of reversible medical conditions or while awaiting lung transplantation. While ECMO offers hope to neonates that experience clinical deterioration while awaiting transplant, the risks and benefits of this intervention should be considered on an individual basis. Owing to the small number of infant lung transplants performed yearly, large studies examining the outcomes of various bridging techniques in this age group do not exist. Multiple single-centre experiences of transplanted neonates have been described and currently serve as guidance for transplant teams. Future investigation of outcomes specific to neonatal transplant recipients bridged with advanced devices is needed.
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Affiliation(s)
- Brandy Johnson
- Division of Pediatric Pulmonary Medicine, UF Health Shands Children's Hospital, Gainesville, FL, USA; Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Shoshana Leftin Dobkin
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Maureen Josephson
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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9
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Goult BT, von Essen M, Hytönen VP. The mechanical cell - the role of force dependencies in synchronising protein interaction networks. J Cell Sci 2022; 135:283155. [PMID: 36398718 PMCID: PMC9845749 DOI: 10.1242/jcs.259769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The role of mechanical signals in the proper functioning of organisms is increasingly recognised, and every cell senses physical forces and responds to them. These forces are generated both from outside the cell or via the sophisticated force-generation machinery of the cell, the cytoskeleton. All regions of the cell are connected via mechanical linkages, enabling the whole cell to function as a mechanical system. In this Review, we define some of the key concepts of how this machinery functions, highlighting the critical requirement for mechanosensory proteins, and conceptualise the coupling of mechanical linkages to mechanochemical switches that enables forces to be converted into biological signals. These mechanical couplings provide a mechanism for how mechanical crosstalk might coordinate the entire cell, its neighbours, extending into whole collections of cells, in tissues and in organs, and ultimately in the coordination and operation of entire organisms. Consequently, many diseases manifest through defects in this machinery, which we map onto schematics of the mechanical linkages within a cell. This mapping approach paves the way for the identification of additional linkages between mechanosignalling pathways and so might identify treatments for diseases, where mechanical connections are affected by mutations or where individual force-regulated components are defective.
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Affiliation(s)
- Benjamin T. Goult
- School of Biosciences, University of Kent, Canterbury CT2 7NJ, Kent, UK,Authors for correspondence (; )
| | - Magdaléna von Essen
- Faculty of Medicine and Health Technology, Tampere University, FI-33100 Tampere, Finland
| | - Vesa P. Hytönen
- Faculty of Medicine and Health Technology, Tampere University, FI-33100 Tampere, Finland,Fimlab Laboratories, FI-33520 Tampere, Finland,Authors for correspondence (; )
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10
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Biochemical Pathways of Cellular Mechanosensing/Mechanotransduction and Their Role in Neurodegenerative Diseases Pathogenesis. Cells 2022; 11:cells11193093. [PMID: 36231055 PMCID: PMC9563116 DOI: 10.3390/cells11193093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/11/2022] Open
Abstract
In this review, we shed light on recent advances regarding the characterization of biochemical pathways of cellular mechanosensing and mechanotransduction with particular attention to their role in neurodegenerative disease pathogenesis. While the mechanistic components of these pathways are mostly uncovered today, the crosstalk between mechanical forces and soluble intracellular signaling is still not fully elucidated. Here, we recapitulate the general concepts of mechanobiology and the mechanisms that govern the mechanosensing and mechanotransduction processes, and we examine the crosstalk between mechanical stimuli and intracellular biochemical response, highlighting their effect on cellular organelles' homeostasis and dysfunction. In particular, we discuss the current knowledge about the translation of mechanosignaling into biochemical signaling, focusing on those diseases that encompass metabolic accumulation of mutant proteins and have as primary characteristics the formation of pathological intracellular aggregates, such as Alzheimer's Disease, Huntington's Disease, Amyotrophic Lateral Sclerosis and Parkinson's Disease. Overall, recent findings elucidate how mechanosensing and mechanotransduction pathways may be crucial to understand the pathogenic mechanisms underlying neurodegenerative diseases and emphasize the importance of these pathways for identifying potential therapeutic targets.
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11
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Cardiovascular, Brain, and Lung Involvement in a Newborn With a Novel FLNA Mutation: A Case Report and Literature Review. Adv Neonatal Care 2022; 22:125-131. [PMID: 33852449 DOI: 10.1097/anc.0000000000000878] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Filamin A (FLNA) is an intracellular actin-binding protein, encoded by the FLNA gene, with a wide tissue expression. It is involved in several cellular functions, and extracellular matrix structuring. FLNA gene alterations lead to diseases with a wide phenotypic spectrum, such as brain periventricular nodular heterotopia (PVNH), cardiovascular abnormalities, skeletal dysplasia, and lung involvement. CLINICAL FINDINGS We present the case of a female infant who showed at birth aortic valve stenosis and PVNH, and subsequently developed interstitial lung disease with severe pulmonary hypertension. PRIMARY DIAGNOSIS The association of aortic valve dysplasia, left ventricular outflow obstruction, persistent patent ductus arteriosus, and brain heterotopic gray matter suggested a possible FLNA gene alteration. A novel heterozygous intronic variant in the FLNA gene (NM_001110556.1), c.4304-1G >A, was detected. INTERVENTIONS In consideration of valve morphology and severity of stenosis, the neonate was scheduled for a transcatheter aortic valvuloplasty. At 3 months of life, she developed hypoxemic respiratory failure with evidence of severe pulmonary hypertension. Inhaled nitric oxide (iNO) and milrinone on continuous infusion were started. Because of a partial response to iNO, an intravenous continuous infusion of sildenafil was introduced. OUTCOMES In consideration of severe clinical course and fatal outcome, the new FLNA gene mutation described in our patient seems to be associated with a loss of function of FLNA. PRACTICE RECOMMENDATIONS Lung and brain involvement, in association with left ventricular outflow obstruction and persistent patency of ductus arteriosus, should be considered highly suggestive of FLNA gene alterations, in a female newborn.
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12
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Tanner LM, Kunishima S, Lehtinen E, Helin T, Volmonen K, Lassila R, Pöyhönen M. Platelet function and filamin A expression in two families with novel FLNA gene mutations associated with periventricular nodular heterotopia and panlobular emphysema. Am J Med Genet A 2022; 188:1716-1722. [PMID: 35156755 PMCID: PMC9303863 DOI: 10.1002/ajmg.a.62690] [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] [Received: 05/03/2021] [Revised: 01/15/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
Pathogenic variants of the X‐linked FLNA gene encoding filamin A protein have been associated with a wide spectrum of symptoms, including the recently described pulmonary phenotype with childhood‐onset panlobular emphysema. We describe three female patients from two families with novel heterozygous FLNA variants c.5837_2del and c.508C > T. Analysis of immunofluorescence of peripheral blood smears and platelet function was performed for all patients. FLNA‐negative platelets were observed, suggesting that these variants result in the loss of a functional protein product. All three patients also had periventricular nodular heterotopia and panlobular emphysema. However, they had considerably milder symptoms and later age of onset than in the previously reported cases. Therefore, patients with pathogenic FLNA variants should be studied actively for lung involvement even in the absence of pronounced respiratory symptoms. Conversely, any patient with unexplained panlobular emphysema should be analyzed for pathogenic FLNA variants. We also suggest that immunofluorescence analysis is a useful tool for investigating the pathogenicity of novel FLNA variants.
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Affiliation(s)
- Laura M Tanner
- HUSLAB Department of Clinical Genetics, Helsinki University Hospital, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Shinji Kunishima
- Department of Medical Technology, Gifu University of Medical Science, Gifu, Japan
| | - Elina Lehtinen
- Coagulation Disorders Unit, Helsinki University Hospital, Research Program Unit in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Tuukka Helin
- HUSLAB Department of Chemistry and Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Volmonen
- HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, Helsinki University Hospital, Research Program Unit in Systems Oncology, University of Helsinki, Helsinki, Finland.,HUSLAB Department of Chemistry and Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Minna Pöyhönen
- HUSLAB Department of Clinical Genetics, Helsinki University Hospital, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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13
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Burrage LC, Heinle JS, Cerfolio RH, Guillerman RP, Patel KR, Santiago NC, Hoover WC, Mallory GB. Application of lung volume reduction surgery for a child with filamin A (FLNA) mutations. Pediatr Pulmonol 2022; 57:224-230. [PMID: 34882997 DOI: 10.1002/ppul.25681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/23/2021] [Accepted: 09/04/2021] [Indexed: 11/07/2022]
Abstract
Diffuse lung disease in early childhood due to mutations in the filamin A gene has been recently reported. Clinical outcomes vary among individuals indicating variability in phenotype but a substantial proportion of reported cases in early life have ended up in death or lung transplantation. We recently encountered a school-aged child in whom the diagnosis of a filamin A mutation was delayed and the natural history of emphysematous lung disease was altered by serial lung volume reduction surgeries. She eventually underwent a bilateral lung transplant and we report the natural history of her disease and treatments applied herein.
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Affiliation(s)
- Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Robert H Cerfolio
- Department of Cardiovascular Surgery, Division of Thoracic Surgery, New York University Langone, New York, New York, USA
| | | | - Kalyani R Patel
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Nahir C Santiago
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Wynton C Hoover
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - George B Mallory
- Department of Pediatrics, Baylor College of Medicine, Section of Pediatric Pulmonology, Houston, Texas, USA
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14
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Billon C, Adham S, Hernandez Poblete N, Legrand A, Frank M, Chiche L, Zuily S, Benistan K, Savale L, Zaafrane-Khachnaoui K, Brehin AC, Bal L, Busa T, Fradin M, Quelin C, Chesneau B, Wahl D, Fergelot P, Goizet C, Mirault T, Jeunemaitre X, Albuisson J. Cardiovascular and connective tissue disorder features in FLNA-related PVNH patients: progress towards a refined delineation of this syndrome. Orphanet J Rare Dis 2021; 16:504. [PMID: 34863227 PMCID: PMC8642866 DOI: 10.1186/s13023-021-02128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND FLNA Loss-of-Function (LoF) causes periventricular nodular heterotopia type 1 (PVNH1), an acknowledged cause of seizures of various types. Neurological symptoms are inconstant, and cardiovascular (CV) defects or connective tissue disorders (CTD) have regularly been associated. We aimed at refining the description of CV and CTD features in patients with FLNA LoF and depicting the multisystemic nature of this condition. METHODS We retrospectively evaluated FLNA variants and clinical presentations in FLNA LoF patient with at least one CV or CTD feature, from three cohorts: ten patients from the French Reference Center for Rare Vascular Diseases, 23 patients from the national reference diagnostic lab for filaminopathies-A, and 59 patients from literature review. RESULTS Half of patients did not present neurological symptoms. Most patients presented a syndromic association combining CV and CTD features. CV anomalies, mostly aortic aneurysm and/or dilation were present in 75% of patients. CTD features were present in 75%. Variants analysis demonstrated an enrichment of coding variants in the CH1 domain of FLNA protein. CONCLUSION In FLNA LoF patients, the absence of seizures should not be overlooked. When considering a diagnosis of PVNH1, the assessment for CV and CTD anomalies is of major interest as they represent interlinked features. We recommend systematic study of FLNA within CTD genes panels, regardless of the presence of neurological symptoms.
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Affiliation(s)
- Clarisse Billon
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,INSERM, U970 PARCC, Université de Paris, Paris, France.
| | - Salma Adham
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Service de Médecine Vasculaire, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Natalia Hernandez Poblete
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Anne Legrand
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Michael Frank
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Laurent Chiche
- Faculté de médecine, Université de la Sorbonne, Paris, France.,Service de chirurgie vasculaire et endovasculaire, Centre aortique tertiaire, Hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stephane Zuily
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karelle Benistan
- Centre de Référence des Syndromes d'Ehlers-Danlos non Vasculaires, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France.,UMR U1179 INSERM, Université Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Laurent Savale
- Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, Université Paris-Sud, Le Plessis-Robinson, France.,Service de Pneumologie, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | | | - Anne-Claire Brehin
- INSERM U1245 , Normandy center for Genomic and Personalized Medicine, Normandie Univ, CHU Rouen, 76000, Rouen, France
| | - Laurence Bal
- Centre de référence régional Marfan et apparentés, Centre aortique, Hôpital La Timone, AP-HM, Marseille, France
| | - Tiffany Busa
- Département de Génétique Médicale, Hôpital La Timone, CHU de Marseille, Marseille, France
| | - Mélanie Fradin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Chloé Quelin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Bertrand Chesneau
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du Syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Denis Wahl
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Patricia Fergelot
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Cyril Goizet
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Faculté de médecine, Université de la Sorbonne, Paris, France
| | - Tristan Mirault
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Xavier Jeunemaitre
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Juliette Albuisson
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France.,Plateforme de Transfert en Biologie Cancérologique, Centre Georges François Leclerc - UNICANCER- Institut GIMI, Dijon, France
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15
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Gahmberg CG, Grönholm M. How integrin phosphorylations regulate cell adhesion and signaling. Trends Biochem Sci 2021; 47:265-278. [PMID: 34872819 PMCID: PMC8642147 DOI: 10.1016/j.tibs.2021.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
Cell adhesion is essential for the formation of organs, cellular migration, and interaction with target cells and the extracellular matrix. Integrins are large protein α/β-chain heterodimers and form a major family of cell adhesion molecules. Recent research has dramatically increased our knowledge of how integrin phosphorylations regulate integrin activity. Phosphorylations determine the signaling complexes formed on the cytoplasmic tails, regulating downstream signaling. α-Chain phosphorylation is necessary for inducing β-chain phosphorylation in LFA-1, and the crosstalk from one integrin to another activating or inactivating its function is in part mediated by phosphorylation of β-chains. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus receptor angiotensin-converting enzyme 2 (ACE2) and possible integrin coreceptors may crosstalk and induce a phosphorylation switch and autophagy.
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Affiliation(s)
- Carl G Gahmberg
- Molecular and Integrative Biosciences Research Programme, University of Helsinki, Viikinkaari 9 C, 00014 Helsinki, Finland.
| | - Mikaela Grönholm
- Molecular and Integrative Biosciences Research Programme, University of Helsinki, Viikinkaari 9 C, 00014 Helsinki, Finland; Faculty of Pharmacy, University of Helsinki, Viikinkaari 5E, 00014 Helsinki, Finland
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16
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Pelizzo G, Silvestro S, Avanzini MA, Zuccotti G, Mazzon E, Calcaterra V. Mesenchymal Stromal Cells for the Treatment of Interstitial Lung Disease in Children: A Look from Pediatric and Pediatric Surgeon Viewpoints. Cells 2021; 10:3270. [PMID: 34943779 PMCID: PMC8699409 DOI: 10.3390/cells10123270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) have been proposed as a potential therapy to treat congenital and acquired lung diseases. Due to their tissue-regenerative, anti-fibrotic, and immunomodulatory properties, MSCs combined with other therapy or alone could be considered as a new approach for repair and regeneration of the lung during disease progression and/or after post- surgical injury. Children interstitial lung disease (chILD) represent highly heterogeneous rare respiratory diseases, with a wild range of age of onset and disease expression. The chILD is characterized by inflammatory and fibrotic changes of the pulmonary parenchyma, leading to gas exchange impairment and chronic respiratory failure associated with high morbidity and mortality. The therapeutic strategy is mainly based on the use of corticosteroids, hydroxychloroquine, azithromycin, and supportive care; however, the efficacy is variable, and their long-term use is associated with severe toxicity. The role of MSCs as treatment has been proposed in clinical and pre-clinical studies. In this narrative review, we report on the currently available on MSCs treatment as therapeutical strategy in chILD. The progress into the therapy of respiratory disease in children is mandatory to ameliorate the prognosis and to prevent the progression in adult age. Cell therapy may be a future therapy from both a pediatric and pediatric surgeon's point of view.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy
- Department of Biomedical and Clinical Sciences-L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Serena Silvestro
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (S.S.); (E.M.)
| | - Maria Antonietta Avanzini
- Cell Factory, Pediatric Hematology Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Sciences-L. Sacco, University of Milan, 20157 Milan, Italy;
- Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (S.S.); (E.M.)
| | - Valeria Calcaterra
- Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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17
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Chung S, Le TP, Vishwakarma V, Cheng YL, Andrew DJ. Isoform-specific roles of the Drosophila filamin-type protein Jitterbug (Jbug) during development. Genetics 2021; 219:iyab100. [PMID: 34173831 PMCID: PMC8860385 DOI: 10.1093/genetics/iyab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 11/14/2022] Open
Abstract
Filamins are highly conserved actin-crosslinking proteins that regulate organization of the actin cytoskeleton. As key components of versatile signaling scaffolds, filamins are implicated in developmental anomalies and cancer. Multiple isoforms of filamins exist, raising the possibility of distinct functions for each isoform during development and in disease. Here, we provide an initial characterization of jitterbug (jbug), which encodes one of the two filamin-type proteins in Drosophila. We generate Jbug antiserum that recognizes all of the spliced forms and reveals differential expression of different Jbug isoforms during development, and a significant maternal contribution of Jbug protein. To reveal the function of Jbug isoforms, we create new genetic tools, including a null allele that deletes all isoforms, hypomorphic alleles that affect only a subset, and UAS lines for Gal4-driven expression of the major isoforms. Using these tools, we demonstrate that Jbug is required for viability and that specific isoforms are required in the formation of actin-rich protrusions including thoracic bristles in adults and ventral denticles in the embryo. We also show that specific isoforms of Jbug show differential localization within epithelia and that maternal and zygotic loss of jbug disrupts Crumbs (Crb) localization in several epithelial cell types.
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Affiliation(s)
- SeYeon Chung
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Thao Phuong Le
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Vishakha Vishwakarma
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Yim Ling Cheng
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Deborah J Andrew
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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18
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Rumping L, Wessels MW, Postma AV, van Schuppen J, van Slegtenhorst MA, Saris JJ, van Tintelen JP, Robertson SP, Alders M, Maas SM, Deprez RHL. Terminal osseous dysplasia with pigmentary defects and cardiomyopathy caused by a novel FLNA variant. Am J Med Genet A 2021; 185:3814-3820. [PMID: 34254723 PMCID: PMC9292317 DOI: 10.1002/ajmg.a.62417] [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] [Received: 02/25/2021] [Revised: 05/29/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Terminal osseous dysplasia with pigmentary defects (TODPD), also known as digitocutaneous dysplasia, is one of the X‐linked filaminopathies caused by a variety of FLNA‐variants. TODPD is characterized by skeletal defects, skin fibromata and dysmorphic facial features. So far, only a single recurrent variant (c.5217G>A;p.Val1724_Thr1739del) in FLNA has found to be responsible for TODPD. We identified a novel c.5217+5G>C variant in FLNA in a female proband with skeletal defects, skin fibromata, interstitial lung disease, epilepsy, and restrictive cardiomyopathy. This variant causes mis‐splicing of exon 31 predicting the production of a FLNA‐protein with an in‐frame‐deletion of 16 residues identical to the miss‐splicing‐effect of the recurrent TODPD c.5217G>A variant. This mis‐spliced transcript was explicitly detected in heart tissue, but was absent from blood, skin, and lung. X‐inactivation analyses showed extreme skewing with almost complete inactivation of the mutated allele (>90%) in these tissues, except for heart. The mother of the proband, who also has fibromata and skeletal abnormalities, is also carrier of the FLNA‐variant and was diagnosed with noncompaction cardiomyopathy after cardiac screening. No other relevant variants in cardiomyopathy‐related genes were found. Here we describe a novel variant in FLNA (c.5217+5G>C) as the second pathogenic variant responsible for TODPD. Cardiomyopathy has not been described as a phenotypic feature of TODPD before.
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Affiliation(s)
- Lynne Rumping
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Alex V Postma
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jasper J Saris
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J Peter van Tintelen
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephen P Robertson
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Mariëlle Alders
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Maas
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronald H Lekanne Deprez
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Bandaru S, Ala C, Zhou AX, Akyürek LM. Filamin A Regulates Cardiovascular Remodeling. Int J Mol Sci 2021; 22:ijms22126555. [PMID: 34207234 PMCID: PMC8235345 DOI: 10.3390/ijms22126555] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/25/2023] Open
Abstract
Filamin A (FLNA) is a large actin-binding cytoskeletal protein that is important for cell motility by stabilizing actin networks and integrating them with cell membranes. Interestingly, a C-terminal fragment of FLNA can be cleaved off by calpain to stimulate adaptive angiogenesis by transporting multiple transcription factors into the nucleus. Recently, increasing evidence suggests that FLNA participates in the pathogenesis of cardiovascular and respiratory diseases, in which the interaction of FLNA with transcription factors and/or cell signaling molecules dictate the function of vascular cells. Localized FLNA mutations associate with cardiovascular malformations in humans. A lack of FLNA in experimental animal models disrupts cell migration during embryogenesis and causes anomalies, including heart and vessels, similar to human malformations. More recently, it was shown that FLNA mediates the progression of myocardial infarction and atherosclerosis. Thus, these latest findings identify FLNA as an important novel mediator of cardiovascular development and remodeling, and thus a potential target for therapy. In this update, we summarized the literature on filamin biology with regard to cardiovascular cell function.
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Affiliation(s)
- Sashidar Bandaru
- Division of Clinical Pathology, Sahlgrenska Academy Hospital, 413 45 Gothenburg, Sweden;
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (C.A.); (A.-X.Z.)
| | - Chandu Ala
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (C.A.); (A.-X.Z.)
| | - Alex-Xianghua Zhou
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (C.A.); (A.-X.Z.)
| | - Levent M. Akyürek
- Division of Clinical Pathology, Sahlgrenska Academy Hospital, 413 45 Gothenburg, Sweden;
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (C.A.); (A.-X.Z.)
- Correspondence:
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20
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Mori S, Tanoue K, Shimizu H, Nagafuchi H, Kim KS, Murakami H, Kurosawa K, Matsui K. Lung disease due to FLNA mutation improved after shunt closure for congenital heart disease. Pediatr Pulmonol 2021; 56:1280-1282. [PMID: 33497531 DOI: 10.1002/ppul.25269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Satomi Mori
- Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Koji Tanoue
- Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hiroyuki Shimizu
- Department of Critical Care Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hiroyuki Nagafuchi
- Department of Critical Care Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Ki-Sung Kim
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hiroaki Murakami
- Department of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenji Kurosawa
- Department of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kiyoshi Matsui
- Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
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21
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Shah AS, Black ED, Simon DM, Gambello MJ, Garber KB, Iannucci GJ, Riedesel EL, Kasi AS. Heterogeneous Pulmonary Phenotypes in Filamin A Mutation-Related Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:7-14. [PMID: 33734874 DOI: 10.1089/ped.2020.1280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Interstitial lung disease (ILD) has been recently reported in a few patients with pathogenic variants in the Filamin A (FLNA) gene with variable presentation and prognosis. This study evaluated the respiratory manifestations and clinical features in children with FLNA disease. Methods: We conducted a retrospective review of pediatric patients with variants in FLNA in a tertiary children's hospital. The clinical features, genotype, management, and outcomes were analyzed. Results: We identified 9 patients with variants in FLNA aged 15 months to 24 years, 4 females and 5 males. Six patients had abnormal chest imaging ranging from mild interstitial prominence to atelectasis, interstitial densities, and hyperinflation. Three patients with ILD presented during the neonatal period or early infancy with respiratory distress or respiratory failure requiring supplemental oxygen or assisted ventilation via tracheostomy. We report male twins with the same FLNA variant and lung disease, but different ages and clinical features at presentation eventually culminating in respiratory failure requiring assisted ventilation. All patients had FLNA variants identified by FLNA sequencing, had abnormal echocardiograms, and none of the patients underwent lung biopsy or lung transplantation. The outcomes were variable and could be as severe as chronic respiratory failure. Conclusion: The wide spectrum of respiratory manifestations and abnormal chest imaging in our study highlights the importance of evaluation for lung disease in patients with variants in FLNA. FLNA sequencing in suspected cases with ILD may obviate the need for a lung biopsy, prompt surveillance for progressive lung disease, and evaluation for associated clinical features.
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Affiliation(s)
- Amit S Shah
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Emily D Black
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Dawn M Simon
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | | | - Kathryn B Garber
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA.,EGL Genetics, Tucker, Georgia, USA
| | - Glen J Iannucci
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Erica L Riedesel
- Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Ajay S Kasi
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
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22
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Mallory GB, Spielberg DR, Silva-Carmona M. Pulmonary growth abnormalities as etiologies for pediatric pulmonary hypertension. Pediatr Pulmonol 2021; 56:678-685. [PMID: 32735399 DOI: 10.1002/ppul.24998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
Abstract
Pulmonary growth abnormality (PGA) is a common type of diffuse lung disease in infants. Although the histologic and radiographic features of PGA have been described in the literature in varying detail, the clinical spectrum of disease has not. The array of case series and case reports has led to a clinical picture that could be confusing to clinicians. We describe three subsets of PGA, including its association with the histologic marker of pulmonary interstitial glycogenosis, and its common association with pulmonary hypertension. We propose a new approach to what we consider an increasingly broad array of different disease entities.
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Affiliation(s)
- George B Mallory
- Division of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - David R Spielberg
- Division of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Manuel Silva-Carmona
- Division of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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23
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Filamin A Mutations: A New Cause of Unexplained Emphysema in Adults? Chest 2021; 159:e131-e135. [PMID: 33678279 DOI: 10.1016/j.chest.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022] Open
Abstract
Emphysema is a chronic respiratory disorder characterized by destruction of alveoli, usually due to cigarette smoking or exposure to noxious particles or gases. Dysfunction of proteins that are involved in lung development and maintenance, such as alpha-1 antitrypsin, also contributes to emphysema. Filamin A (FLNA) is an actin-binding protein involved in cytoskeleton reorganization. Mutations in the FLNA gene classically lead to abnormal neuronal migration and connective and vascular tissue anomalies. Pulmonary manifestations consist of a wide range of pulmonary disorders that occur during infancy. We report the first familial case of emphysema in non- and very low-smoking adults who carry a loss-of-function mutation of the FLNA gene. The identification of this new risk factor for emphysema encourages (1) screening, prevention and monitoring of pulmonary disorders in patients with FLNA mutation and (2) screening for FLNA mutation in patients with early-onset emphysema that is associated with low-smoking or vascular or connective tissue anomalies.
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24
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Deng X, Li S, Qiu Q, Jin B, Yan M, Hu Y, Wu Y, Zhou H, Zhang G, Zheng X. Where the congenital heart disease meets the pulmonary arterial hypertension, FLNA matters: a case report and literature review. BMC Pediatr 2020; 20:504. [PMID: 33143682 PMCID: PMC7607646 DOI: 10.1186/s12887-020-02393-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Pediatric patients with genetic disorders have a higher incidence of pulmonary arterial hypertension (PAH) regardless of their heart defects. Filamin A (FLNA) mutation is recently recognized to be associated with pediatric pulmonary disorders, however, the clinical courses of PAH related to the mutation were reported in limited cases. Here, we presented a case and pooled data for better understanding of the correlation between FLNA mutation and pediatric PAH. Case presentation The patient was a 8-month-old female with repeated episodes of pneumonia. Physical examination revealed cleft lip, cleft palate and developmental retardation. Imaging examination showed a small atrial septal defect (ASD), central pulmonary artery enlargement, left upper lobe of lung atelectasis, and pulmonary infiltration. Genetic test showed she carried a de novo pathogenic variant of FLNA gene (c.5417-1G > A, p.-). Oral medications didn’t slow the progression of PAH in the patient, and she died two years later. Conclusions FLNA mutation causes rare but progressive PAH in addition to a wide spectrum of congenital heart disease and other comorbidities in pediatric patients. We highly recommend genetic testing for pediatric patients when suspected with PAH. Given the high mortality in this group, lung transplantation may offer a better outcome.
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Affiliation(s)
- Xiaoxian Deng
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Shanshan Li
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Qiu Qiu
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Bowen Jin
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Menghuan Yan
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Yuanpin Hu
- Laboratory of Molecular Cardiology, Wuhan Asia Heart hospital, 753 Jinghan Avn, 430022, Wuhan, China
| | - Yang Wu
- Imaging center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Hongmei Zhou
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Gangcheng Zhang
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Xuan Zheng
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China. .,Laboratory of Molecular Cardiology, Wuhan Asia Heart hospital, 753 Jinghan Avn, 430022, Wuhan, China.
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25
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Abstract
There is a wide differential diagnosis of early onset respiratory distress especially in term babies, and interstitial lung disease (chILD) is a rare but important consideration in this context. chILD manifesting immediately after birth is usually related to mutations in surfactant protein genes, or conditions related to the Congenital Acinar Dysplasia -Alveolar capillary dysplasia - Congenital Alveolar Dysplasia (CAD-ACD) spectrum. There is currently no specific treatment for these conditions, and management is supportive. Prognosis is very poor in most of these babies if onset is early, with relentless respiratory deterioration unless transplanted. Ideally, the diagnosis is made on genetic analysis, but this may be time-consuming and complex in CAD-ACD spectrum, so lung biopsy may be needed to avoid prolonged and futile treatment being instituted. Milder forms with prolonged survival have been reported. Early onset, less severe chILD is usually related to neuroendocrine cell hyperplasia of infancy (NEHI), pulmonary interstitial glycogenosis (PIG) and less severe disorders of surfactant proteins. PIG and NEHI are not specific entities, but are pulmonary dysmaturity syndromes, and there may be a number of underlying genetic and other cause. If the child is stable and thriving, many will not be subject to lung biopsy, and slow improvement and weaning of supplemental oxygen can be anticipated. Where possible, a precise genetic diagnosis should be made in early onset cHILD allow for genetic counselling. chILD survivors and their families have complex respiratory and other needs, and co-ordinated, multi-disciplinary support in the community is essential.
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Affiliation(s)
- Andrew Bush
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK.
| | | | - Jo Gregory
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Andrew Gordon Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College, UK
| | - Thomas Semple
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Rishi Pabary
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
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26
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Hawley MH, Moschovis PP, Lu M, Kinane TB, Yonker LM. The future is here: Integrating genetics into the pediatric pulmonary clinic. Pediatr Pulmonol 2020; 55:1810-1818. [PMID: 32533912 PMCID: PMC7384239 DOI: 10.1002/ppul.24723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
Recognition of underlying genetic etiologies of disease is increasing at an exponential rate, likely due to greater access to and lower cost of genetic testing. Monogenic causes of disease, or conditions resulting from a mutation or mutations in a single gene, are now well recognized in every subspecialty, including pediatric pulmonary medicine; thus, it is important to consider genetic conditions when evaluating children with respiratory disease. In the pediatric pulmonary clinic, genetic testing should be considered when multiple family members present with similar or related clinical features and when individuals have unusual clinical presentations, such as early-onset disease or complex, syndromic features. This review provides a practical guide for genetic diagnosis in the pediatric pulmonary setting, including a review of genetic concepts, considerations for test selection and results in interpretation, as well as an overview of genetic differential diagnoses for common pediatric pulmonary phenotypes. Genetic conditions that commonly present to the pediatric pulmonary clinic are reviewed in a companion article by Yonker et al.
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Affiliation(s)
- Megan H Hawley
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts
| | - Peter P Moschovis
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mengdi Lu
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - T Bernard Kinane
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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27
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Yonker LM, Hawley MH, Moschovis PP, Lu M, Kinane TB. Recognizing genetic disease: A key aspect of pediatric pulmonary care. Pediatr Pulmonol 2020; 55:1794-1809. [PMID: 32533909 PMCID: PMC7384240 DOI: 10.1002/ppul.24706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/12/2020] [Indexed: 12/19/2022]
Abstract
Advancement in technology has improved recognition of genetic etiologies of disease, which has impacted diagnosis and management of rare disease patients in the pediatric pulmonary clinic. This review provides an overview of genetic conditions that are likely to present with pulmonary features and require extensive care by the pediatric pulmonologist. Increased familiarity with these conditions allows for improved care of these patients by reducing time to diagnosis, tailoring management, and prompting further investigation into these disorders.
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Affiliation(s)
- Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Megan H Hawley
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts
| | - Peter P Moschovis
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mengdi Lu
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - T Bernard Kinane
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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28
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Nuche J, Palomino-Doza J, Ynsaurriaga FA, Delgado JF, Ibáñez B, Oliver E, Subías PE. Potential Molecular Pathways Related to Pulmonary Artery Aneurysm Development: Lessons to Learn from the Aorta. Int J Mol Sci 2020; 21:ijms21072509. [PMID: 32260370 PMCID: PMC7177585 DOI: 10.3390/ijms21072509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease caused by pulmonary vascular remodeling. Current vasodilator treatments have substantially improved patients’ survival. This improved survival has led to the appearance of complications related to conditions previously underdiagnosed or even ignored, such as pulmonary artery aneurysm (PAA). The presence of a dilated pulmonary artery has been shown to be related to an increased risk of sudden cardiac death among PAH patients. This increased risk could be associated to the development of left main coronary artery compression or pulmonary artery dissection. Nevertheless, very little is currently known about the molecular mechanisms related to PAA. Thoracic aortic aneurysm (TAA) is a well-known condition with an increased risk of sudden death caused by acute aortic dissection. TAA may be secondary to chronic exposure to classic cardiovascular risk factors. In addition, a number of genetic variants have been shown to be related to a marked risk of TAA and dissection as part of multisystemic syndromes or isolated familial TAA. The molecular pathways implied in the development of TAA have been widely studied and described. Many of these molecular pathways are involved in the pathogenesis of PAH and could be involved in PAA. This review aims to describe all these common pathways to open new research lines that could help lead to a better understanding of the pathophysiology of PAH and PAA and their clinical implications.
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Affiliation(s)
- Jorge Nuche
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Julián Palomino-Doza
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Juan F. Delgado
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Borja Ibáñez
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Eduardo Oliver
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
| | - Pilar Escribano Subías
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
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29
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Walsh R, Batra D, Dixit A, Bhatt JM. Clues beyond the lung: an unusual diagnosis in an infant with chronic lung disease. Breathe (Sheff) 2020; 16:190319. [PMID: 32494305 PMCID: PMC7249791 DOI: 10.1183/20734735.0319-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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30
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Iqbal NS, Jascur TA, Harrison SM, Edwards AB, Smith LT, Choi ES, Arevalo MK, Chen C, Zhang S, Kern AJ, Scheuerle AE, Sanchez EJ, Xing C, Baker LA. Prune belly syndrome in surviving males can be caused by Hemizygous missense mutations in the X-linked Filamin A gene. BMC MEDICAL GENETICS 2020; 21:38. [PMID: 32085749 PMCID: PMC7035669 DOI: 10.1186/s12881-020-0973-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
Background Prune belly syndrome (PBS) is a rare, multi-system congenital myopathy primarily affecting males that is poorly described genetically. Phenotypically, its morbidity spans from mild to lethal, however, all isolated PBS cases manifest three cardinal pathological features: 1) wrinkled flaccid ventral abdominal wall with skeletal muscle deficiency, 2) urinary tract dilation with poorly contractile smooth muscle, and 3) intra-abdominal undescended testes. Despite evidence for a genetic basis, previously reported PBS autosomal candidate genes only account for one consanguineous family and single cases. Methods We performed whole exome sequencing (WES) of two maternal adult half-brothers with syndromic PBS (PBS + Otopalatodigital spectrum disorder [OPDSD]) and two unrelated sporadic individuals with isolated PBS and further functionally validated the identified mutations. Results We identified three unreported hemizygous missense point mutations in the X-chromosome gene Filamin A (FLNA) (c.4952 C > T (p.A1448V), c.6727C > T (p.C2160R), c.5966 G > A (p.G2236E)) in two related cases and two unrelated sporadic individuals. Two of the three PBS mutations map to the highly regulatory, stretch-sensing Ig19–21 region of FLNA and enhance binding to intracellular tails of the transmembrane receptor β-integrin 1 (ITGβ1). Conclusions FLNA is a regulatory actin-crosslinking protein that functions in smooth muscle cells as a mechanosensing molecular scaffold, transmitting force signals from the actin-myosin motor units and cytoskeleton via binding partners to the extracellular matrix. This is the first evidence for an X-linked cause of PBS in multiple unrelated individuals and expands the phenotypic spectrum associated with FLNA in males surviving even into adulthood.
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Affiliation(s)
- Nida S Iqbal
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Thomas A Jascur
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Steven M Harrison
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Angelena B Edwards
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Luke T Smith
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Erin S Choi
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Michelle K Arevalo
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Catherine Chen
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Shaohua Zhang
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Adam J Kern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Angela E Scheuerle
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,McDermott Center for Human Growth and Development, Department of Bioinformatics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Emma J Sanchez
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Children's Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX, 75207, USA
| | - Chao Xing
- McDermott Center for Human Growth and Development, Department of Bioinformatics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Linda A Baker
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. .,Children's Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX, 75207, USA.
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31
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Yonker LM, Hawley MH, Kinane TB. Do mesenchymal stromal cell infusions advance the understanding and treatment options of FLNA-associated pulmonary disease? Pediatr Pulmonol 2020; 55:270-271. [PMID: 31746552 DOI: 10.1002/ppul.24570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/26/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Megan H Hawley
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts
| | - T Bernard Kinane
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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32
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Higano NS, Thomen RP, Quirk JD, Huyck HL, Hahn AD, Fain SB, Pryhuber GS, Woods JC. Alveolar Airspace Size in Healthy and Diseased Infant Lungs Measured via Hyperpolarized 3He Gas Diffusion Magnetic Resonance Imaging. Neonatology 2020; 117:704-712. [PMID: 33176330 PMCID: PMC7878286 DOI: 10.1159/000511084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alveolar development and lung parenchymal simplification are not well characterized in vivo in neonatal patients with respiratory morbidities, such as bronchopulmonary dysplasia (BPD). Hyperpolarized (HP) gas diffusion magnetic resonance imaging (MRI) is a sensitive, safe, nonionizing, and noninvasive biomarker for measuring airspace size in vivo but has not yet been implemented in young infants. OBJECTIVE This work quantified alveolar airspace size via HP gas diffusion MRI in healthy and diseased explanted infant lung specimens, with comparison to histological morphometry. METHODS Lung specimens from 8 infants were obtained: 7 healthy left upper lobes (0-16 months, post-autopsy) and 1 left lung with filamin-A mutation, closely representing BPD lung disease (11 months, post-transplantation). Specimens were imaged using HP 3He diffusion MRI to generate apparent diffusion coefficients (ADCs) as biomarkers of alveolar airspace size, with comparison to mean linear intercept (Lm) via quantitative histology. RESULTS Mean ADC and Lm were significantly increased throughout the diseased specimen (ADC = 0.26 ± 0.06 cm2/s, Lm = 587 ± 212 µm) compared with healthy specimens (ADC = 0.14 ± 0.03 cm2/s, Lm = 133 ± 37 µm; p < 1 × 10-7); increased values reflect enlarged airspaces. Mean ADCs in healthy specimens were significantly correlated to Lm (r = 0.69, p = 0.041). CONCLUSIONS HP gas diffusion MRI is sensitive to healthy and diseased regional alveolar airspace size in infant lungs, with good comparison to quantitative histology in ex vivo specimens. This work demonstrates the translational potential of gas MRI techniques for in vivo assessment of normal and abnormal alveolar development in neonates with pulmonary disease.
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Affiliation(s)
- Nara S Higano
- Division of Pulmonary Medicine and Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio, USA,
| | - Robert P Thomen
- Department of Radiology and Bioengineering, University of Missouri, Columbia, Missouri, USA
| | - James D Quirk
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Heidie L Huyck
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Andrew D Hahn
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gloria S Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Jason C Woods
- Division of Pulmonary Medicine and Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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33
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Pelizzo G, Avanzini MA, Lenta E, Mantelli M, Croce S, Catenacci L, Acquafredda G, Ferraro AL, Giambanco C, D'Amelio L, Giordano S, Re G, Zennaro F, Calcaterra V. Allogeneic mesenchymal stromal cells: Novel therapeutic option for mutated FLNA-associated respiratory failure in the pediatric setting. Pediatr Pulmonol 2020; 55:190-197. [PMID: 31468740 DOI: 10.1002/ppul.24497] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mesenchymal stromal cell (MSC)-mediated therapeutic effects have been observed in the treatment of lung diseases. For the first time, this treatment was used as rescue therapy in a pediatric patient with a life-threatening respiratory syndrome associated with the filamin A (FLNA) gene mutation. METHODS A child with a new pathogenic variant of the FLNA gene c.7391_7403del (p.Val2464AlafsTer5), at the age of 18 months, due to serious and irreversible chronic respiratory failure, was treated with repeated intravenous infusions of allogeneic bone marrow (BM)-MSCs. The child's respiratory condition was monitored. Immunologic studies before each MSC treatment were performed. RESULTS No acute adverse events related to the MSC infusions were observed. After the second infusion, the child's respiratory condition progressively improved, with reduced necessity for mechanical ventilation support. A thorax computed tomography (CT) scan showed bilateral recovery of the basal parenchyma, anatomical-functional alignment and aerial penetration improvement. After the first MSC administration, an increase in Th17 and FoxP3+ T percentages in the peripheral blood was observed. After the second MSC infusion, a significant rise in the Treg/Th17 ratio was noted, as well as an increased percentage of CD20+ /CD19+ B lymphocytes and augmented PHA-induced proliferation. DISCUSSION MSC infusions are a promising therapeutic modality for patients in respiratory failure, as observed in this pediatric patient with an FLNA mutation. MSCs may have an immunomodulatory effect and thus mitigate lung injury; although in this case, MSC antimicrobial effects may have synergistically impacted the clinical improvements. Further investigations are planned to establish the safety and efficacy of this treatment option for interstitial lung diseases in children.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital G. di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Maria A Avanzini
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Elisa Lenta
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Melissa Mantelli
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Stefania Croce
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Laura Catenacci
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Gloria Acquafredda
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Aurelio L Ferraro
- Specialized Oncology Laboratory, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Caterina Giambanco
- Specialized Oncology Laboratory, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Lucia D'Amelio
- Specialized Oncology Laboratory, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Salvatore Giordano
- Biology Unit, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Giuseppe Re
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital, Mediterranean Institute for Pediatric Excellence, Palermo, Italy
| | - Floriana Zennaro
- Radiologie Pédiatrique, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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34
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Kremer TM, Lindsay ME, Kinane TB, Hawley MH, Little BP, Mino-Kenudson M. Case 28-2019: A 22-Year-Old Woman with Dyspnea and Chest Pain. N Engl J Med 2019; 381:1059-1067. [PMID: 31509678 DOI: 10.1056/nejmcpc1904041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ted M Kremer
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Mark E Lindsay
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - T Bernard Kinane
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Megan H Hawley
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Brent P Little
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Mari Mino-Kenudson
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
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Pelizzo G, Collura M, Puglisi A, Pappalardo MP, Agolini E, Novelli A, Piccione M, Cacace C, Bussani R, Corsello G, Calcaterra V. Congenital emphysematous lung disease associated with a novel Filamin A mutation. Case report and literature review. BMC Pediatr 2019; 19:86. [PMID: 30922288 PMCID: PMC6440113 DOI: 10.1186/s12887-019-1460-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Progressive lung involvement in Filamin A (FLNA)-related cerebral periventricular nodular heterotopia (PVNH) has been reported in a limited number of cases. CASE PRESENTATION We report a new pathogenic FLNA gene variant (c.7391_7403del; p.Val2464Alafs*5) in a male infant who developed progressive lung disease with emphysematous lesions and interstitial involvement. Following lobar resection, chronic respiratory failure ensued necessitating continuous mechanical ventilation and tracheostomy. Cerebral periventricular nodular heterotopia was also present. CONCLUSIONS We report a novel variant of the FLNA gene, associated with a severe lung disorder and PNVH. The lung disorder led to respiratory failure during infancy and these pulmonary complications may be the first sign of this disorder. Early recognition with thoracic imaging is important to guide genetic testing, neuroimaging and to define optimal timing of potential therapies, such as lung transplant in progressive lung disease.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital "G. di Cristina", ARNAS Civico-Di Cristina-Benfratelli, Via dei Benedettini, 1, 90134, Palermo, Italy.
| | - Mirella Collura
- Cystic Fibrosis and Respiratory Pediatric Center, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Aurora Puglisi
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Maria Pia Pappalardo
- Pediatric Radiology Unit, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Piccione
- Department of Sciences for Health Promotion and Mother and Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| | - Caterina Cacace
- Neonatal Intensive Care Unit, Hospital "Barone Romeo" Patti, ASP Messina, Messina, Italy
| | - Rossana Bussani
- Institute of Pathological Anatomy, Trieste University Hospital, Trieste, Italy
| | - Giovanni Corsello
- Pediatrics and Neonatal Intensive Therapy Unit, Mother and Child Department, University of Palermo, Palermo, Italy
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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