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Del Pino M, Aza-Carmona M, Medino-Martín D, Gomez A, Heath KE, Fano V, Obregon MG. SHOX Deficiency in Argentinean Cohort: Long-Term Auxological Follow-Up and a Family's New Mutation. J Pediatr Genet 2019; 8:123-132. [PMID: 31406617 DOI: 10.1055/s-0039-1691788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
A cohort study on the growth of 19 Argentinean children, aged 0 to 18 years, and 11 of their first-degree relatives with alterations in the SHOX gene or its regulatory regions is reported. Children are born shorter and experience a growth delay during childhood with a stunted pubertal growth spurt. Body disproportion, with a sitting height/height ratio above +2 standard deviation score (SDS), was already present as early as 2 years old. Hand length was normal. Shortening of the radius, with a length below -1.9 SDS, was the earliest and most frequent radiological sign detected as early as 45 days old. We found a previously unreported mutation in a family with a highly variable phenotype, the boy had a severe phenotype with a milder presentation in other affected members of the family. We conclude that body disproportion and a shorter radius length on X-ray are useful tools for selecting children to undergo SHOX molecular studies.
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Affiliation(s)
- Mariana Del Pino
- Department of Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| | - Miriam Aza-Carmona
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, UAM, IdiPAZ, Madrid, Spain.,Skeletal dysplasia multidisciplinary Unit (UMDE), Hospital Universitario La Paz, UAM, Madrid, Spain.,CIBERER, ISCIII, Madrid, Spain
| | - David Medino-Martín
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, UAM, IdiPAZ, Madrid, Spain
| | - Abel Gomez
- Department of Genetics, Hospital Garrahan, Buenos Aires, Argentina
| | - Karen E Heath
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, UAM, IdiPAZ, Madrid, Spain.,Skeletal dysplasia multidisciplinary Unit (UMDE), Hospital Universitario La Paz, UAM, Madrid, Spain.,CIBERER, ISCIII, Madrid, Spain
| | - Virginia Fano
- Department of Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
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Kurnaz E, Savaş-Erdeve Ş, Çetinkaya S, Aycan Z. SHOX gene deletion screening by FISH in children with short stature and Madelung deformity and their characteristics. J Pediatr Endocrinol Metab 2018; 31:1273-1278. [PMID: 30332396 DOI: 10.1515/jpem-2018-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
Abstract
Background The short stature homeobox-containing (SHOX) gene strongly affects height. Therefore, a better understanding of SHOX haploinsufficiency could be advantageous to early diagnosis and treatment. We investigated the rate of SHOX haploinsufficiency in patients of short stature and documented their anthropometric measurements. Methods Between 2010 and 2017, we evaluated 86 patients (70 females, 16 males; age 4.3-18 years) with clinical diagnoses of short stature and Madelung deformity (MD). Clinical abnormalities are presented for patients with MD with and without SHOX haploinsufficiency as determined by fluorescence in situ hybridisation (FISH). Results According to our inclusion criteria, 78 of 86 patients (70 females, 16 males) had short stature (height <-2.5 standard deviation [SD]) and a family history suggestive of short stature. Eight patients had short stature, a family history suggestive of short stature and MD. MD was obvious in eight children in radiographic examinations. Although five of these had no deletion of SHOX, three had deletion of this gene. The deletion detection rate was 37.5% in the individuals with short stature and MD, i.e. Leri-Weill dyschondrosteosis syndrome (LWS), whilst no deletions were detected in the individuals with only short stature. One individual responded well to growth hormone (GH) treatment for the first 2 years but then developed an intolerance with persistently elevated insulin-like growth factor-1 (IGF-1) levels. Conclusions As we likely missed cases due to our methodology, the routine analysis for SHOX screening should be firstly multiplex ligation-dependent probe amplification (MLPA). The incidence of MD may have been higher in the cohort if X-rays were performed in all individuals. GH treatment was not well tolerated in one case due to persistently elevated IGF-1 levels, and long-term evaluations of patients with SHOX deficiency are required.
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Affiliation(s)
- Erdal Kurnaz
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Şenay Savaş-Erdeve
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
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Marchini A, Ogata T, Rappold GA. A Track Record on SHOX: From Basic Research to Complex Models and Therapy. Endocr Rev 2016; 37:417-48. [PMID: 27355317 PMCID: PMC4971310 DOI: 10.1210/er.2016-1036] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SHOX deficiency is the most frequent genetic growth disorder associated with isolated and syndromic forms of short stature. Caused by mutations in the homeobox gene SHOX, its varied clinical manifestations include isolated short stature, Léri-Weill dyschondrosteosis, and Langer mesomelic dysplasia. In addition, SHOX deficiency contributes to the skeletal features in Turner syndrome. Causative SHOX mutations have allowed downstream pathology to be linked to defined molecular lesions. Expression levels of SHOX are tightly regulated, and almost half of the pathogenic mutations have affected enhancers. Clinical severity of SHOX deficiency varies between genders and ranges from normal stature to profound mesomelic skeletal dysplasia. Treatment options for children with SHOX deficiency are available. Two decades of research support the concept of SHOX as a transcription factor that integrates diverse aspects of bone development, growth plate biology, and apoptosis. Due to its absence in mouse, the animal models of choice have become chicken and zebrafish. These models, therefore, together with micromass cultures and primary cell lines, have been used to address SHOX function. Pathway and network analyses have identified interactors, target genes, and regulators. Here, we summarize recent data and give insight into the critical molecular and cellular functions of SHOX in the etiopathogenesis of short stature and limb development.
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Affiliation(s)
- Antonio Marchini
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Tsutomu Ogata
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Gudrun A Rappold
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Rocca MS, Pecile V, Cleva L, Speltra E, Selice R, Di Mambro A, Foresta C, Ferlin A. The Klinefelter syndrome is associated with high recurrence of copy number variations on the X chromosome with a potential role in the clinical phenotype. Andrology 2016; 4:328-34. [DOI: 10.1111/andr.12146] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. S. Rocca
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - V. Pecile
- Institute for Maternal and Child Health; IRCCS “Burlo Garofolo”; Trieste Italy
| | - L. Cleva
- Institute for Maternal and Child Health; IRCCS “Burlo Garofolo”; Trieste Italy
| | - E. Speltra
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - R. Selice
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - A. Di Mambro
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - C. Foresta
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
| | - A. Ferlin
- Unit of Andrology and Reproductive Medicine; Department of Medicine; University of Padova; Padova Italy
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Mei L, Huang Y, Pan Q, Li H, Liang D, Wu L. Identification of a novel SHOX mutation in a Chinese family with isolated Madelung deformity. J Genet 2015; 93:809-12. [PMID: 25572239 DOI: 10.1007/s12041-014-0419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Libin Mei
- State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, People's Republic of China.
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Sandoval GTV, Jaimes GC, Barrios MC, Cespedes C, Velasco HM. SHOX gene and conserved noncoding element deletions/duplications in Colombian patients with idiopathic short stature. Mol Genet Genomic Med 2013; 2:95-102. [PMID: 24689071 PMCID: PMC3960050 DOI: 10.1002/mgg3.39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/06/2022] Open
Abstract
SHOX gene mutations or haploinsufficiency cause a wide range of phenotypes such as Leri Weill dyschondrosteosis (LWD), Turner syndrome, and disproportionate short stature (DSS). However, this gene has also been found to be mutated in cases of idiopathic short stature (ISS) with a 3–15% frequency. In this study, the multiplex ligation-dependent probe amplification (MLPA) technique was employed to determine the frequency of SHOX gene mutations and their conserved noncoding elements (CNE) in Colombian patients with ISS. Patients were referred from different centers around the county. From a sample of 62 patients, 8.1% deletions and insertions in the intragenic regions and in the CNE were found. This result is similar to others published in other countries. Moreover, an isolated case of CNE 9 duplication and a new intron 6b deletion in another patient, associated with ISS, are described. This is one of the first studies of a Latin American population in which deletions/duplications of the SHOX gene and its CNE are examined in patients with ISS.
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Affiliation(s)
| | | | - Mauricio Coll Barrios
- Department of Pediatrics, Hospital De La Misericordia, Universidad Nacional De Colombia Colombia
| | - Camila Cespedes
- Department of Pediatrics, Hospital San Ignacio, Pontificia Universidad Javeriana Colombia
| | - Harvy Mauricio Velasco
- Institute of Genetics, School of Medicine, Master in Human Genetics, Universidad Nacional de Colombia Colombia
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Chianese C, Lo Giacco D, Tüttelmann F, Ferlin A, Ntostis P, Vinci S, Balercia G, Ars E, Ruiz-Castañé E, Giglio S, Forti G, Kliesch S, Krausz C. Y-chromosome microdeletions are not associated with SHOX haploinsufficiency. Hum Reprod 2013; 28:3155-60. [DOI: 10.1093/humrep/det322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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SHOX gene defects and selected dysmorphic signs in patients of idiopathic short stature and Léri–Weill dyschondrosteosis. Gene 2012; 491:123-7. [DOI: 10.1016/j.gene.2011.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/03/2011] [Indexed: 11/18/2022]
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9
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Kayserili H, Altunoglu U, Ozgur H, Basaran S, Uyguner ZO. Mild nasal malformations and parietal foramina caused by homozygous ALX4 mutations. Am J Med Genet A 2011; 158A:236-44. [PMID: 22140057 DOI: 10.1002/ajmg.a.34390] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/24/2011] [Indexed: 01/24/2023]
Abstract
We report on a boy born to consanguineous parents, who had hypertelorism, a broad nasal bridge, ridge and tip, bifid nasal tip, cleft alae nasi, broad columella, unilateral preauricular tag, shallow labiogingival sulcus, and bilateral large parietal foramina. Cranial MRI revealed a kinked corpus body and small cerebellar vermis. Molecular analysis uncovered a homozygous c.673C > G (p.Q225E) mutation in ALX4 gene. We compare the relatively mild phenotype in the patient to the more marked phenotype described in other patients with homozygous ALX4 mutations, and to the phenotypes in patients with mutations in other ALX genes.
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Affiliation(s)
- Hülya Kayserili
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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10
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Sandbacka M, Halttunen M, Jokimaa V, Aittomäki K, Laivuori H. Evaluation of SHOX copy number variations in patients with Müllerian aplasia. Orphanet J Rare Dis 2011; 6:53. [PMID: 21806840 PMCID: PMC3159099 DOI: 10.1186/1750-1172-6-53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/02/2011] [Indexed: 11/10/2022] Open
Abstract
Background Müllerian aplasia (MA) characterized by congenital loss of functional uterus and vagina is one of the most difficult disorders of female reproductive health. Despite of growing interest in this research field, the cause of the disorder for the majority of patients is still unknown. A recent report of partial SHOX duplications in five patients with MA has motivated us to further evaluate their role in the disorder. Therefore we have studied SHOX copy number variations (CNVs) in a cohort of 101 Finnish patients with MA and in 115 healthy controls. Methods We used multiplex ligation-dependent probe amplification (MLPA) to study SHOX CNVs. Results All patients showed normal amplification of SHOX. Several aberrations, duplications and deletions, were found downstream of the gene in five patients and seven controls, but these were all copy number polymorphisms. Conclusions Our study in an extensive cohort of patients with MA does not support a role for SHOX CNVs in the aetiology of the disorder. Further studies in the field are important for both patients looking for answers as well as for the scientific community for better understanding the regulation of the female reproductive duct development.
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Llano-Rivas I, Fernández-Toral J, Navarro-Vera I. Discondrosteosis de Leri-Weill. Mutación en gen SHOX y expresividad variable. An Pediatr (Barc) 2011; 74:405-8. [DOI: 10.1016/j.anpedi.2011.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 08/02/2010] [Accepted: 01/17/2011] [Indexed: 11/27/2022] Open
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Evers C, Heidemann PH, Dunstheimer D, Schulze E, Haag C, Janssen JWG, Fischer C, Jauch A, Moog U. Pseudoautosomal inheritance of Léri-Weill syndrome: what does it mean? Clin Genet 2011; 79:489-94. [DOI: 10.1111/j.1399-0004.2010.01488.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Benito-Sanz S, Barroso E, Heine-Suñer D, Hisado-Oliva A, Romanelli V, Rosell J, Aragones A, Caimari M, Argente J, Ross JL, Zinn AR, Gracia R, Lapunzina P, Campos-Barros A, Heath KE. Clinical and molecular evaluation of SHOX/PAR1 duplications in Leri-Weill dyschondrosteosis (LWD) and idiopathic short stature (ISS). J Clin Endocrinol Metab 2011; 96:E404-12. [PMID: 21147883 DOI: 10.1210/jc.2010-1689] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Léri-Weill dyschondrosteosis (LWD) is a skeletal dysplasia characterized by disproportionate short stature and the Madelung deformity of the forearm. SHOX mutations and pseudoautosomal region 1 deletions encompassing SHOX or its enhancers have been identified in approximately 60% of LWD and approximately 15% of idiopathic short stature (ISS) individuals. Recently SHOX duplications have been described in LWD/ISS but also in individuals with other clinical manifestations, thus questioning their pathogenicity. OBJECTIVE The objective of the study was to investigate the pathogenicity of SHOX duplications in LWD and ISS. DESIGN AND METHODS Multiplex ligation-dependent probe amplification is routinely used in our unit to analyze for SHOX/pseudoautosomal region 1 copy number changes in LWD/ISS referrals. Quantitative PCR, microsatellite marker, and fluorescence in situ hybridization analysis were undertaken to confirm all identified duplications. RESULTS During the routine analysis of 122 LWD and 613 ISS referrals, a total of four complete and 10 partial SHOX duplications or multiple copy number (n > 3) as well as one duplication of the SHOX 5' flanking region were identified in nine LWD and six ISS cases. Partial SHOX duplications appeared to have a more deleterious effect on skeletal dysplasia and height gain than complete SHOX duplications. Importantly, no increase in SHOX copy number was identified in 340 individuals with normal stature or 104 overgrowth referrals. CONCLUSION MLPA analysis of SHOX/PAR1 led to the identification of partial and complete SHOX duplications or multiple copies associated with LWD or ISS, suggesting that they may represent an additional class of mutations implicated in the molecular etiology of these clinical entities.
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Affiliation(s)
- S Benito-Sanz
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, and Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, 28046 Madrid, Spain
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SHOX duplications found in some cases with type I Mayer-Rokitansky-Kuster-Hauser syndrome. Genet Med 2010; 12:634-40. [PMID: 20847698 DOI: 10.1097/gim.0b013e3181ed6185] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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15
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Funari MFA, Jorge AAL, Souza SCAL, Billerbeck AEC, Arnhold IJP, Mendonca BB, Nishi MY. Usefulness of MLPA in the detection of SHOX deletions. Eur J Med Genet 2010; 53:234-8. [PMID: 20538086 DOI: 10.1016/j.ejmg.2010.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 06/01/2010] [Indexed: 12/18/2022]
Abstract
SHOX haploinsufficiency causes a wide spectrum of short stature phenotypes, such as Leri-Weill dyschondrosteosis (LWD) and disproportionate short stature (DSS). SHOX deletions are responsible for approximately two thirds of isolated haploinsufficiency; therefore, it is important to determine the most appropriate methodology for detection of gene deletion. In this study, three methodologies for the detection of SHOX deletions were compared: the fluorescence in situ hybridization (FISH), microsatellite analysis and multiplex ligation-dependent probe amplification (MLPA). Forty-four patients (8 LWD and 36 DSS) were analyzed. The cosmid LLNOYCO3'M'34F5 was used as a probe for the FISH analysis and microsatellite analysis were performed using three intragenic microsatellite markers. MLPA was performed using commercial kits. Twelve patients (8 LWD and 4 DSS) had deletions in SHOX area detected by MLPA and 2 patients generated discordant results with the other methodologies. In the first case, the deletion was not detected by FISH. In the second case, both FISH and microsatellite analyses were unable to identify the intragenic deletion. In conclusion, MLPA was more sensitive, less expensive and less laborious; therefore, it should be used as the initial molecular method for the detection of SHOX gene deletion.
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Affiliation(s)
- Mariana F A Funari
- Unidade de Endocrinologia do Desenvolvimento, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Roos L, Brøndum Nielsen K, Tümer Z. A duplication encompassing the SHOX gene and the downstream evolutionarily conserved sequences. Am J Med Genet A 2010; 149A:2900-1. [PMID: 19938087 DOI: 10.1002/ajmg.a.33118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Thomas NS, Harvey JF, Bunyan DJ, Rankin J, Grigelioniene G, Bruno DL, Tan TY, Tomkins S, Hastings R. Clinical and molecular characterization of duplications encompassing the human SHOX gene reveal a variable effect on stature. Am J Med Genet A 2009; 149A:1407-14. [PMID: 19533800 DOI: 10.1002/ajmg.a.32914] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deletions of the SHOX gene are well documented and cause disproportionate short stature and variable skeletal abnormalities. In contrast interstitial SHOX duplications limited to PAR1 appear to be very rare and the clinical significance of the only case report in the literature is unclear. Mapping of this duplication has now shown that it includes the entire SHOX gene but little flanking sequence and so will not encompass any of the long-range enhancers required for SHOX transcription. We now describe the clinical and molecular characterization of three additional cases. The duplications all included the SHOX coding sequence but varied in the amount of flanking sequence involved. The probands were ascertained for a variety of reasons: hypotonia and features of Asperger syndrome, Leri-Weill dyschondrosteosis (LWD), and a family history of cleft palate. However, the presence of a duplication did not correlate with any of these features or with evidence of skeletal abnormality. Remarkably, the proband with LWD had inherited both a SHOX deletion and a duplication. The effect of the duplications on stature was variable: height appeared to be elevated in some carriers, particularly in those with the largest duplications, but was still within the normal range. SHOX duplications are likely to be under ascertained and more cases need to be identified and characterized in detail in order to accurately determine their phenotypic consequences.
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Affiliation(s)
- N Simon Thomas
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK.
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High resolution 3.0 Tesla MR imaging findings in patients with bilateral Madelung's deformity. Surg Radiol Anat 2009; 31:551-7. [PMID: 19225712 DOI: 10.1007/s00276-009-0476-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE Madelung deformity (MD) is a rare, normally painful abnormality of the wrist and forearm which characteristically begins in adolescence. Usually the deformity appears between the age of 8 and 14 years, often progressing from initially mild functional pain to fatigue and loss of strength and finally, reduced mobility. We present the MR-findings in three patients with bilateral MD, using a high-resolution imaging protocol adapted for 3.0 Tesla (3.0 T) examinations. MATERIALS AND METHODS Wrist images of three patients were acquired at a 3.0 T Scanner (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands), using a dedicated phased array coil. The imaging protocol consisted of coronal T1-weighted Turbo-spin-echo (T1w-TSE) and coronal and sagittal T2-weighted TSE sequences (T2w-TSE). RESULTS MR-images of these three girls demonstrated severe volar bayonet configuration of the forearms with a dorsal prominence of the ulnar head, also a curved distal radial articular surface with increased ulnar angulation, due to a deceleration of growth in the ulnar portion of the distal epiphysis. The proximal carpal row showed pyramidal configuration. Also visible was a prominent short radiolunate ligament, the so called Vickers ligament, which originates from the ulnar border of the radius, inserts into the volar pole of the lunate and likely contributes to carpal pyramidalization. Furthermore, the images demonstrated an anomalous hypertrophied and elongated volar radiotriquetral ligament which, to our knowledge, has been described elsewhere only in another case. CONCLUSION High resolution imaging at 3.0 T permitted a detailed analysis of the complex pathomorphology in patients with MD. Investing the better signal-to-noise ratio at higher field strengths into spatial resolution an excellent image quality could be obtained, depicting the Vickers ligament and the anomalous volar radiotriquetral ligament in this rare disease.
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Jorge AAL, Nishi MY, Funari MFA, Souza SC, Arnhold IJP, Mendonça BB. Baixa estatura por haploinsuficiência do gene SHOX: do diagnóstico ao tratamento. ACTA ACUST UNITED AC 2008; 52:765-73. [DOI: 10.1590/s0004-27302008000500008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 04/28/2008] [Indexed: 11/22/2022]
Abstract
Estudos realizados em pacientes portadores de deleções parciais dos cromossomos sexuais permitiram a caracterização do SHOX, gene localizado na região pseudoautossômica no braço curto dos cromossomos sexuais, fundamental na determinação da altura normal. A perda de uma cópia deste gene na síndrome de Turner (ST) explica dois terços da baixa estatura observada nesta síndrome. A haploinsuficiência do SHOX é detectada em 77% dos pacientes com discondrosteose de Leri-Weill, uma forma comum de displasia esquelética de herança autossômica dominante e em 3% das crianças com baixa estatura idiopática (BEI), tornando os defeitos neste gene a principal causa monogênica de baixa estatura. A medida da altura sentada em relação à altura total (Z da AS/AT para idade e sexo) é uma forma simples de identificar a desproporção corpórea e, associada ao exame cuidadoso do paciente e de outros membros da família, auxilia na seleção de pacientes para o estudo molecular do SHOX. O uso de hormônio de crescimento (GH) está bem estabelecido na ST e em razão da causa comum da baixa estatura com o de crianças com defeitos isolados do SHOX o tratamento destes pacientes com GH é também proposto. Neste artigo será revisado os aspectos clínicos, moleculares e terapêuticos da haploinsuficiência do SHOX.
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Bleyl SB, Byrne JLB, South ST, Dries DC, Stevenson DA, Rope AF, Vianna-Morgante AM, Schoenwolf GC, Kivlin JD, Brothman A, Carey JC. Brachymesomelic dysplasia with Peters anomaly of the eye results from disruptions of the X chromosome near the SHOX and SOX3 genes. Am J Med Genet A 2008; 143A:2785-95. [PMID: 17994562 DOI: 10.1002/ajmg.a.32036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on a mother and son affected with an unusual skeletal dysplasia and anterior segment eye abnormalities. Their skeletal phenotype overlaps with the SHOX-related skeletal dysplasias and is intermediate between Leri-Weill dyschondrosteosis (LWD) and Langer Mesomelic dysplasia (LMD). The mother has bilateral Peters anomaly of the eye and was reported as having a new syndrome; the son had severe bilateral sclerocornea. Chromosome analysis showed that the mother has a pericentric inversion of the X chromosome [46,X,inv(X)(p22.3q27)] and the son, a resultant recombinant X chromosome [46,Y,rec(X)dup(Xq)inv(X)(p22.3q27)]. The observed skeletal and ophthalmologic abnormalities in both patients were similar in severity. The additional features of developmental delay, growth retardation, agenesis of the corpus callosum, cryptorchidism and hypoplastic scrotum in the son are consistent with Xq28 duplication. Analysis of the son's recombinant X chromosome showed that the Xp22.33 breakpoint lies 30-68 kb 5' of the SHOX gene. This finding suggests that the skeletal dysplasia in both mother and son is allelic with LWD and LMD and results from a novel misexpression of SHOX. Analysis of the Xq27.1 breakpoint localized it to a 90 kb interval 3' of the SOX3 gene, supporting a novel role of SOX3 misexpression in the development of Peters anomaly of the eye.
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Affiliation(s)
- Steven B Bleyl
- Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, Utah 84132.
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Abstract
The Short Stature Homeobox-containing Gene SHOX was identified as the genetic cause of the short stature phenotype in patients with Turner Syndrome and in certain patients with idiopathic short stature. Shortly after, SHOX mutations were also associated with the growth failure and skeletal deformities seen in patients with Léri - Weill dyschondrosteosis and Langer mesomelic dysplasia. Today it is estimated that SHOX mutations occur with an incidence of roughly 1:1,000 in newborns, making mutations of this gene one of the most common genetic defects leading to growth failure in humans. This review summarises the involvement of SHOX in several short stature syndromes and describes recent advances in our understanding of SHOX functions and regulation. We also discuss the current evidence in the literature that points to a role of this protein in growth and bone development. These studies have improved our knowledge of the SHOX gene and protein functions, and have given insight into the etiopathogenesis of short stature. However, the exact role of SHOX in bone development still remains elusive and poses the next major challenge for researchers in this field.
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Affiliation(s)
- Antonio Marchini
- German Cancer Research Center (DKFZ) and Inserm U375, Heidelberg, Germany.
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Benito-Sanz S, Thomas NS, Huber C, del Blanco DG, Aza-Carmona M, Crolla JA, Maloney V, Argente J, Campos-Barros Á, Cormier-Daire V, Heath KE. A novel class of Pseudoautosomal region 1 deletions downstream of SHOX is associated with Leri-Weill dyschondrosteosis. Am J Hum Genet 2005; 77:533-44. [PMID: 16175500 PMCID: PMC1275603 DOI: 10.1086/449313] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 07/11/2005] [Indexed: 11/03/2022] Open
Abstract
Leri-Weill dyschondrosteosis (LWD) is a pseudoautosomal dominant disorder characterized by disproportionate short stature and a characteristic curving of the radius, known as the "Madelung deformity." SHOX mutations resulting in SHOX haploinsufficiency have been found in LWD and in a variable proportion of patients with idiopathic short stature (ISS), whereas homozygous loss of SHOX results in the more severe Langer mesomelic dysplasia (LMD). Defects in SHOX have been identified in approximately 60% of LWD cases, whereas, in the remaining approximately 40%, the molecular basis is unknown. This suggests either genetic heterogeneity or the presence of mutations in unanalyzed regions of SHOX, such as the upstream, intragenic, or downstream regulatory sequences. Therefore, the pseudoautosomal region 1 (PAR1) of 80 patients with LWD, in whom SHOX deletions and mutations had been excluded, was screened for deletions by use of a new panel of microsatellite markers. We identified 12 patients with LWD who presented with a novel class of PAR1 deletions that did not include SHOX. The deletions were of variable size and mapped at least approximately 30-530 kb downstream of SHOX. In our cohort, this type of deletion accounted for 15% of cases. In all cases, the deletions cosegregated with the phenotype. No apparent phenotypic differences were observed between patients with SHOX deletions and those with this new class of PAR1 deletions. Thus, we present here the identification of a second PAR1 region implicated in the etiopathogenesis of LWD. Our findings suggest the presence of distal regulatory elements of SHOX transcription in PAR1 or, alternatively, the existence of an additional locus apparently involved in the control of skeletal development. Deletion analysis of this newly identified region should be included in the mutation screening of patients with LWD, LMD, and ISS.
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Affiliation(s)
- Sara Benito-Sanz
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - N. Simon Thomas
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Céline Huber
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Darya Gorbenko del Blanco
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Miriam Aza-Carmona
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - John A. Crolla
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Vivienne Maloney
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Jesús Argente
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Ángel Campos-Barros
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Valérie Cormier-Daire
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
| | - Karen E. Heath
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, Madrid; Wessex Regional Genetics Laboratory and National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, United Kingdom; and Department of Genetics and INSERM U393, Hopital Necker Enfants Malades, Paris
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Schneider KU, Sabherwal N, Jantz K, Röth R, Muncke N, Blum WF, Cutler GB, Rappold G. Identification of a major recombination hotspot in patients with short stature and SHOX deficiency. Am J Hum Genet 2005; 77:89-96. [PMID: 15931595 PMCID: PMC1226197 DOI: 10.1086/431655] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 05/04/2005] [Indexed: 11/03/2022] Open
Abstract
Human growth is influenced not only by environmental and internal factors but also by a large number of different genes. One of these genes, SHOX, is believed to play a major role in growth, since defects in this homeobox-containing gene on the sex chromosomes lead to syndromal short stature (Leri-Weill dyschondrosteosis, Langer mesomelic dysplasia, and Turner syndrome) as well as to idiopathic short stature. We have analyzed 118 unrelated patients with Leri-Weill dyschondrosteosis and >1,500 patients with idiopathic short stature for deletions encompassing SHOX. Deletions were detected in 34% of the patients with Leri-Weill dyschondrosteosis and in 2% of the patients with idiopathic short stature. For 27 patients with Leri-Weill dyschondrosteosis and for 6 with idiopathic short stature, detailed deletion mapping was performed. Analysis was performed by polymerase chain reaction with the use of pseudoautosomal polymorphic markers and by fluorescence in situ hybridization with the use of cosmid clones. Here, we show that, although the identified deletions vary in size, the vast majority (73%) of patients tested share a distinct proximal deletion breakpoint. We propose that the sequence present within this proximal deletion breakpoint "hotspot" region predisposes to recurrent breaks.
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Affiliation(s)
- Katja U Schneider
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
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Thomas NS, Maloney V, Bass P, Mulik V, Wellesley D, Castle B. SHOX mutations in a family and a fetus with Langer mesomelic dwarfism. Am J Med Genet A 2005; 128A:179-84. [PMID: 15214013 DOI: 10.1002/ajmg.a.30095] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Léri-Weill dyschondrosteosis (LWD) and Langer mesomelic dysplasia (LMD) are caused by mutations in the SHOX gene. LWD results from haploinsufficiency and is dominantly inherited, while the more severe LMD results from the homozygous loss of SHOX. We describe a family and fetus with two SHOX mutations. Several relatives carry an approximately 200 kb interstitial deletion that includes the whole SHOX gene. Their condition is mild, with no Madelung deformity, and was originally diagnosed as hypochondroplasia (HCH). This deletion was also transmitted to a female fetus. However, unlike her carrier relatives, the ultrasound scan of the fetus and subsequent autopsy were consistent with LMD. The fetus inherited an additional Xp deletion (Xpter-Xp22.12) that also included the SHOX gene from her chromosomally normal father. This represents a unique molecular condition for LMD: the fetus is a compound heterozygote with two independent deletions, one inherited and one arising from a de novo event.
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Affiliation(s)
- N Simon Thomas
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, United Kingdom.
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Martins RR, Ramos HI, Llerena Jr. JC, Almeida JC. Investigação clínica e genética em meninas com baixa estatura idiopática. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0004-27302003000600010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Em 10 meninas com diagnóstico de baixa estatura idiopática (BEI), realizamos avaliação citogenética após revisão clínica. Dois cariótipos foram anormais: mos 45,X/46,XX; mos 45,X/46,X,der(Xp)/46,X,r(X), e para sua elucidação foram aplicadas técnicas de citogenética molecular e análise de microssatélites, incluindo SHOX CA repeat. Os resultados confirmaram a origem dos cromossomos anômalos e a identificação da haploinsuficiência do gene SHOX. Nos oito casos com cariótipo normal, a pesquisa de mosaicismos crípticos pela técnica FISH através da sonda centromérica (DXZ1) em células de mucosa oral (nuc ish) evidenciou a presença de dois mosaicos verdadeiros (DXZ1x2/DXZ1x1). A revisão clínica da paciente com anomalia estrutural de X e das 2 meninas com mosaicismo detectados pelo nuc ish, mostrou a presença de 3 ou mais sinais clínicos observados na síndrome de Turner (ST). Estes resultados reafirmam a importância da análise citogenética em meninas com diagnóstico de BEI e sinais clínicos da ST. Os resultados do estudo molecular para o gene SHOX confirmam sua relação com estigmas da ST. Sendo normal o cariótipo, a pesquisa de mosaicismos crípticos em outros tecidos deve ser considerada. O diagnóstico mais preciso poderá modificar a conduta terapêutica, como indicação do GH nessas meninas.
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Affiliation(s)
- Rosa R.S. Martins
- Instituto Estadual de Diabetes e Endocrinologia; Universidade Federal do Rio de Janeiro
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Binder G, Ranke MB, Martin DD. Auxology is a valuable instrument for the clinical diagnosis of SHOX haploinsufficiency in school-age children with unexplained short stature. J Clin Endocrinol Metab 2003; 88:4891-6. [PMID: 14557470 DOI: 10.1210/jc.2003-030136] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
SHOX (short stature homeobox-containing gene) mutations causing haploinsufficiency have been reported in some individuals with idiopathic short stature and in many patients with Leri-Weill-dyschondrosteosis. Around 80% of SHOX mutations are complete gene deletions, whereas diverse point mutations account for the rest. The aim of this study was to estimate the prevalence of SHOX mutations in children with idiopathic short stature and to give an unbiased characterization of the haploinsufficiency phenotype of such children. We recruited 140 children (61 girls), in our clinic, with idiopathic short stature, which was defined by the presence of normal IGF-I and free T(4); a normal karyotype in females; the absence of endomysium antibodies, of chronic organic, psychological, or syndromatic disease; and by the lack of clear signs of any osteodysplasia. Height, arm span, and sitting height were recorded, and subischial leg length was calculated. Two highly polymorphic microsatellite markers located around the SHOX coding region (CA-SHOX repeat and DXYS233) were PCR-amplified with fluorescent primers and separated in an automatic sequencing machine. Analysis of parental DNA was performed in the probands who had only one fragment size of each of both markers. SHOX haploinsufficiency caused by a SHOX deletion was confirmed in three probands (2%), all females, who carried a de novo deletion through loss of the paternal allele. Their auxological data revealed a significant shortening of arms and legs in the presence of a low-normal sitting height, when compared with the other 137 children tested. Therefore, the extremities-trunk ratio (sum of leg length and arm span, divided by sitting height) for total height was significantly lower in the three SHOX haploinsufficient probands, in comparison with the whole group. This observation was confirmed with the auxological data of five additional patients (four females) previously diagnosed with SHOX haploinsufficiency; all but the youngest girl had height-adjusted extremities-trunk ratios more than 1 SD below the mean. All children with SHOX haploinsufficiency exhibited at least one characteristic radiological sign of Leri-Weill-dyschondrosteosis in their left-hand radiography, namely triangularization of the distal radial epiphysis, pyramidalization of the distal carpal row, or lucency of the distal ulnar border of the radius. Our observations suggest that it is rational to limit SHOX mutation screening to children with an extremities-trunk ratio less than 1.95 + 1/2 height (m) and to add a critical judgment of the hand radiography.
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Affiliation(s)
- Gerhard Binder
- University Children's Hospital, 72076 Tübingen, Germany.
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Munns CFJ, Glass IA, Flanagan S, Hayes M, Williams B, Berry M, Vickers D, O'Rourke P, Rao E, Rappold GA, Hyland VJ, Batch JA. Familial growth and skeletal features associated with SHOX haploinsufficiency. J Pediatr Endocrinol Metab 2003; 16:987-96. [PMID: 14513875 DOI: 10.1515/jpem.2003.16.7.987] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the intrafamilial effect of SHOX haploinsufficiency on stature, by comparing the growth and phenotype of 26 SHOX haploinsufficient individuals with 45 relatives and population standards. It confirmed that SHOX haploinsufficiency leads to growth restriction from birth to final height. Compared to unaffected siblings, the SHOX haploinsufficient cohort was 2.14 SDS (3.8 cm) shorter at birth and 2.1 SDS shorter through childhood. At final height females were 2.4 SDS (14.4 cm) shorter and males 0.8 SDS (5.3 cm) shorter than normal siblings. The family height analysis suggests that the effect of SHOX haploinsufficiency on growth may have been previously underestimated at birth and overestimated in males at final height. SHOX haploinsufficiency leads to short arms in 92%, bilateral Madelung deformity in 73% and short stature in 54%. Females were more severely affected than males. We conclude that SHOX is a major growth gene and that mutations are associated with a broad range of phenotype.
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Affiliation(s)
- C F J Munns
- Endocrine and Diabetes Research Unit, Royal Children's Hospital Foundation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.
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Zinn AR, Wei F, Zhang L, Elder FF, Scott CI, Marttila P, Ross JL. Complete SHOX deficiency causes Langer mesomelic dysplasia. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 110:158-63. [PMID: 12116254 DOI: 10.1002/ajmg.10422] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The SHOX (short-stature homeobox-containing) gene encodes isoforms of a homeodomain transcription factor important in human limb development. SHOX haploinsufficiency has been implicated in three human growth disorders: Turner syndrome, idiopathic short stature, and Leri-Weill dyschondrosteosis. Langer mesomelic dysplasia is thought to be the homozygous form of dyschondrosteosis. However, complete SHOX deficiency has not been demonstrated for any postnatal patient with the classic Langer phenotype. We studied four adults and one child with Langer mesomelic dysplasia. SHOX abnormalities were detected in all five probands. One was a homozygote or hemizygote and two were compound heterozygotes. The homozygous or hemizygous mutation was in exon 6a, implying that the SHOXa isoform is essential for normal skeletal development. These findings confirm clinical inferences that Langer mesomelic dysplasia is the homozygous form of Leri-Weill dyschondrosteosis and add to our understanding of genotype/phenotype relationships in SHOX deficiency disorders.
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Affiliation(s)
- Andrew R Zinn
- McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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