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Kanwar K, Bashey S, Bohnsack BL, Drackley A, Ing A, Rahmani S, Ranaivo HR, McMullen P, Skol A, Yap K, Allegretti V, Rossen JL. Ocular manifestations of CHARGE syndrome in a pediatric cohort with genotype/phenotype analysis. Am J Med Genet A 2024; 194:e63618. [PMID: 38597178 DOI: 10.1002/ajmg.a.63618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
CHARGE syndrome is a rare multi-system condition associated with CHD7 variants. However, ocular manifestations and particularly ophthalmic genotype-phenotype associations, are not well-studied. This study evaluated ocular manifestations and genotype-phenotype associations in pediatric patients with CHARGE syndrome. A retrospective chart review included pediatric patients under 20 years-old with clinical diagnosis of CHARGE syndrome and documented ophthalmic examination. Demographics, genetic testing, and ocular findings were collected. Comprehensive literature review enhanced the genotype-phenotype analysis. Forty-two patients (20 male) underwent eye examination at an average age of 9.45 ± 6.52 years-old. Thirty-nine (93%) had ophthalmic manifestations in at least one eye. Optic nerve/chorioretinal colobomas were most common (38 patients), followed by microphthalmia (13), cataract (6), and iris colobomas (4). Extraocular findings included strabismus (32 patients), nasolacrimal duct obstructions (11, 5 with punctal agenesis), and cranial nerve VII palsy (10). Genotype-phenotype analyses (27 patients) showed variability in ocular phenotypes without association to location or variant types. Splicing (10 patients) and frameshift (10) variants were most prevalent. Patients with CHARGE syndrome may present with a myriad of ophthalmic manifestations. There is limited data regarding genotype-phenotype correlations and additional studies are needed.
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Affiliation(s)
- Kunal Kanwar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Saffiya Bashey
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Brenda L Bohnsack
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Andy Drackley
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alexander Ing
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Safa Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Hantamalala Ralay Ranaivo
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Patrick McMullen
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Andrew Skol
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kailee Yap
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Valerie Allegretti
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jennifer L Rossen
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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2
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Stamou MI, Brand H, Wang M, Wong I, Lippincott MF, Plummer L, Crowley WF, Talkowski M, Seminara S, Balasubramanian R. Prevalence and Phenotypic Effects of Copy Number Variants in Isolated Hypogonadotropic Hypogonadism. J Clin Endocrinol Metab 2022; 107:2228-2242. [PMID: 35574646 PMCID: PMC9282252 DOI: 10.1210/clinem/dgac300] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT The genetic architecture of isolated hypogonadotropic hypogonadism (IHH) has not been completely defined. OBJECTIVE To determine the role of copy number variants (CNVs) in IHH pathogenicity and define their phenotypic spectrum. METHODS Exome sequencing (ES) data in IHH probands (n = 1394) (Kallmann syndrome [IHH with anosmia; KS], n = 706; normosmic IHH [nIHH], n = 688) and family members (n = 1092) at the Reproductive Endocrine Unit and the Center for Genomic Medicine of Massachusetts General Hospital were analyzed for CNVs and single nucleotide variants (SNVs)/indels in 62 known IHH genes. IHH subjects without SNVs/indels in known genes were considered "unsolved." Phenotypes associated with CNVs were evaluated through review of patient medical records. A total of 29 CNVs in 13 genes were detected (overall IHH cohort prevalence: ~2%). Almost all (28/29) CNVs occurred in unsolved IHH cases. While some genes (eg, ANOS1 and FGFR1) frequently harbor both CNVs and SNVs/indels, the mutational spectrum of others (eg, CHD7) was restricted to SNVs/indels. Syndromic phenotypes were seen in 83% and 63% of IHH subjects with multigenic and single gene CNVs, respectively. CONCLUSION CNVs in known genes contribute to ~2% of IHH pathogenesis. Predictably, multigenic contiguous CNVs resulted in syndromic phenotypes. Syndromic phenotypes resulting from single gene CNVs validate pleiotropy of some IHH genes. Genome sequencing approaches are now needed to identify novel genes and/or other elusive variants (eg, noncoding/complex structural variants) that may explain the remaining missing etiology of IHH.
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Affiliation(s)
- Maria I Stamou
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
| | - Harrison Brand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02141, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02141, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02141, USA
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA 02141, USA
| | - Mei Wang
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
| | - Isaac Wong
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02141, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02141, USA
| | - Margaret F Lippincott
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
| | - Lacey Plummer
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
| | - William F Crowley
- Endocrine Division, Massachusetts General Hospital, Boston, MA 02141, USA
| | - Michael Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02141, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02141, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02141, USA
| | - Stephanie Seminara
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
| | - Ravikumar Balasubramanian
- Reproductive Endocrine Unit, Massachusetts General Hospital and the Center for Reproductive Medicine, Boston, MA 02141, USA
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3
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Bélanger C, Cardinal T, Leduc E, Viger RS, Pilon N. CHARGE syndrome-associated proteins FAM172A and CHD7 influence male sex determination and differentiation through transcriptional and alternative splicing mechanisms. FASEB J 2022; 36:e22176. [PMID: 35129866 PMCID: PMC9304217 DOI: 10.1096/fj.202100837rr] [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: 05/27/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/11/2022]
Abstract
To gain further insight into chromatin‐mediated regulation of mammalian sex determination, we analyzed the role of the CHARGE syndrome‐associated proteins FAM172A and CHD7. This study is based on our prior discoveries that a subset of corresponding mutant mice display complete male‐to‐female sex reversal, and that both of these proteins regulate co‐transcriptional alternative splicing in neural crest cells. Here, we report that FAM172A and CHD7 are present in the developing gonads when sex determination normally occurs in mice. The interactome of FAM172A in pre‐Sertoli cells again suggests a role at the chromatin‐spliceosome interface, like in neural crest cells. Accordingly, analysis of Fam172a‐mutant pre‐Sertoli cells revealed transcriptional and splicing dysregulation of hundreds of genes. Many of these genes are similarly affected in Chd7‐mutant pre‐Sertoli cells, including several known key regulators of sex determination and subsequent formation of testis cords. Among them, we notably identified Sry as a direct transcriptional target and WNT pathway‐associated Lef1 and Tcf7l2 as direct splicing targets. The identified molecular defects are also associated with the abnormal morphology of seminiferous tubules in mutant postnatal testes. Altogether, our results thus identify FAM172A and CHD7 as new players in the regulation of male sex determination and differentiation in mice, and further highlight the importance of chromatin‐mediated regulatory mechanisms in these processes.
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Affiliation(s)
- Catherine Bélanger
- Molecular Genetics of Development Laboratory, Département des Sciences Biologiques, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.,Centre d'Excellence en Recherche sur les Maladies Orphelines - Fondation Courtois (CERMO-FC), Université du Québec à Montréal, Montréal, Québec, Canada
| | - Tatiana Cardinal
- Molecular Genetics of Development Laboratory, Département des Sciences Biologiques, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.,Centre d'Excellence en Recherche sur les Maladies Orphelines - Fondation Courtois (CERMO-FC), Université du Québec à Montréal, Montréal, Québec, Canada
| | - Elizabeth Leduc
- Molecular Genetics of Development Laboratory, Département des Sciences Biologiques, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.,Centre d'Excellence en Recherche sur les Maladies Orphelines - Fondation Courtois (CERMO-FC), Université du Québec à Montréal, Montréal, Québec, Canada
| | - Robert S Viger
- Reproduction, Mother and Child Health, Centre de recherche en reproduction, développement et santé intergénérationnelle (CRDSI), Centre de recherche du CHU de Québec-Université Laval, Quebec City, Québec, Canada.,Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
| | - Nicolas Pilon
- Molecular Genetics of Development Laboratory, Département des Sciences Biologiques, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.,Centre d'Excellence en Recherche sur les Maladies Orphelines - Fondation Courtois (CERMO-FC), Université du Québec à Montréal, Montréal, Québec, Canada.,Département de pédiatrie, Université de Montréal, Montréal, Québec, Canada
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Li JD, Wu J, Zhao Y, Wang X, Jiang F, Hou Q, Chen DN, Zheng R, Yu R, Zhou W, Men M. Phenotypic Spectrum of Idiopathic Hypogonadotropic Hypogonadism Patients With CHD7 Variants From a Large Chinese Cohort. J Clin Endocrinol Metab 2020; 105:5613538. [PMID: 31689711 DOI: 10.1210/clinem/dgz182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/01/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Idiopathic hypogonadotropic hypogonadism (IHH) and CHARGE (C, coloboma; H, heart abnormalities; A, choanal atresia, R, retardation of growth and/or development; G, gonadal defects; E, ear deformities and deafness) syndrome are 2 distinct developmental disorders sharing features of hypogonadism and/or impaired olfaction. CHD7 variants contribute to >60% CHARGE syndrome and ~10% IHH patients. A variety of extended CHARGE-like features are frequently reported in CHARGE patients harboring CHD7 variants. In this study, we aimed to systematically analyze the diagnostic CHARGE features and the extended CHARGE-like features in patients with IHH with CHD7 variants. METHODS Rare sequencing variants (RSVs) in CHD7 were identified through exome sequencing in 177 IHH probands. Detailed phenotyping was performed in the IHH patients harboring CHD7 variants and their available family members. RESULTS CHD7 RSVs were identified in 10.2% (18/177) of the IHH probands. Two diagnostic CHARGE features, hearing loss and ear deformities, were significantly enriched in patients with CHD7 variants. Furthermore, CHD7 variants were significantly associated with a panel of extended CHARGE-like phenotypes, including mild ocular defects, dyspepsia/gastroesophageal reflux disease and skeletal defects. We also developed a predictive model for prioritizing CHD7 genetic testing in IHH patients. CONCLUSION CHD7 variants rarely cause isolated IHH. Surveillance of symptoms in CHARGE syndrome-affected organs will facilitate the proper treatment for these patients. Certain clinical features can be useful for prioritizing CHD7 genetic screening.
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Affiliation(s)
- Jia-Da Li
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
| | - Jiayu Wu
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yaguang Zhao
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
| | - Xinying Wang
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
| | - Fang Jiang
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
| | - Qiao Hou
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
| | - Dan-Na Chen
- Department of Basic Medical Sciences, Changsha Medical University, Changsha, Hunan, China
| | - Ruizhi Zheng
- Department of Endocrinology, The People's Hospital of Henan Province, Zhengzhou, Henan, China
| | - Renhe Yu
- School of Public Health, Xiangya, Central South University, Changsha, Hunan, China
| | - Wei Zhou
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Meichao Men
- School of Life Sciences, Central South University, Changsha, Hunan, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
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5
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de Geus CM, Free RH, Verbist BM, Sival DA, Blake KD, Meiners LC, van Ravenswaaij‐Arts CMA. Guidelines in CHARGE syndrome and the missing link: Cranial imaging. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2017; 175:450-464. [PMID: 29168326 PMCID: PMC5765497 DOI: 10.1002/ajmg.c.31593] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
"CHARGE syndrome" is a complex syndrome with high and extremely variable comorbidity. As a result, clinicians may struggle to provide accurate and comprehensive care, and this has led to the publication of several clinical surveillance guidelines and recommendations for CHARGE syndrome, based on both single case observations and cohort studies. Here we perform a structured literature review to examine all the existing advice. Our findings provide additional support for the validity of the recently published Trider checklist. We also identified a gap in literature when reviewing all guidelines and recommendations, and we propose a guideline for neuroradiological evaluation of patients with CHARGE syndrome. This is of importance, as patients with CHARGE are at risk for peri-anesthetic complications, making recurrent imaging procedures under anesthesia a particular risk in clinical practice. However, comprehensive cranial imaging is also of tremendous value for timely diagnosis, proper treatment of symptoms and for further research into CHARGE syndrome. We hope the guideline for neuroradiological evaluation will help clinicians provide efficient and comprehensive care for individuals with CHARGE syndrome.
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Affiliation(s)
- Christa M. de Geus
- University of Groningen, University Medical Center GroningenCenter of Expertise for CHARGE syndromeGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenDepartment of GeneticsGroningenThe Netherlands
| | - Rolien H. Free
- University of Groningen, University Medical Center GroningenCenter of Expertise for CHARGE syndromeGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenDepartment of ENTGroningenThe Netherlands
| | - Berit M. Verbist
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of RadiologyRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
| | - Deborah A. Sival
- University of Groningen, University Medical Center GroningenCenter of Expertise for CHARGE syndromeGroningenThe Netherlands
- University of Groningen, Beatrix Children's HospitalUniversity Medical Center Groningen, department of PediatricsGroningenThe Netherlands
| | - Kim D. Blake
- IWK Health CentreHalifaxNova ScotiaCanada
- Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Linda C. Meiners
- University of Groningen, University Medical Center GroningenCenter of Expertise for CHARGE syndromeGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenDepartment of RadiologyGroningenThe Netherlands
| | - Conny M. A. van Ravenswaaij‐Arts
- University of Groningen, University Medical Center GroningenCenter of Expertise for CHARGE syndromeGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenDepartment of GeneticsGroningenThe Netherlands
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6
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van Ravenswaaij-Arts C, Martin DM. New insights and advances in CHARGE syndrome: Diagnosis, etiologies, treatments, and research discoveries. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:397-406. [PMID: 29171162 DOI: 10.1002/ajmg.c.31592] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 01/17/2023]
Abstract
CHARGE syndrome is a multiple congenital anomaly condition caused, in a majority of individuals, by loss of function pathogenic variants in the gene CHD7. In this special issue of the American Journal of Medical Genetics part C, authors of eleven manuscripts describe specific organ system features of CHARGE syndrome, with a focus on recent developments in diagnosis, etiologies, and treatments. Since 2004, when CHD7 was identified as the major causative gene in CHARGE, several animal models (mice, zebrafish, flies, and frog) and cell-based systems have been developed to explore the underlying pathophysiology of this condition. In this article, we summarize those advances, highlight opportunities for new discoveries, and encourage readers to explore specific organ systems in more detail in each individual article. We hope the excitement around innovative research and development in CHARGE syndrome will encourage others to join this effort, and will stimulate other investigators and professionals to engage with individuals diagnosed as having CHARGE syndrome, their families, and their care providers.
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Affiliation(s)
- Conny van Ravenswaaij-Arts
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Donna M Martin
- Departments of Human Genetics, The University of Michigan Medical School, Ann Arbor, Michigan.,Departments of Pediatrics, The University of Michigan Medical School, Ann Arbor, Michigan
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7
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CT findings of the temporal bone in CHARGE syndrome: aspects of importance in cochlear implant surgery. Eur Arch Otorhinolaryngol 2016; 273:4225-4240. [PMID: 27324890 PMCID: PMC5104824 DOI: 10.1007/s00405-016-4141-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
To provide an overview of anomalies of the temporal bone in CHARGE syndrome relevant to cochlear implantation (CI), anatomical structures of the temporal bone and the respective genotypes were analysed. In this retrospective study, 42 CTs of the temporal bone of 42 patients with CHARGE syndrome were reviewed in consensus by two head-and-neck radiologists and two otological surgeons. Anatomical structures of the temporal bone were evaluated and correlated with genetic data. Abnormalities that might affect CI surgery were seen, such as a vascular structure, a petrosquamosal sinus (13 %), an underdeveloped mastoid (8 %) and an aberrant course of the facial nerve crossing the round window (9 %) and/or the promontory (18 %). The appearance of the inner ear varied widely: in 77 % of patients all semicircular canals were absent and the cochlea varied from normal to hypoplastic. A stenotic cochlear aperture was observed in 37 %. The middle ear was often affected with a stenotic round (14 %) or oval window (71 %). More anomalies were observed in patients with truncating mutations than with non-truncating mutations. Temporal bone findings in CHARGE syndrome vary widely. Vascular variants, aberrant route of the facial nerve, an underdeveloped mastoid, aplasia of the semicircular canals, and stenotic round window may complicate cochlear implantation.
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8
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Hsu P, Ma A, Barnes EH, Wilson M, Hoefsloot LH, Rinne T, Munns C, Williams G, Wong M, Mehr S. The Immune Phenotype of Patients with CHARGE Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:96-103.e2. [PMID: 26563674 DOI: 10.1016/j.jaip.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/19/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrent sinopulmonary infections are common in children with CHARGE (Coloboma, Heart disease, choanal Atresia, growth/mental Retardation, Genitourinary malformations, Ear abnormalities) syndrome, but no prospective studies on immune function have been conducted. OBJECTIVE This study aims to examine and compare the immune phenotype of patients with CHARGE syndrome to those with 22q11.2 deletion and healthy controls. METHODS A total of 21 patients attended a multidisciplinary CHARGE clinic. All patients had CHD7 mutational analysis performed. Patients with CHARGE syndrome had lymphocyte subsets, immunoglobulins (IgG, A, M), functional protein, and polysaccharide vaccine responses measured at initial evaluation. A total of 55 healthy controls were prospectively recruited, whereas 40 patients with 22q11.2 deletion were retrospectively identified through medical records. A separate analysis compared serial lymphocyte counts and ionized calcium levels between patients with CHARGE syndrome and those with 22q11.2 deletion in the first 72 months of life. RESULTS Despite recurrent childhood ear and chest infections, only 2 children with CHARGE syndrome had an identifiable immune defect (reduced serum IgA). In contrast, T-cell lymphopenia, low immunoglobulin levels, and specific antibody deficiency were noted in patients with 22q11.2 deletion. A greater proportion of patients with 22q11.2 deletion had persistent lymphopenia (57% vs 30%) and hypocalcemia (60% vs 37.5%) compared with patients with CHARGE syndrome in the first 72 months of life. CONCLUSIONS Although phenotypic overlap exists between CHARGE and 22q11.2 deletion syndromes, no significant immune defects were detected in this cohort of patients with CHARGE syndrome at the time of testing. Lymphopenia and hypocalcemia occur in both conditions early in life, but is more pronounced in patients with 22q11.2 deletion.
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Affiliation(s)
- Peter Hsu
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, Australia.
| | - Alan Ma
- Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, Australia
| | - Elizabeth H Barnes
- Biostatistics, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Meredith Wilson
- Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, Australia
| | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Tuula Rinne
- Department of Human Genetics, Radbound University Medical Centre, Nijmegen, the Netherlands
| | - Craig Munns
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - George Williams
- Department of Paediatrics, St George Private Hospital, Sydney, Australia
| | - Melanie Wong
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, Australia
| | - Sam Mehr
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, Australia
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9
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Cerebellar vermis hypoplasia in CHARGE syndrome: clinical and molecular characterization of 18 unrelated Korean patients. J Hum Genet 2015; 61:235-9. [PMID: 26538304 DOI: 10.1038/jhg.2015.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 01/25/2023]
Abstract
CHARGE syndrome (OMIM 214800) is a rare autosomal-dominant congenital malformation syndrome that results from haploinsufficiency of the chromodomain helicase DNA-binding protein 7 (CHD7). We performed a phenotypic characterization and genetic analysis of CHD7 in 18 Korean patients with CHARGE syndrome. Eighteen unrelated Korean patients (10 females and 8 males; age range 0.0-19.6 years) with CHARGE syndrome were enrolled. Clinical data were collected by retrospective review of medical records. A serial analysis via sequencing and multiple ligation-dependent probe amplification of CHD7 was performed to determine the molecular genetic spectrum of the patients. The prevalence of cardinal symptoms was as follows: coloboma (13/18, 72.2%), heart defects (13/18, 72.2%), choanal atresia/stenosis (4/18, 22.2%), retarded growth (10/18, 55.6%), genital anomalies (15/18, 83.3%) and ear abnormalities (18/18, 100%). Five patients had cerebellar vermis hypoplasia (5/17, 29.4%) with no clinical symptoms or signs of cerebellar dysfunction. Furthermore, we identified genetic alterations in all 18 patients, including 10 novel mutations. Considering its frequency among patients with CHD7 mutations, cerebellar vermis hypoplasia may be a clinical diagnostic clue of CHARGE syndrome, although it is not included in the diagnostic criteria. And, the identification of CHD7 mutations may help the confirmative diagnosis.
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10
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van Ravenswaaij-Arts CMA, Blake K, Hoefsloot L, Verloes A. Clinical utility gene card for: CHARGE syndrome - update 2015. Eur J Hum Genet 2015; 23:ejhg201515. [PMID: 25689928 DOI: 10.1038/ejhg.2015.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/05/2014] [Accepted: 01/13/2015] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Kim Blake
- Department of Pediatrics, IWK Health Centre, Dalhouse University, Halifax, Nova Scotia, Canada
| | - Lies Hoefsloot
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Alain Verloes
- Department of Medical Genetics, APHP-Robert DEBRE University Hospital, Paris, France
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11
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Corsten-Janssen N, du Marchie Sarvaas GJ, Kerstjens-Frederikse WS, Hoefsloot LH, van Beynum IM, Kapusta L, van Ravenswaaij-Arts CM. CHD7 mutations are not a major cause of atrioventricular septal and conotruncal heart defects. Am J Med Genet A 2014; 164A:3003-9. [DOI: 10.1002/ajmg.a.36747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Nicole Corsten-Janssen
- University of Groningen, University Medical Center Groningen, Department of Genetics; Groningen Netherlands
| | - Gideon J. du Marchie Sarvaas
- University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases; Groningen Netherlands
| | | | - Lies H. Hoefsloot
- Department of Genetics; Radboud University Nijmegen Medical Center; Nijmegen Netherlands
- Department of Genetics; Erasmus Medical Center; Rotterdam Netherlands
| | - Ingrid M. van Beynum
- Children's Heart Center; Radboud University Nijmegen Medical Center; Nijmegen Netherlands
- Department of Pediatric Cardiology; Erasmus Medical Center; Rotterdam Netherlands
| | - Livia Kapusta
- Children's Heart Center; Radboud University Nijmegen Medical Center; Nijmegen Netherlands
- Pediatric Cardiology; Dana-Dwek Children's Hospital Sourasky Medical Center; Tel Aviv University; Tel Aviv Israel
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12
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Corsten-Janssen N, Kerstjens-Frederikse WS, du Marchie Sarvaas GJ, Baardman ME, Bakker MK, Bergman JE, Hove HD, Heimdal KR, Rustad CF, Hennekam RC, Hofstra RM, Hoefsloot LH, Van Ravenswaaij-Arts CM, Kapusta L. The Cardiac Phenotype in Patients With a
CHD7
Mutation. ACTA ACUST UNITED AC 2013; 6:248-54. [DOI: 10.1161/circgenetics.113.000054] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Loss-of-function mutations in
CHD7
cause Coloboma, Heart Disease, Atresia of Choanae, Retardation of Growth and/or Development, Genital Hypoplasia, and Ear Abnormalities With or Without Deafness (CHARGE) syndrome, a variable combination of multiple congenital malformations including heart defects. Heart defects are reported in 70% to 92% of patients with a
CHD7
mutation, but most studies are small and do not provide a detailed classification of the defects. We present the first, detailed, descriptive study on the cardiac phenotype of 299 patients with a
CHD7
mutation and discuss the role of CHD7 in cardiac development.
Methods and Results—
We collected information on congenital heart defects in 299 patients with a pathogenic
CHD7
mutation, of whom 220 (74%) had a congenital heart defect. Detailed information on the heart defects was available for 202 of these patients. We classified the heart defects based on embryonic cardiac development and compared the distribution to 1007 equally classified nonsyndromic heart defects of patients registered by EUROCAT, a European Registry of Congenital Anomalies. Heart defects are highly variable in patients with
CHD7
mutations, but atrioventricular septal defects and conotruncal heart defects are over-represented. Sex did not have an effect on the presence of heart defects, but truncating
CHD7
mutations resulted in a heart defect significantly more often than missense or splice-site mutations (χ
2
,
P
<0.001).
Conclusions—
CHD7 plays an important role in cardiac development, given that we found a wide range of heart defects in 74% of a large cohort of patients with a CHD7 mutation. Conotruncal defects and atrioventricular septal defects are over-represented in patients with
CHD7
mutations compared with patients with nonsyndromic heart defects.
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Affiliation(s)
- Nicole Corsten-Janssen
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Wilhelmina S. Kerstjens-Frederikse
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Gideon J. du Marchie Sarvaas
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Maria E. Baardman
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Marian K. Bakker
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Jorieke E.H. Bergman
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Hanne D. Hove
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Ketil R. Heimdal
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Cecilie F. Rustad
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Raoul C.M. Hennekam
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Robert M.W. Hofstra
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Lies H. Hoefsloot
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Conny M.A. Van Ravenswaaij-Arts
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
| | - Livia Kapusta
- From the Department of Genetics (N.C.-J., W.S.K.-F., M.E.B., M.K.B., J.E.H.B., C.M.A.V.R.-A.) and Center for Congenital Heart Diseases (G.J.d.M.S.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark (H.D.H.); Department of Medical Genetics, Oslo University Hospital, Oslo, Norway (K.R.H., C.F.R.); Department of Pediatrics and Genetics, Academic Medical Center, University of Amsterdam,
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13
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Corsten-Janssen N, Saitta SC, Hoefsloot LH, McDonald-McGinn DM, Driscoll DA, Derks R, Dickinson KA, Kerstjens-Frederikse WS, Emanuel BS, Zackai EH, van Ravenswaaij-Arts CMA. More Clinical Overlap between 22q11.2 Deletion Syndrome and CHARGE Syndrome than Often Anticipated. Mol Syndromol 2013; 4:235-45. [PMID: 23885230 DOI: 10.1159/000351127] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 12/15/2022] Open
Abstract
CHARGE (coloboma, heart defects, atresia of choanae, retardation of growth and development, genital hypoplasia, and ear abnormalities) and 22q11.2 deletion syndromes are variable, congenital malformation syndromes that show considerable phenotypic overlap. We further explored this clinical overlap and proposed recommendations for the genetic diagnosis of both syndromes. We described 2 patients clinically diagnosed with CHARGE syndrome, who were found to carry a 22q11.2 deletion, and searched the literature for more cases. In addition, we screened our cohort of CHD7 mutation carriers (n = 802) for typical 22q11.2 deletion features and studied CHD7 in 20 patients with phenotypically 22q11.2 deletion syndrome but without haploinsufficiency of TBX1. In total, we identified 5 patients with a clinical diagnosis of CHARGE syndrome and a proven 22q11.2 deletion. Typical 22q11.2 deletion features were found in 30 patients (30/802, 3.7%) of our CHD7 mutation-positive cohort. We found truncating CHD7 mutations in 5/20 patients with phenotypically 22q11.2 deletion syndrome. Differentiating between CHARGE and 22q11.2 deletion syndromes can be challenging. CHD7 and TBX1 probably share a molecular pathway or have common target genes in affected organs. We strongly recommend performing CHD7 analysis in patients with a 22q11.2 deletion phenotype without TBX1 haploinsufficiency and conversely, performing a genome-wide array in CHARGE syndrome patients without a CHD7 mutation.
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Affiliation(s)
- N Corsten-Janssen
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands
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14
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Bergman JEH, Janssen N, van der Sloot AM, de Walle HEK, Schoots J, Rendtorff ND, Tranebjaerg L, Hoefsloot LH, van Ravenswaaij-Arts CMA, Hofstra RMW. A novel classification system to predict the pathogenic effects of CHD7 missense variants in CHARGE syndrome. Hum Mutat 2012; 33:1251-60. [PMID: 22539353 DOI: 10.1002/humu.22106] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 04/10/2012] [Indexed: 01/16/2023]
Abstract
CHARGE syndrome is characterized by the variable occurrence of multisensory impairment, congenital anomalies, and developmental delay, and is caused by heterozygous mutations in the CHD7 gene. Correct interpretation of CHD7 variants is essential for genetic counseling. This is particularly difficult for missense variants because most variants in the CHD7 gene are private and a functional assay is not yet available. We have therefore developed a novel classification system to predict the pathogenic effects of CHD7 missense variants that can be used in a diagnostic setting. Our classification system combines the results from two computational algorithms (PolyPhen-2 and Align-GVGD) and the prediction of a newly developed structural model of the chromo- and helicase domains of CHD7 with segregation and phenotypic data. The combination of different variables will lead to a more confident prediction of pathogenicity than was previously possible. We have used our system to classify 145 CHD7 missense variants. Our data show that pathogenic missense mutations are mainly present in the middle of the CHD7 gene, whereas benign variants are mainly clustered in the 5' and 3' regions. Finally, we show that CHD7 missense mutations are, in general, associated with a milder phenotype than truncating mutations.
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Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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15
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Janssen N, Bergman JEH, Swertz MA, Tranebjaerg L, Lodahl M, Schoots J, Hofstra RMW, van Ravenswaaij-Arts CMA, Hoefsloot LH. Mutation update on the CHD7 gene involved in CHARGE syndrome. Hum Mutat 2012; 33:1149-60. [DOI: 10.1002/humu.22086] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 03/06/2012] [Indexed: 12/17/2022]
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16
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Bilan F, Legendre M, Charraud V, Manière B, Couet D, Gilbert-Dussardier B, Kitzis A. Complete Screening of 50 Patients with CHARGE Syndrome for Anomalies in the CHD7 Gene Using a Denaturing High-Performance Liquid Chromatography–Based Protocol. J Mol Diagn 2012; 14:46-55. [DOI: 10.1016/j.jmoldx.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/07/2011] [Accepted: 08/02/2011] [Indexed: 10/16/2022] Open
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17
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Bartels CF, Scacheri C, White L, Scacheri PC, Bale S. Mutations in the CHD7 gene: the experience of a commercial laboratory. Genet Test Mol Biomarkers 2011; 14:881-91. [PMID: 21158681 DOI: 10.1089/gtmb.2010.0101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CHARGE syndrome is an autosomal dominant multisystem disorder caused by mutation in the CHD7 gene, encoding chromodomain helicase DNA-binding protein 7. Molecular diagnostic testing for CHD7 mutation has been available in a clinical setting since 2005. We report here the results from the first 642 unrelated proband samples submitted for testing. Thirty-two percent (n = 203) of patient samples had a heterozygous pathogenic variant identified. The lower mutation rate than that published for well-characterized clinical samples is likely due to referral bias, as samples submitted for clinical testing may be for "rule-out" diagnoses, rather than solely to confirm clinical suspicion. We identified 159 unique pathogenic mutations, and of these, 134 mutations were each seen in a single individual and 25 mutations were found in two to five individuals (n =69). Of the 203 mutations, only 9 were missense, with 107 nonsense, 69 frameshift, and 15 splice-site mutations likely leading to haploinsufficiency at the cellular level. An additional 72 variations identified in the 642 tested samples (11%) were considered to have unknown clinical significance. Copy number changes (deletion/duplication of the entire gene or one/several exons) were found to account for a very small number of cases (n = 3). This cohort represents the largest CHARGE syndrome sample size to date and is intended to serve as a resource for clinicians, genetic counselors, researchers, and other diagnostic laboratories.
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Affiliation(s)
- Cynthia F Bartels
- Department of Genetics, Case Western Reserve University, Cleveland, Ohio 44016, USA
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18
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19
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Bergman JEH, Bocca G, Hoefsloot LH, Meiners LC, van Ravenswaaij-Arts CMA. Anosmia predicts hypogonadotropic hypogonadism in CHARGE syndrome. J Pediatr 2011; 158:474-9. [PMID: 20884005 DOI: 10.1016/j.jpeds.2010.08.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/20/2010] [Accepted: 08/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the hypothesis that a smell test could predict the occurrence of hypogonadotropic hypogonadism (HH) in patients with CHARGE syndrome, which is a variable combination of ocular coloboma, heart defects, choanal atresia, retardation of growth/development, genital hypoplasia, and ear anomalies or hearing loss caused by mutations in the CHD7 (chromodomain helicase DNA binding protein 7) gene. STUDY DESIGN We performed endocrine studies and smell testing (University of Pennsylvania Smell Identification Test) in 35 adolescent patients with molecularly confirmed CHARGE syndrome. RESULTS Complete data on smell and puberty were available for 15 patients; 11 patients had both anosmia and HH, whereas 4 patients had normosmia/hyposmia and spontaneous puberty. In addition, 7 boys were highly suspected of having HH (they were too young for definite HH diagnosis, but all had cryptorchidism, micropenis, or both) and had anosmia. The type of CHD7 mutation could not predict HH because a father and daughter with the same CHD7 mutation were discordant for HH and anosmia. CONCLUSION Anosmia and HH were highly correlated in our cohort, and therefore smell testing seems to be an attractive method for predicting the occurrence of HH in patients with CHARGE syndrome. The use of this test could prevent delay of hormonal pubertal induction, resulting in an age-appropriate puberty.
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Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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20
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Hartshorne TS, Stratton KK, van Ravenswaaij-Arts CMA. Prevalence of Genetic Testing in CHARGE Syndrome. J Genet Couns 2010; 20:49-57. [DOI: 10.1007/s10897-010-9328-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 09/05/2010] [Indexed: 01/08/2023]
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21
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Foppiani L, Maffè A, Forzano F. CHARGE syndrome as unusual cause of hypogonadism: endocrine and molecular evaluation. Andrologia 2010; 42:326-30. [DOI: 10.1111/j.1439-0272.2009.00994.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Wessels K, Bohnhorst B, Luhmer I, Morlot S, Bohring A, Jonasson J, Epplen JT, Gadzicki D, Glaser S, Göhring G, Mälzer M, Hein A, Arslan-Kirchner M, Stuhrmann M, Schmidtke J, Pabst B. Novel CHD7 mutations contributing to the mutation spectrum in patients with CHARGE syndrome. Eur J Med Genet 2010; 53:280-5. [PMID: 20624498 DOI: 10.1016/j.ejmg.2010.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 07/04/2010] [Indexed: 10/19/2022]
Abstract
CHARGE syndrome is an autosomal dominant inherited multiple malformation disorder typically characterized by coloboma, choanal atresia, hypoplastic semicircular canal, cranial nerve defects, cardiovascular malformations and ear abnormalities. Mutations in the chromodomain helicase DNA-binding protein 7 (CHD7) gene are the major cause of CHARGE syndrome. Mutation analysis was performed in 18 patients with firm or tentative clinical diagnosis of CHARGE syndrome. In this study eight mutations distributed across the gene were found. Five novel mutations - one missense (c.2936T > C), one nonsense (c.8093C > A) and three frameshift mutations (c.804_805insAT, c.1757_1770del14, c.1793delA) - were identified. As far as familial data were available these mutations were found to have arisen de novo. Comparison of the clinical features of patients with the same mutation demonstrates that expression of the phenotype is highly variable. The mutation detection rate in this study was 44.4% in patients with a clinically established or suspected diagnosis of CHARGE syndrome.
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Affiliation(s)
- Kathrin Wessels
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
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23
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Zentner GE, Layman WS, Martin DM, Scacheri PC. Molecular and phenotypic aspects of CHD7 mutation in CHARGE syndrome. Am J Med Genet A 2010; 152A:674-86. [PMID: 20186815 DOI: 10.1002/ajmg.a.33323] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CHARGE syndrome [coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and/or development, genital and/or urinary abnormalities, and ear abnormalities (including deafness)] is a genetic disorder characterized by a specific and a recognizable pattern of anomalies. De novo mutations in the gene encoding chromodomain helicase DNA binding protein 7 (CHD7) are the major cause of CHARGE syndrome. Here, we review the clinical features of 379 CHARGE patients who tested positive or negative for mutations in CHD7. We found that CHARGE individuals with CHD7 mutations more commonly have ocular colobomas, temporal bone anomalies (semicircular canal hypoplasia/dysplasia), and facial nerve paralysis compared with mutation negative individuals. We also highlight recent genetic and genomic studies that have provided functional insights into CHD7 and the pathogenesis of CHARGE syndrome.
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Affiliation(s)
- Gabriel E Zentner
- Department of Genetics, Case Western Reserve University, Cleveland, Ohio, USA
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24
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Layman WS, Hurd EA, Martin DM. Chromodomain proteins in development: lessons from CHARGE syndrome. Clin Genet 2010; 78:11-20. [PMID: 20507341 DOI: 10.1111/j.1399-0004.2010.01446.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In humans, heterozygous mutations in the adenosine triphosphate-dependent chromatin remodeling gene CHD7 cause CHARGE syndrome, a common cause of deaf-blindness, balance disorders, congenital heart malformations, and olfactory dysfunction with an estimated incidence of approximately 1 in 10,000 newborns. The clinical features of CHARGE in humans and mice are highly variable and incompletely penetrant, and most mutations appear to result in haploinsufficiency of functional CHD7 protein. Mice with heterozygous loss of function mutations in Chd7 are a good model for CHARGE syndrome, and analyses of mouse mutant phenotypes have begun to clarify a role for CHD7 during development and into adulthood. Chd7 heterozygous mutant mice have postnatal delayed growth, inner ear malformations, anosmia/hyposmia, and craniofacial defects, and Chd7 homozygous mutants are embryonic lethal. A central question in developmental biology is how chromodomain proteins like CHD7 regulate important developmental processes, and whether they directly activate or repress downstream gene transcription or act more globally to alter chromatin structure and/or function. CHD7 is expressed in a wide variety of tissues during development, suggesting that it has tissue-specific and developmental stage-specific roles. Here, we review recent and ongoing analyses of CHD7 function in mouse models and cell-based systems. These studies explore tissue-specific effects of CHD7 deficiency, known CHD7 interacting proteins, and downstream target sites for CHD7 binding. CHD7 is emerging as a critical regulator of important developmental processes in organs affected by human CHARGE syndrome.
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Affiliation(s)
- W S Layman
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
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25
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Wincent J, Schulze A, Schoumans J. Detection of CHD7 deletions by MLPA in CHARGE syndrome patients with a less typical phenotype. Eur J Med Genet 2009; 52:271-2. [PMID: 19248844 DOI: 10.1016/j.ejmg.2009.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/16/2009] [Indexed: 10/21/2022]
Abstract
Bergman et al. performed a search for exon copy number alterations in the CHD7 gene using MLPA in CHARGE syndrome patients who did not have a CHD7 mutation. Based on their results they recommended to extend testing using MLPA solely in individuals with a typical CHARGE syndrome phenotype. However, since we have found deletions comprising the CHD7 gene in three patients with a less typical phenotype we recommend performing MLPA testing in all CHARGE syndrome patients without causal CHD7 mutations.
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26
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Jongmans MCJ, van Ravenswaaij-Arts CMA, Pitteloud N, Ogata T, Sato N, Claahsen-van der Grinten HL, van der Donk K, Seminara S, Bergman JEH, Brunner HG, Crowley WF, Hoefsloot LH. CHD7 mutations in patients initially diagnosed with Kallmann syndrome--the clinical overlap with CHARGE syndrome. Clin Genet 2008; 75:65-71. [PMID: 19021638 DOI: 10.1111/j.1399-0004.2008.01107.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Kallmann syndrome (KS) is the combination of hypogonadotropic hypogonadism and anosmia or hyposmia, two features that are also frequently present in CHARGE syndrome. CHARGE syndrome is caused by mutations in the CHD7 gene. We performed analysis of CHD7 in 36 patients with KS and 20 patients with normosmic idiopathic hypogonadotropic hypogonadism (nIHH) in whom mutations in KAL1, FGFR1, PROK2 and PROKR2 genes were excluded. Three of 56 KS/nIHH patients had de novo mutations in CHD7. In retrospect, these three CHD7-positive patients showed additional features that are seen in CHARGE syndrome. CHD7 mutations can be present in KS patients who have additional features that are part of the CHARGE syndrome phenotype. We did not find mutations in patients with isolated KS. These findings imply that patients diagnosed with hypogonadotropic hypogonadism and anosmia should be screened for clinical features consistent with CHARGE syndrome. If such features are present, particularly deafness, dysmorphic ears and/or hypoplasia or aplasia of the semicircular canals, CHD7 sequencing is recommended.
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Affiliation(s)
- M C J Jongmans
- Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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