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Costa D, Andreucci M, Ielapi N, Serraino GF, Mastroroberto P, Bracale UM, Serra R. Molecular Determinants of Chronic Venous Disease: A Comprehensive Review. Int J Mol Sci 2023; 24:ijms24031928. [PMID: 36768250 PMCID: PMC9916309 DOI: 10.3390/ijms24031928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Chronic Venous Disease (CVD) refers to several pathological and hemodynamic alterations of the veins of lower limbs causing a wide range of symptoms and signs with a high prevalence in the general population and with disabling consequences in the most severe forms. The etiology and pathophysiology of CVD is complex and multifactorial, involving genetic, proteomic, and cellular mechanisms that result in changes to the venous structure and functions. Expressions of several genes associated with angiogenesis, vascular development, and the regulation of veins are responsible for the susceptibility to CVD. Current evidence shows that several extracellular matrix alterations (ECM) could be identified and in some cases pharmacologically targeted. This review shows the most up to date information on molecular determinants of CVD in order to provide a complete overview of the current knowledge on this topic. In particular, the article explores the genetic influence, the hormonal influence, ECM imbalance, and histopathology of CVD and the role of endothelial dysfunction in CVD.
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Affiliation(s)
- Davide Costa
- Department of Law, Economics and Sociology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
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Martin-Almedina S, Mortimer PS, Ostergaard P. Development and physiological functions of the lymphatic system: insights from human genetic studies of primary lymphedema. Physiol Rev 2021; 101:1809-1871. [PMID: 33507128 DOI: 10.1152/physrev.00006.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary lymphedema is a long-term (chronic) condition characterized by tissue lymph retention and swelling that can affect any part of the body, although it usually develops in the arms or legs. Due to the relevant contribution of the lymphatic system to human physiology, while this review mainly focuses on the clinical and physiological aspects related to the regulation of fluid homeostasis and edema, clinicians need to know that the impact of lymphatic dysfunction with a genetic origin can be wide ranging. Lymphatic dysfunction can affect immune function so leading to infection; it can influence cancer development and spread, and it can determine fat transport so impacting on nutrition and obesity. Genetic studies and the development of imaging techniques for the assessment of lymphatic function have enabled the recognition of primary lymphedema as a heterogenic condition in terms of genetic causes and disease mechanisms. In this review, the known biological functions of several genes crucial to the development and function of the lymphatic system are used as a basis for understanding normal lymphatic biology. The disease conditions originating from mutations in these genes are discussed together with a detailed clinical description of the phenotype and the up-to-date knowledge in terms of disease mechanisms acquired from in vitro and in vivo research models.
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Affiliation(s)
- Silvia Martin-Almedina
- Molecular and Clinical Sciences Institute, St. George's University of London, London, United Kingdom
| | - Peter S Mortimer
- Molecular and Clinical Sciences Institute, St. George's University of London, London, United Kingdom
- Dermatology and Lymphovascular Medicine, St. George's Universities NHS Foundation Trust, London, United Kingdom
| | - Pia Ostergaard
- Molecular and Clinical Sciences Institute, St. George's University of London, London, United Kingdom
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Ackerman IM, Kodsi SR. Refractive Amblyopia Secondary to Astigmatism in Pediatric Patients With Distichiasis. J Pediatr Ophthalmol Strabismus 2021; 58:e16-e18. [PMID: 34288765 DOI: 10.3928/01913913-20210413-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Distichiasis is the presence of accessory eyelashes emerging from the meibomian gland orifices. It may occur as an isolated abnormality or in conjunction with other ocular and systemic defects. Lymphedema-distichiasis syndrome (LDS) is an autosomal dominant disorder characterized by distichiasis and age-dependent lower extremity swelling due to altered lymphatic flow. The authors describe four pediatric patients with distichiasis (one with genetically proven LDS) with refractive amblyopia secondary to astigmatism. [J Pediatr Ophthalmol Strabismus. 2021;58(4);e16-e18.].
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Gordon K, Mortimer PS, van Zanten M, Jeffery S, Ostergaard P, Mansour S. The St George's Classification Algorithm of Primary Lymphatic Anomalies. Lymphat Res Biol 2021; 19:25-30. [PMID: 33395557 DOI: 10.1089/lrb.2020.0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinicians and scientists at St George's University Hospital have collaborated to develop a classification algorithm for primary lymphatic anomalies. Instruction is offered on how to apply the algorithm in clinical practice to refine the diagnosis of primary lymphedema and guide on genetic testing and management. It can also be used to interpret mutation testing results of uncertain significance. The algorithm has evolved as more genes have been discovered, and it remains a "work in progress" as further discoveries are made. This transformational approach has revolutionized the understanding and classification of primary lymphatic anomalies.
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Affiliation(s)
- Kristiana Gordon
- Lymphoedema Department, St. George's Hospital, London, United Kingdom
| | - Peter S Mortimer
- Molecular & Clinical Sciences, St. George's, University of London, London, United Kingdom
| | - Malou van Zanten
- Molecular & Clinical Sciences, St. George's, University of London, London, United Kingdom
| | - Steve Jeffery
- Molecular & Clinical Sciences, St. George's, University of London, London, United Kingdom
| | - Pia Ostergaard
- Molecular & Clinical Sciences, St. George's, University of London, London, United Kingdom
| | - Sahar Mansour
- Molecular & Clinical Sciences, St. George's, University of London, London, United Kingdom.,SW Thames Regional Genetics Service, St. George's, University of London, London, United Kingdom
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Serra R, Ssempijja L, Provenzano M, Andreucci M. Genetic biomarkers in chronic venous disease. Biomark Med 2020; 14:75-80. [PMID: 32053001 DOI: 10.2217/bmm-2019-0408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy.,Department of Medical & Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy
| | - Lwanga Ssempijja
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology at the Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy.,Department of Medical & Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy
| | - Michele Provenzano
- Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy
| | - Michele Andreucci
- Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Calabria, Italy
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Sarica M, Gordon K, van Zanten M, Heenan SD, Mortimer PS, Irwin AG, Ramachandra V, Ostergaard P, Mansour S. Lymphoscintigraphic Abnormalities Associated with Milroy Disease and Lymphedema-Distichiasis Syndrome. Lymphat Res Biol 2019; 17:610-619. [DOI: 10.1089/lrb.2019.0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muberra Sarica
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Kristiana Gordon
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
- Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Malou van Zanten
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Susan D. Heenan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Peter S. Mortimer
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Andrew G. Irwin
- Department of Medical Physics and Clinical Engineering, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vijaya Ramachandra
- Department of SW Thames Regional Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Pia Ostergaard
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Sahar Mansour
- Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
- Department of SW Thames Regional Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Novel FOXC2 Mutation and Distichiasis in a Patient With Lymphedema-Distichiasis Syndrome. Ophthalmic Plast Reconstr Surg 2018; 34:e88-e90. [DOI: 10.1097/iop.0000000000001079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jones GE, Richmond AK, Navti O, Mousa HA, Abbs S, Thompson E, Mansour S, Vasudevan PC. Renal anomalies and lymphedema distichiasis syndrome. A rare association? Am J Med Genet A 2017; 173:2251-2256. [PMID: 28544699 DOI: 10.1002/ajmg.a.38293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 04/22/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022]
Abstract
Lymphedema distichiasis syndrome (LDS) is a rare, autosomal dominant genetic condition, characterized by lower limb lymphedema and distichiasis. Other associated features that have been reported include varicose veins, cleft palate, congenital heart defects, and ptosis. We update a previously reported family with a pathogenic variant in FOXC2 (c.412-413insT) where five affected individuals from the youngest generation had congenital renal anomalies detected on prenatal ultrasound scan. These included four fetuses with hydronephrosis and one with bilateral renal agenesis. A further child with LDS had prominence of the left renal pelvis on postnatal renal ultrasound. We also describe a second family in whom the proband and his affected son had congenital renal anomalies; left ectopic kidney, right duplex kidney, and bilateral duplex collecting systems with partial duplex kidney with mild degree of malrotation, respectively. Foxc2 is expressed in the developing kidney and therefore congenital renal anomalies may well be associated, potentially as a low penetrance feature. We propose that all individuals diagnosed with LDS should have a baseline renal ultrasound scan at diagnosis. It would also be important to consider the possibility of renal anomalies during prenatal ultrasound of at risk pregnancies, and that the presence of hydronephrosis may be an indication that the baby is affected with LDS.
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Affiliation(s)
- Gabriela E Jones
- Department of Clinical Genetics, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Anna K Richmond
- Department of Fetal and Maternal Medicine, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Osric Navti
- Department of Fetal and Maternal Medicine, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Hatem A Mousa
- Department of Fetal and Maternal Medicine, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Stephen Abbs
- Genetics Laboratories, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
| | - Edward Thompson
- Genetics Laboratories, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
| | - Sahar Mansour
- St George's, University of London, London, United Kingdom
| | - Pradeep C Vasudevan
- Department of Clinical Genetics, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
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Nimir M, Abdelrahim M, Abdelrahim M, Abdalla M, Ahmed WE, Abdullah M, Hamid MMA. In silico analysis of single nucleotide polymorphisms (SNPs) in human FOXC2 gene. F1000Res 2017; 6:243. [PMID: 29511529 PMCID: PMC5814747 DOI: 10.12688/f1000research.10937.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 03/14/2024] Open
Abstract
Introduction: Lymphedema is abnormal accumulation of interstitial fluid, due to inefficient uptake and reduced flow, leading to swelling and disability, mostly in the extremities. Hereditary lymphedema usually occurs as an autosomal dominant trait with allelic heterogeneity. Methods: We identified single nucleotide polymorphisms (SNPs) in the FOXC2 gene using dbSNP, analyzed their effect on the resulting protein using VEP and Biomart, modelled the resulting protein using Project HOPE, identified gene - gene interactions using GeneMANIA and predicted miRNAs affected and the resulting effects of SNPs in the 5' and 3' regions using PolymiRTS. Results: We identified 448 SNPs - 429 were nsSNPs and 44 SNPs were in the 5' and 3' UTRs. In total, 2 SNPs have deleterious effects on the resulting protein, and a 3D model confirmed those effects. The gene - gene interaction network showed the involvement of FOXC2 protein in the development of the lymphatic system. hsa-miR-6886-5p, hsa-miRS-6886-5p , hsa-miR-6720-3p, which were affected by the SNPs rs201118690, rs6413505, rs201914560, respectively, were the most important miRNAs affected, due to their high conservation score. Conclusions: rs121909106 and rs121909107 were predicted to have the most harmful effects, while hsa-miR-6886-5p, hsa-miR-6886-5p and hsa-miR-6720-3p were predicted to be the most important miRNAs affected. Computational biology tools have advantages and disadvantages, and the results they provide are predictions that require confirmation.
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Affiliation(s)
- Mohammed Nimir
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Mohanad Abdelrahim
- Department of Human Anatomy, Ahfad University for Women, Khartoum, 11111, Sudan
| | - Mohamed Abdelrahim
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
| | - Mahil Abdalla
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Wala eldin Ahmed
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Muhanned Abdullah
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
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Nimir M, Abdelrahim M, Abdelrahim M, Abdalla M, Ahmed WE, Abdullah M, Hamid MMA. In silico analysis of single nucleotide polymorphisms (SNPs) in human FOXC2 gene. F1000Res 2017; 6:243. [PMID: 29511529 PMCID: PMC5814747 DOI: 10.12688/f1000research.10937.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction: Lymphedema is an abnormal accumulation of interstitial fluid, due to inefficient uptake and reduced flow, leading to swelling and disability, mostly in the extremities. Hereditary lymphedema usually occurs as an autosomal dominant trait with allelic heterogeneity. Methods: We identified single nucleotide polymorphisms (SNPs) in the FOXC2 gene using dbSNP, analyzed their effect on the resulting protein using VEP and Biomart, modelled the resulting protein using Project HOPE, identified gene - gene interactions using GeneMANIA and predicted miRNAs affected and the resulting effects of SNPs in the 5' and 3' regions using PolymiRTS. Results: We identified 473 SNPs - 429 were nsSNPs and 44 SNPs were in the 5' and 3' UTRs. In total, 2 SNPs - rs121909106 and rs121909107 - have deleterious effects on the resulting protein, and a 3D model confirmed those effects. The gene - gene interaction network showed the involvement of FOXC2 protein in the development of the lymphatic system. hsa-miR-6886-5p, hsa-miRS-6886-5p, hsa-miR-6720-3p, which were affected by the SNPs rs201118690, rs6413505, rs201914560, respectively, were the most important miRNAs affected, due to their high conservation score. Conclusions: rs121909106 and rs121909107 were predicted to have the most harmful effects, while hsa-miR-6886-5p, hsa-miR-6886-5p and hsa-miR-6720-3p were predicted to be the most important miRNAs affected. Computational biology tools have advantages and disadvantages, and the results they provide are predictions that require confirmation using methods such as functional studies.
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Affiliation(s)
- Mohammed Nimir
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Mohanad Abdelrahim
- Department of Human Anatomy, Ahfad University for Women, Khartoum, 11111, Sudan
| | - Mohamed Abdelrahim
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
| | - Mahil Abdalla
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Wala eldin Ahmed
- Soba Center for Audit and Research, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Muhanned Abdullah
- Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
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Zhang L, He J, Han B, Lu L, Fan J, Zhang H, Ge S, Zhou Y, Jia R, Fan X. Novel FOXC2 Mutation in Hereditary Distichiasis Impairs DNA-Binding Activity and Transcriptional Activation. Int J Biol Sci 2016; 12:1114-20. [PMID: 27570485 PMCID: PMC4997055 DOI: 10.7150/ijbs.13774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 07/06/2016] [Indexed: 01/16/2023] Open
Abstract
Distichiasis presents as double rows of eyelashes arising from aberrant differentiation of the meibomian glands of the eyelids, and it may be sporadic or hereditary. FOXC2 gene mutations in hereditary distichiasis are rarely reported. Here, we examined two generations of a Chinese family with hereditary distichiasis but without lymphedema or other features of LD syndrome. The FOXC2 gene was amplified and sequenced in all family members. Subcellular localization and luciferase assays were performed to assess the activity of the mutant FOXC2 protein. Clinical examinations showed distichiasis, lower eyelid ectropion, congenital ptosis and photophobia in all affected individuals. Sequence analysis revealed a novel frameshift mutation, c.964_965insG, in the coding region of the FOXC2 gene. This mutation caused protein truncation due to the presence of a premature stop codon. A fluorescence assay showed that this mutation did not change the nuclear localization of the protein. However, it impaired DNA-binding activity and decreased transcriptional activation. This is the first report of a FOXC2 mutation in hereditary distichiasis in the Chinese population. The findings of our study expand the FOXC2 mutation spectrum and contribute to the understanding of the genotype-phenotype correlation of this disease.
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Affiliation(s)
- Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie He
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Han
- Department of endocrinology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Linna Lu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - He Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yixiong Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Connell FC, Gordon K, Brice G, Keeley V, Jeffery S, Mortimer PS, Mansour S, Ostergaard P. The classification and diagnostic algorithm for primary lymphatic dysplasia: an update from 2010 to include molecular findings. Clin Genet 2013; 84:303-14. [PMID: 23621851 DOI: 10.1111/cge.12173] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 12/17/2022]
Abstract
Historically, primary lymphoedema was classified into just three categories depending on the age of onset of swelling; congenital, praecox and tarda. Developments in clinical phenotyping and identification of the genetic cause of some of these conditions have demonstrated that primary lymphoedema is highly heterogenous. In 2010, we introduced a new classification and diagnostic pathway as a clinical and research tool. This algorithm has been used to delineate specific primary lymphoedema phenotypes, facilitating the discovery of new causative genes. This article reviews the latest molecular findings and provides an updated version of the classification and diagnostic pathway based on this new knowledge.
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Affiliation(s)
- F C Connell
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK
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Ogunbiyi S, Chinien G, Field D, Humphries J, Burand K, Sawyer B, Jeffrey S, Mortimer P, Clasper S, Jackson D, Smith A. Molecular characterization of dermal lymphatic endothelial cells from primary lymphedema skin. Lymphat Res Biol 2011; 9:19-30. [PMID: 21417764 DOI: 10.1089/lrb.2010.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lymphatic endothelial cells from primary lymphedema skin have never been cultured nor characterized. A subgroup of patients with primary lymphedema undergo surgery to bring about an improvement in their quality of life. The aim of this study was to culture and characterize LECs from the skin of these patients. METHODS AND RESULTS Lymphatic endothelial cells were isolated and cultured from the skin of patients with primary lymphedema and from normal skin. The isolated cells were compared in their ability to form microvascular networks in a three-dimensional culture medium, and in their response to treatment with vascular endothelial growth factors A, C, and D. Whole tissue transcriptional profiling was carried out on two pools of isolated lymphatic endothelial cells--one from primary lymphedema skin and the other from normal skin. Lymphatic endothelial cells from primary lymphedema skin form tubule-like structures when cultured in three-dimensional media. They respond in a similar fashion to stimulation with the vascular endothelial growth factors A, C, and D. Comparative analysis between lymphedema tissue and normal tissue (fold change >2) showed differential expression of 2793 genes (5% of all transcripts), 2184 upregulated, and 609 downregulated. Genes involved in cellular apoptosis (vascular endothelial growth inhibitor, zinc finger protein), extracellular matrix turnover (matrix metalloproteinase inhibitor-16), and type IV collagen deposition were upregulated. Various pro-inflammatory genes (interleukin-6, interleukin-8, interleukin-32, E-selectin) were downregulated. CONCLUSION Cellular adhesion, apoptosis, and increased extracellular matrix turnover play a more prominent role in primary lymphedema than previously thought. In addition, the acute inflammatory response is attenuated as evidenced by the downregulation of various pro-inflammatory genes.This sheds further light on the interplay of the various pathological processes taking place in primary lymphedema.
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Affiliation(s)
- Samuel Ogunbiyi
- Academic Department of Surgery, BHF Centre of Research Excellence and NIMR Biomedical Research Centre at Kings Health Partners, St. Thomas Hospital, London, United Kingdom.
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Ostergaard P, Simpson MA, Jeffery S. Massively parallel sequencing and identification of genes for primary lymphoedema: a perfect fit. Clin Genet 2011; 80:110-6. [PMID: 21595654 DOI: 10.1111/j.1399-0004.2011.01706.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary lymphoedema is a clinically and genetically heterogeneous group of disorders characterized by disruption of the lymphatic system. To date, the majority of the causative genes in primary lymphoedema have been identified through linkage analysis in large families with multiple affected subjects. Studies aimed at isolating additional genes responsible for primary lymphoedema have been hampered by cohorts comprised primarily of sporadic cases and small affected kindreds. In the absence of genetic heterogeneity, recent development of massively parallel DNA sequencing technology, specifically exome sequencing, has provided novel paradigms for disease gene identification in such cohorts. In this review, we summarize the novel approaches to disease gene discovery with massively parallel sequencing also known as Next Generation Sequencing (NGS), and show how the selection of unrelated affected cases from clinically homogenous phenotypic subclassifications is proving to be a successful approach for disease gene discovery in primary lymphoedema.
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Affiliation(s)
- P Ostergaard
- Medical Genetics Unit, Biomedical Sciences, St George's University of London, London, UK
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Francois M, Harvey NL, Hogan BM. The Transcriptional Control of Lymphatic Vascular Development. Physiology (Bethesda) 2011; 26:146-55. [DOI: 10.1152/physiol.00053.2010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
More than 100 years ago, Florence Sabin suggested that lymphatic vessels develop by sprouting from preexisting blood vessels, but it is only over the past decade that the molecular mechanisms underpinning lymphatic vascular development have begun to be elucidated. Genetic manipulations in mice have identified a transcriptional hub comprised of Prox1, CoupTFII, and Sox18 that is essential for lymphatic endothelial cell fate specification. Recent work has identified a number of additional transcription factors that regulate later stages of lymphatic vessel differentiation and maturation. This review highlights recent advances in our understanding of the transcriptional control of lymphatic vascular development and reflects on efforts to better understand the activities of transcriptional networks during this discrete developmental process. Finally, we highlight the transcription factors associated with human lymphatic vascular disorders, demonstrating the importance of understanding how the activity of these key molecules is regulated, with a view toward the development of innovative therapeutic avenues.
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Affiliation(s)
- Mathias Francois
- Division of Molecular Genetics and Development, Institute for Molecular Bioscience, University of Queensland, Brisbane
| | - Natasha L. Harvey
- Division of Haematology, Centre for Cancer Biology, SA Pathology, Adelaide; and
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Benjamin M. Hogan
- Division of Molecular Genetics and Development, Institute for Molecular Bioscience, University of Queensland, Brisbane
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Affiliation(s)
- Camilla Norrmén
- From the Molecular/Cancer Biology Laboratory, Research Programs Unit, Institute for Molecular Medicine Finland and Helsinki University Hospital, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (C.N., T.T., K.A.), and Division of Experimental Oncology and Department of Biochemistry, CePO, University of Lausanne and CHUV, Epalinges, Switzerland (T.V.P.)
| | - Tuomas Tammela
- From the Molecular/Cancer Biology Laboratory, Research Programs Unit, Institute for Molecular Medicine Finland and Helsinki University Hospital, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (C.N., T.T., K.A.), and Division of Experimental Oncology and Department of Biochemistry, CePO, University of Lausanne and CHUV, Epalinges, Switzerland (T.V.P.)
| | - Tatiana V. Petrova
- From the Molecular/Cancer Biology Laboratory, Research Programs Unit, Institute for Molecular Medicine Finland and Helsinki University Hospital, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (C.N., T.T., K.A.), and Division of Experimental Oncology and Department of Biochemistry, CePO, University of Lausanne and CHUV, Epalinges, Switzerland (T.V.P.)
| | - Kari Alitalo
- From the Molecular/Cancer Biology Laboratory, Research Programs Unit, Institute for Molecular Medicine Finland and Helsinki University Hospital, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (C.N., T.T., K.A.), and Division of Experimental Oncology and Department of Biochemistry, CePO, University of Lausanne and CHUV, Epalinges, Switzerland (T.V.P.)
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18
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Ogunbiyi SO, Modarai B, Smith A, Burnand KG. Quality of life after surgical reduction for severe primary lymphoedema of the limbs and genitalia. Br J Surg 2009; 96:1274-9. [DOI: 10.1002/bjs.6716] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
The aim was to assess the quality of life (QoL) of patients who had surgery for primary lymphoedema.
Methods
A QoL questionnaire was administered to patients who had surgery between 1981 and 2003 (retrospective group) and between 2003 and 2006 (prospective group).
Results
The response rate was 70·3 per cent (109 of 155 patients): 88 patients had limb reduction (78, retrospective; ten, prospective) and 21 had genital reduction (13, retrospective; eight, prospective). Forty-nine patients (63 per cent) who had limb reduction studied retrospectively reported satisfaction with the procedure and most of these would opt for surgery again. In the prospectively studied group, nine of ten patients reported improved limbs, and seven would opt for surgery again. Nineteen of 21 patients who had genital reduction would choose to have surgery again if needed (11 of the retrospectively assessed group and all of the prospective group). Patients' perception that surgery was worthwhile was greater in both of the prospectively assessed groups (P = 0·013).
Conclusion
Surgery for severe lymphoedema improved QoL at early assessment. This, however, may not be sustained. Genital reduction appeared to provide greater benefit than limb reduction.
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Affiliation(s)
- S O Ogunbiyi
- Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - B Modarai
- Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - A Smith
- Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - K G Burnand
- Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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19
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Conjunctival edema and distichiasis in association with congenital lymphedema of the lower legs. Ophthalmic Plast Reconstr Surg 2009; 25:148-50. [PMID: 19300167 DOI: 10.1097/iop.0b013e31819a44a1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An 8-year-old boy with mild congenital lymphedema of both legs was noticed to have a conjunctival lesion of the right eye since birth. Topical corticosteroid eyedrops for slight irritation did not alter the appearance of the lesion. On ocular examination, diffuse conjunctival edema in the inferotemporal and inferonasal quadrants and mild injection of the right eye was noted. There was no edema on the left eye. Three extra rows of eyelashes (congenital distichiasis) were found bilaterally on upper and lower eyelids. Related systemic anomalies included mild aortic coarctation, left ventricular hypertrophy, and simian crease on each palm. Conjunctival edema and distichiasis are important ophthalmic features of the congenital lymphedema distichiasis syndrome.
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20
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Ji RC. Lymphatic endothelial cells, lymphedematous lymphangiogenesis, and molecular control of edema formation. Lymphat Res Biol 2009; 6:123-37. [PMID: 19093784 DOI: 10.1089/lrb.2008.1005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lymphedema, defined as the abnormal accumulation of protein-rich fluid in soft tissues, results from the dysfunction of lymphatic system, an imbalance between lymph formation and its absorption into the initial lymphatics. Primary lymphedema occurs rarely on idiopathic or developmental abnormalities, especially hypoplasia or aplasia of lymphatics. Secondary lymphedema commonly develops when lymph transport is impaired due to lymphatic damage or resection of lymph nodes in surgery, infection, and radiation. Lymphatic endothelial cells (LECs) actively participate in the phenotypic consequences of a deranged lymphangiogenesis relating to tissue fluid accumulation in the pathogenesis of lymphedema. Recent insights into molecular genetic bases have shown an updated genotype-phenotype correlation between lymphangiogenesis, lymphatic function, and lymphedema. FOXC2, EphrinB2, VEGFR-3, VEGF-C, angiopoietin-2, Prox-1 and podoplanin have proved to be important factors of the genetic cascade linking to hereditary lymphedema, and embryonic and postnatal lymphatic development. FOXC2 may have a key role in regulating interactions between LECs and smooth muscle cells, and in the morphogenesis of lymphatic valves. Reduced VEGFR-3 tyrosine kinase activity and subsequent failure in transducing sufficient physiological VEGF-C/-D signals may affect LEC function and structure in the intercellular junctions and peri-lymphatic components. Identification of genetic markers in humans and animal models would facilitate the management of environmental factors influencing the expression and severity of lymphedema, and provide a basis for developing novel targeted therapies for the disease.
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Affiliation(s)
- Rui-Cheng Ji
- Department of Anatomy, Biology and Medicine, Oita University Faculty of Medicine, Oita 879-5593, Japan.
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21
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Abstract
O estudo do genoma humano propiciou recentes descobertas de genes e de complexos mecanismos de controle da linfangiogênese. Neste artigo esses conhecimentos são revistos, com suas implicações na embriogênese e desenvolvimento do sistema linfático e na etiopatogenia de diferentes formas e síndromes de linfedema hereditário. Algumas doenças linfáticas de transmissão genética e síndromes de aneuploidia são descritas nas suas características genotípicas e fenotípicas. Os avanços na compreensão do crescimento e desenvolvimento dos vasos linfáticos devem trazer novas alternativas terapêuticas nas linfangiodisplasias e no controle da disseminação linfática dos tumores.
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22
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Lymphatic endothelium in health and disease. Cell Tissue Res 2008; 335:97-108. [DOI: 10.1007/s00441-008-0644-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Accepted: 05/13/2008] [Indexed: 12/22/2022]
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23
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Shin WS, Rockson SG. Animal models for the molecular and mechanistic study of lymphatic biology and disease. Ann N Y Acad Sci 2008; 1131:50-74. [PMID: 18519959 DOI: 10.1196/annals.1413.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The development of animal model systems for the study of the lymphatic system has resulted in an explosion of information regarding the mechanisms governing lymphatic development and the diseases associated with lymphatic dysfunction. Animal studies have led to a new molecular model of embryonic lymphatic vascular development, and have provided insight into the pathophysiology of both inherited and acquired lymphatic insufficiency. It has become apparent, however, that the importance of the lymphatic system to human disease extends, beyond its role in lymphedema, to many other diverse pathologic processes, including, very notably, inflammation and tumor lymphangiogenesis. Here, we have undertaken a systematic review of the models as they relate to molecular and functional characterization of the development, maturation, genetics, heritable and acquired diseases, and neoplastic implications of the lymphatic system. The translation of these advances into therapies for human diseases associated with lymphatic dysfunction will require the continued study of the lymphatic system through robust animal disease models that simulate their human counterparts.
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Affiliation(s)
- William S Shin
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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24
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Primary non-syndromic lymphoedema (Meige disease) is not caused by mutations in FOXC2. Eur J Hum Genet 2008; 16:300-4. [DOI: 10.1038/sj.ejhg.5201982] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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25
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Sözener ZC, Tekin M, Mungan D, Karnak D. A 15-year-old girl with swelling of the face, legs, breast, and eyes. Pediatr Ann 2007; 36:150-3. [PMID: 17385581 DOI: 10.3928/0090-4481-20070301-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Abstract
Congenital malformations may affect any part of the eye and the ocular adnexa. Developmental defects may occur in isolation or as part of a larger systemic malformation syndrome. Many malformations can severely impair vision, whereas others have only cosmetic significance, and still others cause no symptoms and may go undiscovered or may be noted incidentally on routine eye examination. Congenital anomalies have numerous causes, most commonly of developmental genetic origin. The genetic basis of congenital eye and orbit anomalies is just beginning to be delineated, and future research on the subject will undoubtedly broaden understanding of the developmental etiology, pathophysiology, and treatment of congenital ocular disorders.
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Affiliation(s)
- Jason R Guercio
- University of Pennsylvania School of Medicine, 3450 Hamilton Walk, Philadelphia, PA 19104, USA.
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27
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Ng MYM, Andrew T, Spector TD, Jeffery S. Linkage to the FOXC2 region of chromosome 16 for varicose veins in otherwise healthy, unselected sibling pairs. J Med Genet 2006; 42:235-9. [PMID: 15744037 PMCID: PMC1736007 DOI: 10.1136/jmg.2004.024075] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The FOXC2 gene on 16q24 is mutated in lymphoedema distichiasis (LD), in which varicose veins (VV) are a common feature. We hypothesised that this gene might be implicated in the development of VV in the normal population, therefore, after performing a classical twin study, we tested for linkage and association in white women. We also tested for linkage with haemorrhoids (H), as a separate venous anomaly at the same locus. METHODS A total of 2060 complete female twin pairs aged 18-80 years from the St Thomas' Adult UK Twin registry replied to questions on VV and H as part of a broader postal survey of 6600 twins (62% response rate). Dizygotic female twin pairs were tested for linkage and association to the candidate marker D16S520 (1903 individuals genotyped), which is located about 80 kb from FOXC2. RESULTS Casewise concordance rates were significantly higher for monozygotic than dizygotic twins for both phenotypes (VV 67% v 45%; p = 2.2x10(-6); H 68% v 59%; p = 0.01; H including during pregnancy 73% v 64%; p = 2.1x10(-4)), corresponding to additive genetic heritabilities in liability of 86% (95% confidence interval (CI) 73% to 99%) for VV and 56-61% for H (95% CI 43% to 73%). The presence of VV and H were significantly correlated. We found significant evidence of linkage to the marker for VV (MLS(ASP) = 1.37, p = 0.01; GLM(ASP/DSP) Z = 3.17 p = 0.002), but no association. Both linkage and association tests were negative for H. The combined phenotype of having VV and H did not show any evidence of linkage or association. CONCLUSION These results demonstrate VV and H to be heritable, related conditions, and the data strongly suggest FOXC2 to be implicated in the development of VV in the general population.
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Affiliation(s)
- M Y M Ng
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital, London SE1 7EH
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28
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Kanaan IN, Sakati N, Otaibi F. Type I congenital multiple intraspinal extradural cysts associated with distichiasis and lymphedema syndrome. ACTA ACUST UNITED AC 2006; 65:162-6. [PMID: 16427414 DOI: 10.1016/j.surneu.2005.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 05/02/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The hereditary syndrome of multiple congenital intraspinal cysts associated with distichiasis, lymphedema and other congenital deformities is extremely rare. Modern imaging techniques have promoted the non-invasive diagnosis of spinal pathology and paved the way for better surgical planning. We reviewed the clinical data, imaging studies and treatment outcomes of a 12-year-old boy with this syndrome. CLINICAL PRESENTATION Progressive spastic paraparesis with signs of spinal cord compression leading to frequent falls. This was associated with bilateral double row of eyelashes and pretibial edema. The MRI of thoracic spine depicted two large elongated extradural lesions extending from D5-D10 with signal intensity compatible with cerebrospinal fluid leading to severe compression of the spinal cord dorsally. TREATMENT Laminotomy and complete microsurgical excision of the cysts resulted in a fast and full clinical recovery of his neurological deficit. CONCLUSION Type I congenital intraspinal cysts is a rare etiology of cord compression syndrome and may be associated with distichiasis, lymphedema and other congenital deformaties. It has several characteristics, which include the higher incidence in thoracic spine and younger age group, disproportional sever motor deficit as compared with sensory disturbances and the excellent clinical recovery following successful surgical treatment.
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Affiliation(s)
- Imad N Kanaan
- Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
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29
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Sholto-Douglas-Vernon C, Bell R, Brice G, Mansour S, Sarfarazi M, Child AH, Smith A, Mellor R, Burnand K, Mortimer P, Jeffery S. Lymphoedema-distichiasis and FOXC2: unreported mutations, de novo mutation estimate, families without coding mutations. Hum Genet 2005; 117:238-42. [PMID: 15906099 DOI: 10.1007/s00439-005-1275-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 01/13/2005] [Indexed: 10/25/2022]
Abstract
Lymphoedema-distichiasis (LD) is a syndromic form of primary lymphoedema, where mutations in the gene for the developmental transcription factor FOXC2 have been shown to be causative. The disorder has been considered very rare, but our group has now ascertained 34 families and 11 sporadic cases in the UK. Two families with LD have no mutation in the coding region of FOXC2, although both are consistent with linkage to the FOXC2 locus. A deletion has been ruled out as a possible cause of LD in these families, leaving promoter mutations as the most likely cause. Sixteen previously unpublished mutations are reported, plus an estimate of the frequency of new mutations in this disorder.
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Affiliation(s)
- Carolyn Sholto-Douglas-Vernon
- Medical Genetics Unit, Department of Clinical Developmental Sciences, St. George's Medical School, Cranmer Terrace, Tooting, London, SW17 ORE, UK.
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30
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Abstract
Vascular anomalies arise from genetic, environmental, mechanical, and/or hormonal factors. Some are inherited in a Mendelian fashion whereas others result from abnormal chromosomal segregation during gametogenesis or appear sporadically during various stages of life. Understanding the molecular basis of vascular development and vascular anomalies provides potential tools for diagnosis and treatment of the diseases.
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Affiliation(s)
- Jamie E Chaft
- Department of Pediatrics, (Division of Hematology/Oncology), NYU Medical Center, New York, New York 10016, USA
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31
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Abstract
Increased understanding of the mechanisms of angiogenesis and lymphangiogenesis has provided a glimpse at some of the molecules involved in the pathophysiology of hemangiomas and vascular malformations. This review focuses on recent advances in our understanding of the mechanisms of angiogenesis/lymphangiogenesis and the differentiation of arterial, venous, and lymphatic vessels. We integrate this knowledge with new data obtained from genetic studies in humans, which have revealed a number of heretofore-unsuspected candidates involved in the development of familial vascular anomalies. We present a common infantile vascular tumor, hemangioma, and then focus on hereditary familial vascular and lymphatic malformations. We also summarize transgenic mouse models for some of these malformations. It seems reasonable to believe that novel therapeutic strategies will soon emerge for the treatment of hemangiomas and vascular malformations.
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Affiliation(s)
- J-C Tille
- Department of Clinical Pathology, University Medical Center, Geneva, Switzerland
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32
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Brooks BP, Dagenais SL, Nelson CC, Glynn MW, Caulder MS, Downs CA, Glover TW. Mutation of the FOXC2 gene in familial distichiasis. J AAPOS 2003; 7:354-7. [PMID: 14566319 DOI: 10.1016/s1091-8531(03)00144-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the FOXC2 gene in a family with hereditary distichiasis. BACKGROUND Distichiasis, ie, a second row of eyelashes arising from the meibomian glands of the eyelids, can be inherited either alone (Online Mendelian Inheritance in Man [OMIM] no. 126300) or, more commonly, as part of the lymphedema-distichiasis (LD) syndrome (OMIM no. 153400). More than 45 families with mutations in the FOXC2 gene and LD have been described. Both lymphedema and distichiasis are highly penetrant. Distichiasis without lymphedema is not commonly seen. METHODS We examined three generations of a family (N = nine members) with hereditary distichiasis but without lymphedema or other features of LD syndrome. The FOXC2 gene was polymerase chain reaction--amplified from genomic DNA from all family members and examined for mutations. RESULTS Clinical examination showed distichiasis of all four lids in two affected family members across two generations. There were no other consistent ophthalmologic abnormalities in the family. A cytosine-to-adenine transversion was identified in DNA from affected study participants at nucleotide position 1076, which would be predicted to cause truncation of the protein at codon 359. This change was not observed in any of the nine unaffected family members participating. CONCLUSIONS This finding suggests that hereditary distichiasis and LD may not be separate genetic disorders but different phenotypic expressions of the same underlying disorder. Ophthalmologists should be aware that LD may present as distichiasis alone and counsel and refer their patients appropriately.
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Affiliation(s)
- Brian P Brooks
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
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33
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Affiliation(s)
- M Ameen
- Department of Dermatology, St. George's Hospital, Tooting, London, UK.
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34
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Abstract
OBJECTIVE To characterize age of onset patterns and penetrance in hereditary lymphedema, including differences caused by sex and genetic heterogeneity. STUDY DESIGN Kaplan-Meier analysis of three family cohorts with autosomal dominant lymphedema: (1) five families with unique mutations in FLT4, (2) 16 families with unique mutations in FOXC2, and (3) 77 families with no mutations yet identified in any gene (the heterogeneous group). RESULTS Age of onset was typically congenital among FLT4 mutation families and pubertal among FOXC2 mutation families, with similar male and female penetrance in both groups. Age of onset was highly variable in the families with no identified mutation, with substantially higher penetrance among female patients than male patients. In addition, male patients and female patients in the heterogeneous group had very different overall age of onset profiles. CONCLUSIONS The two genes identified to date that cause hereditary lymphedema have equal male and female effects, but each displays a different pattern of onset age and penetrance. The heterogeneous group represents a genetically heterogeneous population and has phenotypic overlaps with the FLT4 and FOXC2 mutation families.
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Affiliation(s)
- Kara L Levinson
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
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35
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Abstract
Vascular anomalies are localized defects of the vasculature, and usually affect a limited number of vessels in a restricted area of the body. They are subdivided into vascular malformations and vascular tumours. Most are sporadic, but Mendelian inheritance is observed in some families. By genetic analysis, several causative genes have been identified during the last 10 years. This has shed light into the pathophysiological pathways involved. Interestingly, in most cases, the primary defect seems to affect the characteristics of endothelial cells. Only mutations in the glomulin gene, responsible for hereditary glomuvenous malformations, are thought to directly affect vascular smooth-muscle cells.
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Affiliation(s)
- P Brouillard
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology and Université Catholique de Louvain, Brussels, Belgium.
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36
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Abstract
The hereditary lymphedemas provide an opportunity to identify genes involved in normal and deranged lymphatic development. Genetic analysis of families with Milroy's disease identified mutations in VEGFR3 as a cause of congenital lymphedema, confirming the importance of VEGFC/VEGFR3 signaling in lymphatic development. These observations led to the identification of a mouse model for primary lymphedema, and subsequent analysis of this mouse model, using transgenic and gene transfer techniques, has provided initial clues to the development of a biologically based therapy for primary lymphedema. Of more importance from a public health perspective is the fact that manipulation of this pathway may lead to effective therapies for the more prevalent forms of secondary lymphedema. Identification of FOXC2 as the gene mutated in the lymphedema-distichiasis syndrome has revealed new molecular insight into lymphatic development. Molecular analysis of the FOXC2 pathway may provide clues to developmental pathways shared by the lymphatic system and the other developmental abnormalities associated with this complex syndrome. With improving knowledge of the human genome, genetic analysis of families with lymphedema continues to offer one of the most promising approaches to identifying genes influencing lymphatic development.
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Affiliation(s)
- Robert E Ferrell
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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37
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Bahuau M, Houdayer C, Tredano M, Soupre V, Couderc R, Vazquez MP. FOXC2 truncating mutation in distichiasis, lymphedema, and cleft palate. Clin Genet 2002; 62:470-3. [PMID: 12485195 DOI: 10.1034/j.1399-0004.2002.620608.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a family showing autosomal-dominant segregation of upper- and lower-eyelid distichiasis (double row of eyelashes) in seven affected relatives over three generations, in addition to below-knee lymphedema of pubertal onset (lymphoedema proecox) in three. Two children had cleft palate in addition to distichiasis, but without the previously reported association with the Pierre-Robin sequence. Other ophthalmologic anomalies included divergent strabismus and early-onset myopia. This family was found to be completely linked to markers mapped to 16q24.3 and thereby proposed to be allelic to the distichiasis-lymphedema syndrome (DL, MIM 153400), although pterygium colli, congenital heart disease, or facial dysmorphism were not features found here. As FOXC2/FKLH14 mutations were found to underlie DL and diverse hereditary lymphedema conditions, this gene was examined by sequence analysis. An out-of-frame deletion (914-921del) was identified and found to segregate with the disease, further highlighting the phenotypic heterogeneity of lymphedema conditions linked to FOXC2 truncating mutations. Whether such heterogeneity is related to genotype-phenotype correlation, a hypothesis not primarily supported by the apparent loss-of-function mechanism of the mutations, or governed by modifying genes, remains to be determined.
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Affiliation(s)
- M Bahuau
- Service de Biochimie et Biologie Moléculaire, Hôpital d'Enfants Armand-Trousseau, AP-HP Paris, France.
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38
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Traboulsi EI, Al-Khayer K, Matsumoto M, Kimak MA, Crowe S, Wilson SE, Finegold DN, Ferrell RE, Meisler DM. Lymphedema-distichiasis syndrome and FOXC2 gene mutation. Am J Ophthalmol 2002; 134:592-6. [PMID: 12383817 DOI: 10.1016/s0002-9394(02)01642-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the clinical characteristics of a family with autosomal dominant lymphedema-distichiasis syndrome and to report the results of analysis of the FOXC2 gene DESIGN Observational and experimental study. METHODS The setting was a clinical practice. The study population was 17 members of a family with lymphedema-distichiasis. Observation procedures were complete ophthalmologic examinations and collection of blood samples. DNA was extracted. Mutation analysis of the coding region of the FOXC2 gene was performed using direct sequencing of polymerase chain reaction (PCR) product and a restriction enzyme assay. The main outcome measure was inheritance of mutation in FOXC2 gene. RESULTS Nine patients had distichiasis or lymphedema or both and eight did not. Sequencing of the coding region of the only translated exon of the FOXC2 gene revealed a C to A transversion at position 939 resulting in a Tyr313Stop codon with premature termination of translation and a truncated protein product. The mutation was present in all nine affected individuals and in an asymptomatic 9-year-old boy. CONCLUSIONS Distichiasis-lymphedema syndrome results from mutations in FOXC2, a member of the forkhead/winged family of transcription factors. There is intrafamilial variation in the clinical expression of the mutation.
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Affiliation(s)
- Elias I Traboulsi
- Center for Genetic Eye Diseases, Cole Eye Institute, Cleveland Clinic Foundation, Ohio 44195, USA
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39
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Affiliation(s)
- S Jeffery
- Medical Genetics Unit, St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE, UK.
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40
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Brice G, Mansour S, Bell R, Collin JRO, Child AH, Brady AF, Sarfarazi M, Burnand KG, Jeffery S, Mortimer P, Murday VA. Analysis of the phenotypic abnormalities in lymphoedema-distichiasis syndrome in 74 patients with FOXC2 mutations or linkage to 16q24. J Med Genet 2002; 39:478-83. [PMID: 12114478 PMCID: PMC1735188 DOI: 10.1136/jmg.39.7.478] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Lymphoedema-distichiasis syndrome (LD) (OMIM 153400) is a rare, primary lymphoedema of pubertal onset, associated with distichiasis. Causative mutations have now been described in FOXC2, a forkhead transcription factor gene. Numerous clinical associations have been reported with this condition, including congenital heart disease, ptosis, varicose veins, cleft palate, and spinal extradural cysts. SUBJECTS We report clinical findings in 74 affected subjects from 18 families and six isolated cases. All of them were shown to have mutations in FOXC2 with the exception of one family who had two affected subjects with lymphoedema and distichiasis and linkage consistent with the 16q24 locus. RESULTS The presence of lymphoedema was highly penetrant. Males had an earlier onset of lymphoedema and a significantly increased risk of complications. Lymphatic imaging confirmed the earlier suggestion that LD is associated with a normal or increased number of lymphatic vessels rather than the hypoplasia or aplasia seen in other forms of primary lymphoedema. Distichiasis was 94.2% penetrant, but not always symptomatic. Associated findings included ptosis (31%), congenital heart disease (6.8%), and cleft palate (4%). Other than distichiasis, the most commonly occurring anomaly was varicose veins of early onset (49%). This has not been previously reported and suggests a possible developmental role for FOXC2 in both venous and lymphatic systems. This is the first gene that has been implicated in the aetiology of varicose veins. CONCLUSION Unlike previous publications, the thorough clinical characterisation of our patients permits more accurate prediction of various phenotypic abnormalities likely to manifest in subjects with FOXC2 mutations.
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Affiliation(s)
- G Brice
- Department of Cardiological Sciences, St George's Medical School, Cranmer Terrace, Tooting, London SW17 0RE, UK
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Quéré I, Coupé M, Soulier-Sotto V, Evrard-Bras M, Laroche JP, Janbon C. [Genetics of lymphedema: from Milroy's disease to cancer investigations]. Rev Med Interne 2002; 23 Suppl 3:379s-387s. [PMID: 12162200 DOI: 10.1016/s0248-8663(02)80379-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
New insight has recently been obtained into the molecular mechanisms regulating lymphatic development and function during embryogenesis. VEGF-C and D ligands have been shown to stimulate lymphangiogenesis and their lymphatic-specific receptor VEGFR-3 is linked to the human congenital and hereditary lymphedema in humans. Above all, new focus on lymphatic endothelial cells gives opportunities for developing innovative therapies for lymphedema and cancer metastasis.
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Affiliation(s)
- I Quéré
- Service de médecine interne et maladies vasculaires, hôpital Saint-Eloi, 2, avenue Bertin-Sans, 34295 Montpellier, France.
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Abstract
Distichiasis is defined as a double row of eyelashes. Inherited forms of distichiasis have been associated with early and late-onset congenital lymphedema. We report on a child with distichiasis and congenital lymphedema in which it is unknown whether the cause of lymphedema was due to a spontaneous mutation or acquired secondary to an intrauterine infection. Acquired forms of distichiasis are reviewed.
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Affiliation(s)
- Curt P Samlaska
- University of Nevada School of Medicine, Henderson, Nevada 89014, USA.
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Karkkainen MJ, Alitalo K. Lymphatic endothelial regulation, lymphoedema, and lymph node metastasis. Semin Cell Dev Biol 2002; 13:9-18. [PMID: 11969367 DOI: 10.1006/scdb.2001.0286] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vascular endothelial growth factor receptor-3 (VEGFR-3) mediates lymphatic endothelial cell (LEC) growth, migration, and survival by binding VEGF-C and VEGF-D. Recent studies have revealed new regulators of the lymphatic endothelium, such as the transcription factor Prox1, and the cell surface proteins podoplanin and lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1). Furthermore, the isolation of LECs now allows detailed molecular studies of the factors regulating the lymphatic vasculature. These studies are aimed at targeting the lymphatic vasculature in the treatment of various diseases, such as tumour metastasis and lymphoedema.
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Affiliation(s)
- Marika J Karkkainen
- Molecular/Cancer Biology Laboratory and Ludwig Institute for Cancer Research, Haartman Institute, Biomedicum Helsinki, Helsinki University Hospital and University of Helsinki, 00014 Helsinki, Finland.
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Witte MH, Bernas MJ, Martin CP, Witte CL. Lymphangiogenesis and lymphangiodysplasia: from molecular to clinical lymphology. Microsc Res Tech 2001; 55:122-45. [PMID: 11596157 DOI: 10.1002/jemt.1163] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The lymph vascular system parallels the blood vasculature and as one of its key functions returns liquid and solutes to the bloodstream, including macromolecules that have escaped from blood capillaries and entered the interstitium. In conjunction with interspersed lymph nodes and lymphoid organs, the lymphatic vasculature also acts as a conduit for trafficking immune cell populations. Echoing the explosion of knowledge about blood vessel angiogenesis (properly termed "hemangiogenesis"), the past two decades have also witnessed a series of significant, yet less-noticed discoveries bearing on "lymphangiogenesis," along with delineation of the spectrum of lymphedema-angiodysplasia syndromes. Failure of lymph transport promotes a brawny proteinaceous edema of the affected limb, organ, or serous space that is disfiguring, disabling, and on occasion even life-threatening. Key members of the vascular endothelial growth factor (VEGF) and angiopoietin families of vascular growth factors (and their corresponding tyrosine kinase endothelial receptors) have been identified which preferentially influence lymphatic growth and, when manipulated in genetically engineered murine models, produce aberrant "lymphatic phenotypes." Moreover, mutations in VEGF receptor and forkhead family developmental genes have now been linked and implicated in the pathogenesis of two familial lymphedema-angiodysplasia syndromes. Thus, recent advances in "molecular lymphology" are elucidating the poorly understood development, physiology, and pathophysiology of the neglected lymphatic vasculature. In combination with fresh insights and refined tools in "clinical lymphology," these advances should lead not only to earlier detection and more rational classification of lymphatic disease but also to better therapeutic approaches, including designer drugs for lymphangiostimulation and lymphangioinhibition and gene therapy to modulate lymphatic growth.
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Affiliation(s)
- M H Witte
- Department of Surgery, The University of Arizona College of Medicine, Tucson, Arizona 85724-5063, USA.
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Abstract
Vascular malformations are localized errors of angiogenic development. Most are cutaneous and are called vascular 'birthmarks'. These anomalies are usually obvious in the newborn, grow commensurately with the child, and gradually expand in adulthood (Mulliken and Glowacki, 1982). Vascular malformations also occur in visceral organs, such as the respiratory and gastrointestinal tract, but are more common in the brain (Mulliken and Young, 1988). These anomalies are composed of tortuous vascular channels of varying size and shape, lined by a continuous endothelium and surrounded by abnormal complement of mural cells. Vascular malformation can be life threatening due to obstruction, bleeding or congestive heart failure. Most anomalies occur sporadically, but there are families exhibiting autosomal dominant inheritance. Genetic studies of such families have resulted in the identification of mutated genes, directly giving proof of their important role in the regulation of angiogenesis.
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Affiliation(s)
- M Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology and Université Catholique de Louvain, Avenue Hippocrate 75+4, bp. 75.39, B-1200 Brussels, Belgium.
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46
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Abstract
Lymphedema is a set of pathologic conditions that are characterized by the regional accumulation of excessive amounts of interstitial protein-rich fluid. These occur as a result of an imbalance between the demand for lymphatic flow and the capacity of the lymphatic circulation. Lymphedema can result from either primary or acquired (secondary) disorders. In this review, the pathophysiology, classification, natural history, differential diagnosis, and treatment of lymphedema are discussed.
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Affiliation(s)
- S G Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, California 94305, USA
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Holberg CJ, Erickson RP, Bernas MJ, Witte MH, Fultz KE, Andrade M, Witte CL. Segregation analyses and a genome-wide linkage search confirm genetic heterogeneity and suggest oligogenic inheritance in some Milroy congenital primary lymphedema families. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 98:303-12. [PMID: 11170072 DOI: 10.1002/1096-8628(20010201)98:4<303::aid-ajmg1113>3.0.co;2-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We previously described six families with Milroy congenital lymphedema, only one of which showed possible linkage to a candidate locus on chromosome 5 [Witte et al., 1998]. We have now performed a complex segregation analysis of these families, and performed linkage analyses with the other 387 markers used in our genome-wide search. Our results confirm that Milroy lymphedema is generally inherited as a dominant condition. However, this mode of inheritance, as elucidated from the segregation analyses, did not account for all observed familial correlations. The segregation analysis also suggested that shared environmental or additional genetic factors are important in explaining the observed familial aggregation. The finding of linkage to multiple locations in the largest family studied by multipoint parametric mapping (one of which was confirmed by sib-pair non-parametric mapping), suggests that Milroy congenital lymphedema may be oligogenic in this family.
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Affiliation(s)
- C J Holberg
- Respiratory Sciences Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
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Karkkainen MJ, Jussila L, Ferrell RE, Finegold DN, Alitalo K. Molecular regulation of lymphangiogenesis and targets for tissue oedema. Trends Mol Med 2001; 7:18-22. [PMID: 11427983 DOI: 10.1016/s1471-4914(00)01864-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New insight has recently been obtained into the molecular mechanisms regulating the function of lymphatic endothelial cells. Vascular endothelial growth factors-C and -D have been shown to stimulate lymphangiogenesis, and their receptor VEGFR-3 has been linked to human hereditary lymphoedema, although there is evidence that other genes are also involved. These data suggest that it may become possible to stimulate lymphatic growth and function and to treat tissue oedema involved in many diseases.
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Affiliation(s)
- M J Karkkainen
- Molecular/Cancer Biology Laboratory and Ludwig Institute for Cancer Research, Haartman Institute, University of Helsinki, P.O.B. 21 (Haartmaninkatu 3), 00014 Helsinki, Finland.
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Fang J, Dagenais SL, Erickson RP, Arlt MF, Glynn MW, Gorski JL, Seaver LH, Glover TW. Mutations in FOXC2 (MFH-1), a forkhead family transcription factor, are responsible for the hereditary lymphedema-distichiasis syndrome. Am J Hum Genet 2000; 67:1382-8. [PMID: 11078474 PMCID: PMC1287915 DOI: 10.1086/316915] [Citation(s) in RCA: 450] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2000] [Accepted: 10/20/2000] [Indexed: 11/03/2022] Open
Abstract
Lymphedema-distichiasis (LD) is an autosomal dominant disorder that classically presents as lymphedema of the limbs, with variable age at onset, and double rows of eyelashes (distichiasis). Other complications may include cardiac defects, cleft palate, extradural cysts, and photophobia, suggesting a defect in a gene with pleiotrophic effects acting during development. We previously reported neonatal lymphedema, similar to that in Turner syndrome, associated with a t(Y;16)(q12;q24.3) translocation. A candidate gene was not found on the Y chromosome, and we directed our efforts toward the chromosome 16 breakpoint. Subsequently, a gene for LD was mapped, by linkage studies, to a 16-cM region at 16q24.3. By FISH, we determined that the translocation breakpoint was within this critical region and further narrowed the breakpoint to a 20-kb interval. Because the translocation did not appear to interrupt a gene, we considered candidate genes in the immediate region that might be inactivated by position effect. In two additional unrelated families with LD, we identified inactivating mutations-a nonsense mutation and a frameshift mutation-in the FOXC2 (MFH-1) gene. FOXC2 is a member of the forkhead/winged-helix family of transcription factors, whose members are involved in diverse developmental pathways. FOXC2 knockout mice display cardiovascular, craniofacial, and vertebral abnormalities similar to those seen in LD syndrome. Our findings show that FOXC2 haploinsufficiency results in LD. FOXC2 represents the second known gene to result in hereditary lymphedema, and LD is only the second hereditary disorder known to be caused by a mutation in a forkhead-family gene.
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Affiliation(s)
- Jianming Fang
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Susan L. Dagenais
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Robert P. Erickson
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Martin F. Arlt
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Michael W. Glynn
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Jerome L. Gorski
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Laurie H. Seaver
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
| | - Thomas W. Glover
- Departments of Pediatrics and Human Genetics, University of Michigan, Ann Arbor; Steele Memorial Children’s Research Center, Department of Pediatrics, University of Arizona, Tucson; and J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, SC
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50
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Karkkainen MJ, Petrova TV. Vascular endothelial growth factor receptors in the regulation of angiogenesis and lymphangiogenesis. Oncogene 2000; 19:5598-605. [PMID: 11114740 DOI: 10.1038/sj.onc.1203855] [Citation(s) in RCA: 280] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
VEGFR-1 (Flt-1), VEGFR-2 (KDR) and VEGFR-3 (Flt4) are endothelial specific receptor tyrosine kinases, regulated by members of the vascular endothelial growth factor family. VEGFRs are indispensable for embryonic vascular development, and are involved in the regulation of many aspects of physiological and pathological angiogenesis. VEGF-C and VEGF-D, as ligands for VEGFR-3 are also capable of stimulating lymphangiogenesis and at least VEGF-C can enhance lymphatic metastasis. Recent studies have shown that missense mutations within the VEGFR-3 tyrosine kinase domain are associated with human hereditary lymphedema, suggesting an important role for this receptor in the development of the lymphatic vasculature.
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Affiliation(s)
- M J Karkkainen
- Molecular Cancer Biology Laboratory, and the Ludwig Institute for Cancer Research, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland
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