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Li Q, Chang G, Yin L, Li J, Huang X, Shen Y, Li G, Xu Y, Wang J, Wang X. Clinical and molecular analysis in a cohort of Chinese children with Cornelia de Lange syndrome. Sci Rep 2020; 10:21224. [PMID: 33277604 PMCID: PMC7718889 DOI: 10.1038/s41598-020-78205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 11/09/2020] [Indexed: 11/09/2022] Open
Abstract
Cornelia de Lange Syndrome (CdLS) is a rare genetic disorder, which causes a range of physical, cognitive, and medical challenges. To retrospectively analyze the clinical characteristics and genetic variations of Chinese patients, and to provide experience for further diagnosis and treatment of CdLS in Chinese children, we identified 15 unrelated Chinese children who presented with unusual facial features, short stature, developmental delay, limb abnormalities, and a wide range of health conditions. In this study, targeted-next generation sequencing was used to screen for causal variants and the clinically relevant variants were subsequently verified using Sanger sequencing. DNA sequencing identified 15 genetic variations, including 11 NIPBL gene variants, two SMC1A gene variants, one RAD21 gene variant, and one HDAC8 variant. The phenotype of these patients was summarized and differences between this cohort and another four groups were compared. The clinical manifestations of the patients in this cohort were mostly consistent with other ethnicities, but several clinical features in our cohort had different frequencies compared with other groups. We identified 15 deleterious variants of which 11 were novel. Variants in the NIPBL gene were the most common cause in our cohort. Our study not only expands upon the spectrum of genetic variations in CdLS, but also broadens our understanding of the clinical features of CdLS.
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Affiliation(s)
- Qun Li
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
| | - Guoying Chang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
| | - Lei Yin
- Department of Rare Disease Clinic, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Li
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
| | - Xiaodong Huang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
| | - Yongnian Shen
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
| | - Guoqiang Li
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yufei Xu
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
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Kaur M, Mehta D, Noon SE, Deardorff MA, Zhang Z, Krantz ID. NIPBL expression levels in CdLS probands as a predictor of mutation type and phenotypic severity. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:163-70. [PMID: 27125329 DOI: 10.1002/ajmg.c.31495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cornelia de Lange syndrome (CdLS) is a rare, genetically heterogeneous multisystem developmental disorder with a high degree of variability in its clinical presentation. Approximately 65% of probands harbor mutations in genes that encode core components (SMC1A, SMC3, and RAD21) or regulators (NIPBL, HDAC8) of the cohesin complex, of which mutations in NIPBL are the most common. Cohesin plays a canonical role in sister chromatid cohesion during cell division and non-canonical roles in DNA repair, stem cell maintenance and differentiation, and regulation of gene expression. Disruption of the latter role seems to be the major contributor to the underlying molecular pathogenesis of CdLS. NIPBL is required for loading and unloading the cohesin complex onto chromosomes. The expression levels of NIPBL itself appear to be tightly regulated and highly evolutionarily conserved. Droplet digital PCR was used to quantify NIPBL mRNA expression levels with high precision from a cohort of 37 samples (NIPBL, SMC1A, SMC3, and HDAC8 mutation positive probands and negative control). Probands with severe forms of CdLS or severe mutation types were found to have lower levels of NIPBL in comparison to phenotypically milder patients and controls. Levels of NIPBL also correlated with the presence of mutations in different CdLS-causing genes. The data suggests that NIPBL levels are closely correlated with the severity of CdLS and with specific causative genes and types of mutations. ddPCR may provide a tool to assist in diagnostic approaches to CdLS, for genetic counseling and prognosis, and for monitoring potential therapeutic modalities in the future. © 2016 Wiley Periodicals, Inc.
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Kline AD, Grados M, Sponseller P, Levy HP, Blagowidow N, Schoedel C, Rampolla J, Clemens DK, Krantz I, Kimball A, Pichard C, Tuchman D. Natural history of aging in Cornelia de Lange syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 145C:248-60. [PMID: 17640042 PMCID: PMC4902018 DOI: 10.1002/ajmg.c.30137] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Observations about the natural history of aging in Cornelia de Lange syndrome (CdLS) are made, based on 49 patients from a multidisciplinary clinic for adolescents and adults. The mean age was 17 years. Although most patients remain small, obesity may develop. Gastroesophageal reflux persists or worsens, and there are early long-term sequelae, including Barrett esophagus in 10%; other gastrointestinal findings include risk for volvulus, rumination, and chronic constipation. Submucous cleft palate was found in 14%, most undetected before our evaluation. Chronic sinusitis was noted in 39%, often with nasal polyps. Blepharitis improves with age; cataracts and detached retina may occur. Decreased bone density is observed, with occasional fractures. One quarter have leg length discrepancy and 39% scoliosis. Most females have delayed or irregular menses but normal gynecologic exams and pap smears. Benign prostatic hypertrophy occurred in one male prior to 40 years. The phenotype is variable, but there is a distinct pattern of facial changes with aging. Premature gray hair is frequent; two patients had cutis verticis gyrata. Behavioral issues and specific psychiatric diagnoses, including self-injury, anxiety, attention-deficit disorder, autistic features, depression, and obsessive-compulsive behavior, often worsen with age. This work presents some evidence for accelerated aging in CdLS. Of 53% with mutation analysis, 55% demonstrate a detectable mutation in NIPBL or SMC1A. Although no specific genotype-phenotype correlations have been firmly established, individuals with missense mutations in NIPBL and SMC1A appear milder than those with other mutations. Based on these observations, recommendations for clinical management of adults with CdLS are made.
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Affiliation(s)
- Antonie D Kline
- Harvey Institute for Human Genetics, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA.
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Ellaithi M, Gisselsson D, Nilsson T, Elagib A, Fadl-Elmula I, Abdelgadir M. A case of Cornelia de Lange syndrome from Sudan. BMC Pediatr 2007; 7:6. [PMID: 17261173 PMCID: PMC1794225 DOI: 10.1186/1471-2431-7-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Accepted: 01/29/2007] [Indexed: 11/10/2022] Open
Abstract
Background Brachmann de Lange syndrome (BDLS) is a multiple congenital anomaly syndrome characterized by a distinctive facial appearance, prenatal and postnatal growth deficiency, psychomotor delay, behavioral problems, and malformations of the upper extremities. Case presentation Here we present for the first time a case of BDLS from Sudan, a 7-month-old female infant, who was referred as a case of malnutrition. The patient was from a Sudanese western tribe. Clinical investigation showed that the child was a classical case of BDLS, but with some additional clinical findings not previously reported including crowded ribs and tied tongue. Conclusion Reporting BDLS cases of different ethnic backgrounds could add nuances to the phenotypic description of the syndrome and be helpful in diagnosis.
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Affiliation(s)
- Mona Ellaithi
- The Orchids Organization for Children with Special Needs, Khartoum, Sudan
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Therese Nilsson
- Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Atif Elagib
- Tropical Medical Research Institute, Khartoum, Sudan
| | - Imad Fadl-Elmula
- Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
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Gillis LA, McCallum J, Kaur M, DeScipio C, Yaeger D, Mariani A, Kline AD, Li HH, Devoto M, Jackson LG, Krantz ID. NIPBL mutational analysis in 120 individuals with Cornelia de Lange syndrome and evaluation of genotype-phenotype correlations. Am J Hum Genet 2004; 75:610-23. [PMID: 15318302 PMCID: PMC1182048 DOI: 10.1086/424698] [Citation(s) in RCA: 217] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 07/21/2004] [Indexed: 11/03/2022] Open
Abstract
The Cornelia de Lange syndrome (CdLS) is a multisystem developmental disorder characterized by facial dysmorphia, upper-extremity malformations, hirsutism, cardiac defects, growth and cognitive retardation, and gastrointestinal abnormalities. Both missense and protein-truncating mutations in NIPBL, the human homolog of the Drosophila melanogaster Nipped-B gene, have recently been reported to cause CdLS. The function of NIPBL in mammals is unknown. The Drosophila Nipped-B protein facilitates long-range enhancer-promoter interactions and plays a role in Notch signaling and other developmental pathways, as well as being involved in mitotic sister-chromatid cohesion. We report the spectrum and distribution of NIPBL mutations in a large well-characterized cohort of individuals with CdLS. Mutations were found in 56 (47%) of 120 unrelated individuals with sporadic or familial CdLS. Statistically significant phenotypic differences between mutation-positive and mutation-negative individuals were identified. Analysis also suggested a trend toward a milder phenotype in individuals with missense mutations than in those with other types of mutations.
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Affiliation(s)
- Lynette A. Gillis
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Jennifer McCallum
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Maninder Kaur
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Cheryl DeScipio
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Dinah Yaeger
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Allison Mariani
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Antonie D. Kline
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Hui-hua Li
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Marcella Devoto
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Laird G. Jackson
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
| | - Ian D. Krantz
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia, The University of Pennsylvania School of Medicine, and Division of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia; Divisions of Gastroenterology and Genetics, The Vanderbilt University Medical Center, Nashville; The Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore; Nemours Children’s Clinic, Wilmington, DE; and Department of Biology, Oncology, and Genetics, University of Genoa, Genoa
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Tonkin ET, Smith M, Eichhorn P, Jones S, Imamwerdi B, Lindsay S, Jackson M, Wang TJ, Ireland M, Burn J, Krantz ID, Carr P, Strachan T. A giant novel gene undergoing extensive alternative splicing is severed by a Cornelia de Lange-associated translocation breakpoint at 3q26.3. Hum Genet 2004; 115:139-48. [PMID: 15168106 PMCID: PMC4894837 DOI: 10.1007/s00439-004-1134-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Accepted: 04/19/2004] [Indexed: 10/26/2022]
Abstract
Cornelia de Lange syndrome (CdLS) is a rare developmental malformation syndrome characterised by mental handicap, growth retardation, distinctive facial features and limb reduction defects. The vast majority of CdLS cases are sporadic. We carried out a high density bacterial artificial chromosome (BAC) microarray comparative genome hybridisation screen but no evidence was found for a consistent pattern of microdeletion/microduplication. As an alternative, we focused on identifying chromosomal regions spanning associated translocation breakpoints. We prioritised the distal 3q region because of the occurrence, in a classical CdLS patient, of a de novo balanced translocation with a breakpoint at 3q26.3 and of reports of phenotypic overlap between cases of mild CdLS and individuals trisomic for the 3q26-q27 region. We show that the 3q26.3 breakpoint severs a previously uncharacterised giant gene, NAALADL2, containing at least 32 exons spanning 1.37 Mb. Northern blot analysis identified up to six different transcripts in the 1-10 kb range with strongest expression in kidney and placenta; embryonic expression was largely confined to duodenal and stomach endoderm, mesonephros, metanephros and pancreas. Transcript analysis identified extensive alternative splicing leading to multiple 5' and 3' untranslated regions and variable coding sequences. Multiple protein isoforms were defined by different N-terminal regions (with at least four alternative initiating methionine codons), and by differential protein truncation/use of alternative C-terminal sequences attributable to alternative splicing/polyadenylation. Outside the N-terminal regions, the predicted proteins showed significant homology to N-acetylated alpha-linked acidic dipeptidase and transferrin receptors. Mutation screening of NAALADL2 in a panel of CdLS patient DNA samples failed to identify patient-specific mutations. We discuss the possibility that the 3q26.3 translocation could nevertheless contribute to pathogenesis.
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Affiliation(s)
- Emma T. Tonkin
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Melanie Smith
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Piet Eichhorn
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Sandie Jones
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Burhan Imamwerdi
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Susan Lindsay
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Mike Jackson
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Tzu-Jou Wang
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Maggie Ireland
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - John Burn
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Ian D. Krantz
- Division of Human Genetics and Molecular Biology, The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Philippa Carr
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Tom Strachan
- Institute of Human Genetics, International Centre for Life, University of Newcastle, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK, Tel.: +44-191-2418616 Fax: +44-191-2418666
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