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Revencu N, Eijkelenboom A, Bracquemart C, Alhopuro P, Armstrong J, Baselga E, Cesario C, Dentici ML, Eyries M, Frisk S, Karstensen HG, Gene-Olaciregui N, Kivirikko S, Lavarino C, Mero IL, Michiels R, Pisaneschi E, Schönewolf-Greulich B, Wieland I, Zenker M, Vikkula M. Assessment of gene-disease associations and recommendations for genetic testing for somatic variants in vascular anomalies by VASCERN-VASCA. Orphanet J Rare Dis 2024; 19:213. [PMID: 38778413 PMCID: PMC11110196 DOI: 10.1186/s13023-024-03196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Vascular anomalies caused by somatic (postzygotic) variants are clinically and genetically heterogeneous diseases with overlapping or distinct entities. The genetic knowledge in this field is rapidly growing, and genetic testing is now part of the diagnostic workup alongside the clinical, radiological and histopathological data. Nonetheless, access to genetic testing is still limited, and there is significant heterogeneity across the approaches used by the diagnostic laboratories, with direct consequences on test sensitivity and accuracy. The clinical utility of genetic testing is expected to increase progressively with improved theragnostics, which will be based on information about the efficacy and safety of the emerging drugs and future molecules. The aim of this study was to make recommendations for optimising and guiding the diagnostic genetic testing for somatic variants in patients with vascular malformations. RESULTS Physicians and lab specialists from 11 multidisciplinary European centres for vascular anomalies reviewed the genes identified to date as being involved in non-hereditary vascular malformations, evaluated gene-disease associations, and made recommendations about the technical aspects for identification of low-level mosaicism and variant interpretation. A core list of 24 genes were selected based on the current practices in the participating laboratories, the ISSVA classification and the literature. In total 45 gene-phenotype associations were evaluated: 16 were considered definitive, 16 strong, 3 moderate, 7 limited and 3 with no evidence. CONCLUSIONS This work provides a detailed evidence-based view of the gene-disease associations in the field of vascular malformations caused by somatic variants. Knowing both the gene-phenotype relationships and the strength of the associations greatly help laboratories in data interpretation and eventually in the clinical diagnosis. This study reflects the state of knowledge as of mid-2023 and will be regularly updated on the VASCERN-VASCA website (VASCERN-VASCA, https://vascern.eu/groupe/vascular-anomalies/ ).
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Affiliation(s)
- Nicole Revencu
- Center for Human Genetics, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Astrid Eijkelenboom
- Department of Pathology, Radboud University Medical Center, VASCERN VASCA European Reference Centre, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Claire Bracquemart
- Normandie Univ, UNICAEN, Service de Génétique, CHU Caen Normandie, BIOTARGEN EA 7450, VASCERN VASCA European Reference Centre, Caen, 14000, France
| | - Pia Alhopuro
- HUS Diagnostic Center, Laboratory of Genetics, University of Helsinki and Helsinki University Hospital, VASCERN VASCA European Reference Centre, Helsinki, Finland
| | - Judith Armstrong
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBER-ER (Biomedical Network Research Center for Rare Diseases), Instituto de Salud Carlos III (ISCIII), Madrid, and Genomic Unit, Molecular and Genetic Medicine Section, Hospital Sant Joan de Déu, VASCERN VASCA European Reference Centre, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital Sant Joan de Deu, VASCERN VASCA European Reference Centre, Barcelona, Spain
| | - Claudia Cesario
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, VASCERN VASCA European Reference Centre, Rome, Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, VASCERN VASCA European Reference Centre, 00165, Rome, Italy
| | - Melanie Eyries
- Sorbonne Université, Département de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, VASCERN VASCA European Reference Centre, Paris, France
| | - Sofia Frisk
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Clinical Genetics, Karolinska University Hospital, VASCERN VASCA European Reference Centre, Stockholm, Sweden
| | - Helena Gásdal Karstensen
- Department of Genetics, Center of Diagnostics, Copenhagen University Hospital - Rigshospitalet, VASCERN VASCA European Reference Centre, Copenhagen, Denmark
| | - Nagore Gene-Olaciregui
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, VASCERN VASCA European Reference Centre, Barcelona, Spain
| | - Sirpa Kivirikko
- Department of Clinical Genetics, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, VASCERN VASCA European Reference Centre, Helsinki, Finland
| | - Cinzia Lavarino
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, VASCERN VASCA European Reference Centre, Barcelona, Spain
| | - Inger-Lise Mero
- Department of Medical Genetics, Oslo University Hospital, VASCERN VASCA European Reference Centre, Oslo, Norway
| | - Rodolphe Michiels
- Center for Human Genetics, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Elisa Pisaneschi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, VASCERN VASCA European Reference Centre, Rome, Italy
| | - Bitten Schönewolf-Greulich
- Department of Genetics, Center of Diagnostics, Copenhagen University Hospital - Rigshospitalet, VASCERN VASCA European Reference Centre, Copenhagen, Denmark
| | - Ilse Wieland
- Institute of Human Genetics, University Hospital Otto-Von-Guericke-University, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Otto-Von-Guericke-University, Magdeburg, Germany
| | - Miikka Vikkula
- Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Human Molecular Genetics , de Duve Institute, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium.
- WELBIO Department, WEL Research Institute, Avenue Pasteur, 6, 1300, Wavre, Belgium.
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2
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Laval N, Kleiber N, Soucy JF, Dubois J, Assaad MA. Atypical Presentation and Evolution of Necrotizing Enterocolitis as a PIK3CA Pathological Variant. Cureus 2024; 16:e59243. [PMID: 38813336 PMCID: PMC11134116 DOI: 10.7759/cureus.59243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Activating mutation of PIK3CA is linked with cases of overgrowth syndromes and belongs to the PIK3CA-related overgrowth spectrum (PROS). Mutations in this gene are associated with vascular malformations, brain abnormalities, and an increased risk for certain tumors. We report the case of a newborn girl, preterm at 34 weeks of gestation, referred to our center for atypical necrotizing enterocolitis (NEC). At laparotomy, the appearance of the intestinal tract was described as puffy, cauliflower-like with a dark purplish coloration. Subsequently, the colostomy was described as having a consistent proliferative appearance. Medical treatment with sirolimus resulted in minimal improvement. There are no reported cases in the literature of association between NEC and PIK3CA mutation. It is possible that PIK3CA mutation, including the related vascular anomalies, plays a role in the pathogenesis of NEC with this condition.
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Affiliation(s)
- Nancy Laval
- Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, CAN
- Neonatology, Centre Hospitalier Chrétien MontLégia, Liège, BEL
| | - Niina Kleiber
- Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, CAN
| | - Jean-François Soucy
- Medical Genetics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, CAN
| | - Josée Dubois
- Radiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, CAN
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3
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Cossio ML, Rodríguez J, Flores JC, De Barbieri F, Flores Á, Marín J, Florin C, Cuevas F, Gutiérrez M. Four-month-old with severe PIK3CA-related overgrowth spectrum disorder successfully treated with alpelisb. Pediatr Dermatol 2024. [PMID: 38444084 DOI: 10.1111/pde.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PIK3CA-related overgrowth spectrum (PROS) encompasses different clinical entities caused by somatic activating mutations in PIK3CA. Among PROS, CLOVES syndrome represents a severe phenotype with poor survival rate. We present the case of a 4-month-old girl with CLOVES syndrome successfully treated with alpelisib, a PIKC3A inhibitor.
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Affiliation(s)
- María-Laura Cossio
- Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Dermatology, Hospital Dr. Sótero del Río, Santiago, Chile
| | | | - Juan Carlos Flores
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Pediatrics, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Florencia De Barbieri
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Flores
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Pediatric Radiology, Hospital Dr. Sótero del Río, Santiago, Chile
| | - José Marín
- Department of Pediatric Neurology, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Carla Florin
- Department of Pediatric Plastic Surgery, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Francisco Cuevas
- Department of Pediatrics, Hospital Josefina Martínez, Santiago, Chile
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4
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de Kock L, Cuillerier A, Gillespie M, Couse M, Hartley T, Mears W, Bernier FP, Chudley AE, Frosk P, Nikkel SM, Innes AM, Lauzon J, Thomas M, Guerin A, Armour CM, Weksberg R, Scott JN, Watkins D, Harvey S, Cytrynbaum C, Kernohan KD, Boycott KM. Molecular characterization of 13 patients with PIK3CA-related overgrowth spectrum using a targeted deep sequencing approach. Am J Med Genet A 2024; 194:e63466. [PMID: 37949664 DOI: 10.1002/ajmg.a.63466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
Activating variants in the PIK3CA gene cause a heterogeneous spectrum of disorders that involve congenital or early-onset segmental/focal overgrowth, now referred to as PIK3CA-related overgrowth spectrum (PROS). Historically, the clinical diagnoses of patients with PROS included a range of distinct syndromes, including CLOVES syndrome, dysplastic megalencephaly, hemimegalencephaly, focal cortical dysplasia, Klippel-Trenaunay syndrome, CLAPO syndrome, fibroadipose hyperplasia or overgrowth, hemihyperplasia multiple lipomatosis, and megalencephaly capillary malformation-polymicrogyria (MCAP) syndrome. MCAP is a sporadic overgrowth disorder that exhibits core features of progressive megalencephaly, vascular malformations, distal limb malformations, cortical brain malformations, and connective tissue dysplasia. In 2012, our research group contributed to the identification of predominantly mosaic, gain-of-function variants in PIK3CA as an underlying genetic cause of the syndrome. Mosaic variants are technically more difficult to detect and require implementation of more sensitive sequencing technologies and less stringent variant calling algorithms. In this study, we demonstrated the utility of deep sequencing using the Illumina TruSight Oncology 500 (TSO500) sequencing panel in identifying variants with low allele fractions in a series of patients with PROS and suspected mosaicism: pathogenic, mosaic PIK3CA variants were identified in all 13 individuals, including 6 positive controls. This study highlights the importance of screening for low-level mosaic variants in PROS patients. The use of targeted panels with deep sequencing in clinical genetic testing laboratories would improve diagnostic yield and accuracy within this patient population.
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Affiliation(s)
- Leanne de Kock
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexanne Cuillerier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Meredith Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Madeline Couse
- The Centre for Computational Medicine, the Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario, Canada
| | - Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Wendy Mears
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Francois P Bernier
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Albert E Chudley
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patrick Frosk
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah M Nikkel
- Provincial Medical Genetics Program, BC Women's Hospital, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Micheil Innes
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Julie Lauzon
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Maryann Thomas
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Andrea Guerin
- Division of Medical Genetics, Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rosanna Weksberg
- Division of Clinical and Metabolic Genetics, Department of Paediatrics and Genetics and Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Sciences and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - James N Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Debra Watkins
- Northeastern Ontario Medical Genetics Program, Health Sciences North, Greater Sudbury, Ontario, Canada
| | - Shirley Harvey
- Program of Genetics and Metabolism, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Cheryl Cytrynbaum
- Division of Clinical and Metabolic Genetics, Department of Genetic Counselling and Genetics and Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristin D Kernohan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Ottawa, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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5
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Phillips HW, D'Gama AM, Wang Y, Chahine Y, Chiu M, Swanson AC, Ahtam B, Bolton JB, Madsen JR, Lee EA, Prabhu SP, Lidov HG, Papadakis J, Huang AY, Poduri A, Stone SS, Walsh CA. Somatic Mosaicism in PIK3CA Variant Correlates With Stereoelectroencephalography-Derived Electrophysiology. Neurol Genet 2024; 10:e200117. [PMID: 38149038 PMCID: PMC10751024 DOI: 10.1212/nxg.0000000000200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 12/28/2023]
Abstract
Objectives Brain-limited pathogenic somatic variants are associated with focal pediatric epilepsy, but reliance on resected brain tissue samples has limited our ability to correlate epileptiform activity with abnormal molecular pathology. We aimed to identify the pathogenic variant and map variant allele fractions (VAFs) across an abnormal region of epileptogenic brain in a patient who underwent stereoelectroencephalography (sEEG) and subsequent motor-sparing left frontal disconnection. Methods We extracted genomic DNA from peripheral blood, brain tissue resected from peri-sEEG electrode regions, and microbulk brain tissue adherent to sEEG electrodes. Samples were mapped based on an anatomic relationship with the presumed seizure onset zone (SOZ). We performed deep panel sequencing of amplified and unamplified DNA to identify pathogenic variants with subsequent orthogonal validation. Results We detect a pathogenic somatic PIK3CA variant, c.1624G>A (p.E542K), in the brain tissue samples, with VAF inversely correlated with distance from the SOZ. In addition, we identify this variant in amplified electrode-derived samples, albeit with lower VAFs. Discussion We demonstrate regional mosaicism across epileptogenic tissue, suggesting a correlation between variant burden and SOZ. We also validate a pathogenic variant from individual amplified sEEG electrode-derived brain specimens, although further optimization of techniques is required.
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Affiliation(s)
- H Westley Phillips
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Alissa M D'Gama
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Yilan Wang
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Yasmine Chahine
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Michelle Chiu
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Amanda C Swanson
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Banu Ahtam
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Jeffrey B Bolton
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Joseph R Madsen
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Eunjung A Lee
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Sanjay P Prabhu
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Hart G Lidov
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Joanna Papadakis
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - August Y Huang
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Annapurna Poduri
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Scellig S Stone
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
| | - Christopher A Walsh
- From the Department of Neurosurgery (H.W.P.), Stanford School of Medicine, Palo Alto, CA; Department of Neurosurgery (H.W.P., J.R.M., J.P., S.S.S.), Boston Children's Hospital, Harvard Medical School; Broad Institute of MIT and Harvard (H.W.P., Y.W., Y.C., E.A.L., A.Y.H., C.A.W.), Cambridge; Division of Genetics and Genomics (H.W.P., Y.W., E.A.L., A.Y.H., C.A.W.), Manton Center for Orphan Disease Research; Division of Newborn Medicine (A.M.D.G., B.A.), Department of Pediatrics; Epilepsy Genetics Program (A.M.D.G., J.B.B., A.P.), Department of Neurology; Department of Pediatrics (A.M.D.G., J.B.B., E.A.L., A.Y.H., C.A.W.), Harvard Medical School, Boston Children's Hospital; Program in Biological and Biomedical Sciences (Y.W.); Department of Neurology (M.C., J.B.B., A.P., C.A.W.), Boston Children's Hospital, Harvard Medical School; Translational Neuroscience Center (A.C.S.), Boston Children's Hospital; Department of Radiology (S.P.P.), Division of Neuroradiology; Department of Pathology (H.G.L.), Division of Neuropathology, Boston Children's Hospital, Harvard Medical School; and Howard Hughes Medical Institute (C.A.W.), Boston, MA
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6
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Klein SD, Nisbet A, Kalish JM. Overgrowth syndromes, diagnosis and management. Curr Opin Pediatr 2023; 35:620-630. [PMID: 37791807 PMCID: PMC10872759 DOI: 10.1097/mop.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW This review will focus on the current knowledge of the diagnosis and management of overgrowth syndromes with specific focus on mosaic conditions and treatment strategies. RECENT FINDINGS With the implementation of massively parallel sequencing, the genetic etiology of many classically described overgrowth syndromes have been identified. More recently, the role of mosaic genetic changes has been well described in numerous syndromes. Furthermore, the role of imprinting and methylation, especially of the 11p15 region, has been shown to be instrumental for growth. Perhaps most importantly, many overgrowth syndromes carry an increased risk of neoplasm formation especially in the first 10 years of life and possibly beyond. The systematic approach to the child with overgrowth will aide in timely diagnosis and efficiently align them with appropriate screening strategies. In some cases, precision medical interventions are available to target the perturbed growth signaling pathways. SUMMARY The systematic approach to the child with overgrowth aids in the standardization of the diagnostic pathway for these young patients, thereby expediting the diagnostic timeline, enabling rigorous monitoring, and delivering tailored therapeutic interventions.
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Affiliation(s)
- Steven D. Klein
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Alex Nisbet
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jennifer M. Kalish
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Genetics, Perelman School of Medicine, Philadelphia, PA 19104, USA
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7
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Gazzin A, Leoni C, Viscogliosi G, Borgini F, Perri L, Iacoviello M, Piglionica M, De Pellegrin M, Ferrero GB, Bartuli A, Zampino G, Buonuomo PS, Resta N, Mussa A. Work-Up and Treatment Strategies for Individuals with PIK3CA-Related Disorders: A Consensus of Experts from the Scientific Committee of the Italian Macrodactyly and PROS Association. Genes (Basel) 2023; 14:2134. [PMID: 38136956 PMCID: PMC10742781 DOI: 10.3390/genes14122134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
PIK3CA-related disorders encompass many rare and ultra-rare conditions caused by somatic genetic variants that hyperactivate the PI3K-AKT-mTOR signaling pathway, which is essential for cell cycle control. PIK3CA-related disorders include PIK3CA-related overgrowth spectrum (PROS), PIK3CA-related vascular malformations and PIK3CA-related non-vascular lesions. Phenotypes are extremely heterogeneous and overlapping. Therefore, diagnosis and management frequently involve various health specialists. Given the rarity of these disorders and the limited number of centers offering optimal care, the Scientific Committee of the Italian Macrodactyly and PROS Association has proposed a revision of the most recent recommendations for the diagnosis, molecular testing, clinical management, follow-up, and treatment strategies. These recommendations give insight on molecular diagnosis, eligible samples, preferable sequencing, and validation methods and management of negative results. The purpose of this paper is to promote collaboration between health care centers and clinicians with a joint shared approach. Finally, we suggest the direction of present and future research studies, including new systemic target therapies, which are currently under evaluation in several clinical trials, such as specific inhibitors that can be employed to downregulate the signaling pathway.
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Affiliation(s)
- Andrea Gazzin
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
- Postgraduate School of Pediatrics, University of Torino, 10126 Torino, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Federica Borgini
- Italian Macrodactyly and PROS Association, 27010 San Genesio ed Uniti (PV), Italy;
| | - Lucrezia Perri
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Matteo Iacoviello
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Marilidia Piglionica
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Maurizio De Pellegrin
- Pediatric Orthopedic Unit, Piccole Figlie Hospital, 43125 Parma, Italy
- Department of Orthopedics, ASST Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
| | | | - Andrea Bartuli
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Alessandro Mussa
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
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8
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Welters A, Leiter SM, Bachmann N, Bergmann C, Hoermann H, Korsch E, Meissner T, Payne F, Williams R, Hussain K, Semple RK, Kummer S. An expanded clinical spectrum of hypoinsulinaemic hypoketotic hypoglycaemia. Orphanet J Rare Dis 2023; 18:360. [PMID: 37974153 PMCID: PMC10652530 DOI: 10.1186/s13023-023-02954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hypoketotic hypoglycaemia with suppressed plasma fatty acids and detectable insulin suggests congenital hyperinsulinism (CHI). Severe hypoketotic hypoglycaemia mimicking hyperinsulinism but without detectable insulin has recently been described in syndromic individuals with mosaic genetic activation of post-receptor insulin signalling. We set out to expand understanding of this entity focusing on metabolic phenotypes. METHODS Metabolic profiling, candidate gene and exome sequencing were performed in six infants with hypoketotic, hypoinsulinaemic hypoglycaemia, with or without syndromic features. Additional signalling studies were carried out in dermal fibroblasts from two individuals. RESULTS Two infants had no syndromic features. One was mistakenly diagnosed with CHI. One had mild features of megalencephaly-capillary malformation-polymicrogyria (MCAP) syndrome, one had non-specific macrosomia, and two had complex syndromes. All required intensive treatment to maintain euglycaemia, with CHI-directed therapies being ineffective. Pathogenic PIK3CA variants were found in two individuals - de novo germline c.323G>A (p.Arg108His) in one non-syndromic infant and postzygotic mosaic c.2740G>A (p.Gly914Arg) in the infant with MCAP. No causal variants were proven in the other individuals despite extensive investigation, although rare variants in mTORC components were identified in one. No increased PI3K signalling in fibroblasts of two individuals was seen. CONCLUSIONS We expand the spectrum of PI3K-related hypoinsulinaemic hypoketotic hypoglycaemia. We demonstrate that pathogenic germline variants activating post-insulin-receptor signalling may cause non-syndromic hypoinsulinaemic hypoketotic hypoglycaemia closely resembling CHI. This distinct biochemical footprint should be sought and differentiated from CHI in infantile hypoglycaemia. To facilitate adoption of this differential diagnosis, we propose the term "pseudohyperinsulinism".
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Sarah M Leiter
- MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Nadine Bachmann
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | | | - Henrike Hoermann
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Eckhard Korsch
- Paediatric Endocrinology, Children's Hospital, Amsterdamer Straße 59, Cologne, Germany
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Felicity Payne
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Rachel Williams
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Khalid Hussain
- Department of Paediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, Education City North Campus, Doha, Qatar
| | - Robert K Semple
- MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Sebastian Kummer
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany.
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9
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Krishnamurthy K, Edema U, Ustun B, Villanueva-Siles E, Koehler SM, Naeem R, Wang Y, Goldstein DY. PIK3CA-related overgrowth spectrum (PROS) presenting as isolated macrodactyly. J Surg Case Rep 2023; 2023:rjad549. [PMID: 37846420 PMCID: PMC10576994 DOI: 10.1093/jscr/rjad549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
PIK3CA-related overgrowth spectrum (PROS) is a heterogeneous group of diseases, with varied clinical presentations ranging from isolated segmental overgrowths to megalencephaly and vascular malformations, all resulting from post-zygotic activating mutations in PIK3CA. Isolated macrodactyly of upper limb is extremely rare, accounting only for 0.9%-1% of all congenital anomalies of the upper limb. This report describes a case of congenital, isolated, nonprogressive macrodactyly of the right index finger and thumb, in an adult patient that was treated with debulking surgery. The microscopic features were compatible with lipomatosis of nerve. Due to the prompt and pertinent molecular testing, which identified a somatic PIK3CA variant, c.3140A > G, p.H1047R., the case was classified as a PROS. The availability of mTOR inhibitors offers additional treatment possibilities in cases with progressive disease. This case report highlights the importance of molecular testing to identify PROS, to further the knowledge of this continually expanding entity.
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Affiliation(s)
- Kritika Krishnamurthy
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
| | - Ukuemi Edema
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
| | - Berrin Ustun
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
| | - Esperanza Villanueva-Siles
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
| | - Steven M Koehler
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York 10467, United States
| | - Rizwan Naeem
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
| | - Doctor Y Goldstein
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467, United States
- Albert Einstein College of Medicine, Department of Pathology, Bronx, New York 10461, United States
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10
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Wang Z, Yan H, Ma Y, Yao W, Zheng S, Li K. Case Report: Kaposiform hemangioendothelioma with PIK3CA mutation successfully treated with sirolimus. Front Oncol 2023; 13:1132702. [PMID: 37274236 PMCID: PMC10235594 DOI: 10.3389/fonc.2023.1132702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is an extremely rare, locally aggressive vascular neoplasm. The etiopathogenesis of KHE is still poorly understood. In the present study, we found a new mutation in KHE (c.685delA, p.Thr229fs). The KHE patient with the PIK3CA mutation showed complete regression after sirolimus treatment. We propose that the presence of the PIK3CA mutation in KHE may correlate with good response to sirolimus.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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11
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Gubala A, Venkatesh K, Akhter M, Meyer TE, Fitzgibbons TP. High-Output Heart Failure in a Patient With Klippel-Trénaunay Syndrome: A Case Report. Cureus 2023; 15:e38963. [PMID: 37313059 PMCID: PMC10259310 DOI: 10.7759/cureus.38963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
Klippel-Trénaunay syndrome (KTS) is a rare and complex congenital syndrome defined as the triad of cutaneous capillary malformation, bone and soft tissue hypertrophy, and venous and lymphatic malformations. KTS is thought to be due to a somatic mutation in phosphatidyl-inositol 3 kinase. It belongs to a group of syndromes termed the PI3CA-Related Overgrowth Spectrum (PROS) disorders. Because of the rarity and clinical heterogeneity of these disorders, management is patient specific, and best evidence guidelines are lacking. The most common clinical complications are thromboembolism, thrombophlebitis, pain, bleeding, and high-output heart failure. Surgery is recommended for hemangiomas and chronic venous insufficiency. The early identification of children with PROS disorders has allowed treatment with mTOR inhibitors which have been shown to be effective. The recent development of a direct PI3K inhibitor (alpelisib) has shown promise in preventing abnormal growth and long-term complications of KTS. This report documents a case of high-output heart failure due to the vascular malformations associated with KTS in a 57-year-old male patient and discusses current literature regarding the management of KTS with inhibitors of mTOR and PI3KCA.
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Affiliation(s)
- Anna Gubala
- Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Kiran Venkatesh
- Internal Medicine, Sanger Heart and Vascular Institute, Charlotte, USA
| | - Mohammed Akhter
- Internal Medicine, Duke University School of Medicine, Durham, USA
| | - Theo E Meyer
- Internal Medicine, University of Massachusetts Medical School, Worcester, USA
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12
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Chen H, Gao W, Liu H, Sun B, Hua C, Lin X. Updates on Diagnosis and Treatment of PIK3CA-Related Overgrowth Spectrum. Ann Plast Surg 2023; 90:S209-S215. [PMID: 36729078 DOI: 10.1097/sap.0000000000003389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Hyperactivation of the PI3K/AKT/mTOR signaling pathway caused by PIK3CA mutations is associated with a category of overgrowth syndromes that are defined as PIK3CA -related overgrowth spectrum (PROS). The clinical features of PROS are highly heterogeneous and usually present as vascular malformations, bone and soft tissue overgrowth, and neurological and visceral abnormalities. Detection of PIK3CA variants is necessary for diagnosis and provides the basis for targeted therapy for PROS. Drugs that inhibit the PI3K pathway offer alternatives to conventional therapies. This article reviews the current knowledge of PROS and summarizes the latest progress in precise treatment, providing new insights into future therapies and research goals.
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Affiliation(s)
- Hongrui Chen
- From the Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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13
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Wang Z, Yan H, Ding Y, Gong Y, Ma Y, Yao W, Li K. Successful treatment of fibro-adipose Vascular Anomaly with sirolimus. J Pediatr Surg 2023:S0022-3468(23)00100-8. [PMID: 36898877 DOI: 10.1016/j.jpedsurg.2023.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The purpose of this study was to present our initial experience in using sirolimus therapy to treat fibro-adipose vascular anomaly (FAVA). METHODS We retrospectively reviewed the medical records of eight patients with FAVA who were treated with sirolimus at our hospital between July 2017 and October 2020. RESULTS Six girls (75%) and two boys (25%) were included in the cohort; the average age was 8 years (range, 1-13 years). Vascular tumors developed mainly on the extremities, including the forearm (n = 2; 25.0%), calf (n = 4; 50.0%), and thigh (n = 2; 25.0%). The predominant symptoms included swelling of the lesion (n = 8; 100%), pain (n = 7; 87.5%), contracture (n = 3; 37.5%), and phlebectasia (n = 3; 37.5%). Magnetic resonance imaging was the primary method used for FAVA diagnosis, and all patients underwent enhanced MRI. All lesions were heterogeneous with hyperintense T1 signals. The fat-suppressed T2-weighted images also revealed heterogeneous hyperintense masses, thus indicating fibrofatty infiltration. All eight patients received a sirolimus treatment regimen after FAVA diagnosis. One patient underwent tumor resection but experienced recurrence, whereas the other six patients underwent biopsy. Histological examination revealed that the lesions consisted of fibrofatty tissue with abnormal venous channels and anomalous lymphatic vascular components. Sirolimus softened the masses and caused tumor shrinkage within 5.25 ± 2.6 weeks (range, 2-10 weeks) after treatment initiation. The tumors also involuted rapidly and became stable within 7.75 ± 2.25 months after treatment initiation (range, 6-12 months). All seven patients experiencing pain reported relief within 3.8 ± 1.8 weeks (range, 2-7 weeks) after initiation of sirolimus therapy. Sirolimus alleviated but did not fully resolve the contracture in three patients. Remarkably, five patients exhibited a complete response, and three patients exhibited a partial response. At the time of the last follow-up, three patients had begun to gradually taper off sirolimus after 24 months of treatment and maintained a low blood sirolimus concentration. No serious adverse effects were observed during treatment. CONCLUSION FAVA is a complex vascular malformation that appears to respond well to sirolimus treatment. Thus, sirolimus may be an effective and safe treatment for FAVA. LEVEL OF EVIDENCE LEVEL IV.
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Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yingjing Ding
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ying Gong
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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14
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Romano F, Madia F, De Marco P, Ognibene M, Guerrisi S, Scala M, Iacomino M, Baldassari S, Vercellino N, Manunza F, Tallone R, Pavanello M, Piatelli G, Garaventa A, Zara F, Capra V. Clinical and genetic analysis of patients with segmental overgrowth features and somatic mammalian target of rapamycin (mTOR) pathway disruption: Possible novel clinical issues. Birth Defects Res 2022; 114:1440-1448. [DOI: 10.1002/bdr2.2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ferruccio Romano
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genoa Genoa Italy
| | - Francesca Madia
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | | | - Marzia Ognibene
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | - Sara Guerrisi
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | - Marcello Scala
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | - Michele Iacomino
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | | | | | | | - Ramona Tallone
- D.O.P.O. Ambulatory for Oncologic Follow‐up IRCCS Istituto Giannina Gaslini Genoa Italy
| | - Marco Pavanello
- Neurosurgery Unit IRCCS Istituto Giannina Gaslini Genoa Italy
| | | | | | - Federico Zara
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genoa Genoa Italy
| | - Valeria Capra
- Medical Genetics Unit IRCCS Istituto Giannina Gaslini Genoa Italy
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15
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Becker J, Gross UC, Weber DM, Weibel L, Theiler M, Brandt S, Bode PK. PIK3CA Mutational Analysis in Patients With Macrodactyly. Pediatr Dev Pathol 2022; 25:624-634. [PMID: 36314082 DOI: 10.1177/10935266221080155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Somatic mosaicism for PIK3CA mutations causes various types of growth disorders, which have been summarized under the term PROS (PIK3CA related overgrowth spectrum). Targeted therapy with PI3K inhibitors seems to be a promising alternative for severe PROS cases. Therefore, PIK3CA testing may become more relevant in the future. METHODS We report on 14 PROS patients, who had surgery for macrodactyly in the majority of cases. Clinical data were retrieved from the patient's records. Macroscopic and microscopic findings were retrospectively reviewed. Mutational analysis was performed on formalin-fixed paraffin-embedded (FFPE) material. RESULTS Patient age ranged from 7 months to 35 years. Five patients showed additional anomalies. One patient had CLOVES syndrome. The majority of the specimens were ray resections characterized by hypertrophic fat tissue. Overall, microscopy was subtle. The abnormal adipose tissue showed lobules exhibiting at least focally fibrous septa. In each case, we could detect a PIK3CA mutation. CONCLUSION Histology of affected fat tissue in PROS patients is overall nonspecific. Therefore, mutational analysis represents the key to the diagnosis, especially in unclear clinical cases. We demonstrated that FFPE material is suitable for PIK3CA testing, which can be considered as basis for targeted therapy with PI3K inhibitors.
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Affiliation(s)
- Jakob Becker
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Ulrike Camenisch Gross
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel M Weber
- Division of Hand Surgery, Department of Pediatric Surgery, 30995University Children's Hospital Zürich, Zürich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Martin Theiler
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Simone Brandt
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland.,Institute of Pathology Medica, Zürich, Switzerland
| | - Peter K Bode
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
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16
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Wenger TL, Ganti S, Bull C, Lutsky E, Bennett JT, Zenner K, Jensen DM, Dmyterko V, Mercan E, Shivaram GM, Friedman SD, Bindschadler M, Drusin M, Perkins JN, Kong A, Bly RA, Dahl JP, Bonilla-Velez J, Perkins JA. Alpelisib for the treatment of PIK3CA-related head and neck lymphatic malformations and overgrowth. Genet Med 2022; 24:2318-2328. [PMID: 36066547 PMCID: PMC11091962 DOI: 10.1016/j.gim.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE PIK3CA-related overgrowth spectrum (PROS) conditions of the head and neck are treatment challenges. Traditionally, these conditions require multiple invasive interventions, with incomplete malformation removal, disfigurement, and possible dysfunction. Use of the PI3K inhibitor alpelisib, previously shown to be effective in PROS, has not been reported in PIK3CA-associated head and neck lymphatic malformations (HNLMs) or facial infiltrating lipomatosis (FIL). We describe prospective treatment of 5 children with PIK3CA-associated HNLMs or head and neck FIL with alpelisib monotherapy. METHODS A total of 5 children with PIK3CA-associated HNLMs (n = 4) or FIL (n = 1) received alpelisib monotherapy (aged 2-12 years). Treatment response was determined by parental report, clinical evaluation, diary/questionnaire, and standardized clinical photography, measuring facial volume through 3-dimensional photos and magnetic resonance imaging. RESULTS All participants had reduction in the size of lesion, and all had improvement or resolution of malformation inflammation/pain/bleeding. Common invasive therapy was avoided (ie, tracheotomy). After 6 or more months of alpelisib therapy, facial volume was reduced (range 1%-20%) and magnetic resonance imaging anomaly volume (range 0%-23%) were reduced, and there was improvement in swallowing, upper airway patency, and speech clarity. CONCLUSION Individuals with head and neck PROS treated with alpelisib had decreased malformation size and locoregional overgrowth, improved function and symptoms, and fewer invasive procedures.
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Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Catherine Bull
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Erika Lutsky
- Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - James T Bennett
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Center for Developmental Biology and Regenerative Medicine, Seattle Children's Hospital, Seattle, WA
| | - Kaitlyn Zenner
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Dana M Jensen
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Hospital, Seattle, WA
| | - Victoria Dmyterko
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Hospital, Seattle, WA
| | - Ezgi Mercan
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA
| | - Giri M Shivaram
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, WA
| | - Seth D Friedman
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Michael Bindschadler
- Division of Neurology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Madeleine Drusin
- Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Jonathan N Perkins
- Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Ada Kong
- Investigational Drug Services, Seattle Children's Hospital, Seattle, WA
| | - Randall A Bly
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - John P Dahl
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Juliana Bonilla-Velez
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
| | - Jonathan A Perkins
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA
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17
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Brain Abnormalities in PIK3CA-Related Overgrowth Spectrum: Physician, Patient, and Caregiver Experiences. Adv Ther 2022; 39:3871-3880. [PMID: 35857185 PMCID: PMC9297058 DOI: 10.1007/s12325-022-02246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
PIK3CA-related overgrowth spectrum (PROS) disorders are caused by somatic, gain-of-function mutations in PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) that result in hyperactivation of the phosphatidylinositol-3-kinase (PI3K) signaling pathway. PROS encompasses a broad spectrum of overlapping phenotypes that vary considerably in their severity and tissue distribution, leading to different and complex experiences for affected children and their families. The parent of a child with the PROS disorder megalencephaly-capillary malformation (MCAP) coauthored this article. MCAP is characterized by significant neurological involvement, and she describes personal experiences with this condition, including delays associated with obtaining a correct diagnosis, finding an experienced care team, challenges with schooling, medical complications, and the ongoing emotional and financial impacts on their lives. A physician perspective, which reinforces the challenges faced by the young child and his family, is provided by a clinician and researcher specializing in PROS disorders with central nervous system involvement. The physician reviews the mechanism of disease, some of the challenges in accurately diagnosing PROS conditions, disease-related complications, current treatment options and their limitations, and emerging therapeutic options including ongoing clinical trials. Our objective is to share these experiences and insights to benefit patients with PROS disorders, their families, and health care professionals involved with caring for patients with PROS.
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18
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Lee M, Lui ACY, Mak CCY, Tsang MHY, Fung JLF, Yeung KS, Chung BHY. Clinical implications of mosaicism: a 10-year retrospective review of 83 families in a university-affiliated genetics clinic. Clin Dysmorphol 2022; 31:113-124. [PMID: 35256561 DOI: 10.1097/mcd.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mosaicism refers to the coexistence of two or more genetically distinct cell populations in an individual from a single fertilized egg. We performed a retrospective analysis of all patients diagnosed with mosaic disorders between 2010 and 2021 in a university-affiliated genetics clinic, which attends to territory-wide genetic consultations. All patients with confirmed mosaic diagnoses through reproductive (n = 6), prenatal (n = 24), and postnatal (n = 53) testing were examined. We observed that mosaic 45, X (n = 31) and PIK3CA-related overgrowth spectrum (n = 16) disorders were among the most prevalent diagnoses in the clinic, and the total percentage of patients with mosaicism in our cohort was 2.0% (83/4157). A review of the diagnostic journey highlights the challenge in diagnosing mosaic disorders, whereby 38% of the subjects required more than one test sample, and 52% of the cases required more than one orthogonal method of detection to reach the correct diagnosis. While detection of mosaicism is passive through routine clinical testing, for example karyotyping in reproductive and prenatal care, in postnatal care, clinicians can more actively drive the detection of mosaicism. Therefore, we recommend a low threshold for additional genetic testing in suspected mosaicism for more accurate diagnosis and counselling.
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Affiliation(s)
- Mianne Lee
- School of Clinical Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
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19
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Rodríguez-Laguna L, Davis K, Finger M, Aubel D, Vlamis R, Johnson C. Mapping the PIK3CA-related overgrowth spectrum (PROS) patient and caregiver journey using a patient-centered approach. Orphanet J Rare Dis 2022; 17:189. [PMID: 35526022 PMCID: PMC9077929 DOI: 10.1186/s13023-022-02338-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND PROS disorders are driven by somatic, gain-of-function mutations in PIK3CA that result in hyperactivation of the phosphatidylinositol-3-kinase (PI3K) signaling pathway. PROS encompasses a broad spectrum of overlapping phenotypes (including overgrowth and vascular malformations) that vary significantly in their severity; every case is unique, leading to different, complex experiences. Here, we aim to describe the PROS experience from the patients' and caregivers' points of view, from onset to diagnosis to treatment and support. RESULTS The PROS patient journey was developed using a literature review, an ethnography study, health care professional (HCP) research, and social listening. It was then validated with patients, caregivers, and patient advocates. Physician research included 94 PROS centers and other vascular anomaly centers throughout the United States and Europe. Ethnographic research included 24 patients, caregivers, and/or advocates; selected data from 223 patients were reviewed. Key priority areas of need were identified, along with barriers to and potential enablers of quality care. Visual mapping of the PROS patient and family journey was developed to identify key personal health and system issues, and opportunities for improvements throughout patients' lifespans. Maps were also developed for 3 specific conditions: Klippel-Trénaunay syndrome (K-T); congenital lipomatous overgrowth, vascular malformations, epidermal nevi, scoliosis/skeletal and spinal anomalies (CLOVES) syndrome; and megalencephaly-capillary malformation syndrome (M-CM). Overall, most patients with PROS conditions and their families struggle with a long path to diagnosis, access to genetic testing, and finding qualified specialists. Following diagnosis, patients and families are frequently challenged with major medical events, comorbidities, unpredictability, frequent hospitalization, impact on school and work, the need for multidisciplinary care, unwanted attention, adverse impact on mental and emotional health, and financial pressures. Lack of effective pain management emerged as a substantial issue. Challenges and barriers to quality care shift throughout patients' lifespans; transition from pediatric to adult care can be especially difficult. CONCLUSIONS This patient journey in PROS was created in collaboration with patients, caregivers, and advocates as key partners. This novel methodology, which could be applied elsewhere, can more accurately identify areas of unmet need, barriers to care, education topics, and assist HCPs to understand the patient and family perspective.
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Affiliation(s)
- Lara Rodríguez-Laguna
- Vascular Malformations Section, Institute of Medical and Molecular Genetics, INGEMM-IdiPAZ, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | | | | | - Dawn Aubel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Robin Vlamis
- Solstice HealthCommunications, Far Hills, NJ, USA
| | - Craig Johnson
- Interventional Radiology, Nemours Children's Hospital, Orlando, FL, USA
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20
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Yung D, Freeman K, Mirzaa G. Pulmonary Vein Stenosis Associated with Germline PIK3CA Mutation. CHILDREN 2022; 9:children9050671. [PMID: 35626846 PMCID: PMC9139298 DOI: 10.3390/children9050671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
Pulmonary vein stenosis is a rare and frequently lethal childhood disease. There are few known genetic associations, and the pathophysiology is not well known. Current treatments include surgery, interventional cardiac catheterization, and more recently, medications targeting cell proliferation, which are not uniformly effective. We present a patient with PVS and a PIK3CA mutation, who demonstrated a good response to the targeted inhibitor, alpelisib.
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Affiliation(s)
- Delphine Yung
- Department of Pediatrics, Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98105, USA;
- Correspondence:
| | - Kaitlyn Freeman
- Department of Pediatrics, Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Ghayda Mirzaa
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98105, USA;
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA
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21
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Gökpınar İli E, Taşdelen E, Durmaz CD, Altıner Ş, Tuncalı T, Martinez-Glez V, Karabulut HG, Vural S, Ceylaner S, Acar MO, Ilgın Ruhi H. Phenotypic and molecular characterization of five patients with PIK3CA-related overgrowth spectrum (PROS). Am J Med Genet A 2022; 188:1792-1800. [PMID: 35238469 DOI: 10.1002/ajmg.a.62709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/18/2021] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
Abstract
Somatic and germline PI3K-AKT-mTOR pathway pathogenic variants are involved in several segmental overgrowth phenotypes such as the PIK3CA-related overgrowth spectrum (PROS), Proteus syndrome, and PTEN hamartoma tumor syndrome. In this study, we describe five patients with PROS. We identified by high-throughput sequencing four different somatic PIK3CA pathogenic variants in five individuals. The Glu726Lys variant, which was previously reported in megalencephaly-capillary malformation-polymicrogyria (MCAP) syndrome, was identified in two patients with unclassified PROS. The Cys420Arg substitution, which was previously reported in CLOVES, was found in a patient with fibroadipose hyperplasia. Additionally, relatively rare pathogenic variants, His1047Tyr and Tyr1021Cys, were detected in two patients with MCAP. Therefore, we suggest performing deep sequencing of PIK3CA in all patients with suspected PROS, instead of targeted polymerase chain reaction for hotspot pathogenic variants.
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Affiliation(s)
- Ezgi Gökpınar İli
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey.,Genetic Diseases Center, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Elifcan Taşdelen
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey.,Genetic Diseases Center, Şanlıurfa Eyyübiye Training and Research Hospital, Şanlıurfa, Turkey
| | - Ceren Damla Durmaz
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey.,Genetic Diseases Center, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.,Department of Medical Genetics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Şule Altıner
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Timur Tuncalı
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Victor Martinez-Glez
- Vascular Malformations Section, Institute of Medical and Molecular Genetics (INGEMM-IdiPAZ), Hospital Universitario La Paz, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | | | - Seçil Vural
- Department of Dermatology, Koç University School of Medicine, İstanbul, Turkey
| | - Serdar Ceylaner
- Intergen Genetic Diagnosis and Research Center, Ankara, Turkey
| | - Mustafa Oğuz Acar
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Hatice Ilgın Ruhi
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
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