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Lin ZB, Chen ZJ, Yang H, Ding XR, Li J, Pan AP, Sun HS, Yu AY, Chen SH. Expanded phenotypic spectrum of FOXL2 Variant c.672_701dup revealed by whole-exome sequencing in a rare blepharophimosis, ptosis, and epicanthus inversus syndrome family. BMC Ophthalmol 2023; 23:446. [PMID: 37932670 PMCID: PMC10629009 DOI: 10.1186/s12886-023-03189-5] [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: 05/14/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is a rare genetic disease with diverse ocular malformations. This study aimed to investigate the disease-causing gene in members of a BPES pedigree presenting with the rare features of anisometropia, unilateral pathologic myopia (PM), and congenital cataracts. METHODS The related BPES patients underwent a comprehensive ocular examination. Next, whole-exome sequencing (WES) was performed to screen for the disease-causing genetic variants. A step-wise variant filtering was performed to select candidate variants combined with the annotation of the variant's pathogenicity, which was assessed using several bioinformatic approaches. Co-segregation analysis and Sanger sequencing were then conducted to validate the candidate variant. RESULTS The variant c.672_701dup in FOXL2 was identified to be the disease-causing variant in this rare BPES family. Combined with clinical manifestations, the two affected individuals were diagnosed with type II BPES. CONCLUSION This study uncovered the variant c.672_701dup in FOXL2 as a disease causal variant in a rare-presenting BPES family with anisometropia, unilateral pathogenic myopia, and/or congenital cataracts, thus expanding the phenotypic spectrum of FOXL2.
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Affiliation(s)
- Zhi-Bo Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Zhen-Ji Chen
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China
| | - Hui Yang
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xing-Ru Ding
- Zhejiang Provincial Clinical Research Center for Pediatric Disease, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jin Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - An-Peng Pan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hai-Sen Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - A-Yong Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shi-Hao Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Nabih O, Arab L, El Maaloum L, Allali B, El Kettani A. Bilateral cataract in a child with blepharophimosis-ptosis-epicanthus inversus syndrome: A surgical challenge. Int J Surg Case Rep 2022; 92:106845. [PMID: 35219116 PMCID: PMC8881523 DOI: 10.1016/j.ijscr.2022.106845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare autosomal dominant genetic disorder characterized by complex orbito-palpebral anomalies. We report a rare case of BPES associated with bilateral congenital cataract. Observation This study reports the case of a 6-month-old infant with BPES in whom a bilateral congenital cataract was diagnosed, after the parents noticed leukocoria and signs of poor vision in their child. No other ophthalmologic manifestations commonly associated with this syndrome were found. The infant underwent cataract surgery first, with lens phacoaspiration and posterior capsulotomy coupled with anterior vitrectomy and placement of a 3-piece foldable hydrophobic posterior chamber lens in the capsular bag. The surgery was a real challenge due to the orbito-palpebral anomalies that limited a small surgical space, and the placement of the IOL was a matter of discussion. Discussion Publications on the association of congenital cataract with BPES are very rare. The link between these two anomalies is difficult to establish since different genes on different chromosomes code for the two diseases. A lateral canthotomy can be considered to overcome the surgical difficulties due to the reduced working space. The surgical management of pediatric cataract varies in the literature. Conclusion This case highlights the difficulty of cataract surgery in children, even more so when associated with BPES, and the challenge of improving vision in these children given the high risk of amblyopia. Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare autosomal dominant genetic disorder. It characterized by complex orbito-palpebral anomalies. Association with a cataract constitutes a rare clinical form thus making the surgery of this cataract a callenge even for the most experienced surgeons.
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Landau Prat D, Nguyen BJ, Strong A, Katowitz WR, Katowitz JA. "Blepharophimosis-plus" syndromes: Frequency of systemic genetic disorders that also include blepharophimosis. Clin Exp Ophthalmol 2021; 49:448-453. [PMID: 33882191 DOI: 10.1111/ceo.13933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine the frequency of isolated blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) versus systemic genetic disorders in patients presenting with blepharophimosis. METHODS Retrospective clinical records review. The records of all patients with blepharophimosis seen in the Division of Ophthalmology at the Children's Hospital of Philadelphia during a 12-year-period (2009-2020) were reviewed for medical history, clinical examination findings and results of genetic analyses. RESULTS The 135 patients identified with blepharophimosis included 72 females (53%) and 63 males (47%) whose mean ± standard deviation age at first visit was 3.5 ± 6.4 years (range 0-39.8 years). Sixty-seven of the patients (50%) had undergone genetic testing for FOXL2 gene mutation. Fifty-four (81%) harboured FOXL2 gene mutations and 13 (19%) did not. Altogether, 126 patients (93%) had a final diagnosis of isolated BPES. The remaining nine (7%) had syndromic diagnoses ("blepharophimosis-plus"), including Dubowitz syndrome (n = 2), Ohdo syndrome (n = 1), 22q11.2 duplication (n = 1) and 3q22 deletion (n = 2). Three patients with multiple congenital anomalies remain undiagnosed. CONCLUSIONS Blepharophimosis is an eyelid feature occurring most commonly in isolation due to FOXL2 gene mutation, but can also be a harbinger of multisystem disease not exclusive to isolated BPES, as observed in 7% of cases in this series. The ophthalmologist is often the first to recognise these unique features, and must consider and rule out non-BPES syndromes before establishing a diagnosed classic BPES. A comprehensive genetic evaluation is, therefore, indicated in all cases.
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Affiliation(s)
- Daphna Landau Prat
- Division of Ophthalmology, Oculoplastic and Orbital Surgery Service, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall, Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brian J Nguyen
- Division of Ophthalmology, Oculoplastic and Orbital Surgery Service, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall, Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alanna Strong
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William R Katowitz
- Division of Ophthalmology, Oculoplastic and Orbital Surgery Service, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall, Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James A Katowitz
- Division of Ophthalmology, Oculoplastic and Orbital Surgery Service, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall, Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gupta N, Ganesh S, Singla P, Kumar S. A rare association of blepharophimosis-ptosis-epicanthus inversus case with congenital nasolacrimal duct obstruction. Eur J Ophthalmol 2019; 31:NP8-NP11. [PMID: 31752537 DOI: 10.1177/1120672119886427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of reporting this case is to describe a rare combination of blepharophimosis-ptosis-epicanthus inversus syndrome with congenital nasolacrimal duct obstruction. A variety of lacrimal anomalies have been seen in blepharophimosis-ptosis-epicanthus inversus syndrome but the occurrence of nasolacrimal duct obstruction is rare. METHOD The blepharophimosis-ptosis-epicanthus inversus syndrome is an autosomal dominant rare genetic defect with clinical manifestation of dysplasia of the eyelids, palpebral fissures, flat nasal bridge, and ptosis. A 20-month-old boy was referred with the complaints of watering and discharge from his right eyes since birth. On examination, the child had all the features of blepharophimosis-ptosis-epicanthus inversus syndrome with right congenital nasolacrimal duct obstruction in line with the published reports. RESULT On endoscopic probing and irrigation, the probe could not be visualized into the inferior meatus. On dacryoendoscopy, the membranous part of the nasolacrimal duct was found to be completely obliterated with no light transmission into the nose indicating a malformed nasolacrimal duct. The child was managed by endoscopic dacryocystorhinostomy. We could find only one case report published so far on the combination of congenital nasolacrimal duct obstruction with blepharophimosis-ptosis-epicanthus inversus syndrome. This study adds one more case of blepharophimosis-ptosis-epicanthus inversus syndrome with congenital nasolacrimal duct obstruction and adjuvant use of dacryoendoscopy.
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Affiliation(s)
- Nishi Gupta
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Sunil Kumar
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Gilbert SB, Roof AK, Rajendra Kumar T. Mouse models for the analysis of gonadotropin secretion and action. Best Pract Res Clin Endocrinol Metab 2018; 32:219-239. [PMID: 29779578 PMCID: PMC5973545 DOI: 10.1016/j.beem.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gonadotropins are pituitary gonadotrope-derived glycoprotein hormones. They act by binding to G-protein coupled receptors on gonads. Gonadotropins play critical roles in reproduction by regulating both gametogenesis and steroidogenesis. Although biochemical and physiological studies provided a wealth of knowledge, gene manipulation techniques using novel mouse models gave new insights into gonadotropin synthesis, secretion and action. Both gain of function and loss of function mouse models for understanding gonadotropin action in a whole animal context have already been generated. Moreover, recent studies on gonadotropin actions in non-gonadal tissues challenged the central dogma of classical gonadotropin actions in gonads and revealed new signaling pathways in these non-gonadal tissues. In this Chapter, we have discussed our current understanding of gonadotropin synthesis, secretion and action using a variety of genetically engineered mouse models.
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Affiliation(s)
- Sara Babcock Gilbert
- Division of Reproductive Endocrinology and Infertility, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Division of Reproductive Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Allyson K Roof
- Division of Reproductive Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - T Rajendra Kumar
- Division of Reproductive Endocrinology and Infertility, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Division of Reproductive Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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Surve A, Meel R, Pushker N, Bajaj MS. Ultrasound biomicroscopy image patterns in normal upper eyelid and congenital ptosis in the Indian population. Indian J Ophthalmol 2018; 66:383-388. [PMID: 29480247 PMCID: PMC5859591 DOI: 10.4103/ijo.ijo_915_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM). Methods This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenital ptosis (n = 33) cases; Marcus Gunn jaw-winking ptosis (MGJWP, n = 7) cases, and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES, n = 20) cases were studied on a vertical UBM scan using 50-MHz probe. Lid-thickness, tarsal-thickness, orbicularis oculi and levator-Muller-orbital septum-conjunctival (LMSC) complex were measured in primary gaze. Comparison was made between four groups and results were statistically analyzed using ANOVA test. In normal individuals, LMSC measurements were repeated in down-gaze imaging. Results Skin with subcutaneous tissue, LMSC complex and pre-aponeurotic fat-pad appeared echodense while orbicularis oculi and tarsus appeared echolucent. In primary gaze, mean thickness (± standard deviation) of the eyelid, tarsus, orbicularis oculi and LMSC, respectively, were: 1.612 ± 0.205, 0.907 ± 0.098, 0.336 ± 0.083, and 0.785 ± 0.135 mm in normal individual. LMSC showed 46.64% increase in thickness on down-gaze. The mean eyelid thickness and LMSC were thicker in MGJWP and BPES as compared to normal. In different types of congenital ptosis cases, various patterns of UBM imaging were observed. Conclusion UBM allows noninvasive imaging of eyelid structures with good anatomical correspondence in normal eyelids and study the structural alterations of eyelids in different types of congenital ptosis. UBM can be used to highlight the anatomical difference in normal eyelids that may help modify the surgery for better cosmetic outcomes. Furthermore, it has the potential to be used in preoperative evaluation and operative planning in certain types of acquired ptosis, which needs to be evaluated.
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Affiliation(s)
- Abhidnya Surve
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M S Bajaj
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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A modified staged surgical intervention for blepharophimosis-ptosis-epicanthus inversus syndrome: 125 cases with encouraging results. Ann Plast Surg 2015; 74:410-7. [PMID: 24164792 DOI: 10.1097/01.sap.0000437072.17014.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare autosomal dominant condition characterized by typical eyelid malformations that include blepharophimosis, ptosis, epicanthus inversus, and telecanthus. METHODS We retrospectively reviewed 125 consecutive BPES patients who underwent staged surgical intervention from July 2003 to December 2011. All patients underwent initial medial and lateral canthoplasties, followed by blephroptosis correction 6 to 12 months afterward. The parameters that were studied included horizontal palpebral fissure length (PFL), vertical interpalpebral fissure height, inner intercanthal distance (IICD), the ratio of IICD to PFL, and frontalis function (FF). Facial photographs were taken preoperatively and postoperatively. Paired and group t tests were used for statistical analysis to evaluate surgical outcomes. RESULTS After consecutive operations, the mean PFL increased from 19.5 to 25.7 mm (mean difference, 6.2 mm; P < 0.01). The mean interpalpebral fissure height increased from 3.4 to 8.5 mm (mean difference, 5.1 mm; P < 0.01). The mean IICD decreased from 38.0 to 30.9 mm (mean difference, 7.1 mm; P < 0.01). The mean FF was 7.3 mm for BPES patients approximately 5 years old and 10.4 mm for patients approximately 7 years old. There was no difference between children who underwent muscle flap suspension and healthy children of the same age (P > 0.05). CONCLUSIONS The modified staged surgical intervention, including Y-V flap, von Ammon, and frontalis muscle flap suspension, provided effective results both in function and cosmesis for BPES. The FF was not weakened by surgery.
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Tripathy K, Sharma YR, Chawla R, Basu K, Vohra R, Venkatesh P. Triads in Ophthalmology: A Comprehensive Review. Semin Ophthalmol 2015; 32:237-250. [DOI: 10.3109/08820538.2015.1045150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Koushik Tripathy
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Yog Raj Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Basu
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Fortin J, Ongaro L, Li Y, Tran S, Lamba P, Wang Y, Zhou X, Bernard DJ. Minireview: Activin Signaling in Gonadotropes: What Does the FOX say… to the SMAD? Mol Endocrinol 2015; 29:963-77. [PMID: 25942106 DOI: 10.1210/me.2015-1004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The activins were discovered and named based on their abilities to stimulate FSH secretion and FSHβ (Fshb) subunit expression by pituitary gonadotrope cells. According to subsequent in vitro observations, activins also stimulate the transcription of the GnRH receptor (Gnrhr) and the activin antagonist, follistatin (Fst). Thus, not only do activins stimulate FSH directly, they have the potential to regulate both FSH and LH indirectly by modulating gonadotrope sensitivity to hypothalamic GnRH. Moreover, activins may negatively regulate their own actions by stimulating the production of one of their principal antagonists. Here, we describe our current understanding of the mechanisms through which activins regulate Fshb, Gnrhr, and Fst transcription in vitro. The activin signaling molecules SMAD3 and SMAD4 appear to partner with the winged-helix/forkhead transcription factor, forkhead box L2 (FOXL2), to regulate expression of all 3 genes. However, in vivo data paint a different picture. Although conditional deletion of Foxl2 and/or Smad4 in murine gonadotropes produces impairments in FSH synthesis and secretion as well as in pituitary Fst expression, Gnrhr mRNA levels are either unperturbed or increased in these animals. Surprisingly, gonadotrope-specific deletion of Smad3 alone or with Smad2 does not impair FSH production or fertility; however, mice harboring these mutations may express a DNA binding-deficient, but otherwise functional, SMAD3 protein. Collectively, the available data firmly establish roles for FOXL2 and SMAD4 in Fshb and Fst expression in gonadotrope cells, whereas SMAD3's role requires further investigation. Gnrhr expression, in contrast, appears to be FOXL2, SMAD4, and, perhaps, activin independent in vivo.
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Affiliation(s)
- Jérôme Fortin
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Luisina Ongaro
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Yining Li
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Stella Tran
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Pankaj Lamba
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Ying Wang
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Xiang Zhou
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
| | - Daniel J Bernard
- Department of Pharmacology and Therapeutics (J.F., L.O., Y.L., S.T., P.L., Y.W., X.Z., D.J.B.), McGill University, Montréal, Québec, Canada H3G 1Y6; The Campbell Family Cancer Research Institute (J.F.), Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada M5G 2C1; Diabetes Center (S.T.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; and Psychiatry (P.L.), St Mary Mercy Hospital, Livonia, Michigan 48154
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Wan MJ, VanderVeen DK. Eye disorders in newborn infants (excluding retinopathy of prematurity). Arch Dis Child Fetal Neonatal Ed 2015; 100:F264-9. [PMID: 25395469 DOI: 10.1136/archdischild-2014-306215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/22/2014] [Indexed: 01/01/2023]
Abstract
A screening eye examination is an essential part of the newborn assessment. The detection of many ocular disorders in newborn infants can be achieved through careful observation of the infant's visual behaviour and the use of a direct ophthalmoscope to assess the ocular structures and check the red reflex. Early diagnosis and subspecialty referral can have a critical impact on the prognosis for many ocular conditions, including potentially blinding but treatable conditions such as congenital cataracts, life-threatening malignancies such as retinoblastoma and harbingers of disease elsewhere such as sporadic aniridia and its association with the development of Wilms tumour.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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The CpG island in the murine foxl2 proximal promoter is differentially methylated in primary and immortalized cells. PLoS One 2013; 8:e76642. [PMID: 24098544 PMCID: PMC3788739 DOI: 10.1371/journal.pone.0076642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/30/2013] [Indexed: 11/23/2022] Open
Abstract
Forkhead box L2 (Foxl2), a member of the forkhead transcription factor family, plays important roles in pituitary follicle-stimulating hormone synthesis and in ovarian maintenance and function. Mutations in the human FOXL2 gene cause eyelid malformations and premature ovarian failure. FOXL2/Foxl2 is expressed in pituitary gonadotrope and thyrotrope cells, the perioptic mesenchyme of the developing eyelid, and ovarian granulosa cells. The mechanisms governing this cell-restricted expression have not been described. We mapped the Foxl2 transcriptional start site in immortalized murine gonadotrope-like cells, LβT2, by 5’ rapid amplification of cDNA ends and then PCR amplified approximately 1 kb of 5’ flanking sequence from murine genomic DNA. When ligated into a reporter plasmid, the proximal promoter conferred luciferase activity in both homologous (LβT2) and, unexpectedly, heterologous (NIH3T3) cells. In silico analyses identified a CpG island in the proximal promoter and 5’ untranslated region, suggesting that Foxl2 transcription might be regulated epigenetically. Indeed, pyrosequencing and quantitative analysis of DNA methylation using real-time PCR revealed Foxl2 proximal promoter hypomethylation in homologous compared to some, though not all, heterologous cell lines. The promoter was also hypomethylated in purified murine gonadotropes. In vitro promoter methylation completely silenced reporter activity in heterologous and homologous cells. Collectively, the data suggest that differential proximal promoter DNA methylation may contribute to cell-specific Foxl2 expression in some cellular contexts. However, gonadotrope-specific expression of the gene cannot be explained by promoter hypomethylation alone.
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Cheng JC, Klausen C, Leung PCK. Overexpression of wild-type but not C134W mutant FOXL2 enhances GnRH-induced cell apoptosis by increasing GnRH receptor expression in human granulosa cell tumors. PLoS One 2013; 8:e55099. [PMID: 23372819 PMCID: PMC3553060 DOI: 10.1371/journal.pone.0055099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 12/22/2012] [Indexed: 02/02/2023] Open
Abstract
The etiology of granulosa cell tumors (GCTs) is largely unknown. The primary mode of treatment is surgical, however not all women are cured by surgery alone. Thus, it is important to develop improved treatments through a greater understanding of the molecular mechanisms that contribute to this disease. Recently, it has been shown that a FOXL2 402C>G (C134W) mutation is present in 97% of human adult-type GCTs, suggesting an important role for this mutation in the development of GCTs. We have shown previously that gonadotropin-releasing hormone (GnRH)-I and -II induce apoptosis in cultured normal human granulosa cells. Moreover, it has been reported that FOXL2 can bind to the promoter of the mouse GnRH receptor gene and regulate its transcription. Thus, we hypothesized that C134W mutant FOXL2 could modulate the pro-apoptotic effects of GnRH via aberrant regulation of GnRH receptor levels. Using KGN cells, a human GCT-derived cell line which harbors the FOXL2 402C>G mutation, we show that treatment with GnRH-I and -II induces cell apoptosis, and that small interfering RNA-mediated depletion of GnRH receptor abolishes these effects. Overexpression of wild-type FOXL2 increases both mRNA and protein levels of GnRH receptor and consequently enhances GnRH-induced apoptosis. Importantly, neither the expression levels of GnRH receptor nor GnRH-induced apoptosis were affected by overexpression of the C134W mutant FOXL2. Interestingly, knockdown of endogenous FOXL2 down-regulates GnRHR expression in normal human granulosa cells with wild-type FOXL2, but not in KGN cells. These results suggest that the FOXL2 402C>G mutation may contribute to the development of human adult-type GCTs by reducing the expression of GnRH receptor, thus conferring resistance to GnRH-induced cell apoptosis.
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Affiliation(s)
- Jung-Chien Cheng
- Department of Obstetrics and Gynaecology, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Klausen
- Department of Obstetrics and Gynaecology, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C. K. Leung
- Department of Obstetrics and Gynaecology, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Nuruddin M, Osmani M. Two-Stage Correction of Blepharophimosis Syndrome: Analysis of Surgical Outcome. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:345-8. [PMID: 26107727 DOI: 10.1097/apo.0b013e31826b1f8f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the outcome of surgical correction of blepharophimosis syndrome. DESIGN A retrospective, non-randomized, interventional case series. METHODS Ten patients undergoing surgical correction of blepharophimosis syndrome in 2 stages were reviewed. In the first stage, correction of epicanthic fold and telecanthus was done by either Y-V plasty or Roveda procedure with or without medial canthal tendon shortening. In the second stage, ptosis correction was done by bilateral frontalis sling. The preoperative and postoperative ratio of intercanthal distance (ICD) to horizontal palpebral fissure length (HPFL) was compared to assess the outcome of surgical correction of blepharophimosis. The ratio was graded as good (ratio < 1.3), suboptimal (ratio between 1.3 and 1.5), and poor (ratio > 1.5). The outcome of ptosis correction was graded as good, moderate, and poor. RESULTS Of 10 patients, 5 (50%) underwent Y-V plasty, and 5 (50%) underwent Roveda procedure. Medial canthal tendon shortening was done in 5 patients (50%) having a preoperative ICD of 35 mm or more. After surgical correction, mean reduction in ICD was 4.8 mm (P < 0.0001), and mean improvement in HPFL was 5.45 mm (P < 0.0001). The mean ICD to HPFL ratio changed from 2.02 to 1.31 after surgery, which was statistically significant (P < 0.0001). Two patients (20%) had a ratio greater than 1.5. Nine patients (90%) had either good or moderate ptosis correction after bilateral frontalis sling with silicone rod. CONCLUSIONS Functionally and cosmetically acceptable outcome can be achieved after surgical correction of blepharophimosis syndrome in 2 stages.
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Affiliation(s)
- Murtuza Nuruddin
- From the *Eye Infirmary and Training Complex and †Institute of Community Ophthalmology, Chittagong, Bangladesh
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Abstract
The authors present the clinical case of a 5-month-old boy, affected by multimalformative syndrome with features of microdeletion 3q syndrome. In the literature so far, the real incidence is unknown because of its rarity. The goal of this study was to describe the salient findings of this rare malformative syndrome, which needs a multidisciplinary approach. The patient had 3q interstitial chromosome deletion (q22.1-q25.2). He showed the following clinical features: microcephaly, microphthalmia, epicantus inversus, blepharophimosis, palpebral ptosis, short neck with pterygium, brachycephaly, round face, hypotelorism, broad nasal bridge, beaked nose, large and low-set ears, soft cleft palate, retromicrognathia with large mouth, arthrogryposis of the superior limbs and knees in association with clinodactyly, overlapping of second and third digits of both hands and feet, and gastroesophageal reflux. The patient developed physical and motor development delay. He was affected by Dandy-walker malformation, characterized by cerebellum vermis hypoplasia. The placement of the patient in contiguous gene syndrome (Dandy walker syndrome, Pierre-Robin sequence, and Seckel syndrome) was carried out by a multidisciplinary team to have a holistic evaluation of clinical findings. Thanks to this approach, it was possible to establish a complete diagnostic and therapeutic course. The genetic analysis enables to arrange an assistive program. Surgeons' attention was focused on the malformations, which represented an obstacle for normal development and social life.
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Bhattacharjee K, Bhattacharjee H, Kuri G, Shah ZT, Deori N. Single stage surgery for Blepharophimosis syndrome. Indian J Ophthalmol 2012; 60:195-201. [PMID: 22569380 PMCID: PMC3361814 DOI: 10.4103/0301-4738.95870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 05/31/2011] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The purpose of this study was to report the functional and cosmetic outcome of single stage surgical procedure for correction of the classic components of Blepharophimosis syndrome. MATERIALS AND METHODS We report a retrospective case file review of 11 patients with Blepharophimosis syndrome operated between July 2004 and April 2008. Each patient had undergone the correction of epicanthus inversus, telecanthus, palpebral phimosis, and bilateral ptosis as a single-stage surgical procedure. Patients were examined and photographed before and after surgery. The mean follow-up was 3 years (range 2-6 years). RESULTS A total of 11 patients (8 males, 3 females) with a mean age of 9 years (range 6--22 years) were reviewed. The surgical outcome was assessed both functionally and cosmetically. The mean preoperative visual acuity was 0.729 ± 0.316 SD and the mean postoperative visual acuity was 0.856 ± 0.277 SD (P <0.0428). There was a statistically significant decrease of astigmatism following ptosis correction (P<0.05), improvement of telecanthus (P<0.0001) in terms of IICD (inner intercanthal distance), and HPFL (horizontal palpebral fissure length) (P=0.019) along with improvement of the superior visual field. The mean preoperative and postoperative IICD was 3±0.33 SD and 2.418 ± 0.189 SD, respectively. There was also a significant postoperative improvement of ptosis (P< 0.01), as measured by IPFH (vertical interpalpebral fissure height). All the patients had a stable functional and cosmetic result after a mean follow-up period of 3 years. CONCLUSION Single-stage surgical correction of the classic anomalies of Blepharophimosis syndrome provides stable and successful long-term results.
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Affiliation(s)
- Kasturi Bhattacharjee
- Department of Orbit, Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Harsha Bhattacharjee
- Department of Orbit, Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Ganesh Kuri
- Department of Orbit, Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Zeenat Tajmin Shah
- Department of Orbit, Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Nilutparna Deori
- Department of Orbit, Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Leon-Mateos A, Ginarte M, Ruiz-Ponte C, Carracedo A, Toribio J. Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Int J Dermatol 2007; 46:61-3. [PMID: 17214723 DOI: 10.1111/j.1365-4632.2007.03066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare inherited condition that includes characteristic eyelid malformations and sometimes reduced fertility in females. Genetic studies have implicated mutations in the forkhead transcription factor FOXL2 as responsible for BPES. We report a female and her father with BPES type I, who presented the 1092-1108dup17 mutation in the FOXL2 gene. Molecular studies and the typical clinical features of BPES should allow the dermatologist to reach an early diagnosis and permit the treatment of eyelid alterations and the investigation of infertility.
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Abstract
PURPOSE To classify the severity of blepharophimosis, describe associated features and their effects on the incidence of amblyopia and to recommend guidelines for surgical treatment and management of surgical complications. METHODS The case records of 23 patients with blepharophimosis syndrome were examined retrospectively. Patients' photographs and measurements were reviewed to analyse the severity of blepharophimosis, surgical techniques undertaken, surgical outcomes, and complications. Statistical analyses were performed using paired-sample t-tests to evaluate the surgical outcome and Spearman correlation to examine the influence of blepharophimosis on the interpalpebral fissure height (PFH). RESULTS Eighteen out of 23 (78%) patients underwent one-stage surgery before the age of 5 years. About 31% of these patients had amblyopia. Only two patients had a blepharophimosis ratio greater than 1.5 as poor result. Two out of 18 (11%) patients with PFHs more than 2 mm needed a repeat operation, but all five (100%) patients with s less than 2 mm (very severe ptosis) needed repeat operations. CONCLUSIONS The one-stage corrective procedure provided acceptable results both in function and cosmesis. However, patients with very severe ptosis required multiple stages of reconstruction for ptosis correction at an earlier age, after which correction of telecanthus and small horizontal palpebral fissure length followed at an older age.
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Affiliation(s)
- S-Y Wu
- Department of Ophthalmology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Kewi-Shan, Taoyuan, Taiwan, Republic of China
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Choi KH, Kyung S, Oh SY. The factors influencing visual development in blepharophimosis-ptosis-epicanthus inversus syndrome. J Pediatr Ophthalmol Strabismus 2006; 43:285-8. [PMID: 17022162 DOI: 10.3928/01913913-20060901-03] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the factors influencing visual development in blepharophimosis-ptosis-epicanthus inversus syndrome. MATERIALS AND METHODS The study population comprised 20 patients with blepharophimosis-ptosis-epicanthus inversus syndrome who were referred for an oculoplastic opinion. The ocular examination included measurement of Snellen visual acuity, cycloplegic refraction, ocular movements and alignment, and the presence of amblyopia. Patients were treated with spectacle correction, occlusion therapy, strabismus surgery, and oculoplastic surgery if necessary. Minimum follow-up was 2 years. RESULTS Nine (45%) patients had amblyopia; 5 (25%) of these patients had unilateral amblyopia and 4 (20%) had bilateral amblyopia. Six (67%) patients with amblyopia had a significant coexisting strabismus. A significant strabismus was present in 11 (55%) patients; 6 (55%) of these patients had unilateral or bilateral amblyopia. Patients with strabismus were more likely to have amblyopia than those without. A total of 14 (70%) patients had refractive error; 6 (43%) of these patients had amblyopia. CONCLUSIONS Patients with blepharophimosis-ptosis-epicanthus inversus syndrome had a high rate of amblyopia, especially bilateral amblyopia. Patients with strabismus were more likely to have amblyopia than those without. Patients also had a high incidence of refractive errors.
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Affiliation(s)
- Ki-Hwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mari F, Giachino D, Russo L, Pilia G, Ariani F, Scala E, Chiappe F, Sampieri K, Caporossi A, Renieri A, Lasorella G. Blepharophimosis, ptosis, and epicanthus inversus syndrome: clinical and molecular analysis of a case. J AAPOS 2006; 10:279-80. [PMID: 16814186 DOI: 10.1016/j.jaapos.2006.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 10/25/2005] [Accepted: 10/25/2005] [Indexed: 11/28/2022]
Abstract
Blepharophimosis-ptosis-epicanthus inversus syndrome (OMIM #U10100) is a rare autosomal-dominant disorder in which an eyelid malformation is associated (type I) or not (type H) with premature ovarian failure in the affected female. It is invariably characterized by 4 major features: (1) bilaterally shortened horizontal palpebral fissure (blepharophimosis); (2) severe impairment of the superior palpebral levator (ptosis); (3) a vertical skin fold arising from the lower eyelid, which inserts medially in the upper lid (epicanthus inversus) and (4) an increased inner can-thal distance with a normal outer canthal distance (telecanthus). The mutations causing this disorder are found in the FOXL2 gene, a forkhead transcription factor, located in 3q23. Although many patients with blepharophimosis-ptosis-epicanthus inversus syndrome have an affected parent, a conspicuous number of sporadic cases also have been reported. We describe here a sporadic case with a mutation in the FOXL2 gene that was well characterized both clinically and molecularly.
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Affiliation(s)
- Francesca Mari
- Medical Genetics, Molecular Biology Department, University of Siena, Siena, Italy
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Cha SC, Jang YS, Lee JH, Kim HK, Kim SC, Kim S, Baek SH, Jung WS, Kim JR. Mutational analysis of forkhead transcriptional factor 2 (FOXL2) in Korean patients with blepharophimosis-ptosis-epicanthus inversus syndrome. Clin Genet 2004; 64:485-90. [PMID: 14986827 DOI: 10.1046/j.1399-0004.2003.00162.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We screened for mutations in the forkhead transcription factor gene, FOXL2, in Korean patients with sporadic or familial blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) by polymerase chain reaction-single-stranded conformation polymorphism (PCR-SSCP) and direct sequencing. Five of nine BPES families and three of seven sporadic cases were detected to have FOXL2 mutations. We identified four types of FOXL2 mutations, two of which are novel. A new 14 bp deletion (939-952del14) causing a frameshift from G235W and the extension of the predicted protein to 527 amino acids was detected in a BPES family patient. In addition, a novel 845C > A transversion, resulting in a nonsense mutation (S203X), was found in a sporadic case of BPES. The previously reported in-frame 30 bp duplication (909-938dup30) was the most common mutation and was found in eight patients of four BPES families and one sporadic case. A known 17 bp duplication (1080-1096dup17) was observed in a sporadic BPES case. We were unable to find a causal mutation in four BPES families and four sporadic cases. These results suggest that in a fraction of BPES patients, the genetic defect might be associated with a mutation in the non-coding region of the FOXL2 gene or in other genes.
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Affiliation(s)
- S C Cha
- Department of Ophthalmology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Möhrenschlager M, Wessner DB, Abeck D, Ring J. Cutaneous peculiarities in blepharophimosis-ptosis-epicanthus inversus syndrome: report of a case. J AAPOS 2001; 5:58-9. [PMID: 11182677 DOI: 10.1067/mpa.2001.111781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare inherited disorder with characteristic oculofacial affection of the eyelid region. Recent results of genetic analysis of the causative gene, as well as a hitherto unknown association with hormone-dependent endometrial carcinoma, motivated us to review this syndrome.
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Affiliation(s)
- M Möhrenschlager
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Germany
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Cai T, Tagle DA, Xia X, Yu P, He XX, Li LY, Xia JH. A novel case of unilateral blepharophimosis syndrome and mental retardation associated with de novo trisomy for chromosome 3q. J Med Genet 1997; 34:772-6. [PMID: 9321768 PMCID: PMC1051066 DOI: 10.1136/jmg.34.9.772] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We have evaluated a 3 2/12 year old girl who presented with unilateral blepharophimosis, ptosis of the eyelid, and mental retardation. Additional dysmorphic features include microcephaly, high, narrow forehead, short stubby fingers, and adduction of the right first toe. Cytogenetic analysis showed an unbalanced karyotype consisting of 46,XX,add(7)(q+) that was de novo in origin. Fluorescence in situ hybridisation (FISH) using microdissected library probe pools from chromosomes 1,2,3,7, and 3q26-qter showed that the additional material on 7q was derived from the distal end of the long arm of chromosome 3. Our results indicate that the patient had an unbalanced translocation, 46,XX,der(7)t(3;7)(q26-qter;q+) which resulted in trisomy for distal 3q. All currently reported cases of BPES (blepharophimosis-ptosis-epicanthus inversus syndrome) with associated cytogenetic abnormalities show interstitial deletions or balanced translocations involving 3q22-q23 or 3p25.3. Our patient shares similar features to BPES, except for the unilateral ptosis and absence of epicanthus inversus. It is possible that our patient has a contiguous gene defect including at least one locus for a type of blepharophimosis, further suggesting that multiple loci exist for eyelid development.
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Affiliation(s)
- T Cai
- National Key Laboratory of Medical Genetics, Human Medical University, PR China
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