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Zhang H, Guo X, Yang C, Zhang K, Wang D, Wang J, Liu Y, Kang L, Liu Q, Li X. Clinical feature and genetic mutation of KBG syndrome diagnosed in neonatal period: A case report. Medicine (Baltimore) 2023; 102:e35449. [PMID: 37800809 PMCID: PMC10553122 DOI: 10.1097/md.0000000000035449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
RATIONALE KBG syndrome (KBGS, OMIM: 148050), a rare genetic disorder, is clinically characterized by megalodontia, short stature, skeletal abnormalities, and nervous system manifestations. In the study, we explore the clinical and genetic characteristics of one neonate suffering KBGS caused by ANKRD11 gene mutation. PATIENT CONCERNS The proband, a female, was born prematurely at 31 + 2 weeks. There were repeated infections and abdominal distension in the first month after birth, and the platelets could not rise to normal. Head ultrasound showed intracranial brain injury and intracranial hemorrhage. DIAGNOSES Sequencing revealed that there was a heterozygous mutation in exon 9 of the ANKRD11 gene (NM_013275.5) for the child, c.1896_1897delTA (p.H632Qfs*30), which was a de novo mutation and has not been reported. Combining clinical features and genetic results, the proband was diagnosed as KBGS. INTERVENTIONS AND OUTCOMES The brain sonography on day 4 after birth showed brain injury and intracranial hemorrhage. Therefore, 140 mg of bovine lung surfactant was administered through endotracheal intubation in addition to ventilator-assisted ventilation. Antibiotic treatment was also given till the inflammatory indicators of the infant returned to normal levels. The following-up of 1-year-6-month showed that the language, motion and height of development is slight falling behind the children of the same age. LESSONS This is the first case of KBGS was diagnosed in the neonatal period, which provides a reference for the child to receive timely and correct treatment.
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Affiliation(s)
- HaoZheng Zhang
- Pediatric Research Institute, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Xuening Guo
- Neonatal Intensive Care Unit, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Chun Yang
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Kaihui Zhang
- Pediatric Research Institute, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Dong Wang
- Pediatric Research Institute, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Juan Wang
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Yi Liu
- Neonatal Intensive Care Unit, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Lili Kang
- Neonatal Intensive Care Unit, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Qinghua Liu
- Department of Ultrasound, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaoying Li
- Pediatric Research Institute, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Neonatal Intensive Care Unit, Children’s Hospital Affiliated to Shandong University, Jinan, China
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2
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Choi Y, Choi J, Do H, Hwang S, Seo GH, Choi IH, Keum C, Choi JH, Kang M, Kim GH, Yoo HW, Lee BH. KBG syndrome: Clinical features and molecular findings in seven unrelated Korean families with a review of the literature. Mol Genet Genomic Med 2022; 11:e2127. [PMID: 36564961 PMCID: PMC10094073 DOI: 10.1002/mgg3.2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND KBG syndrome is a rare genetic disorder involving macrodontia of the upper central incisors, craniofacial, skeletal, and neurologic symptoms, caused either by a heterozygous variant in ANKRD11 or deletion of 16q24.3, including ANKRD11. Diagnostic criteria were proposed in 2007 based on 50 cases, but KBG syndrome remains underdiagnosed. METHODS Whole exome sequencing (WES) and array comparative genomic hybridization (array CGH) were conducted for genetic analysis and patient phenotypes were characterized based on medical records. RESULTS Eight patients from seven unrelated families were confirmed with KBG syndrome. All patients (8/8, 100%) had some degree of craniofacial dysmorphism and developmental delay or intellectual disabilities. Triangular face, synophrys, anteverted nostril, prominent ears, long philtrum, and tented upper lip, which are typical facial dysmorphism findings in patients with KBG syndrome, were uniformly identified in the eight patients participating in this study, with co-occurrence rates of 4/8 (50%), 4/8 (50%), 4/8 (50%), 4/8 (50%), 5/8 (62.5%), and 5/8 (62.5%), respectively. Various clinical manifestations not included in the diagnostic criteria were observed. Six patients had point mutations in ANKRD11, one had an exonic deletion of ANKRD11, and one had a 16q24.3 microdeletion. According to the ACMG guidelines, all mutations were classified as pathogenic. The c.2454dup (p.Asn819fs*1) mutation in Pt 4 was reported previously. The remaining variants (c.397 + 1G>A, c.226 + 1G>A, c.2647del (p.Glu883Argfs*94), and c.4093C>T (p.Arg1365Ter)) were novel. CONCLUSION The clinical and molecular features of eight patients from seven unrelated Korean families with KBG syndrome described here will assist physicians in understanding this rare genetic condition.
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Affiliation(s)
- Yunha Choi
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jungmin Choi
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyosang Do
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soojin Hwang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - In Hee Choi
- Department of Genetic Counseling, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minji Kang
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Beom Hee Lee
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
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3
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Gao F, Zhao X, Cao B, Fan X, Li X, Li L, Sui S, Su Z, Gong C. Genetic and Phenotypic Spectrum of KBG Syndrome: A Report of 13 New Chinese Cases and a Review of the Literature. J Pers Med 2022; 12:jpm12030407. [PMID: 35330407 PMCID: PMC8948816 DOI: 10.3390/jpm12030407] [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: 01/13/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
KBG syndrome (KBGS) is a rare autosomal dominant inherited disease that involves multiple systems and is associated with variations in the ankyrin repeat domain 11 (ANKRD11) gene. We report the clinical and genetic data for 13 Chinese KBGS patients diagnosed by genetic testing and retrospectively analyse the genotypes and phenotypes of previously reported KBGS patients. The 13 patients in this study had heterozygous variations in the ANKRD11 gene, including seven frameshift variations, three nonsense variations, and three missense variations. They carried 11 variation sites, of which eight were previously unreported. The clinical phenotype analysis of these 13 patients and 240 previously reported patients showed that the occurrence rates of craniofacial anomalies, dental anomalies, global developmental delays, intellectual disability/learning difficulties, limb anomalies, and behavioural anomalies were >70%. The occurrence rates of short stature, delayed bone age, and spinal vertebral body anomalies were >50%. The frequency of global developmental delays and intellectual disability/learning difficulties in patients with truncated ANKRD11 gene variation was higher than that in patients with missense variation in the ANKRD11 gene (p < 0.05). Collectively, this study reported the genotypic and phenotypic characteristics of the largest sample of KBGS patients from China and discovered eight new ANKRD11 gene variations, which enriched the variation spectrum of the ANKRD11 gene. Variation in the ANKRD11 gene mainly caused craniofacial anomalies, growth and developmental anomalies, skeletal system anomalies, and nervous system anomalies. Truncated variation in the ANKRD11 gene is more likely to lead to global growth retardation and intellectual disability/learning difficulties than missense variation in ANKRD11.
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Affiliation(s)
- Fenqi Gao
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
| | - Xiu Zhao
- Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen 518000, China;
| | - Bingyan Cao
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
| | - Xin Fan
- Pediatric Dapartment, The Second Affiliated Hospital of Guangxi Medical University, Nanning 510000, China;
| | - Xiaoqiao Li
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
| | - Lele Li
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
| | - Shengbin Sui
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen 518000, China;
- Correspondence: (Z.S.); (C.G.)
| | - Chunxiu Gong
- Department of Endocrinology, Genetics, Metabolism and Adolescent Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China; (F.G.); (B.C.); (X.L.); (L.L.); (S.S.)
- Correspondence: (Z.S.); (C.G.)
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4
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Ho S, Luk HM, Lo IFM. KBG syndrome in a Chinese population: A case series. Am J Med Genet A 2022; 188:1693-1699. [PMID: 35174959 DOI: 10.1002/ajmg.a.62688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 01/12/2023]
Abstract
KBG syndrome (OMIM #148050) is an autosomal dominant neurodevelopmental disorder characterized by the presence of macrodontia of the permanent central upper incisors, characteristic facial features, delay in development, intellectual disability, short stature, and various skeletal abnormalities. Over 200 affected individuals have been described worldwide, though underdiagnosis is suspected because the characteristic features are variably present and affected individuals can have a mild phenotype. This case series provides a summary of the clinical and molecular characteristics of 10 Chinese KBG syndrome patients recruited from a single center. To our knowledge, this is the first case series for Chinese KBG patients. This case series aimed at exploring potential ethnicity-related variability in KBG syndrome.
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Affiliation(s)
- Stephanie Ho
- Clinical Genetic Service, Department of Health, HKSAR, Hong Kong
| | - Ho-Ming Luk
- Clinical Genetic Service, Department of Health, HKSAR, Hong Kong
| | - Ivan F M Lo
- Clinical Genetic Service, Department of Health, HKSAR, Hong Kong
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5
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Digilio MC, Calcagni G, Gnazzo M, Versacci P, Dentici ML, Capolino R, Sinibaldi L, Baban A, Putotto C, Alfieri P, Unolt M, Lepri FR, Alesi V, Genovese S, Novelli A, Marino B, Dallapiccola B. Congenital heart defects in molecularly confirmed KBG syndrome patients. Am J Med Genet A 2021; 188:1149-1159. [PMID: 34971082 DOI: 10.1002/ajmg.a.62632] [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: 06/05/2021] [Revised: 10/30/2021] [Accepted: 12/11/2021] [Indexed: 11/11/2022]
Abstract
Congenital heart defects (CHDs) are known to occur in 9%-25% of patients with KBG syndrome. In this study we analyzed the prevalence and anatomic types of CHDs in 46 personal patients with KBG syndrome, carrying pathogenetic variants in ANKRD11 or 16q24.3 deletion, and reviewed CHDs in patients with molecular diagnosis of KBG syndrome from the literature. CHD was diagnosed in 15/40 (38%) patients with ANKRD11 variant, and in one patient with 16q24.3 deletion. Left ventricular outflow tract obstructions have been diagnosed in 9/15 (60%), subaortic or muscular ventricular septal defect in 5/15 (33%), dextrocardia in 1/15 (8%). The single patient with 16q24.3 deletion and CHD had complete atrioventricular septal defect (AVSD) with aortic coarctation. Review of KBG patients from the literature and present series showed that septal defects have been diagnosed in 44% (27/61) of the cases, left ventricular tract obstructions in 31% (19/61), AVSD in 18% (11/61). Septal defects have been diagnosed in 78% of total patients with 16q24.3 deletion. Valvar anomalies are frequently diagnosed, prevalently involving the left side of the heart. A distinctive association with AVSD is identifiable and could represent a marker to suggest the diagnosis in younger patients. In conclusion, after precise molecular diagnosis and systematic cardiological screening the prevalence of CHD in KBG syndrome seems to be higher than previously reported in clinical articles. In addition to septal defects, left-sided anomalies and AVSD should be considered. Clinical management of KBG syndrome should include accurate and detailed echocardiogram at time of diagnosis.
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Affiliation(s)
- Maria Cristina Digilio
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Giulio Calcagni
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Maria Gnazzo
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Paolo Versacci
- Pediatric Cardiology Unit, Department of Pediatrics and Urologic Sciences, "La Sapienza" University, Rome, Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Rossella Capolino
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Lorenzo Sinibaldi
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Anwar Baban
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Carolina Putotto
- Pediatric Cardiology Unit, Department of Pediatrics and Urologic Sciences, "La Sapienza" University, Rome, Italy
| | - Paolo Alfieri
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Marta Unolt
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Francesca R Lepri
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Viola Alesi
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Silvia Genovese
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Bruno Marino
- Pediatric Cardiology Unit, Department of Pediatrics and Urologic Sciences, "La Sapienza" University, Rome, Italy
| | - Bruno Dallapiccola
- Medical Genetics Unit and Medical Genetics and Rare Disease Research Division, Pediatric Cardiology, Medical Genetics Laboratory, Neuropsychiatry, Scientific Rectorate, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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6
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Parenti I, Mallozzi MB, Hüning I, Gervasini C, Kuechler A, Agolini E, Albrecht B, Baquero-Montoya C, Bohring A, Bramswig NC, Busche A, Dalski A, Guo Y, Hanker B, Hellenbroich Y, Horn D, Innes AM, Leoni C, Li YR, Lynch SA, Mariani M, Medne L, Mikat B, Milani D, Onesimo R, Ortiz-Gonzalez X, Prott EC, Reutter H, Rossier E, Selicorni A, Wieacker P, Wilkens A, Wieczorek D, Zackai EH, Zampino G, Zirn B, Hakonarson H, Deardorff MA, Gillessen-Kaesbach G, Kaiser FJ. ANKRD11 variants: KBG syndrome and beyond. Clin Genet 2021; 100:187-200. [PMID: 33955014 DOI: 10.1111/cge.13977] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/18/2022]
Abstract
Mutations affecting the transcriptional regulator Ankyrin Repeat Domain 11 (ANKRD11) are mainly associated with the multisystem developmental disorder known as KBG syndrome, but have also been identified in individuals with Cornelia de Lange syndrome (CdLS) and other developmental disorders caused by variants affecting different chromatin regulators. The extensive functional overlap of these proteins results in shared phenotypical features, which complicate the assessment of the clinical diagnosis. Additionally, re-evaluation of individuals at a later age occasionally reveals that the initial phenotype has evolved toward clinical features more reminiscent of a developmental disorder different from the one that was initially diagnosed. For this reason, variants in ANKRD11 can be ascribed to a broader class of disorders that fall within the category of the so-called chromatinopathies. In this work, we report on the clinical characterization of 23 individuals with variants in ANKRD11. The subjects present primarily with developmental delay, intellectual disability and dysmorphic features, and all but two received an initial clinical diagnosis of either KBG syndrome or CdLS. The number and the severity of the clinical signs are overlapping but variable and result in a broad spectrum of phenotypes, which could be partially accounted for by the presence of additional molecular diagnoses and distinct pathogenic mechanisms.
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Affiliation(s)
- Ilaria Parenti
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Mark B Mallozzi
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Irina Hüning
- Institut für Humangenetik, Universität zu Lübeck, Lübeck, Germany
| | - Cristina Gervasini
- Genetica Medica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alma Kuechler
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Beate Albrecht
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Carolina Baquero-Montoya
- Department of Pediatrics, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Genetics Unit, Sura Ayudas Diagnosticas, Medellín, Colombia
| | - Axel Bohring
- Institut für Humangenetik, Westfälische Wilhelms-Universität, Münster, Germany
| | - Nuria C Bramswig
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Andreas Busche
- Institut für Humangenetik, Westfälische Wilhelms-Universität, Münster, Germany
| | - Andreas Dalski
- Institut für Humangenetik, Universität zu Lübeck, Lübeck, Germany
| | - Yiran Guo
- Center for Applied Genomics and Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Britta Hanker
- Institut für Humangenetik, Universität zu Lübeck, Lübeck, Germany
| | | | - Denise Horn
- Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Yun R Li
- Center for Applied Genomics and Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Medical Scientist Training Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sally Ann Lynch
- Department of Clinical Genetics, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Milena Mariani
- Centro Fondazione Mariani per il Bambino Fragile ASST-Lariana Sant'Anna Hospital, Department of Pediatrics, San Fermo della Battaglia (Como), Italy
| | - Livija Medne
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara Mikat
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Donatella Milani
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Xilma Ortiz-Gonzalez
- Department of Pediatrics, Division of Neurology, Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eva Christina Prott
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany.,Institut für Praenatale Medizin & Humangenetik, Wuppertal, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University Hospital of Bonn, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
| | - Eva Rossier
- Institut für Medizinische Genetik und Angewandte Genomik, Universität Tübingen, Tübingen, Germany.,Genetikum Stuttgart, Genetic Counselling and Diagnostics, Stuttgart, Germany
| | - Angelo Selicorni
- Centro Fondazione Mariani per il Bambino Fragile ASST-Lariana Sant'Anna Hospital, Department of Pediatrics, San Fermo della Battaglia (Como), Italy
| | - Peter Wieacker
- Institut für Humangenetik, Westfälische Wilhelms-Universität, Münster, Germany
| | - Alisha Wilkens
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dagmar Wieczorek
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Birgit Zirn
- Genetikum Stuttgart, Genetic Counselling and Diagnostics, Stuttgart, Germany
| | - Hakon Hakonarson
- Center for Applied Genomics and Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew A Deardorff
- Department of Pathology and Laboratory Medicine and Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Frank J Kaiser
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany.,Essener Zentrum für Seltene Erkrankungen (EZSE), Universitätsmedizin Essen, Essen, Germany
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7
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Li Q, Sun C, Yang L, Lu W, Luo F. Comprehensive analysis of clinical spectrum and genotype associations in Chinese and literature reported KBG syndrome. Transl Pediatr 2021; 10:834-842. [PMID: 34012832 PMCID: PMC8107870 DOI: 10.21037/tp-20-385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with KBG Syndrome due to ANKRD11 mutations and 16q24.3 microdeletions including ANKRD11 were identified. Classical and most frequent phenotypes include various degrees of intelligence disability (ID), short stature (SS), delayed bone age, macrodontia, distinctive facial features and skeletal anomalies. The variable expressivity of KBG syndrome makes it challenging to establish genotype-phenotype correlations, which also affects further studies for this novel syndrome. We aim to report three unrelated patients with KBG syndrome caused by ANKRD11 gene pathological variants and to evaluate potential associations among ANKRD11 gene variant types, the 16q24.3 microdeletion, and the clinical spectrum of KBG syndrome. METHODS The genetic etiology of three unreported KBG patients was identified by whole exome sequencing and confirmed via Sanger sequencing. Literature review was conducted to summarize the phenotype-genotype relationship based on three unreported Chinese cases and 186 reported cases. RESULTS Two pathological variants (c.7407dupC, p.P2530Rfs*61; c.G3046A, p.D1016N) and one reported variant (c.6792dupC, p. P2271Pfs*8) were detected in our patients. Compared with the 16q24.3 microdeletion, patients harboring ANKRD11 gene mutations showed significantly higher frequency of malformations including macrodontia, long philtrum, abnormal eyebrows, widely spaced eyes, anteverted nares, eyelid ptosis, brachydactyly, brachycephaly (P<0.05), and significantly lower risk of congenital heart diseases and frontal bossing (P<0.05). The intellectual disability (ID) was significantly milder among patients carrying truncating variants located between repression domain 1 (RD1) and activation domain (AD) than those carrying mutations disrupting repression domain 2 (RD2) alone and disrupting all functional domain (RD1, AD or RD2) (P<0.05). CONCLUSIONS Novel pathological variants harbored in the ANKRD11 gene contribute to the KBG syndrome variant spectrum. ANKRD11 gene variants disrupting RD1 and RD2 or RD2 alone are more likely to have more severe ID, which warrants different intervention strategies for KBG syndrome.
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Affiliation(s)
- Qiuyue Li
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Chengjun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Lu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
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8
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Mattei D, Cavarzere P, Gaudino R, Antoniazzi F, Piacentini G. DYSMORPHIC features and adult short stature: possible clinical markers of KBG syndrome. Ital J Pediatr 2021; 47:15. [PMID: 33494799 PMCID: PMC7830821 DOI: 10.1186/s13052-021-00961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growth monitoring is an essential part of primary health care in children and short stature is frequently regarded as a relatively early sign of poor health. The association of short stature and dysmorphic features should always lead to exclude an underlying syndromic disorder. CASE PRESENTATION We report the case of an Indian school-aged boy with dysmorphic features, intellectual disability and a clinical history characterized by seizures and hearing problems. Although his height was always included in the normal range for age and sex throughout childhood, he presented a short near-adult stature in relation to his mid-parent sex-adjusted target height. This is probably due to a rapidly progressive pubertal development. CONCLUSIONS In the presence of characteristic dysmorphic features, intellectual disability, seizures and hearing problems, KBG syndrome should always be considered. This emergent condition presents a wide spectrum of clinical phenotypes and is often associated with adult short stature.
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Affiliation(s)
- Davide Mattei
- Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.
| | - Rossella Gaudino
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for the diagnosis and treatment of children and adolescents rare skeletal disorders. Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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9
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Kim SJ, Yang A, Park JS, Kwon DG, Lee JS, Kwon YS, Lee JE. Two Novel Mutations of ANKRD11 Gene and Wide Clinical Spectrum in KBG Syndrome: Case Reports and Literature Review. Front Genet 2020; 11:579805. [PMID: 33262785 PMCID: PMC7687677 DOI: 10.3389/fgene.2020.579805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background KBG syndrome (OMIM #148050) is a rare, autosomal dominant inherited genetic disorder caused by heterozygous mutations in the ankyrin repeat domain-containing protein 11 (ANKRD11) gene or by microdeletion of chromosome 16q24.3. It is characterized by macrodontia of the upper central incisors, distinctive facial dysmorphism, short stature, vertebral abnormalities, hand anomaly including clinodactyly, and various degrees of developmental delay. KBG syndrome presents with variable clinical feature and severity among individuals. Here, we report two KBG patients who have different novel heterozygous mutations of ANKRD11 gene with wide range of clinical manifestations. Case presentation Two novel heterozygous mutations of ANKRD11 gene were identified in two unrelated Korean patients with variable clinical presentations. The first patient presented with short stature and early puberty and was treated with growth hormone and gonadotropin-releasing hormone agonist without adverse effects. He had mild intellectual disability. In targeted exome sequencing, a novel de novo frameshift variant was identified in ANKRD11, c.5889del, and p. (Ile1963MetfsX9). The second patient had severe intellectual disability with epilepsy. He had normal height and prepubertal stage at the age of 11 years. He had behavioral problems such as autism-like features, anxiety, and stereotypical movements. Whole exome sequencing (WES) was performed, and the novel heterozygous mutation, c3310dup, p. (Glu110GlyfsTer5) in ANKRD11 was identified. Conclusion KBG syndrome is often underdiagnosed because of its non-specific features and phenotypic variability. Performing a next—generation sequencing panel, including the ANKRD11 gene for cases of developmental delay with/without short stature may be helpful to identify hitherto undiagnosed KBG syndrome patients.
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Affiliation(s)
- Su Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Aram Yang
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Sun Park
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Dae Gyu Kwon
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Young Se Kwon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
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10
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Homma TK, Freire BL, Honjo R, Dauber A, Funari MFA, Lerario AM, Albuquerque EVA, Vasques GA, Bertola DR, Kim CA, Malaquias AC, Jorge AAL. Growth and Clinical Characteristics of Children with Floating-Harbor Syndrome: Analysis of Current Original Data and a Review of the Literature. Horm Res Paediatr 2020; 92:115-123. [PMID: 31715605 DOI: 10.1159/000503782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Floating-Harbor syndrome (FHS) is a rare condition characterized by dysmorphic facial features, short stature, and expressive language delay. OBJECTIVE The aim of this study was to describe a cohort of patients with FHS and review the literature about the response to recombinant human growth hormone (rhGH) therapy. METHODS Anthropometric and laboratory data from 7 patients with FHS were described. The molecular diagnosis was established by multigene analysis. Moreover, we reviewed the literature concerning patients with FHS treated with rhGH. RESULTS All 7 patients were born small for gestational age. At first evaluation, 6 patients had a height standard deviation score (SDS) ≤-2 and 1 had short stature in relation to their target height. Bone age was usually delayed, which rapidly advanced during puberty. Nonspecific skeletal abnormalities were frequently noticed, and normal to elevated plasma IGF-I levels were observed in all except 1 patient with growth hormone deficiency. Information about 20 patients with FHS treated with rhGH was analyzed (4 from our cohort and 16 from the literature). The median height changes during the treatment period (approx. 2.9 years) were 1.1 SDS (range from -0.4 to 3.1). Nontreated patients had an adult height SDS of -4.1 ± 1.2 (n = 10) versus -2.6 ± 0.8 SDS (n = 7, p 0.012) for treated patients. CONCLUSION We observed a laboratory profile compatible with IGF-1 insensitivity in some patients with FHS. Nevertheless, our study suggests that children with FHS may be considered as candidates for rhGH therapy. Further studies are necessary to establish the real benefit and safety of rhGH therapy in these patients.
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Affiliation(s)
- Thais K Homma
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil.,Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Bruna L Freire
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil.,Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Rachel Honjo
- Unidade de Genetica do Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andrew Dauber
- Division of Endocrinology, Children's National Health System, Washington, District of Columbia, USA
| | - Mariana F A Funari
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Antonio M Lerario
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Edoarda V A Albuquerque
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Gabriela A Vasques
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Debora R Bertola
- Unidade de Genetica do Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Chong A Kim
- Unidade de Genetica do Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexsandra C Malaquias
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil.,Unidade de Endocrinologia Pediatrica, Departamento de Pediatria, Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Alexander A L Jorge
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil, .,Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil,
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11
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Ge XY, Ge L, Hu WW, Li XL, Hu YY. Growth hormone therapy for children with KBG syndrome: A case report and review of literature. World J Clin Cases 2020; 8:1172-1179. [PMID: 32258089 PMCID: PMC7103963 DOI: 10.12998/wjcc.v8.i6.1172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of short stature in KBG syndrome is relatively high. Data on the therapeutic effects of growth hormone (GH) on children with KBG syndrome accompanied by short stature in the previous literature has not been summarized.
CASE SUMMARY Here we studied a girl with KBG syndrome and collected the data of children with KBG syndrome accompanied by short stature from previous studies before and after GH therapy. The girl was referred to our department because of short stature. Physical examination revealed mild dysmorphic features. The peak GH responses to arginine and clonidine were 6.22 and 5.40 ng/mL, respectively. The level of insulin-like growth factor 1 (IGF-1) was 42.0 ng/mL. Genetic analysis showed a c.2635 dupG (p.Glu879fs) mutation in the ANKRD11 gene. She received GH therapy. During the first year of GH therapy, her height increased by 0.92 standard deviation score (SDS). Her height increased from -1.95 SDS to -0.70 SDS after two years of GH therapy. There were ten children with KBG syndrome accompanied by short stature who received GH therapy in reported cases. Height SDS was improved in nine (9/10) of them. The mean height SDS in five children with KBG syndrome accompanied by short stature increased from -2.72 ± 0.44 to -1.95 ± 0.57 after the first year of GH therapy (P = 0.001). There were no adverse reactions reported after GH treatment.
CONCLUSION GH treatment is effective in our girl and most children with KBG syndrome accompanied by short stature during the first year of therapy.
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Affiliation(s)
- Xiu-Ying Ge
- Department of Child Health, Maternal and Child Health Hospital of Linyi, Linyi 276000, Shandong Province, China
| | - Long Ge
- Department of Clinical Laboratory, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Wen-Wen Hu
- Department of Pediatrics, The People's Hospital of Lanshan District, Linyi 276000, Shandong Province, China
| | - Xiao-Ling Li
- Department of Pediatrics, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Yan-Yan Hu
- Department of Pediatrics, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
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12
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Gnazzo M, Lepri FR, Dentici ML, Capolino R, Pisaneschi E, Agolini E, Rinelli M, Alesi V, Versacci P, Genovese S, Cesario C, Sinibaldi L, Baban A, Bartuli A, Marino B, Cappa M, Dallapiccola B, Novelli A, Digilio MC. KBG syndrome: Common and uncommon clinical features based on 31 new patients. Am J Med Genet A 2020; 182:1073-1083. [PMID: 32124548 DOI: 10.1002/ajmg.a.61524] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/08/2019] [Accepted: 01/17/2020] [Indexed: 12/18/2022]
Abstract
KBG syndrome (MIM #148050) is an autosomal dominant disorder characterized by developmental delay, intellectual disability, distinct craniofacial anomalies, macrodontia of permanent upper central incisors, skeletal abnormalities, and short stature. This study describes clinical features of 28 patients, confirmed by molecular testing of ANKRD11 gene, and three patients with 16q24 deletion encompassing ANKRD11 gene, diagnosed in a single center. Common clinical features are reported, together with uncommon findings, clinical expression in the first years of age, distinctive associations, and familial recurrences. Unusual manifestations emerging from present series include juvenile idiopathic arthritis, dysfunctional dysphonia, multiple dental agenesis, idiopathic precocious telarche, oral frenula, motor tics, and lipoma of corpus callosum, pilomatrixoma, and endothelial corneal polymorphic dystrophy. Facial clinical markers suggesting KBG syndrome before 6 years of age include ocular and mouth conformation, wide eyebrows, synophrys, long black eyelashes, long philtrum, thin upper lip. General clinical symptoms leading to early genetic evaluation include developmental delay, congenital malformations, hearing anomalies, and feeding difficulties. It is likely that atypical clinical presentation and overlapping features in patients with multiple variants are responsible for underdiagnosis in KBG syndrome. Improved knowledge of common and atypical features of this disorder improves clinical management.
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Affiliation(s)
- Maria Gnazzo
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Francesca R Lepri
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Rossella Capolino
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Elisa Pisaneschi
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Martina Rinelli
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Viola Alesi
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Paolo Versacci
- Pediatric Cardiology, Department of Pediatrics, Sapienza University, Rome, Italy
| | - Silvia Genovese
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Claudia Cesario
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Lorenzo Sinibaldi
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Anwar Baban
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Andrea Bartuli
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Bruno Marino
- Pediatric Cardiology, Department of Pediatrics, Sapienza University, Rome, Italy
| | - Marco Cappa
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Bruno Dallapiccola
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Laboratory of Medical Genetics, Medical Genetics, Rare Diseases, Pediatric Cardiology, and Endocrinology Units, Scientific Rectorate, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
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13
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Homma TK, Freire BL, Honjo Kawahira RS, Dauber A, Funari MFDA, Lerario AM, Nishi MY, Albuquerque EVD, Vasques GDA, Collett-Solberg PF, Miura Sugayama SM, Bertola DR, Kim CA, Arnhold IJP, Malaquias AC, Jorge AADL. Genetic Disorders in Prenatal Onset Syndromic Short Stature Identified by Exome Sequencing. J Pediatr 2019; 215:192-198. [PMID: 31630891 DOI: 10.1016/j.jpeds.2019.08.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/25/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To perform a prospective genetic investigation using whole exome sequencing of a group of patients with syndromic short stature born small for gestational age of unknown cause. STUDY DESIGN For whole exome sequencing analysis, we selected 44 children born small for gestational age with persistent short stature, and additional features, such as dysmorphic face, major malformation, developmental delay, and/or intellectual disability. Seven patients had negative candidate gene testing based on clinical suspicion and 37 patients had syndromic conditions of unknown etiology. RESULTS Of the 44 patients, 15 (34%) had pathogenic/likely pathogenic variants in genes already associated with growth disturbance: COL2A1 (n = 2), SRCAP (n = 2), AFF4, ACTG1, ANKRD11, BCL11B, BRCA1, CDKN1C, GINS1, INPP5K, KIF11, KMT2A, and POC1A (n = 1 each). Most of the genes found to be deleterious participate in fundamental cellular processes, such as cell replication and DNA repair. CONCLUSIONS The rarity and heterogeneity of syndromic short stature make the clinical diagnosis difficult. Whole exome sequencing allows the diagnosis of previously undiagnosed patients with syndromic short stature.
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Affiliation(s)
- Thais Kataoka Homma
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil; Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Bruna Lucheze Freire
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil; Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Rachel Sayuri Honjo Kawahira
- Genetic Unit of the Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Andrew Dauber
- Division of Endocrinology, Children's National Health System, USA
| | - Mariana Ferreira de Assis Funari
- Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Antônio Marcondes Lerario
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, USA
| | - Mirian Yumie Nishi
- Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Edoarda Vasco de Albuquerque
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Gabriela de Andrade Vasques
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Paulo Ferrez Collett-Solberg
- Endocrinology Discipline of the Faculdade de Ciência Médicas da Universidade do Estado do Rio de Janeiro - FCM/UERJ, Rio de Janeiro, Brazil
| | - Sofia Mizuho Miura Sugayama
- Genetic Unit of the Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Debora Romeo Bertola
- Genetic Unit of the Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Chong Ae Kim
- Genetic Unit of the Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Ivo Jorge Prado Arnhold
- Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil
| | - Alexsandra Christianne Malaquias
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil; Pediatric Endocrinology Unit, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - Alexander Augusto de Lima Jorge
- Genetic Endocrinology Unit, Laboratory of Cellular and Molecular Endocrinology (LIM25), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil; Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics (LIM42), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil.
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14
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Kang Y, He D, Li Y, Zhang Y, Shao Q, Zhang M, Ban B. A heterozygous point mutation of the ANKRD11 (c.2579C>T) in a Chinese patient with idiopathic short stature. Mol Genet Genomic Med 2019; 7:e988. [PMID: 31566922 PMCID: PMC6900381 DOI: 10.1002/mgg3.988] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/29/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background Pathogenic variants of ANKRD11 have been reported to cause KBG syndrome characterized by short stature, characteristic facial appearance, intellectual disability, macrodontia, and skeletal anomalies. However, the direct clinical relevance of ANKRD11 mutation with short stature is yet unknown. Methods Here, we report a Chinese boy with idiopathic short stature (ISS) based on clinical and genetic characteristics. Comprehensive medical evaluations were performed including metabolic studies, endocrine function tests, bone X‐rays, and echocardiography. Whole‐exome and Sanger sequencing was used to detect and confirm genetic mutations associated with short stature in this patient, respectively. The pathogenicity of the variant was further predicted by several in silico prediction tools and repositories of sequence variation. Twenty‐four months follow‐up was performed to observe the growth rate of the patient treated with recombinant human growth hormone (GH). Results One heterozygous point mutation (c.2579C>T) was confirmed in the ANKRD11 gene of the patient and inherited from his mother. This mutation site was located within the highly conservative region of ANKRD11 protein and predicted to be possibly damaging in several in silico prediction programs and repositories of sequence variation. Additionally, patient underwent GH replacement therapy for 24 months exhibited good response to the treatment. Conclusion A heterozygous point mutation of AKNRD11 gene was identified in a Chinese patient with short stature phenotype. The patient was treated effectively with GH supplementation.
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Affiliation(s)
- Yabin Kang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Dongye He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
| | - Yanying Li
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
| | - Yanhong Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
| | - Qian Shao
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China.,Chinese Research Center for Behavior Medicine in Growth and Development, Jining, China
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15
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Scarano E, Tassone M, Graziano C, Gibertoni D, Tamburrino F, Perri A, Gnazzo M, Severi G, Lepri F, Mazzanti L. Novel Mutations and Unreported Clinical Features in KBG Syndrome. Mol Syndromol 2019; 10:130-138. [PMID: 31191201 DOI: 10.1159/000496172] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 01/06/2023] Open
Abstract
KBG syndrome is an autosomal dominant disorder caused by pathogenic variants within ANKRD11 or deletions of 16q24.3 which include ANKRD11. It is characterized by distinctive facial features, developmental delay, short stature, and skeletal anomalies. We report 12 unrelated patients where a clinical diagnosis of KBG was suspected and confirmed by targeted analyses. Nine patients showed a point mutation in ANKRD11 (none of which were previously reported) and 3 carried a 16q24.3 deletion. All patients presented with typical facial features and macrodontia. Skeletal abnormalities were constant, and the majority of patients showed joint stiffness. Three patients required growth hormone treatment with a significant increase of height velocity. Brain malformations were identified in 8 patients. All patients showed behavioral abnormalities and most had developmental delay. Two patients had hematological abnormalities. We emphasize that genetic analysis of ANKRD11 can easily reach a detection rate higher than 50% thanks to clinical phenotyping, although it is known that a subset of ANKRD11-mutated patients show very mild features and will be more easily identified through the implementation of gene panels or exome sequencing. Joint stiffness was reported previously in few patients, but it seems to be a common feature and can be helpful for the diagnosis. Hematological abnormalities could be present and warrant a specific follow-up.
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Affiliation(s)
- Emanuela Scarano
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Martina Tassone
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Graziano
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Dino Gibertoni
- Unit of Hygiene and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University Alma Mater Studiorum, Bologna, Italy
| | - Federica Tamburrino
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Annamaria Perri
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Gnazzo
- Laboratory of Medical Genetics, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Giulia Severi
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Lepri
- Laboratory of Medical Genetics, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Laura Mazzanti
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
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16
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Andrade AC, Jee YH, Nilsson O. New Genetic Diagnoses of Short Stature Provide Insights into Local Regulation of Childhood Growth
. Horm Res Paediatr 2018; 88:22-37. [PMID: 28334714 DOI: 10.1159/000455850] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/03/2017] [Indexed: 12/12/2022] Open
Abstract
Idiopathic short stature is a common condition with a heterogeneous etiology. Advances in genetic methods, including genome sequencing techniques and bioinformatics approaches, have emerged as important tools to identify the genetic defects in families with monogenic short stature. These findings have contributed to the understanding of growth regulation and indicate that growth plate chondrogenesis, and therefore linear growth, is governed by a large number of genes important for different signaling pathways and cellular functions, including genetic defects in hormonal regulation, paracrine signaling, cartilage matrix, and fundamental cellular processes. In addition, mutations in the same gene can cause a wide phenotypic spectrum depending on the severity and mode of inheritance of the mutation.
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Affiliation(s)
- Anenisia C Andrade
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Youn Hee Jee
- Section of Growth and Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Ola Nilsson
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Sciences, Örebro University and University Hospital, Örebro, Sweden
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17
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Abstract
CLINICAL DESCRIPTION KBG syndrome is characterized by macrodontia of upper central incisors, distinctive craniofacial features such as triangular face, prominent nasal bridge, thin upper lip and synophrys; skeletal findings including short stature, delayed bone age, and costovertebral anomalies; and developmental delay/intellectual disability sometimes associated with seizures and EEG abnormalities. The condition was named KBG syndrome after the initials of the last names of three original families reported in 1975. EPIDEMIOLOGY The prevalence of KBG syndrome is not established. There are over 100 patients reported in the literature. It is likely that KBG syndrome is underreported due to incomplete recognition and very mild presentations of the disorder in some individuals. KBG syndrome is typically milder in females. ETIOLOGY Causative variants in ANKRD11 have been identified in affected individuals. The vast majority of identified variants are loss of function, which include nonsense and frameshift variants and larger deletions at 16q24.3. Haploinsufficiency appears to be the mechanism of pathogenicity. GENETIC COUNSELING Familial and de novo cases have been reported. Causative de novo variants occur approximately one third of the time. Transmission follows an autosomal dominant pattern. The syndrome displays inter- and intra-familial variability.
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Affiliation(s)
- Dayna Morel Swols
- Division of Clinical and Translational Genetics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, 1501 NW 10th Avenue, BRB-336 (M-860), Miami, FL, 33136, USA
| | - Joseph Foster
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Graduate Education, School of Medicine, 130 Mason Farm Road, CB7108, Chapel Hill, 27599, USA
| | - Mustafa Tekin
- Division of Clinical and Translational Genetics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, 1501 NW 10th Avenue, BRB-336 (M-860), Miami, FL, 33136, USA. .,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.
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18
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Low K, Ashraf T, Canham N, Clayton-Smith J, Deshpande C, Donaldson A, Fisher R, Flinter F, Foulds N, Fryer A, Gibson K, Hayes I, Hills A, Holder S, Irving M, Joss S, Kivuva E, Lachlan K, Magee A, McConnell V, McEntagart M, Metcalfe K, Montgomery T, Newbury-Ecob R, Stewart F, Turnpenny P, Vogt J, Fitzpatrick D, Williams M, Smithson S. Clinical and genetic aspects of KBG syndrome. Am J Med Genet A 2016; 170:2835-2846. [PMID: 27667800 PMCID: PMC5435101 DOI: 10.1002/ajmg.a.37842] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/17/2016] [Indexed: 12/19/2022]
Abstract
KBG syndrome is characterized by short stature, distinctive facial features, and developmental/cognitive delay and is caused by mutations in ANKRD11, one of the ankyrin repeat-containing cofactors. We describe 32 KBG patients aged 2-47 years from 27 families ascertained via two pathways: targeted ANKRD11 sequencing (TS) in a group who had a clinical diagnosis of KBG and whole exome sequencing (ES) in a second group in whom the diagnosis was unknown. Speech delay and learning difficulties were almost universal and variable behavioral problems frequent. Macrodontia of permanent upper central incisors was seen in 85%. Other clinical features included short stature, conductive hearing loss, recurrent middle ear infection, palatal abnormalities, and feeding difficulties. We recognized a new feature of a wide anterior fontanelle with delayed closure in 22%. The subtle facial features of KBG syndrome were recognizable in half the patients. We identified 20 ANKRD11 mutations (18 novel: all truncating) confirmed by Sanger sequencing in 32 patients. Comparison of the two ascertainment groups demonstrated that facial/other typical features were more subtle in the ES group. There were no conclusive phenotype-genotype correlations. Our findings suggest that mutation of ANKRD11 is a common Mendelian cause of developmental delay. Affected patients may not show the characteristic KBG phenotype and the diagnosis is therefore easily missed. We propose updated diagnostic criteria/clinical recommendations for KBG syndrome and suggest that inclusion of ANKRD11 will increase the utility of gene panels designed to investigate developmental delay. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Karen Low
- University Hospitals Bristol NHS Trust/University of Bristol, Bristol, United Kingdom.
| | - Tazeen Ashraf
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Natalie Canham
- North West Thames Regional Genetics Service, Harrow, London, United Kingdom
| | - Jill Clayton-Smith
- Manchester Centre For Genomic Medicine, St Mary's Hospital Manchester, United Kingdom
- Institute of Human Development, University of Manchester, Manchester, United Kingdom
| | | | - Alan Donaldson
- University Hospitals Bristol NHS Trust/University of Bristol, Bristol, United Kingdom
| | - Richard Fisher
- Teesside Genetics Unit, The James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Nicola Foulds
- Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Alan Fryer
- Liverpool Women's NHS Trust, Liverpool, United Kingdom
| | - Kate Gibson
- Genetic Health Service NZ, Christchurch Hospital, Christchurch, New Zealand
| | - Ian Hayes
- Genetic Health Service NZ, Auckland Hospital, Auckland, New Zealand
| | - Alison Hills
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, United Kingdom
| | - Susan Holder
- North West Thames Regional Genetics Service, Harrow, London, United Kingdom
| | - Melita Irving
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Shelagh Joss
- West of Scotland Department of Clinical Genetics, Glasgow, United Kingdom
| | - Emma Kivuva
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Kathryn Lachlan
- Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Alex Magee
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, Ireland
| | - Vivienne McConnell
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, Ireland
| | - Meriel McEntagart
- South West Thames Clinical Genetics Service, St Georges Hospital, London, United Kingdom
| | - Kay Metcalfe
- Manchester Centre For Genomic Medicine, St Mary's Hospital Manchester, United Kingdom
| | - Tara Montgomery
- Northern Genetics Service, Newcastle Upon Tyne, United Kingdom
| | - Ruth Newbury-Ecob
- University Hospitals Bristol NHS Trust/University of Bristol, Bristol, United Kingdom
| | - Fiona Stewart
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, Ireland
| | | | - Julie Vogt
- West Midlands Regional Genetics Service, Birmingham, United Kingdom
| | - David Fitzpatrick
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Maggie Williams
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sarah Smithson
- University Hospitals Bristol NHS Trust/University of Bristol, Bristol, United Kingdom
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19
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Goldenberg A, Riccardi F, Tessier A, Pfundt R, Busa T, Cacciagli P, Capri Y, Coutton C, Delahaye-Duriez A, Frebourg T, Gatinois V, Guerrot AM, Genevieve D, Lecoquierre F, Jacquette A, Khau Van Kien P, Leheup B, Marlin S, Verloes A, Michaud V, Nadeau G, Mignot C, Parent P, Rossi M, Toutain A, Schaefer E, Thauvin-Robinet C, Van Maldergem L, Thevenon J, Satre V, Perrin L, Vincent-Delorme C, Sorlin A, Missirian C, Villard L, Mancini J, Saugier-Veber P, Philip N. Clinical and molecular findings in 39 patients with KBG syndrome caused by deletion or mutation of ANKRD11. Am J Med Genet A 2016; 170:2847-2859. [PMID: 27605097 DOI: 10.1002/ajmg.a.37878] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/19/2016] [Indexed: 12/28/2022]
Abstract
KBG syndrome, due to ANKRD11 alteration is characterized by developmental delay, short stature, dysmorphic facial features, and skeletal anomalies. We report a clinical and molecular study of 39 patients affected by KBG syndrome. Among them, 19 were diagnosed after the detection of a 16q24.3 deletion encompassing the ANKRD11 gene by array CGH. In the 20 remaining patients, the clinical suspicion was confirmed by the identification of an ANKRD11 mutation by direct sequencing. We present arguments to modulate the previously reported diagnostic criteria. Macrodontia should no longer be considered a mandatory feature. KBG syndrome is compatible with autonomous life in adulthood. Autism is less frequent than previously reported. We also describe new clinical findings with a potential impact on the follow-up of patients, such as precocious puberty and a case of malignancy. Most deletions remove the 5'end or the entire coding region but never extend toward 16q telomere suggesting that distal 16q deletion could be lethal. Although ANKRD11 appears to be a major gene associated with intellectual disability, KBG syndrome remains under-diagnosed. NGS-based approaches for sequencing will improve the detection of point mutations in this gene. Broad knowledge of the clinical phenotype is essential for a correct interpretation of the molecular results. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alice Goldenberg
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France.
| | - Florence Riccardi
- Département de génétique médicale, Hôpital de la Timone-Enfant, Assistance publique hôpitaux de Marseille, Marseille, France
| | - Aude Tessier
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France
| | - Rolph Pfundt
- Afdeling Genetica, Radboud universitair medisch centrum, Nijmegen, Holland
| | - Tiffany Busa
- Département de génétique médicale, Hôpital de la Timone-Enfant, Assistance publique hôpitaux de Marseille, Marseille, France
| | | | - Yline Capri
- Unité fonctionnelle de génétique clinique, CHU Robert Debré, Paris, France
| | - Charles Coutton
- Unité fonctionnelle de génétique chromosomique, Hôpital Couple-Enfant, CHU de Grenoble, Université de Grenoble Alpes, INSERM 1209, CNRS UMR 5309, Grenoble, France
| | - Andree Delahaye-Duriez
- Laboratoire d'histologie-embryologie-cytogénétique-BDR, Hôpital Jean Verdier, CHU de Paris Seine-Saint-Denis, APHP et Université Paris 13, Sorbonne Paris Cité, Bondy, France
| | - Thierry Frebourg
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France
| | - Vincent Gatinois
- Laboratoire de génétique des maladies rares et auto-inflammatoires, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Anne-Marie Guerrot
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France
| | - David Genevieve
- Département de génétique médicale, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Francois Lecoquierre
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France
| | - Aurélia Jacquette
- APHP, Département de Génétique, Centre de référence déficiences intellectuelles de Causes Rares, GRC UPMC "déficiences intellectuelles et autisme", Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Philippe Khau Van Kien
- Unité fonctionnelle de génétique médicale et cytogénétique, Hôpital Caremeau, CHU de Nîmes, Nîmes, France
| | - Bruno Leheup
- Service de génétique clinique, Hôpital de Brabois, CHU de Nancy, Nancy, France
| | - Sandrine Marlin
- Service de génétique, Hôpital Necker-Enfants Malades, Paris, France
| | - Alain Verloes
- Unité fonctionnelle de génétique clinique, CHU Robert Debré, Paris, France
| | - Vincent Michaud
- Service de génétique médicale, GH Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Gwenael Nadeau
- Unité fonctionnelle de cytogénétique, CH de Valence, Valence, France
| | - Cyril Mignot
- APHP, Département de Génétique, Centre de référence déficiences intellectuelles de Causes Rares, GRC UPMC "déficiences intellectuelles et autisme", Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Philippe Parent
- Département de pédiatrie et génétique médicale, Hôpital Morvan, CHRU de Brest, Brest, France
| | - Massimiliano Rossi
- Service de génétique, Hôpital Femme-Mère-Enfant, GH Est, CHU de Lyon, Lyon, France
| | - Annick Toutain
- Service de génétique, Hôpital Bretonneau, CHRU de Tours, Tours, France
| | - Elise Schaefer
- Service de génétique médicale, Hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France
| | | | - Lionel Van Maldergem
- Centre de génétique humaine, Hôpital Saint-Jacques, CHRU de Besançon, Besançon, France
| | - Julien Thevenon
- Centre de génétique, Hôpital François Mitterrand, CHU Dijon Bourgogne, Dijon, France
| | - Véronique Satre
- Unité fonctionnelle de génétique chromosomique, Hôpital Couple-Enfant, CHU de Grenoble, Université de Grenoble Alpes, INSERM 1209, CNRS UMR 5309, Grenoble, France
| | - Laurence Perrin
- Unité fonctionnelle de génétique clinique, CHU Robert Debré, Paris, France
| | | | - Arthur Sorlin
- Service de génétique clinique, Hôpital de Brabois, CHU de Nancy, Nancy, France
| | - Chantal Missirian
- Département de génétique médicale, Hôpital de la Timone-Enfant, Assistance publique hôpitaux de Marseille, Marseille, France
| | | | - Julien Mancini
- Aix Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, Marseille, France.,APHM, Hôpital de la Timone, BiosTIC, Marseille, France
| | - Pascale Saugier-Veber
- Service de génétique, CHU de Rouen et Inserm U1079, Université de Rouen, Centre Normand de Génomique Médicale et Médecine Personnalisée, Rouen, France
| | - Nicole Philip
- Département de génétique médicale, Hôpital de la Timone-Enfant, Assistance publique hôpitaux de Marseille, Marseille, France.,Aix Marseille Université, INSERM, GMGF, Marseille, France
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20
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Hafiz A, Mufeed A, Ismael M, Alam M. An unusual case of KBG syndrome with unique oral findings. BMJ Case Rep 2015; 2015:bcr-2015-210352. [PMID: 26187867 DOI: 10.1136/bcr-2015-210352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
KBG syndrome is a condition characterised by macrodontia, neurological disturbance, short stature, a distinct cranio-facial appearance, and skeletal anomalies. The authors describe what appears to be the first case of KBG syndrome reported from the Indian subcontinent. Meticulous evaluation of the dental findings helps to identify such cases which may otherwise remain undiagnosed. Further research is warranted to determine the classic and variant presentations of this condition, with follow-up data providing valuable insights into its natural history and long-term prognosis.
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Affiliation(s)
- Abdul Hafiz
- Department of Paediatric Dentistry, MES Dental College, Perinthalmanna, Kerala, India
| | - Abdulla Mufeed
- Department of Oral Medicine and Radiology, MES Dental College, Perinthalmanna, Kerala, India
| | - Mohamad Ismael
- Department of Paediatrics, MES Medical College, Perinthalmanna, Kerala, India
| | - Mheboob Alam
- Department of Paediatrics, MES Medical College, Perinthalmanna, Kerala, India
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