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El Bouchikhi I, Belhassan K, Moufid FZ, Iraqui Houssaini M, Bouguenouch L, Samri I, Atmani S, Ouldim K. Noonan syndrome-causing genes: Molecular update and an assessment of the mutation rate. Int J Pediatr Adolesc Med 2016; 3:133-142. [PMID: 30805484 PMCID: PMC6372459 DOI: 10.1016/j.ijpam.2016.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/14/2016] [Indexed: 12/16/2022]
Abstract
Noonan syndrome is a common autosomal dominant disorder characterized by short stature, congenital heart disease and facial dysmorphia with an incidence of 1/1000 to 2500 live births. Up to now, several genes have been proven to be involved in the disturbance of the transduction signal through the RAS-MAP Kinase pathway and the manifestation of Noonan syndrome. The first gene described was PTPN11, followed by SOS1, RAF1, KRAS, BRAF, NRAS, MAP2K1, and RIT1, and recently SOS2, LZTR1, and A2ML1, among others. Progressively, the physiopathology and molecular etiology of most signs of Noonan syndrome have been demonstrated, and inheritance patterns as well as genetic counseling have been established. In this review, we summarize the data concerning clinical features frequently observed in Noonan syndrome, and then, we describe the molecular etiology as well as the physiopathology of most Noonan syndrome-causing genes. In the second part of this review, we assess the mutational rate of Noonan syndrome-causing genes reported up to now in most screening studies. This review should give clinicians as well as geneticists a full view of the molecular aspects of Noonan syndrome and the authentic prevalence of the mutational events of its causing-genes. It will also facilitate laying the groundwork for future molecular diagnosis research, and the development of novel treatment strategies.
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Key Words
- CDC25, cell division cycle 25
- CHD, congenital heart defects
- CR, conserved region
- CRD, cysteine-rich domain
- GAP, GTPase activating protein
- GDP, guanosine-DiPhosphate
- GEF, guanine exchange factor
- GH, growth hormone
- GTP, guanosine-TriPhosphate
- HCM, hypertrophic cardiomyopathy
- IGF-1, insulin-like growth factor I
- MAP kinase signaling pathways
- Molecular etiology
- Mutation rate
- Noonan syndrome
- PTPN11
- RAS family
- RBD, RAS binding domain
- REM, RAS exchange motif
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Affiliation(s)
- Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco.,Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Khadija Belhassan
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Fatima Zohra Moufid
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco.,Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Mohammed Iraqui Houssaini
- Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Laila Bouguenouch
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Imane Samri
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Samir Atmani
- Medico-Surgical Unit of Cardio-pediatrics, Department of Pediatrics, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
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de Jong M, Schieving J, Goraj B. Remarkable intra-cerebral lesions on MRI in a patient with Noonan syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2011.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Denayer E, Legius E. What's new in the neuro-cardio-facial-cutaneous syndromes? Eur J Pediatr 2007; 166:1091-8. [PMID: 17611774 DOI: 10.1007/s00431-007-0535-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 05/29/2007] [Indexed: 01/17/2023]
Abstract
UNLABELLED The RAS-MAPKinase pathway is a signal transduction cascade which has been studied extensively during the last decades for its role in human oncogenesis. Activation of this cascade is controlled by cycling of the RAS protein between an inactive and an active state and by phosphorylation of downstream proteins. The signalling cascade regulates cell proliferation, differentiation and survival. Disturbed RAS signalling in malignancies is caused by acquired somatic mutations in RAS genes or other components of this pathway. Recently, germline mutations in genes coding for different components of the RAS signalling cascade have been recognized as the cause of several phenotypically overlapping disorders, recently referred to as the neuro-cardio-facial-cutaneous syndromes. Neurofibromatosis type 1, Noonan, LEOPARD, Costello and cardiofaciocutaneous syndromes all present with variable degrees of psychomotor delay, congenital heart defects, facial dysmorphism, short stature, skin abnormalities and a predisposition for malignancy. These findings point to important roles for this evolutionary conserved pathway in oncogenesis, development, cognition and growth. CONCLUSION it has become obvious in recent years that the neuro-cardio-facial-cutaneous syndromes all share a common genetic and pathophysiologic basis. Dysregulation of the RAS-MAPKinase pathway is caused by germline mutations in genes involved in this pathway. Undoubtedly more genes causing related syndromes will be discovered in the near future since there are still a substantial number of genes in the pathway that are not yet associated with a known syndrome.
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Affiliation(s)
- Ellen Denayer
- Department of Human Genetics, Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium
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Kitsiou-Tzeli S, Papadopoulou A, Kanaka-Gantenbein C, Fretzayas A, Daskalopoulos D, Kanavakis E, Nicolaidou P. Does the rare A172G mutation of PTPN11 gene convey a mild Noonan syndrome phenotype? HORMONE RESEARCH 2006; 66:124-31. [PMID: 16804314 DOI: 10.1159/000094145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 05/15/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Noonan syndrome NS (OMIM 163950) is an autosomal dominant developmental disorder characterized mainly by typical facial dysmorphism, growth retardation and variable congenital heart defects. In unrelated individuals with sporadic or familial NS, heterozygous missense point mutations in the gene PTPN11 (OMIM 176876) have been confirmed, with a clustering of mutations in exons 3 and 8, the mutation A922G Asn308Asp accounting for nearly 25% of cases. PATIENT AND METHODS We report a 7-year-old boy with short stature and some other clinical features of NS, who has been investigated by molecular analysis for the presence of mutations in the PTPN11 gene. RESULT The de novo mutation A172G in the exon 3 of the PTPN11 gene, predicting an Asn58Asp substitution, has been found. To the best of our knowledge, this specific mutation has only been described once before, but this is the first report of detailed clinical data suggesting a mild phenotype. CONCLUSION Detailed clinical phenotype in every patient with major or minor features of NS and molecular identification of PTPN11 gene mutation may contribute to a better phenotype-genotype correlation.
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Affiliation(s)
- Sophia Kitsiou-Tzeli
- Department of Medical Genetics, University of Athens, Aghia Sophia Children's Hospital, Thivon & Levadias, Goudi, Athens, Greece.
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Otsuka M, Yamamoto H, Criley JM, Oba O, Hisamochi K, Okimoto T, Tasaki N, Hirai Y, Ochi N, Ohnishi M, Kohno N. Hemodynamic consequences of a swinging, infarcted ventricular septum. Circ J 2006; 70:634-7. [PMID: 16636503 DOI: 10.1253/circj.70.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Noonan syndrome presents with dysmorphic facial features, short stature, and cardiac abnormalities (most commonly pulmonic stenosis and hypertrophic cardiomyopathy). This report describes a rare case accompanied by a secundum atrial septal defect (ASD) and a ventricular septal aneurysm causing right ventricular (RV) pressure gradient. A 29-year-old mentally retarded man was admitted to hospital with exertional dyspnea. His somatic features included short stature (148 cm), hypertelorism, a shield chest, and thoracic scoliosis. Echocardiogram showed a secundum ASD with bidirectional shunting and a ventricular septum bulging toward the left ventricle in diastole, and then toward the RV in systole causing obliteration of the RV. The peak pressure gradient measured across the RV outflow by continuous wave Doppler was 30 mmHg. Cardiac catheterization revealed an elevated RV pressure without pulmonary hypertension and confirmed the pressure gradient. Right ventriculography revealed the septal excursion toward the RV in systole, leaving only a small residual cavity in the inflow and outflow regions of the RV. The ASD was closed with an autologous pericardial patch. A thin, fibrous portion of the ventricular septum was resected and replaced with a Dacron patch. From the histological examination, the RV cavity obliteration turned out to be produced by the excursion of the infarcted ventricular septum.
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Affiliation(s)
- Masaya Otsuka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Limal JM, Parfait B, Cabrol S, Bonnet D, Leheup B, Lyonnet S, Vidaud M, Le Bouc Y. Noonan syndrome: relationships between genotype, growth, and growth factors. J Clin Endocrinol Metab 2006; 91:300-6. [PMID: 16263833 DOI: 10.1210/jc.2005-0983] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Half of the patients with Noonan syndrome (NS) carry mutation of the PTPN11 gene, which plays a role in many hormonal signaling pathways. The mechanism of stunted growth in NS is not clear. OBJECTIVE The objective of the study was to compare growth and hormonal growth factors before and during recombinant human GH therapy in patients with and without PTPN11 mutations (M+ and M-). SETTING, DESIGN, AND PATIENTS This was a prospective multicenter study in 35 NS patients with growth retardation. Auxological data and growth before and during 2 yr of GH therapy are shown. GH, IGF-I, IGF binding protein (IGFBP)-3, and acid-labile subunit (ALS) levels were evaluated before and during therapy. RESULTS Molecular investigation of the PTPN11 coding sequence revealed 12 different heterozygous missense mutations in 20 of 35 (57%). Birth length was reduced [mean -1.2 sd score (SDS); six m+ and two m- were < -2 SDS] but not birth weight. M+ vs. M- patients were shorter at 6 yr (P = 0.04). In the prepubertal group (n = 25), GH therapy resulted in a catch-up height SDS, which was lower after 2 yr in M+ vs. M- patients (P < 0.03). The mean peak GH level (n = 35) was 15.4 +/- 6.5 ng/ml. Mean blood IGF-I concentration in 19 patients (11 m+, eight m-) was low (especially in M+) for age, sex, and puberty (-1.6 +/- 1.0 SDS) and was normalized after 1 yr of GH therapy (P < 0.001), without difference in M+ vs. M- patients. ALS levels (n = 10) were also very low. By contrast, the mean basal IGFBP-3 value (n = 19) was normal. CONCLUSIONS In NS patients with short stature, some neonates have birth length less than -2 SDS. Growth of M+ is reduced and responds less efficiently to GH than M- patients. The association of low IGF-I and ALS with normal IGFBP-3 levels could explain growth impairment of M+ children and could suggest a GH resistance by a late postreceptor signaling defect.
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Affiliation(s)
- Jean-Marie Limal
- Department of Pediatrics, University Hospital, 49933 Angers, France.
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Silvio F, Carlo L, Elena B, Nicoletta B, Daniela F, Roberto M. Transient abnormal myelopoiesis in Noonan syndrome. J Pediatr Hematol Oncol 2002; 24:763-4. [PMID: 12468921 DOI: 10.1097/00043426-200212000-00017] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An infant affected by Noonan syndrome and presenting with abnormal hemopoiesis is described. Cytogenetic analysis, molecular studies, and in vitro culture assays ruled out myelodysplasia or other hematologic malignancies but were consistent with transient abnormal myelopoiesis. At present, 3 years and 10 months after diagnosis, the patient shows a normal hematologic picture. Supportive treatment in such patients, unless refractory cytopenias or overt leukemia develops, is emphasized.
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Affiliation(s)
- Ferraris Silvio
- Department of Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy.
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Abstract
The hereditary lymphedemas provide an opportunity to identify genes involved in normal and deranged lymphatic development. Genetic analysis of families with Milroy's disease identified mutations in VEGFR3 as a cause of congenital lymphedema, confirming the importance of VEGFC/VEGFR3 signaling in lymphatic development. These observations led to the identification of a mouse model for primary lymphedema, and subsequent analysis of this mouse model, using transgenic and gene transfer techniques, has provided initial clues to the development of a biologically based therapy for primary lymphedema. Of more importance from a public health perspective is the fact that manipulation of this pathway may lead to effective therapies for the more prevalent forms of secondary lymphedema. Identification of FOXC2 as the gene mutated in the lymphedema-distichiasis syndrome has revealed new molecular insight into lymphatic development. Molecular analysis of the FOXC2 pathway may provide clues to developmental pathways shared by the lymphatic system and the other developmental abnormalities associated with this complex syndrome. With improving knowledge of the human genome, genetic analysis of families with lymphedema continues to offer one of the most promising approaches to identifying genes influencing lymphatic development.
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Affiliation(s)
- Robert E Ferrell
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Abstract
Although much of male infertility is currently unexplained, it is likely that underlying defects in critical genes or entire gene pathways are responsible. Because powerful technologies exist to bypass severe male-factor infertility, improving the diagnosis of genetic infertility is important for the infertile couple, not only to explain the problem but also to inform them of conditions potentially transmissible to offspring.
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Affiliation(s)
- Paul J Turek
- Department of Urology, University of California San Francisco, 2330 Post Street, San Francisco, California 94115-1695, USA.
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Witters I, Spitz B, Van Hole C, Devriendt K, Fryns JP, Verbek K. Resolution of non-immune hydrops in Noonan syndrome with favorable outcome. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 110:408-9. [PMID: 12116221 DOI: 10.1002/ajmg.10475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tartaglia M, Kalidas K, Shaw A, Song X, Musat DL, van der Burgt I, Brunner HG, Bertola DR, Crosby A, Ion A, Kucherlapati RS, Jeffery S, Patton MA, Gelb BD. PTPN11 mutations in Noonan syndrome: molecular spectrum, genotype-phenotype correlation, and phenotypic heterogeneity. Am J Hum Genet 2002; 70:1555-63. [PMID: 11992261 PMCID: PMC379142 DOI: 10.1086/340847] [Citation(s) in RCA: 497] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2002] [Accepted: 03/21/2002] [Indexed: 01/20/2023] Open
Abstract
Noonan syndrome (NS) is a developmental disorder characterized by facial dysmorphia, short stature, cardiac defects, and skeletal malformations. We recently demonstrated that mutations in PTPN11, the gene encoding the non-receptor-type protein tyrosine phosphatase SHP-2 (src homology region 2-domain phosphatase-2), cause NS, accounting for approximately 50% of cases of this genetically heterogeneous disorder in a small cohort. All mutations were missense changes and clustered at the interacting portions of the amino-terminal src-homology 2 (N-SH2) and protein tyrosine phosphatase (PTP) domains. A gain of function was postulated as a mechanism for the disease. Here, we report the spectrum and distribution of PTPN11 mutations in a large, well-characterized cohort with NS. Mutations were found in 54 of 119 (45%) unrelated individuals with sporadic or familial NS. There was a significantly higher prevalence of mutations among familial cases than among sporadic ones. All defects were missense, and several were recurrent. The vast majority of mutations altered amino acid residues located in or around the interacting surfaces of the N-SH2 and PTP domains, but defects also affected residues in the C-SH2 domain, as well as in the peptide linking the N-SH2 and C-SH2 domains. Genotype-phenotype analysis revealed that pulmonic stenosis was more prevalent among the group of subjects with NS who had PTPN11 mutations than it was in the group without them (70.6% vs. 46.2%; P<.01), whereas hypertrophic cardiomyopathy was less prevalent among those with PTPN11 mutations (5.9% vs. 26.2%; P<.005). The prevalence of other congenital heart malformations, short stature, pectus deformity, cryptorchidism, and developmental delay did not differ between the two groups. A PTPN11 mutation was identified in a family inheriting Noonan-like/multiple giant-cell lesion syndrome, extending the phenotypic range of disease associated with this gene.
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Affiliation(s)
- Marco Tartaglia
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Kamini Kalidas
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Adam Shaw
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Xiaoling Song
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Dan L. Musat
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Ineke van der Burgt
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Han G. Brunner
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Débora R. Bertola
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Andrew Crosby
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Andra Ion
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Raju S. Kucherlapati
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Steve Jeffery
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Michael A. Patton
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
| | - Bruce D. Gelb
- Departments of Pediatrics and Human Genetics, Mount Sinai School of Medicine, New York; Laboratorio di Metabolismo e Biochimica Patologica, Istituto Superiore di Sanità, Rome; Department of Medical Genetics, St. George's Hospital Medical School, London; Department of Human Genetics, University Medical Centre, Nijmegen, The Netherlands; Department of Pediatrics, University of São Paulo, São Paulo, Brazil; and Department of Genetics, Harvard Medical School, Boston
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Menashe M, Arbel R, Raveh D, Achiron R, Yagel S. Poor prenatal detection rate of cardiac anomalies in Noonan syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:51-55. [PMID: 11851968 DOI: 10.1046/j.0960-7692.2001.00485.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The wide variation and nonspecific nature of many of the associated ultrasonographic findings complicate prenatal diagnosis of Noonan syndrome. The aim of the present study was to define the rate of prenatal diagnosis of heart malformations in cases diagnosed postnatally with Noonan syndrome. METHODS English-language literature review of 29 cases of Noonan syndrome examined prenatally with confirmed postnatal diagnosis and four case reports from our center. RESULTS Cases were evaluated for cervical spine pathologies, cardiac anomalies and other pathological findings, including hydrops fetalis and polyhydramnios. Cardiac anomalies were suspected in only nine of 33 cases; three of these were associated with cystic hygroma. Cardiac anomalies were eventually diagnosed in 31/33 cases postnatally. Polyhydramnios was diagnosed in 19/33 cases in the third trimester, and hydrops fetalis was detected in eight of 33. Cystic hygroma was present in a total of nine cases at mid-trimester. CONCLUSIONS Noonan syndrome is characterized by late-onset and progressive pathologies, particularly the associated cardiac anomalies, which develop through the course of gestation and postnatal life. This complicates or precludes prenatal diagnosis at mid-trimester or at any time in the prenatal period, and partly explains the low rate of detection of fetal cardiac lesions in this syndrome.
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Affiliation(s)
- M Menashe
- Department of Obstetrics, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel
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13
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Tartaglia M, Mehler EL, Goldberg R, Zampino G, Brunner HG, Kremer H, van der Burgt I, Crosby AH, Ion A, Jeffery S, Kalidas K, Patton MA, Kucherlapati RS, Gelb BD. Mutations in PTPN11, encoding the protein tyrosine phosphatase SHP-2, cause Noonan syndrome. Nat Genet 2001; 29:465-8. [PMID: 11704759 DOI: 10.1038/ng772] [Citation(s) in RCA: 1140] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Noonan syndrome (MIM 163950) is an autosomal dominant disorder characterized by dysmorphic facial features, proportionate short stature and heart disease (most commonly pulmonic stenosis and hypertrophic cardiomyopathy). Webbed neck, chest deformity, cryptorchidism, mental retardation and bleeding diatheses also are frequently associated with this disease. This syndrome is relatively common, with an estimated incidence of 1 in 1,000-2,500 live births. It has been mapped to a 5-cM region (NS1) [corrected] on chromosome 12q24.1, and genetic heterogeneity has also been documented. Here we show that missense mutations in PTPN11 (MIM 176876)-a gene encoding the nonreceptor protein tyrosine phosphatase SHP-2, which contains two Src homology 2 (SH2) domains-cause Noonan syndrome and account for more than 50% of the cases that we examined. All PTPN11 missense mutations cluster in interacting portions of the amino N-SH2 domain and the phosphotyrosine phosphatase domains, which are involved in switching the protein between its inactive and active conformations. An energetics-based structural analysis of two N-SH2 mutants indicates that in these mutants there may be a significant shift of the equilibrium favoring the active conformation. This implies that they are gain-of-function changes and that the pathogenesis of Noonan syndrome arises from excessive SHP-2 activity.
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Affiliation(s)
- M Tartaglia
- Department of Pediatrics, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Abstract
Noonan syndrome is a multiple congenital anomaly condition characterized by craniofacial anomalies, short stature, cardiac malformations, and normal peripheral blood karyotype analysis. Prior reports of individuals with Noonan syndrome have revealed an association with several autoimmune diseases, including vasculitis and anterior uveitis, but no reports of systemic lupus erythematosus (SLE). Here we present the first case report of a 21-year-old man with a clinical diagnosis of Noonan syndrome and a recent history of mitral valve dysfunction and systemic lupus erythematosus. We discuss his findings in the context of known features of Noonan syndrome and propose that individuals with Noonan syndrome be regularly monitored for associated autoimmune phenomena.
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Affiliation(s)
- D M Martin
- Department of Pediatrics and Communicable Diseases, The University of Michigan, Ann Arbor, Michigan 48109, USA
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Lee L, Dowhanick-Morrissette J, Katz A, Jukofsky L, Krantz ID. Chromosomal localization, genomic characterization, and mapping to the Noonan syndrome critical region of the human Deltex (DTX1) gene. Hum Genet 2000; 107:577-81. [PMID: 11153911 DOI: 10.1007/s004390000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The human Deltex (DTX1) gene encodes a cytoplasmic protein that functions as a positive regulator of the Notch signaling pathway. We have determined the genomic organization and map location of the human gene. DTX1 encodes a 2.5-kb cDNA that is composed of nine exons. The DTX1 gene maps to chromosomal region 12q24 in the vicinity of the Noonan syndrome critical region. We have fine-mapped DTX1 to within this critical region and evaluate it as a candidate gene for this disorder.
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Affiliation(s)
- L Lee
- Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, PA 19104, USA
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16
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Bisogno G, Murgia A, Mammi I, Strafella MS, Carli M. Rhabdomyosarcoma in a patient with cardio-facio-cutaneous syndrome. J Pediatr Hematol Oncol 1999; 21:424-7. [PMID: 10524458 DOI: 10.1097/00043426-199909000-00016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A boy with characteristic facial features, pulmonary valvular stenosis, ectodermal abnormalities, growth failure, and mental retardation was admitted for intestinal occlusion at 20 months of age. Clinical findings were consistent with a diagnosis of cardio-facio-cutaneous syndrome (CFC-s), and a huge abdominal mass was evident on computed tomography scan. A biopsy was performed, and embryonal rhabdomyosarcoma was diagnosed. Molecular analysis was performed by reverse transcription (RT) polymerase chain reaction (PCR) on tumor RNA to seek the chimerical transcript of the most common soft tissue sarcoma translocations and analyze neurofibromatosis 1 (NF1) gene expression. Translocations involving 1;13, 2;13, and 11;22 were not found, and the specific transcripts of the NF1 gene were present. Chemotherapy was implemented, but the child died 7 months later of tumor progression. Few patients with CFC-s have been described, and their follow-up is not well known. The association of CFC-s with rhabdomyosarcoma has not been reported previously, but other neoplasms have been reported in patients with Noonan syndrome, a condition similar to CFC-s. More observations are needed, but this and other reports suggest there could be a higher risk of malignancy in patients with syndromes in the Noonan phenotype category.
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Affiliation(s)
- G Bisogno
- Department of Pediatrics, University of Padova, Italy
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17
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Mah CS, Vaughan CJ, Basson CT. Advances in the molecular genetics of congenital structural heart disease. GENETIC TESTING 1999; 3:157-72. [PMID: 10464664 DOI: 10.1089/gte.1999.3.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Molecular genetic analyses have generated significant advances in our understanding of congenital heart disease. Techniques of genetic mapping with polymorphic microsatellites and fluorescence in situ hybridization (FISH) have provided informative tools for localization and identification of disease genes. Some cardiovascular diseases have proven to result from single gene defects. Others relate to more complex etiologies involving several genes and their interactions. Elucidation of the molecular genetic etiologies of congenital heart disease prompts consideration of DNA testing for cardiac disorders. Future integration of these diagnostic modalities with improved treatments may ultimately decrease morbidity and mortality from congenital heart diseases.
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Affiliation(s)
- C S Mah
- Department of Medicine, Weill Medical College of Cornell University, New York Hospital, NY 10021, USA
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18
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Abstract
We report six cases of Noonan syndrome which presented prenatally with sonographic abnormalities. These included increased nuchal fluid, short femora, pleural effusions, hydrops, cardiac and renal abnormalities. A review of all cases of Noonan syndrome seen at two regional genetics centres confirms the association with these sonographic abnormalities. These cases demonstrate the diversity of prenatal presentation of Noonan syndrome and highlight the need to consider this diagnosis, particularly when faced with a fetus with a normal karyotype and varying degrees of oedema or hydrops, with a short femur length.
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Affiliation(s)
- D L Nisbet
- Fetal Medicine Unit, University College Obstetric Hospital, London, WC1E 6AU, U.K
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