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Ruijmbeek CW, Housley F, Idrees H, Housley MP, Pestel J, Keller L, Lai JK, van der Linde HC, Willemsen R, Piesker J, Al-Hassnan ZN, Almesned A, Dalinghaus M, van den Bersselaar LM, van Slegtenhorst MA, Tessadori F, Bakkers J, van Ham TJ, Stainier DY, Verhagen JM, Reischauer S. Biallelic variants in FLII cause pediatric cardiomyopathy by disrupting cardiomyocyte cell adhesion and myofibril organization. JCI Insight 2023; 8:e168247. [PMID: 37561591 PMCID: PMC10544232 DOI: 10.1172/jci.insight.168247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Pediatric cardiomyopathy (CM) represents a group of rare, severe disorders that affect the myocardium. To date, the etiology and mechanisms underlying pediatric CM are incompletely understood, hampering accurate diagnosis and individualized therapy development. Here, we identified biallelic variants in the highly conserved flightless-I (FLII) gene in 3 families with idiopathic, early-onset dilated CM. We demonstrated that patient-specific FLII variants, when brought into the zebrafish genome using CRISPR/Cas9 genome editing, resulted in the manifestation of key aspects of morphological and functional abnormalities of the heart, as observed in our patients. Importantly, using these genetic animal models, complemented with in-depth loss-of-function studies, we provided insights into the function of Flii during ventricular chamber morphogenesis in vivo, including myofibril organization and cardiomyocyte cell adhesion, as well as trabeculation. In addition, we identified Flii function to be important for the regulation of Notch and Hippo signaling, crucial pathways associated with cardiac morphogenesis and function. Taken together, our data provide experimental evidence for a role for FLII in the pathogenesis of pediatric CM and report biallelic variants as a genetic cause of pediatric CM.
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Affiliation(s)
- Claudine W.B. Ruijmbeek
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Filomena Housley
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Hafiza Idrees
- Medical Clinic I (Cardiology/Angiology) and Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
| | - Michael P. Housley
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jenny Pestel
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Leonie Keller
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jason K.H. Lai
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Herma C. van der Linde
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rob Willemsen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Janett Piesker
- Scientific Service Group Microscopy, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Zuhair N. Al-Hassnan
- Department of Medical Genetics, and
- Cardiovascular Genetics Program, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lisa M. van den Bersselaar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marjon A. van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Federico Tessadori
- Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen Bakkers
- Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tjakko J. van Ham
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Didier Y.R. Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), RheinMain partner site, Bad Nauheim, Germany
| | - Judith M.A. Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sven Reischauer
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Medical Clinic I (Cardiology/Angiology) and Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), RheinMain partner site, Bad Nauheim, Germany
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2
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van der Meulen MH, Herkert JC, den Boer SL, du Marchie Sarvaas GJ, Blom N, ten Harkel AD, Breur HM, Rammeloo LA, Tanke R, Marcelis C, van de Laar IM, Verhagen JM, Lekanne dit Deprez RH, Barge-Schaapveld DQ, Baas A, Sammani A, Christiaans I, van Tintelen JP, Dalinghaus M. Genetic Evaluation of A Nation-Wide Dutch Pediatric DCM Cohort: The Use of Genetic Testing in Risk Stratification. Circ Genom Precis Med 2022; 15:e002981. [DOI: 10.1161/circgen.120.002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
This study aimed to describe the current practice and results of genetic evaluation in Dutch children with dilated cardiomyopathy and to evaluate genotype-phenotype correlations that may guide prognosis.
Methods:
We performed a multicenter observational study in children diagnosed with dilated cardiomyopathy, from 2010 to 2017.
Results:
One hundred forty-four children were included. Initial diagnostic categories were idiopathic dilated cardiomyopathy in 67 children (47%), myocarditis in 23 (16%), neuromuscular in 7 (5%), familial in 18 (13%), inborn error of metabolism in 4 (3%), malformation syndrome in 2 (1%), and “other” in 23 (16%). Median follow-up time was 2.1 years [IQR 1.0–4.3]. Hundred-seven patients (74%) underwent genetic testing. We found a likely pathogenic or pathogenic variant in 38 children (36%), most often in
MYH7
(n = 8). In 1 patient initially diagnosed with myocarditis, a pathogenic
LMNA
variant was found. During the study, 39 patients (27%) reached study endpoint (SE: all-cause death or heart transplantation). Patients with a likely pathogenic or pathogenic variant were more likely to reach SE compared with those without (hazard ratio 2.8; 95% CI 1.3–5.8,
P
= 0.007), while transplant-free survival was significantly lower (
P
= 0.006). Clinical characteristics at diagnosis did not differ between the 2 groups.
Conclusions:
Genetic testing is a valuable tool for predicting prognosis in children with dilated cardiomyopathy, with carriers of a likely pathogenic or pathogenic variant having a worse prognosis overall. Genetic testing should be incorporated in clinical work-up of all children with dilated cardiomyopathy regardless of presumed disease pathogenesis.
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Affiliation(s)
| | - Johanna C. Herkert
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
| | | | | | - Nico Blom
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
| | - Arend D.J. ten Harkel
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
- Dept of Pediatric Cardiology, Univ of Amsterdam, Academic Medical Center, Amsterdam (A.D.J.H.)
| | - Hans M.P.J. Breur
- Dept of Pediatric Cardiology, Univ of Utrecht, Wilhelmina Children’s Hospital, Univ Medical Center Utrecht, Utrecht (H.M.P.J.B.)
| | - Lukas A.J. Rammeloo
- Dept of Pediatric Cardiology, Amsterdam Univ Medical Center, location Free Univ Medical Center, Amsterdam (L.A.J.R.)
| | - Ronald Tanke
- Dept of Pediatric Cardiology, Radboud Univ Medical Center, Nijmegen (R.T.)
| | - Carlo Marcelis
- Dept of Genetics, Radboud Univ Medical Center, Nijmegen (C.M.)
| | - Ingrid M.B.H. van de Laar
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | - Judith M.A. Verhagen
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | | | | | - Annette Baas
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Arjan Sammani
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Imke Christiaans
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
- Dept of Clinical Genetics, Univ of Leiden, Leiden Univ Medical Center, Leiden (D.Q.C.M.B-S., I.C.)
| | - J. Peter van Tintelen
- Dept of Clinical Genetics, Amsterdam Univ Medical Center, location AMC, Amsterdam (R.H.L.D., J.P.T.)
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Michiel Dalinghaus
- Dept of Pediatric Cardiology, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (M.H.M., M.D.)
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3
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Herkert JC, Verhagen JM, Yotti R, Haghighi A, Phelan DG, James PA, Brown NJ, Stutterd C, Macciocca I, Leong K, Bulthuis ML, van Bever Y, van Slegtenhorst MA, Boven LG, Roberts AE, Agarwal R, Seidman J, Lakdawala NK, Fernández-Avilés F, Burke MA, Pierpont ME, Braunlin E, Ḉağlayan AO, Barge-Schaapveld DQ, Birnie E, van Osch-Gevers L, van Langen IM, Jongbloed JD, Lockhart PJ, Amor DJ, Seidman CE, van de Laar IM. Expanding the clinical and genetic spectrum of ALPK3 variants: Phenotypes identified in pediatric cardiomyopathy patients and adults with heterozygous variants. Am Heart J 2020; 225:108-119. [PMID: 32480058 DOI: 10.1016/j.ahj.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Biallelic damaging variants in ALPK3, encoding alpha-protein kinase 3, cause pediatric-onset cardiomyopathy with manifestations that are incompletely defined. METHODS AND RESULTS We analyzed clinical manifestations of damaging biallelic ALPK3 variants in 19 pediatric patients, including nine previously published cases. Among these, 11 loss-of-function (LoF) variants, seven compound LoF and deleterious missense variants, and one homozygous deleterious missense variant were identified. Among 18 live-born patients, 8 exhibited neonatal dilated cardiomyopathy (44.4%; 95% CI: 21.5%-69.2%) that subsequently transitioned into ventricular hypertrophy. The majority of patients had extracardiac phenotypes, including contractures, scoliosis, cleft palate, and facial dysmorphisms. We observed no association between variant type or location, disease severity, and/or extracardiac manifestations. Myocardial histopathology showed focal cardiomyocyte hypertrophy, subendocardial fibroelastosis in patients under 4 years of age, and myofibrillar disarray in adults. Rare heterozygous ALPK3 variants were also assessed in adult-onset cardiomyopathy patients. Among 1548 Dutch patients referred for initial genetic analyses, we identified 39 individuals with rare heterozygous ALPK3 variants (2.5%; 95% CI: 1.8%-3.4%), including 26 missense and 10 LoF variants. Among 149 U.S. patients without pathogenic variants in 83 cardiomyopathy-related genes, we identified six missense and nine LoF ALPK3 variants (10.1%; 95% CI: 5.7%-16.1%). LoF ALPK3 variants were increased in comparison to matched controls (Dutch cohort, P = 1.6×10-5; U.S. cohort, P = 2.2×10-13). CONCLUSION Biallelic damaging ALPK3 variants cause pediatric cardiomyopathy manifested by DCM transitioning to hypertrophy, often with poor contractile function. Additional extracardiac features occur in most patients, including musculoskeletal abnormalities and cleft palate. Heterozygous LoF ALPK3 variants are enriched in adults with cardiomyopathy and may contribute to their cardiomyopathy. Adults with ALPK3 LoF variants therefore warrant evaluations for cardiomyopathy.
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4
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Verhagen JM, van den Born M, Kurul S, Asimaki A, van de Laar IM, Frohn-Mulder IM, Kammeraad JA, Yap SC, Bartelings MM, van Slegtenhorst MA, von der Thüsen JH, Wessels MW. Homozygous Truncating Variant in
PKP2
Causes Hypoplastic Left Heart Syndrome. Circ: Genomic and Precision Medicine 2018; 11:e002397. [DOI: 10.1161/circgen.118.002397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith M.A. Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Myrthe van den Born
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Serife Kurul
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Angeliki Asimaki
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (A.A.)
| | - Ingrid M.B.H. van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Ingrid M.E. Frohn-Mulder
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (I.M.E.F.-M., J.A.E.K.)
| | - Janneke A.E. Kammeraad
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (I.M.E.F.-M., J.A.E.K.)
| | - Sing C. Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (S.C.Y.)
| | - Margot M. Bartelings
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands (M.M.B.)
| | - Marjon A. van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
| | - Jan H. von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.H.v.d.T.)
| | - Marja W. Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (J.M.A.V., M.v.d.B., S.K., I.M.B.H.v.d.L., M.A.v.S., M.W.W.)
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5
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Wan J, Steiner J, Baselga E, Blei F, Cordisco M, Garzon MC, Goddard DS, Haggstrom A, Krol A, Frieden IJ, Metry D, Morel KD, Verhagen JM, Wargon O, Drolet BA, Siegel DH. Prenatal Risk Factors for PHACE Syndrome: A Study Using the PHACE Syndrome International Clinical Registry and Genetic Repository. J Pediatr 2017; 190:275-279. [PMID: 28867065 PMCID: PMC5690843 DOI: 10.1016/j.jpeds.2017.06.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/18/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023]
Abstract
The cause of PHACE syndrome is unknown. In a study of 218 patients, we examined potential prenatal risk factors for PHACE syndrome. Rates of pre-eclampsia and placenta previa in affected individuals were significantly greater than in the general population. No significant risk factor differences were detected between male and female subjects.
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Affiliation(s)
- Joy Wan
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA.
| | - Jack Steiner
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Francine Blei
- Vascular Anomalies Program, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Maria Cordisco
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Maria C. Garzon
- Departments of Dermatology and Pediatrics, Columbia University, New York, NY
| | | | - Anita Haggstrom
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, IN
| | - Alfons Krol
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Ilona J. Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Denise Metry
- Department of Dermatology, Texas Children’s Baylor, Houston, TX
| | - Kimberly D. Morel
- Departments of Dermatology and Pediatrics, Columbia University, New York, NY
| | - Judith M.A. Verhagen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Orli Wargon
- Department of Pediatric Dermatology, Sydney Children’s Hospital School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Beth A. Drolet
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Dawn H. Siegel
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, WI
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6
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Almomani R, Verhagen JM, Herkert JC, Brosens E, van Spaendonck-Zwarts KY, Asimaki A, van der Zwaag PA, Frohn-Mulder IM, Bertoli-Avella AM, Boven LG, van Slegtenhorst MA, van der Smagt JJ, van IJcken WF, Timmer B, van Stuijvenberg M, Verdijk RM, Saffitz JE, du Plessis FA, Michels M, Hofstra RM, Sinke RJ, van Tintelen JP, Wessels MW, Jongbloed JD, van de Laar IM. Biallelic Truncating Mutations in ALPK3 Cause Severe Pediatric Cardiomyopathy. J Am Coll Cardiol 2016; 67:515-25. [DOI: 10.1016/j.jacc.2015.10.093] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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7
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Alders M, Mendola A, Adès L, Al Gazali L, Bellini C, Dallapiccola B, Edery P, Frank U, Hornshuh F, Huisman SA, Jagadeesh S, Kayserili H, Keng WT, Lev D, Prada CE, Sampson JR, Schmidtke J, Shashi V, van Bever Y, Van der Aa N, Verhagen JM, Verheij JB, Vikkula M, Hennekam RC. Evaluation of Clinical Manifestations in Patients with Severe Lymphedema with and without CCBE1 Mutations. Mol Syndromol 2012; 4:107-13. [PMID: 23653581 DOI: 10.1159/000342486] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 11/19/2022] Open
Abstract
The lymphedema-lymphangiectasia-intellectual disability (Hennekam) syndrome (HS) is characterised by a widespread congenital lymph vessel dysplasia manifesting as congenital lymphedema of the limbs and intestinal lymphangiectasia, accompanied by unusual facial morphology, variable intellectual disabilities and infrequently malformations. The syndrome is heterogeneous as mutations in the gene CCBE1 have been found responsible for the syndrome in only a subset of patients. We investigated whether it would be possible to predict the presence of a CCBE1 mutation based on phenotype by collecting clinical data of patients diagnosed with HS, with or without a CCBE1 mutation. We report here the results of 13 CCBE1 positive patients, 16 CCBE1 negative patients, who were clinically found to have classical HS, and 8 patients in whom the diagnosis was considered possible, but not certain, and in whom no CCBE1 mutation was identified. We found no statistically significant phenotypic differences between the 2 groups with the clinical HS phenotype, although the degree of lymphatic dysplasia tended to be more pronounced in the mutation positive group. We also screened 158 patients with less widespread and less pronounced forms of lymphatic dysplasia for CCBE1 mutations, and no mutation was detected in this group. Our results suggest that (1) CCBE1 mutations are present only in patients with a likely clinical diagnosis of HS, and not in patients with less marked forms of lymphatic dysplasia, and (2) that there are no major phenotypic differences between HS patients with or without CCBE1 mutations.
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Affiliation(s)
- M Alders
- Department of Clinical Genetics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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8
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Verhagen JM, Huijmans JG, Williams M, van Ruyven RL, Bergen AA, Wouters CH, Brooks AS. Incidental finding of alpha-methylacyl-CoA racemase deficiency in a patient with oculocutaneous albinism type 4. Am J Med Genet A 2012; 158A:2931-4. [DOI: 10.1002/ajmg.a.35611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/17/2012] [Indexed: 11/09/2022]
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9
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Verhagen JM, Diderich KE, Oudesluijs G, Mancini GM, Eggink AJ, Verkleij-Hagoort AC, Groenenberg IA, Willems PJ, du Plessis FA, de Man SA, Srebniak MI, van Opstal D, Hulsman LO, van Zutven LJ, Wessels MW. Phenotypic variability of atypical 22q11.2 deletions not includingTBX1. Am J Med Genet A 2012; 158A:2412-20. [DOI: 10.1002/ajmg.a.35517] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/10/2012] [Indexed: 11/09/2022]
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