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Abstract
BACKGROUND Thalassaemia is a recessively-inherited blood disorder that leads to anaemia of varying severity. In those affected by the more severe forms, regular blood transfusions are required which may lead to iron overload. Accumulated iron from blood transfusions may be deposited in vital organs including the heart, liver and endocrine organs such as the pituitary glands which can affect growth hormone production. Growth hormone deficiency is one of the factors that can lead to short stature, a common complication in people with thalassaemia. Growth hormone replacement therapy has been used in children with thalassaemia who have short stature and growth hormone deficiency. This review on the role of growth hormone was originally published in September 2017 and updated in April 2020. OBJECTIVES To assess the benefits and safety of growth hormone therapy in people with thalassaemia. SEARCH METHODS We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 14 November 2019. We also searched the reference lists of relevant articles, reviews and clinical trial registries. Date of latest search: 06 January 2020. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing the use of growth hormone therapy to placebo or standard care in people with thalassaemia of any type or severity. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion. Data extraction and assessment of risk of bias were also conducted independently by two authors. The certainty of the evidence was assessed using GRADE criteria. MAIN RESULTS We included one parallel trial conducted in Turkey. The trial recruited 20 children with homozygous beta thalassaemia who had short stature; 10 children received growth hormone therapy administered subcutaneously on a daily basis at a dose of 0.7 IU/kg per week and 10 children received standard care. The overall risk of bias in this trial was low except for the selection criteria and attrition bias which were unclear. The certainty of the evidence for all major outcomes was moderate, the main concern was imprecision of the estimates due to the small sample size leading to wide confidence intervals. Final height (cm) (the review's pre-specified primary outcome) and change in height were not assessed in the included trial. The trial reported no clear difference between groups in height standard deviation (SD) score after one year, mean difference (MD) -0.09 (95% confidence interval (CI) -0.33 to 0.15 (moderate-certainty evidence). However, modest improvements appeared to be observed in the following key outcomes in children receiving growth hormone therapy compared to control (moderate-certainty evidence): change between baseline and final visit in height SD score, MD 0.26 (95% CI 0.13 to 0.39); height velocity, MD 2.28 cm/year (95% CI 1.76 to 2.80); height velocity SD score, MD 3.31 (95% CI 2.43 to 4.19); and change in height velocity SD score between baseline and final visit, MD 3.41 (95% CI 2.45 to 4.37). No adverse effects of treatment were reported in either group; however, while there was no clear difference between groups in the oral glucose tolerance test at one year, fasting blood glucose was significantly higher in the growth hormone therapy group compared to control, although both results were still within the normal range, MD 6.67 mg/dL (95% CI 2.66 to 10.68). There were no data beyond the one-year trial period. AUTHORS' CONCLUSIONS A small single trial contributed evidence of moderate certainty that the use of growth hormone for a year may improve height velocity of children with thalassaemia although height SD score in the treatment group was similar to the control group. There are no randomised controlled trials in adults or trials that address the use of growth hormone therapy over a longer period and assess its effect on final height and quality of life. The optimal dosage of growth hormone and the ideal time to start this therapy remain uncertain. Large well-designed randomised controlled trials over a longer period with sufficient duration of follow up are needed.
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Affiliation(s)
- Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | - Janet Yh Hong
- Department of Paediatrics, Putrajaya Hospital, Putrajaya, Malaysia
| | - Shir Ley Tan
- HPS Pharmacies, Calvary North Adelaide Hospital, Adelaide, Australia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia
| | | | - Meow-Keong Thong
- Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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2
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Kruszka P, Porras AR, de Souza DH, Moresco A, Huckstadt V, Gill AD, Boyle AP, Hu T, Addissie YA, Mok GTK, Tekendo-Ngongang C, Fieggen K, Prijoles EJ, Tanpaiboon P, Honey E, Luk HM, Lo IFM, Thong MK, Muthukumarasamy P, Jones KL, Belhassan K, Ouldim K, El Bouchikhi I, Bouguenouch L, Shukla A, Girisha KM, Sirisena ND, Dissanayake VHW, Paththinige CS, Mishra R, Kisling MS, Ferreira CR, de Herreros MB, Lee NC, Jamuar SS, Lai A, Tan ES, Ying Lim J, Wen-Min CB, Gupta N, Lotz-Esquivel S, Badilla-Porras R, Hussen DF, El Ruby MO, Ashaat EA, Patil SJ, Dowsett L, Eaton A, Innes AM, Shotelersuk V, Badoe Ë, Wonkam A, Obregon MG, Chung BHY, Trubnykova M, La Serna J, Gallardo Jugo BE, Chávez Pastor M, Abarca Barriga HH, Megarbane A, Kozel BA, van Haelst MM, Stevenson RE, Summar M, Adeyemo AA, Morris CA, Moretti-Ferreira D, Linguraru MG, Muenke M. Williams-Beuren syndrome in diverse populations. Am J Med Genet A 2019; 176:1128-1136. [PMID: 29681090 DOI: 10.1002/ajmg.a.38672] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 01/12/2023]
Abstract
Williams-Beuren syndrome (WBS) is a common microdeletion syndrome characterized by a 1.5Mb deletion in 7q11.23. The phenotype of WBS has been well described in populations of European descent with not as much attention given to other ethnicities. In this study, individuals with WBS from diverse populations were assessed clinically and by facial analysis technology. Clinical data and images from 137 individuals with WBS were found in 19 countries with an average age of 11 years and female gender of 45%. The most common clinical phenotype elements were periorbital fullness and intellectual disability which were present in greater than 90% of our cohort. Additionally, 75% or greater of all individuals with WBS had malar flattening, long philtrum, wide mouth, and small jaw. Using facial analysis technology, we compared 286 Asian, African, Caucasian, and Latin American individuals with WBS with 286 gender and age matched controls and found that the accuracy to discriminate between WBS and controls was 0.90 when the entire cohort was evaluated concurrently. The test accuracy of the facial recognition technology increased significantly when the cohort was analyzed by specific ethnic population (P-value < 0.001 for all comparisons), with accuracies for Caucasian, African, Asian, and Latin American groups of 0.92, 0.96, 0.92, and 0.93, respectively. In summary, we present consistent clinical findings from global populations with WBS and demonstrate how facial analysis technology can support clinicians in making accurate WBS diagnoses.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia
| | - Deise Helena de Souza
- Department of Genetics, Institute of Biosciences, Sao Paulo State University - UNESP, São Paulo, Brazil
| | - Angélica Moresco
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Victoria Huckstadt
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Ashleigh D Gill
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Alec P Boyle
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia
| | - Tommy Hu
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Gary T K Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hongkong, China
| | | | - Karen Fieggen
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | | | - Pranoot Tanpaiboon
- Rare Disease Institute, Children's National Medical Center, Washington, District of Columbia
| | - Engela Honey
- Department of Genetics, University of Pretoria, Pretoria, South Africa
| | - Ho-Ming Luk
- Clinical Genetic Service, Department of Health, Hong Kong Special Administrative Region, Hongkong, China
| | - Ivan F M Lo
- Clinical Genetic Service, Department of Health, Hong Kong Special Administrative Region, Hongkong, China
| | - Meow-Keong Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Premala Muthukumarasamy
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kelly L Jones
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Khadija Belhassan
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland.,Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco
| | - Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco.,Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Laila Bouguenouch
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | - Nirmala D Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Rupesh Mishra
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Monisha S Kisling
- Rare Disease Institute, Children's National Medical Center, Washington, District of Columbia
| | - Carlos R Ferreira
- Rare Disease Institute, Children's National Medical Center, Washington, District of Columbia
| | - María Beatriz de Herreros
- National Secretariat for the Rights of People with Disabilities (SENADIS), Fernando de la Mora, Paraguay
| | - Ni-Chung Lee
- Department of Pediatrics and Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Saumya S Jamuar
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Angeline Lai
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ee Shien Tan
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jiin Ying Lim
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Cham Breana Wen-Min
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ramsés Badilla-Porras
- Medical Genetics and Metabolism Department, Hospital Nacional de Niños (CCSS), San José, Costa Rica
| | - Dalia Farouk Hussen
- Department of Human Cytogenetics, The National Research Centre, Cairo, Egypt
| | - Mona O El Ruby
- Clinical Genetics Department, National Research Centre, Cairo, Egypt
| | - Engy A Ashaat
- Clinical Genetics Department, National Research Centre, Cairo, Egypt
| | | | - Leah Dowsett
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Alison Eaton
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ëben Badoe
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | | | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hongkong, China
| | | | | | | | | | | | | | - Beth A Kozel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mieke M van Haelst
- Department of Genetics, University Medical Centre, Utrecht, Utrecht, The Netherlands
| | | | - Marshall Summar
- Rare Disease Institute, Children's National Medical Center, Washington, District of Columbia
| | - A Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Colleen A Morris
- Department of Pediatrics (Genetics Division), University of Nevada School of Medicine, Las Vegas, Nevada
| | - Danilo Moretti-Ferreira
- Department of Genetics, Institute of Biosciences, Sao Paulo State University - UNESP, São Paulo, Brazil
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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3
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Kruszka P, Porras AR, de Souza DH, Moresco A, Huckstadt V, Gill AD, Boyle AP, Hu T, Addissie YA, Mok GTK, Tekendo‐Ngongang C, Fieggen K, Prijoles EJ, Tanpaiboon P, Honey E, Luk H, Lo IFM, Thong M, Muthukumarasamy P, Jones KL, Belhassan K, Ouldim K, El Bouchikhi I, Bouguenouch L, Shukla A, Girisha KM, Sirisena ND, Dissanayake VHW, Paththinige CS, Mishra R, Kisling MS, Ferreira CR, de Herreros MB, Lee N, Jamuar SS, Lai A, Tan ES, Ying Lim J, Wen‐Min CB, Gupta N, Lotz‐Esquivel S, Badilla‐Porras R, Hussen DF, El Ruby MO, Ashaat EA, Patil SJ, Dowsett L, Eaton A, Innes AM, Shotelersuk V, Badoe Ë, Wonkam A, Obregon MG, Chung BHY, Trubnykova M, La Serna J, Gallardo Jugo BE, Chávez Pastor M, Abarca Barriga HH, Megarbane A, Kozel BA, van Haelst MM, Stevenson RE, Summar M, Adeyemo AA, Morris CA, Moretti‐Ferreira D, Linguraru MG, Muenke M. Cover Image, Volume 176A, Number 5, May 2018. Am J Med Genet A 2018. [DOI: 10.1002/ajmg.a.38714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
| | - Antonio R. Porras
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren's National Health SystemWashington District of Columbia
| | - Deise Helena de Souza
- Department of Genetics, Institute of BiosciencesSao Paulo State University – UNESPSão Paulo Brazil
| | - Angélica Moresco
- Servicio de GenéticaHospital de Pediatría GarrahanBuenos Aires Argentina
| | - Victoria Huckstadt
- Servicio de GenéticaHospital de Pediatría GarrahanBuenos Aires Argentina
| | - Ashleigh D. Gill
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
| | - Alec P. Boyle
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren's National Health SystemWashington District of Columbia
| | - Tommy Hu
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
| | - Yonit A. Addissie
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
| | - Gary T. K. Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of MedicineThe University of Hong Kong, Hong Kong Special Administrative RegionHongkong China
| | | | - Karen Fieggen
- Division of Human GeneticsUniversity of Cape TownCape Town South Africa
| | | | - Pranoot Tanpaiboon
- Rare Disease InstituteChildren's National Medical CenterWashington District of Columbia
| | - Engela Honey
- Department of GeneticsUniversity of PretoriaPretoria South Africa
| | - Ho‐Ming Luk
- Clinical Genetic Service, Department of HealthHong Kong Special Administrative RegionHongkong China
| | - Ivan F. M. Lo
- Clinical Genetic Service, Department of HealthHong Kong Special Administrative RegionHongkong China
| | - Meow‐Keong Thong
- Department of Paediatrics, Faculty of MedicineUniversity of MalayaKuala Lumpur Malaysia
| | | | - Kelly L. Jones
- Division of Medical Genetics and MetabolismChildren's Hospital of The King's DaughtersNorfolk Virginia
| | - Khadija Belhassan
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
- Medical Genetics and Oncogenetics UnitHassan II University HospitalFez Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics UnitHassan II University HospitalFez Morocco
| | - Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics UnitHassan II University HospitalFez Morocco
- Laboratory of Microbial Biotechnology, Faculty of Sciences and TechniquesUniversity of Sidi Mohammed Ben AbdellahFez Morocco
| | - Laila Bouguenouch
- Medical Genetics and Oncogenetics UnitHassan II University HospitalFez Morocco
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical CollegeManipal UniversityManipal India
| | - Katta M. Girisha
- Department of Medical Genetics, Kasturba Medical CollegeManipal UniversityManipal India
| | - Nirmala D. Sirisena
- Human Genetics Unit, Faculty of MedicineUniversity of ColomboColombo Sri Lanka
| | | | | | - Rupesh Mishra
- Human Genetics Unit, Faculty of MedicineUniversity of ColomboColombo Sri Lanka
| | - Monisha S. Kisling
- Rare Disease InstituteChildren's National Medical CenterWashington District of Columbia
| | - Carlos R. Ferreira
- Rare Disease InstituteChildren's National Medical CenterWashington District of Columbia
| | - María Beatriz de Herreros
- National Secretariat for the Rights of People with Disabilities (SENADIS)Fernando de la Mora Paraguay
| | - Ni‐Chung Lee
- Department of Pediatrics and Medical GeneticsNational Taiwan University HospitalTaipei Taiwan
| | - Saumya S. Jamuar
- Genetics Service, Department of PaediatricsKK Women's and Children's HospitalSingapore Singapore
| | - Angeline Lai
- Genetics Service, Department of PaediatricsKK Women's and Children's HospitalSingapore Singapore
| | - Ee Shien Tan
- Genetics Service, Department of PaediatricsKK Women's and Children's HospitalSingapore Singapore
| | - Jiin Ying Lim
- Genetics Service, Department of PaediatricsKK Women's and Children's HospitalSingapore Singapore
| | - Cham Breana Wen‐Min
- Genetics Service, Department of PaediatricsKK Women's and Children's HospitalSingapore Singapore
| | - Neerja Gupta
- Division of Genetics, Department of PediatricsAll India Institute of Medical SciencesNew Delhi India
| | | | - Ramsés Badilla‐Porras
- Medical Genetics and Metabolism DepartmentHospital Nacional de Niños (CCSS)San José Costa Rica
| | | | - Mona O. El Ruby
- Clinical Genetics DepartmentNational Research CentreCairo Egypt
| | - Engy A. Ashaat
- Clinical Genetics DepartmentNational Research CentreCairo Egypt
| | | | - Leah Dowsett
- Kapi'olani Medical Center for Women and ChildrenHonolulu Hawaii
| | - Alison Eaton
- Department of Medical Genetics and Alberta Children's Hospital Research InstituteCumming School of Medicine, University of CalgaryCalgary Alberta
| | - A. Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research InstituteCumming School of Medicine, University of CalgaryCalgary Alberta
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkok Thailand
| | - Ëben Badoe
- School of Medicine and Dentistry, College of Health SciencesUniversity of GhanaAccra Ghana
| | - Ambroise Wonkam
- Division of Human GeneticsUniversity of Cape TownCape Town South Africa
| | | | - Brian H. Y. Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of MedicineThe University of Hong Kong, Hong Kong Special Administrative RegionHongkong China
| | | | | | | | | | | | | | - Beth A. Kozel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, Department of PediatricsWashington University School of MedicineSt. Louis Missouri
| | - Mieke M. van Haelst
- Department of GeneticsUniversity Medical CentreUtrecht, Utrecht The Netherlands
| | | | - Marshall Summar
- Rare Disease InstituteChildren's National Medical CenterWashington District of Columbia
| | - A. Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of HealthBethesda Maryland
| | - Colleen A. Morris
- Department of Pediatrics (Genetics Division)University of Nevada School of MedicineLas Vegas Nevada
| | - Danilo Moretti‐Ferreira
- Department of Genetics, Institute of BiosciencesSao Paulo State University – UNESPSão Paulo Brazil
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical InnovationChildren's National Health SystemWashington District of Columbia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research InstituteThe National Institutes of HealthBethesda Maryland
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4
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Kruszka P, Addissie YA, McGinn DE, Porras AR, Biggs E, Share M, Crowley TB, Chung BHY, Mok GTK, Mak CCY, Muthukumarasamy P, Thong MK, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Mishra R, Shotelersuk V, Ekure EN, Sokunbi OJ, Kalu N, Ferreira CR, Duncan JM, Patil SJ, Jones KL, Kaplan JD, Abdul-Rahman OA, Uwineza A, Mutesa L, Moresco A, Obregon MG, Richieri-Costa A, Gil-da-Silva-Lopes VL, Adeyemo AA, Summar M, Zackai EH, McDonald-McGinn DM, Linguraru MG, Muenke M. 22q11.2 deletion syndrome in diverse populations. Am J Med Genet A 2017; 173:879-888. [PMID: 28328118 DOI: 10.1002/ajmg.a.38199] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 11/10/2022]
Abstract
22q11.2 deletion syndrome (22q11.2 DS) is the most common microdeletion syndrome and is underdiagnosed in diverse populations. This syndrome has a variable phenotype and affects multiple systems, making early recognition imperative. In this study, individuals from diverse populations with 22q11.2 DS were evaluated clinically and by facial analysis technology. Clinical information from 106 individuals and images from 101 were collected from individuals with 22q11.2 DS from 11 countries; average age was 11.7 and 47% were male. Individuals were grouped into categories of African descent (African), Asian, and Latin American. We found that the phenotype of 22q11.2 DS varied across population groups. Only two findings, congenital heart disease and learning problems, were found in greater than 50% of participants. When comparing the clinical features of 22q11.2 DS in each population, the proportion of individuals within each clinical category was statistically different except for learning problems and ear anomalies (P < 0.05). However, when Africans were removed from analysis, six additional clinical features were found to be independent of ethnicity (P ≥ 0.05). Using facial analysis technology, we compared 156 Caucasians, Africans, Asians, and Latin American individuals with 22q11.2 DS with 156 age and gender matched controls and found that sensitivity and specificity were greater than 96% for all populations. In summary, we present the varied findings from global populations with 22q11.2 DS and demonstrate how facial analysis technology can assist clinicians in making accurate 22q11.2 DS diagnoses. This work will assist in earlier detection and in increasing recognition of 22q11.2 DS throughout the world.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Daniel E McGinn
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Elijah Biggs
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Matthew Share
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - T Blaine Crowley
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Gary T K Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Christopher C Y Mak
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Premala Muthukumarasamy
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala D Sirisena
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | | | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching, Lagos, Nigeria
| | | | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching, Lagos, Nigeria
| | - Carlos R Ferreira
- Division of Genetics and Metabolism, Children's National Health System, Washington, D.C
| | - Jordann-Mishael Duncan
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | | | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Julie D Kaplan
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Omar A Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Annette Uwineza
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Angélica Moresco
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies, São Paulo University, Bauru, Brazil
| | | | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington, D.C
| | - Elaine H Zackai
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna M McDonald-McGinn
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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5
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Kruszka P, Porras AR, Sobering AK, Ikolo FA, La Qua S, Shotelersuk V, Chung BHY, Mok GTK, Uwineza A, Mutesa L, Moresco A, Obregon MG, Sokunbi OJ, Kalu N, Joseph DA, Ikebudu D, Ugwu CE, Okoromah CAN, Addissie YA, Pardo KL, Brough JJ, Lee NC, Girisha KM, Patil SJ, Ng ISL, Min BCW, Jamuar SS, Tibrewal S, Wallang B, Ganesh S, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Richieri-Costa A, Muthukumarasamy P, Thong MK, Jones KL, Abdul-Rahman OA, Ekure EN, Adeyemo AA, Summar M, Linguraru MG, Muenke M. Down syndrome in diverse populations. Am J Med Genet A 2017; 173:42-53. [PMID: 27991738 DOI: 10.1002/ajmg.a.38043] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/25/2016] [Indexed: 11/08/2022]
Abstract
Down syndrome is the most common cause of cognitive impairment and presents clinically with universally recognizable signs and symptoms. In this study, we focus on exam findings and digital facial analysis technology in individuals with Down syndrome in diverse populations. Photos and clinical information were collected on 65 individuals from 13 countries, 56.9% were male and the average age was 6.6 years (range 1 month to 26 years; SD = 6.6 years). Subjective findings showed that clinical features were different across ethnicities (Africans, Asians, and Latin Americans), including brachycephaly, ear anomalies, clinodactyly, sandal gap, and abundant neck skin, which were all significantly less frequent in Africans (P < 0.001, P < 0.001, P < 0.001, P < 0.05, and P < 0.05, respectively). Evaluation using a digital facial analysis technology of a larger diverse cohort of newborns to adults (n = 129 cases; n = 132 controls) was able to diagnose Down syndrome with a sensitivity of 0.961, specificity of 0.924, and accuracy of 0.943. Only the angles at medial canthus and ala of the nose were common significant findings amongst different ethnicities (Caucasians, Africans, and Asians) when compared to ethnically matched controls. The Asian group had the least number of significant digital facial biometrics at 4, compared to Caucasians at 8 and Africans at 7. In conclusion, this study displays the wide variety of findings across different geographic populations in Down syndrome and demonstrates the accuracy and promise of digital facial analysis technology in the diagnosis of Down syndrome internationally. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington DC
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Felicia A Ikolo
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Samantha La Qua
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Vorasuk Shotelersuk
- Faculty of Medicine, Department of Pediatrics, Center of Excellence for Medical Genetics, Chulalongkorn University, Bangkok, Thailand
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong kong, China
| | - Gary T K Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong kong, China
| | - Annette Uwineza
- Center of Human Genetics/ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Center of Human Genetics/ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Angélica Moresco
- Servicio de Genética Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Ogochukwu Jidechukwu Sokunbi
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Daniel Akinsanya Joseph
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Desmond Ikebudu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Christopher Emeka Ugwu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Christy A N Okoromah
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Katherine L Pardo
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - J Joseph Brough
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Ni-Chung Lee
- Department of Pediatrics and Medical Genetics, National Taiwan University Hospital, Taiwan
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | | | - Ivy S L Ng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Saumya S Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | | | - Suma Ganesh
- Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Nirmala D Sirisena
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | | | | | | | | | - Premala Muthukumarasamy
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Omar A Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington DC
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington DC
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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6
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Abstract
BACKGROUND Thalassaemia is a recessively-inherited blood disorder that leads to anaemia of varying severity. In those affected by the more severe forms, regular blood transfusions are required which may lead to iron overload. Accumulated iron from blood transfusions may be deposited in vital organs including the heart, liver and endocrine organs such as the pituitary glands which can affect growth hormone production. Growth hormone deficiency is one of the factors that can lead to short stature, a common complication in people with thalassaemia. Growth hormone replacement therapy has been used in children with thalassaemia who have short stature and growth hormone deficiency. OBJECTIVES To assess the benefits and safety of growth hormone therapy in people with thalassaemia. SEARCH METHODS We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles, reviews and clinical trial registries. Our database and trial registry searches are current to 10 August 2017 and 08 August 2017, respectively. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing the use of growth hormone therapy to placebo or standard care in people with thalassaemia of any type or severity. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion. Data extraction and assessment of risk of bias were also conducted independently by two authors. The quality of the evidence was assessed using GRADE criteria. MAIN RESULTS One parallel trial conducted in Turkey was included. The trial recruited 20 children with homozygous beta thalassaemia who had short stature; 10 children received growth hormone therapy administered subcutaneously on a daily basis at a dose of 0.7 IU/kg per week and 10 children received standard care. The overall risk of bias in this trial was low except for the selection criteria and attrition bias which were unclear. The quality of the evidence for all major outcomes was moderate, the main concern was imprecision of the estimates due to the small sample size leading to wide confidence intervals. Final height (cm) (the review's pre-specified primary outcome) and change in height were not assessed in the included trial. The trial reported no clear difference between groups in height standard deviation (SD) score after one year, mean difference (MD) -0.09 (95% confidence interval (CI) -0.33 to 0.15 (moderate quality evidence). However, modest improvements appeared to be observed in the following key outcomes in children receiving growth hormone therapy compared to control (moderate quality evidence): change between baseline and final visit in height SD score, MD 0.26 (95% CI 0.13 to 0.39); height velocity, MD 2.28 cm/year (95% CI 1.76 to 2.80); height velocity SD score, MD 3.31 (95% CI 2.43 to 4.19); and change in height velocity SD score between baseline and final visit, MD 3.41 (95% CI 2.45 to 4.37). No adverse effects of treatment were reported in either group; however, while there was no clear difference between groups in the oral glucose tolerance test at one year, fasting blood glucose was significantly higher in the growth hormone therapy group compared to control, although both results were still within the normal range, MD 6.67 mg/dL (95% CI 2.66 to 10.68). There were no data beyond the one-year trial period. AUTHORS' CONCLUSIONS A small single trial contributed evidence of moderate quality that the use of growth hormone for a year may improve height velocity of children with thalassaemia although height SD score in the treatment group was similar to the control group. There are no randomised controlled trials in adults or trials that address the use of growth hormone therapy over a longer period and assess its effect on final height and quality of life. The optimal dosage of growth hormone and the ideal time to start this therapy remain uncertain. Large well-designed randomised controlled trials over a longer period with sufficient duration of follow up are needed.
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Affiliation(s)
- Chin Fang Ngim
- Monash University MalaysiaJeffrey Cheah School of Medicine and Health SciencesJohor BahruMalaysia
| | - Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
| | - Janet YH Hong
- Putrajaya HospitalDepartment of PaediatricsPrecinct 7PutrajayaMalaysia62250
| | - Shir Ley Tan
- Taylor's UniversitySchool of PharmacyNo 1, Jalan Taylor'sSubang JayaMalaysia47500
| | - Amutha Ramadas
- Monash University MalaysiaJeffrey Cheah School of Medicine and Health SciencesJohor BahruMalaysia
| | - Premala Muthukumarasamy
- University of Malaya Medical CenterDepartment of PaediatricsJalan UniversitiKuala LumpurMalaysia519000
| | - Meow‐Keong Thong
- University of Malaya Medical CenterDepartment of PaediatricsJalan UniversitiKuala LumpurMalaysia519000
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7
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Kruszka P, Porras AR, Addissie YA, Moresco A, Medrano S, Mok GTK, Leung GKC, Tekendo-Ngongang C, Uwineza A, Thong MK, Muthukumarasamy P, Honey E, Ekure EN, Sokunbi OJ, Kalu N, Jones KL, Kaplan JD, Abdul-Rahman OA, Vincent LM, Love A, Belhassan K, Ouldim K, El Bouchikhi I, Shukla A, Girisha KM, Patil SJ, Sirisena ND, Dissanayake VHW, Paththinige CS, Mishra R, Klein-Zighelboim E, Gallardo Jugo BE, Chávez Pastor M, Abarca-Barriga HH, Skinner SA, Prijoles EJ, Badoe E, Gill AD, Shotelersuk V, Smpokou P, Kisling MS, Ferreira CR, Mutesa L, Megarbane A, Kline AD, Kimball A, Okello E, Lwabi P, Aliku T, Tenywa E, Boonchooduang N, Tanpaiboon P, Richieri-Costa A, Wonkam A, Chung BHY, Stevenson RE, Summar M, Mandal K, Phadke SR, Obregon MG, Linguraru MG, Muenke M. Cover Image, Volume 173A, Number 9, September 2017. Am J Med Genet A 2017. [DOI: 10.1002/ajmg.a.38408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Antonio R. Porras
- Children's National Health System; Sheikh Zayed Institute for Pediatric Surgical Innovation; Washington District of Columbia
| | - Yonit A. Addissie
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Angélica Moresco
- Servicio de Genética; Hospital de Pediatría Garrahan; Buenos Aires Argentina
| | - Sofia Medrano
- Servicio de Genética; Hospital de Pediatría Garrahan; Buenos Aires Argentina
| | - Gary T. K. Mok
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
| | - Gordon K. C. Leung
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
| | | | - Annette Uwineza
- Center of Human Genetics, School of Medicine and Pharmacy, College of Medicine and Pharmacy; University of Rwanda; Kigali Rwanda
| | - Meow-Keong Thong
- Faculty of Medicine,Department of Paediatrics; University of Malaya; Kuala Lumpur Malaysia
| | | | - Engela Honey
- Department of Genetics; University of Pretoria; Pretoria South Africa
| | - Ekanem N. Ekure
- Department of Paediatrics College of Medicine, University of Lagos; Lagos University Teaching Hospital; Lagos Nigeria
| | - Ogochukwu J. Sokunbi
- Department of Paediatrics College of Medicine, University of Lagos; Lagos University Teaching Hospital; Lagos Nigeria
| | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos; Lagos University Teaching Hospital; Lagos Nigeria
| | - Kelly L. Jones
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Julie D. Kaplan
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Omar A. Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | | | | | - Khadija Belhassan
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
- Medical Genetics and Oncogenetics Unit; Hassan II University Hospital; Fez Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Unit; Hassan II University Hospital; Fez Morocco
| | - Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics Unit; Hassan II University Hospital; Fez Morocco
- Faculty of Sciences and Techniques,Laboratory of Microbial Biotechnology; University of Sidi Mohammed Ben Abdellah; Fez Morocco
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College; Manipal University; Manipal India
| | - Katta M. Girisha
- Department of Medical Genetics, Kasturba Medical College; Manipal University; Manipal India
| | | | - Nirmala D. Sirisena
- Faculty of Medicine, Human Genetics Unit; University of Colombo; Colombo Sri Lanka
| | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit; University of Colombo; Colombo Sri Lanka
| | | | | | | | | | | | | | - Eben Badoe
- School of Medicine and Dentistry,Department of Child Health; College of Health Sciences; Accra Ghana
| | - Ashleigh D. Gill
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Vorasuk Shotelersuk
- Faculty of Medicine,Center of Excellence for Medical Genetics, Department of Pediatrics; Chulalongkorn University; Bangkok Thailand
| | - Patroula Smpokou
- Division of Genetics and Metabolism; Children's National Health System; Washington District of Columbia
| | - Monisha S. Kisling
- Division of Genetics and Metabolism; Children's National Health System; Washington District of Columbia
| | - Carlos R. Ferreira
- Division of Genetics and Metabolism; Children's National Health System; Washington District of Columbia
| | - Leon Mutesa
- Center of Human Genetics, School of Medicine and Pharmacy, College of Medicine and Pharmacy; University of Rwanda; Kigali Rwanda
| | | | - Antonie D. Kline
- Harvey Institute for Human Genetics; Greater Baltimore Medical Center; Baltimore Maryland
| | - Amy Kimball
- Harvey Institute for Human Genetics; Greater Baltimore Medical Center; Baltimore Maryland
| | | | | | | | - Emmanuel Tenywa
- Uganda Heart Institute; Kampala Uganda
- Jinja Regional Referral Hospital; Jinja Uganda
| | - Nonglak Boonchooduang
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics; Chiangmai University; Chiang Mai Thailand
| | - Pranoot Tanpaiboon
- Division of Genetics and Metabolism; Children's National Health System; Washington District of Columbia
| | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies; São Paulo University; Bauru Brazil
| | - Ambroise Wonkam
- Division of Human Genetics; University of Cape Town; Cape Town South Africa
| | - Brian H. Y. Chung
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
| | | | - Marshall Summar
- Division of Genetics and Metabolism; Children's National Health System; Washington District of Columbia
| | - Kausik Mandal
- Department of Medical Genetics; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow Uttar Pradesh India
| | - Shubha R. Phadke
- Department of Medical Genetics; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow Uttar Pradesh India
| | - María G. Obregon
- Servicio de Genética; Hospital de Pediatría Garrahan; Buenos Aires Argentina
| | - Marius G. Linguraru
- Children's National Health System; Sheikh Zayed Institute for Pediatric Surgical Innovation; Washington District of Columbia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
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8
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Rokicki D, Pajdowska M, Trubicka J, Thong MK, Ciara E, Piekutowska-Abramczuk D, Pronicki M, Sikora R, Haidar R, Ołtarzewski M, Jabłońska E, Muthukumarasamy P, Sthaneswar P, Gan CS, Krajewska-Walasek M, Carrozzo R, Verrigni D, Semeraro M, Rizzo C, Taurisano R, Alhaddad B, Kovacs-Nagy R, Haack TB, Dionisi-Vici C, Pronicka E, Wortmann SB. 3-Methylglutaconic aciduria, a frequent but underrecognized finding in carbamoyl phosphate synthetase I deficiency. Clin Chim Acta 2017; 471:95-100. [DOI: 10.1016/j.cca.2017.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/16/2022]
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9
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Kruszka P, Porras AR, Addissie YA, Moresco A, Medrano S, Mok GTK, Leung GKC, Tekendo-Ngongang C, Uwineza A, Thong MK, Muthukumarasamy P, Honey E, Ekure EN, Sokunbi OJ, Kalu N, Jones KL, Kaplan JD, Abdul-Rahman OA, Vincent LM, Love A, Belhassan K, Ouldim K, El Bouchikhi I, Shukla A, Girisha KM, Patil SJ, Sirisena ND, Dissanayake VHW, Paththinige CS, Mishra R, Klein-Zighelboim E, Gallardo Jugo BE, Chávez Pastor M, Abarca-Barriga HH, Skinner SA, Prijoles EJ, Badoe E, Gill AD, Shotelersuk V, Smpokou P, Kisling MS, Ferreira CR, Mutesa L, Megarbane A, Kline AD, Kimball A, Okello E, Lwabi P, Aliku T, Tenywa E, Boonchooduang N, Tanpaiboon P, Richieri-Costa A, Wonkam A, Chung BHY, Stevenson RE, Summar M, Mandal K, Phadke SR, Obregon MG, Linguraru MG, Muenke M. Noonan syndrome in diverse populations. Am J Med Genet A 2017; 173:2323-2334. [PMID: 28748642 DOI: 10.1002/ajmg.a.38362] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/24/2017] [Indexed: 12/21/2022]
Abstract
Noonan syndrome (NS) is a common genetic syndrome associated with gain of function variants in genes in the Ras/MAPK pathway. The phenotype of NS has been well characterized in populations of European descent with less attention given to other groups. In this study, individuals from diverse populations with NS were evaluated clinically and by facial analysis technology. Clinical data and images from 125 individuals with NS were obtained from 20 countries with an average age of 8 years and female composition of 46%. Individuals were grouped into categories of African descent (African), Asian, Latin American, and additional/other. Across these different population groups, NS was phenotypically similar with only 2 of 21 clinical elements showing a statistically significant difference. The most common clinical characteristics found in all population groups included widely spaced eyes and low-set ears in 80% or greater of participants, short stature in more than 70%, and pulmonary stenosis in roughly half of study individuals. Using facial analysis technology, we compared 161 Caucasian, African, Asian, and Latin American individuals with NS with 161 gender and age matched controls and found that sensitivity was equal to or greater than 94% for all groups, and specificity was equal to or greater than 90%. In summary, we present consistent clinical findings from global populations with NS and additionally demonstrate how facial analysis technology can support clinicians in making accurate NS diagnoses. This work will assist in earlier detection and in increasing recognition of NS throughout the world.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Antonio R Porras
- Children's National Health System, Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, District of Columbia
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Angélica Moresco
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Sofia Medrano
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Gary T K Mok
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Gordon K C Leung
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | | | - Annette Uwineza
- Center of Human Genetics, School of Medicine and Pharmacy, College of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Meow-Keong Thong
- Faculty of Medicine,Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Engela Honey
- Department of Genetics, University of Pretoria, Pretoria, South Africa
| | - Ekanem N Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ogochukwu J Sokunbi
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Julie D Kaplan
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Omar A Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Khadija Belhassan
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland.,Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco
| | - Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Fez, Morocco.,Faculty of Sciences and Techniques,Laboratory of Microbial Biotechnology, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | | | - Nirmala D Sirisena
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Colombo, Sri Lanka
| | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Colombo, Sri Lanka
| | | | | | | | | | | | | | - Eben Badoe
- School of Medicine and Dentistry,Department of Child Health, College of Health Sciences, Accra, Ghana
| | - Ashleigh D Gill
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Vorasuk Shotelersuk
- Faculty of Medicine,Center of Excellence for Medical Genetics, Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
| | - Patroula Smpokou
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Monisha S Kisling
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Carlos R Ferreira
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Leon Mutesa
- Center of Human Genetics, School of Medicine and Pharmacy, College of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - Antonie D Kline
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Amy Kimball
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland
| | | | | | | | - Emmanuel Tenywa
- Uganda Heart Institute, Kampala, Uganda.,Jinja Regional Referral Hospital, Jinja, Uganda
| | - Nonglak Boonchooduang
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Chiangmai University, Chiang Mai, Thailand
| | - Pranoot Tanpaiboon
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies, São Paulo University, Bauru, Brazil
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Brian H Y Chung
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | | | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - María G Obregon
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Marius G Linguraru
- Children's National Health System, Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, District of Columbia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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Maddirevula S, AlZahrani F, Anazi S, Almureikhi M, Ben-Omran T, Abdel-Salam GMH, Hashem M, Ibrahim N, Abdulwahab FM, Meriki N, Bashiri FA, Thong MK, Muthukumarasamy P, Azwani Mazlan R, Shaheen R, Alkuraya FS. GWAS signals revisited using human knockouts. Genet Med 2017. [PMID: 28640246 DOI: 10.1038/gim.2017.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PurposeGenome-wide association studies (GWAS) have been instrumental to our understanding of the genetic risk determinants of complex traits. A common challenge in GWAS is the interpretation of signals, which are usually attributed to the genes closest to the polymorphic markers that display the strongest statistical association. Naturally occurring complete loss of function (knockout) of these genes in humans can inform GWAS interpretation by unmasking their deficiency state in a clinical context.MethodsWe exploited the unique population structure of Saudi Arabia to identify novel knockout events in genes previously highlighted in GWAS using combined autozygome/exome analysis.ResultsWe report five families with homozygous truncating mutations in genes that had only been linked to human disease through GWAS. The phenotypes observed in the natural knockouts for these genes (TRAF3IP2, FRMD3, RSRC1, BTBD9, and PXDNL) range from consistent with, to unrelated to, the previously reported GWAS phenotype.ConclusionWe expand the role of human knockouts in the medical annotation of the human genome, and show their potential value in informing the interpretation of GWAS of complex traits.
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Affiliation(s)
- Sateesh Maddirevula
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fatema AlZahrani
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shams Anazi
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mariam Almureikhi
- Section of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Tawfeg Ben-Omran
- Section of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Ghada M H Abdel-Salam
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mais Hashem
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Niema Ibrahim
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Firdous M Abdulwahab
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Neama Meriki
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad A Bashiri
- Department of Pediatrics, College of Medicine & King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Meow-Keong Thong
- Genetics and Metabolism Unit, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Premala Muthukumarasamy
- Genetics and Metabolism Unit, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rifhan Azwani Mazlan
- Genetics and Metabolism Unit, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ranad Shaheen
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
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Kruszka P, Addissie YA, McGinn DE, Porras AR, Biggs E, Share M, Crowley TB, Chung BHY, Mok GTK, Mak CCY, Muthukumarasamy P, Thong MK, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Mishra R, Shotelersuk V, Ekure EN, Sokunbi OJ, Kalu N, Ferreira CR, Duncan JM, Patil SJ, Jones KL, Kaplan JD, Abdul-Rahman OA, Uwineza A, Mutesa L, Moresco A, Obregon MG, Richieri-Costa A, Gil-da-Silva-Lopes VL, Adeyemo AA, Summar M, Zackai EH, McDonald-McGinn DM, Linguraru MG, Muenke M. Cover Image, Volume 173A, Number 4, April 2017. Am J Med Genet A 2017. [DOI: 10.1002/ajmg.a.38224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Yonit A. Addissie
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Daniel E. McGinn
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Antonio R. Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Elijah Biggs
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Matthew Share
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - T. Blaine Crowley
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Brian H. Y. Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | - Gary T. K. Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | - Christopher C. Y. Mak
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | | | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics; University of Malaya; Kuala Lumpur Malaysia
| | | | | | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit; University of Colombo; Sri Lanka
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics; Faculty of Medicine, Department of Pediatrics, Chulalongkorn University; Bangkok Thailand
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine; University of Lagos, Lagos University Teaching; Lagos Nigeria
| | | | - Nnenna Kalu
- Department of Paediatrics College of Medicine; University of Lagos, Lagos University Teaching; Lagos Nigeria
| | - Carlos R. Ferreira
- Division of Genetics and Metabolism; Children's National Health System; Washington, D.C
| | - Jordann-Mishael Duncan
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | | | - Kelly L. Jones
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Julie D. Kaplan
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Omar A. Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Annette Uwineza
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences; University of Rwanda; Kigali Rwanda
| | - Leon Mutesa
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences; University of Rwanda; Kigali Rwanda
| | - Angélica Moresco
- Servicio de Genética; Hospital de Pediatría Garrahan; Buenos Aires Argentina
| | | | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies; São Paulo University; Bauru Brazil
| | | | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism; Children's National Health System; Washington, D.C
| | - Elaine H. Zackai
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Donna M. McDonald-McGinn
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
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