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Baroncelli GI, Sessa MR, Pelosini C, Bertelloni S, Michelucci A, Toschi B, Piaggi P, Peroni D, Comberiati P. Intact FGF23 concentration in healthy infants, children, and adolescents, and diagnostic usefulness in patients with X-linked hypophosphatemic rickets. J Endocrinol Invest 2024; 47:873-882. [PMID: 37991698 DOI: 10.1007/s40618-023-02202-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE FGF23 measurement may have a diagnostic role to investigate patients with phosphate disorders. However, normal values for infants, children, and adolescents have not been defined. METHODS In a total of 282 (males 145, females 137) healthy infants (n = 30), prepubertal (n = 147), pubertal (n = 59), and postpubertal (n = 46), and in twenty patients with X-linked hypophosphatemic rickets (XLH, age 10.2 ± 5.6 years) serum phosphate (automated analyzer), and plasma intact FGF23 (immunochemiluminescent sandwich assay, DiaSorin) concentrations were measured. RESULTS Intact FGF23 concentrations were higher in healthy infants than in prepubertal (P < 0.01) and postpubertal subjects (P < 0.05); pubertal subjects showed higher values (P < 0.05) than postpubertal subjects. Serum phosphate concentrations were higher (P < 0.001) in healthy infants than in prepubertal, pubertal, and postpubertal subjects. Pubertal subjects had higher (P < 0.001) serum phosphate concentrations than postpubertal subjects. Intact FGF23 and serum phosphate concentrations did not differ (P = NS) by sex, age of menarche, and time after menarche. In healthy subjects, there was no correlation between intact FGF23 and serum phosphate concentrations. Intact FGF23 concentrations were higher (P < 0.0001) in patients with XLH than in healthy subjects according to chronological age and pubertal development. In all patients, intact FGF23 concentrations were above 40 pg/mL; intact FGF23 concentrations were inversely correlated with serum phosphate concentrations (r = -0.65; P < 0.01). CONCLUSION In healthy subjects, chronological age and puberty were main determinants of intact FGF23 concentrations. Intact FGF23 concentrations may be a useful marker for the early diagnosis of XLH in pediatric patients.
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Affiliation(s)
- G I Baroncelli
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - M R Sessa
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - C Pelosini
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - S Bertelloni
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - A Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - B Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital, Pisa, Italy
| | - P Piaggi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - D Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - P Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
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Orsini A, Santangelo A, Carmignani A, Camporeale A, Massart F, Tyutyusheva N, Peroni DG, Foiadelli T, Ferretti A, Toschi B, Romano S, Bonuccelli A. An Ultra-Rare Mixed Phenotype with Combined AP-4 and ERF Mutations: The First Report in a Pediatric Patient and a Literature Review. Genes (Basel) 2024; 15:436. [PMID: 38674371 PMCID: PMC11049481 DOI: 10.3390/genes15040436] [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: 02/12/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The adaptor protein 4 (AP-4) constitutes a conserved hetero-tetrameric complex within the family of adaptor protein (AP) complex, crucial for the signal-mediated trafficking of integral membrane proteins. Mutations affecting all subunits of the AP-4 complex have been linked to autosomal-recessive cerebral palsy and a complex hereditary spastic paraparesis (HSP) phenotype. Our report details the case of a 14-year-old boy born to consanguineous parents, presenting psychomotor delay, severe intellectual disability, microcephaly, and trigonocephaly. Despite a history of febrile seizures, subsequent years were devoid of seizures, with normal EEG. Exome sequencing revealed pathogenic variants in both the AP4B1 and ERF genes. Significantly, the patient exhibited features associated with AP4B1 mutations, including distinctive traits such as cranial malformations. The ERF gene variant, linked to craniosynostosis, likely contributes to the observed trigonocephaly. This case represents the initial documentation of a concurrent mutation in the AP4B1 and ERF genes, underscoring the critical role of exome analysis in unraveling complex phenotypes. Understanding these complex genotypes offers valuable insights into broader syndromic conditions, facilitating comprehensive patient management.
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Affiliation(s)
- Alessandro Orsini
- Pediatric Neurology, Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.O.); (A.B.)
| | - Andrea Santangelo
- Pediatric Neurology, Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.O.); (A.B.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Alessandra Carmignani
- Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.C.); (A.C.); (D.G.P.)
| | - Anna Camporeale
- Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.C.); (A.C.); (D.G.P.)
| | - Francesco Massart
- Pediatric Endocrinology, Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (F.M.); (N.T.)
| | - Nina Tyutyusheva
- Pediatric Endocrinology, Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (F.M.); (N.T.)
| | - Diego Giampietro Peroni
- Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.C.); (A.C.); (D.G.P.)
| | - Thomas Foiadelli
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Alessandro Ferretti
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Benedetta Toschi
- Division of Medical Genetics, Department of Medical and Oncological Area, University-Hospital, 56126 Pisa, Italy; (B.T.); (S.R.)
| | - Silvia Romano
- Division of Medical Genetics, Department of Medical and Oncological Area, University-Hospital, 56126 Pisa, Italy; (B.T.); (S.R.)
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric Department, AOUP Santa Chiara Hospital, 56100 Pisa, Italy; (A.O.); (A.B.)
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Baroncelli GI, Carlucci G, Freri E, Giuca MR, Guarnieri V, Navarra G, Toschi B, Mora S. The diagnosis of hypophosphatasia in children as a multidisciplinary effort: an expert opinion. J Endocrinol Invest 2024; 47:739-747. [PMID: 37752373 PMCID: PMC10904512 DOI: 10.1007/s40618-023-02199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
Hypophosphatasia (HPP) is a rare genetic disorder in which pathogenic variants of the ALPL gene lead to a marked decrease of tissue non-specific alkaline phosphatase (TNSALP) activity. Although HPP is a systemic disorder, its clinical manifestations are more evident on bones, teeth, muscle and central nervous system. The clinical spectrum ranges from severe forms with extreme skeletal deformities, respiratory impairment, seizures, to very mild forms with onset in late adulthood and few clinical signs. The diagnosis can be suspected by measurement of TNSALP activity, but the insufficient awareness among health professionals and the lack of official guidelines are responsible for delayed diagnosis in children with HPP. The purpose of the current document is to provide an expert opinion directed at optimizing the diagnostic pathway of pediatric HPP. From April to December 2022, a multidisciplinary working group of 6 experts including two pediatric endocrinologists, a pediatric neurologist, a pediatric odontologist, a clinical geneticist, and a molecular biologist gathered in a series of periodic meetings to discuss the main issues related to the diagnosis of HPP in children and formalize an Expert Opinion statement. The experts agreed on a diagnostic trail that begins with the recognition of specific clinical signs, leading to biochemical analyses of TNSALP activity and vitamin B6 serum concentration. Very important are the neurological and dental manifestation of the disease that should be thoroughly investigated. The evaluation of TNSALP activity must consider sex and age variability and low activity must be persistent. Repeated blood measurements are thus necessary. The molecular analysis is then mandatory to confirm the diagnosis and for genetic counseling.
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Affiliation(s)
- G I Baroncelli
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - G Carlucci
- OPT S.P.A., Soluzioni Per Il Mondo Healthcare, Milan, Italy
| | - E Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M R Giuca
- Unit of Pediatric Dentistry, Department of Surgical Medical Molecular Pathology and Critical Area, Dental and Oral Surgery Clinic, University of Pisa, Pisa, Italy
| | - V Guarnieri
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - G Navarra
- OPT S.P.A., Soluzioni Per Il Mondo Healthcare, Milan, Italy
| | - B Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital, Pisa, Italy
| | - S Mora
- Laboratory of Pediatric Endocrinology, Department of Pediatrics, IRCCS San Raffaele Hospital, Milan, Italy.
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Bonetti G, Cozza W, Bernini A, Kaftalli J, Mareso C, Cristofoli F, Medori MC, Colombo L, Martella S, Staurenghi G, Salvetti AP, Falsini B, Placidi G, Attanasio M, Pertile G, Bengala M, Bosello F, Petracca A, D’Esposito F, Toschi B, Lanzetta P, Ricci F, Viola F, Marceddu G, Bertelli M. Towards a Long-Read Sequencing Approach for the Molecular Diagnosis of RPGR ORF15 Genetic Variants. Int J Mol Sci 2023; 24:16881. [PMID: 38069202 PMCID: PMC10706286 DOI: 10.3390/ijms242316881] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Sequencing of the low-complexity ORF15 exon of RPGR, a gene correlated with retinitis pigmentosa and cone dystrophy, is difficult to achieve with NGS and Sanger sequencing. False results could lead to the inaccurate annotation of genetic variants in dbSNP and ClinVar databases, tools on which HGMD and Ensembl rely, finally resulting in incorrect genetic variants interpretation. This paper aims to propose PacBio sequencing as a feasible method to correctly detect genetic variants in low-complexity regions, such as the ORF15 exon of RPGR, and interpret their pathogenicity by structural studies. Biological samples from 75 patients affected by retinitis pigmentosa or cone dystrophy were analyzed with NGS and repeated with PacBio. The results showed that NGS has a low coverage of the ORF15 region, while PacBio was able to sequence the region of interest and detect eight genetic variants, of which four are likely pathogenic. Furthermore, molecular modeling and dynamics of the RPGR Glu-Gly repeats binding to TTLL5 allowed for the structural evaluation of the variants, providing a way to predict their pathogenicity. Therefore, we propose PacBio sequencing as a standard procedure in diagnostic research for sequencing low-complexity regions such as RPGRORF15, aiding in the correct annotation of genetic variants in online databases.
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Affiliation(s)
- Gabriele Bonetti
- MAGI’s LAB, 38068 Rovereto, Italy; (M.C.M.); (M.B.)
- Department of Pharmaceutical Sciences, University of Perugia, 06123 Perugia, Italy
| | - William Cozza
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Andrea Bernini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy;
| | - Jurgen Kaftalli
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Chiara Mareso
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | | | | | - Leonardo Colombo
- Department of Ophthalmology, ASST Santi Paolo e Carlo Hospital, University of Milan, 20142 Milan, Italy; (L.C.); (S.M.)
| | - Salvatore Martella
- Department of Ophthalmology, ASST Santi Paolo e Carlo Hospital, University of Milan, 20142 Milan, Italy; (L.C.); (S.M.)
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (A.P.S.)
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (A.P.S.)
| | - Benedetto Falsini
- UOC Oculistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Gemelli 8, 00168 Rome, Italy (G.P.)
- Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giorgio Placidi
- UOC Oculistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Gemelli 8, 00168 Rome, Italy (G.P.)
| | - Marcella Attanasio
- Ospedale Sacrocuore Don Calabria, Viale Luigi Rizzardi, 4, 37024 Negrar di Valpolicella, Italy; (M.A.); (G.P.)
| | - Grazia Pertile
- Ospedale Sacrocuore Don Calabria, Viale Luigi Rizzardi, 4, 37024 Negrar di Valpolicella, Italy; (M.A.); (G.P.)
| | - Mario Bengala
- Medical Genetics Unit, Department of Oncohematology, Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesca Bosello
- Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, Section of Ophthalmology, University of Verona, 37134 Verona, Italy;
| | - Antonio Petracca
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Fabiana D’Esposito
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London NW1 5QH, UK
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80138 Naples, Italy
| | - Benedetta Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital of Pisa, 56126 Pisa, Italy;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy;
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Federico Ricci
- Department of Experimental Medicine, Tor Vergata University of Rome, Viale Oxford, 00133 Rome, Italy;
| | - Francesco Viola
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Clinica Regina Elena, 20122 Milan, Italy;
| | - Giuseppe Marceddu
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Matteo Bertelli
- MAGI’s LAB, 38068 Rovereto, Italy; (M.C.M.); (M.B.)
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
- MAGISNAT, Atlanta Tech Park, 107 Technology Parkway, Peachtree Corners, GA 30092, USA
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Baroncelli GI, Zampollo E, Manca M, Toschi B, Bertelloni S, Michelucci A, Isola A, Bulleri A, Peroni D, Giuca MR. Pulp chamber features, prevalence of abscesses, disease severity, and PHEX mutation in X-linked hypophosphatemic rickets. J Bone Miner Metab 2021; 39:212-223. [PMID: 32772199 DOI: 10.1007/s00774-020-01136-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Rickets, growth failure, and recurrent periapical abscesses with fistulae are main signs in patients with X-linked hypophosphatemic rickets (XLH). Prevalence of abscesses, pulp chamber features, biochemical findings, disease severity, and PHEX gene mutation were examined. MATERIALS AND METHODS Pulp chambers size, shape, and morphology were assessed by orthopantomography in XLH patients (n = 24, age 5.8 ± 1.6 years) and in sex and age-matched healthy controls (n = 23, age 6.2 ± 1.4 years). XLH patients received conventional treatment (3.5 ± 1.9 years). Pulp chamber features were assessed in teeth of primary dentition and in the permanent left mandibular first molar and compared with those of controls. Rickets severity score was assessed at wrist, knee, and ankle. RESULTS The mean pulp chamber area/tooth area ratio, mean pulp chamber height/pulp chamber width ratio, and prominence of pulp horns into the tooth crown in primary and secondary molars were significantly higher in patients than in controls and in patients suffered abscesses than in patients without abscesses. Sixteen patients (67%) had a history of abscesses; incisors were affected more than canines and molars. Severity of rickets and mean serum parathyroid hormone (PTH) levels were significantly higher, and mean serum 1,25-dihydroxyvitamin D [1,25(OH)2D] levels significantly lower in patients suffered abscesses than in patients without abscesses. PHEX gene mutations were not correlated with dental phenotype and disease severity. CONCLUSION Enlarged pulp chambers with altered shape and morphology affected the majority of XLH patients predisposing to recurrent periapical abscesses with fistulae. Dental phenotype was associated with severity of rickets, high serum PTH, and low serum 1,25(OH)2D levels.
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Affiliation(s)
- Giampiero I Baroncelli
- Division of Pediatrics, Endocrine Unit, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Via Roma 67, 56126, Pisa, Italy.
| | - Elisa Zampollo
- Division of Dentistry and Oral Surgery, Department of Surgical Specialties, University-Hospital, Pisa, Italy
| | - Mario Manca
- Unit of Orthopedics, Usl Northwest-Tuscany, Versilia Hospital, Camaiore, Italy
| | - Benedetta Toschi
- Division of Medical Genetics, Department of Medical and Oncological Area, University-Hospital, Pisa, Italy
| | - Silvano Bertelloni
- Division of Pediatrics, Endocrine Unit, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Angela Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University-Hospital, Pisa, Italy
| | - Alessandro Isola
- Unit of Orthopedics, Usl Northwest-Tuscany, Versilia Hospital, Camaiore, Italy
| | - Alessandra Bulleri
- Unit of Radiodiagnostic, Department of Diagnostic Imaging, University-Hospital, Pisa, Italy
| | - Diego Peroni
- Division of Pediatrics, Endocrine Unit, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Maria Rita Giuca
- Division of Dentistry and Oral Surgery, Department of Surgical Specialties, University-Hospital, Pisa, Italy
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Gana S, Valetto A, Toschi B, Sardelli I, Cappelli S, Peroni D, Bertini V. Familial Interstitial 6q23.2 Deletion Including Eya4 Associated With Otofaciocervical Syndrome. Front Genet 2019; 10:650. [PMID: 31379922 PMCID: PMC6656857 DOI: 10.3389/fgene.2019.00650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/19/2019] [Indexed: 01/01/2023] Open
Abstract
We report on a 34-year-old woman and her mother who both have clinical features suggestive for otofaciocervical syndrome (OTFCS), a disorder characterized by a combination of facial dysmorphisms, ear abnormalities with hearing loss, and shoulder girdle anomalies. OTFCS presents overlapping features with branchiootorenal spectrum disorders, including branchiootorenal syndrome and branchiootic syndrome. These disorders have been described as clinically distinct entities, but molecular studies have shown that all the causative genes belong to the Pax-Six-Eya-Dach network (PSEDN). So far, the genetic diagnosis of OTFCS has been performed only in very few cases and involves two genes, EYA1 and PAX1; thus, it is likely that other genes have still to be identified. In the present patient, array CGH analysis showed a 3.7-Mb deletion in 6q23; a smaller 1.9-Mb deletion in the same region was detected in her mother. The minimal overlapping region harbors the EYA4 gene. The cases here described are interesting, since they all showed the typical clinical features of OTFCS, associated with a deletion in 6q23.2. Even if we cannot exclude the contribution of other genes to the phenotype, EYA4 is a good candidate for OTFCS according to its pattern of expression, its sequence similarity to EYA1, and its involvement in PSEDN.
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Affiliation(s)
- Simone Gana
- Medical Genetics, IRCCS Mondino Foundation, Pavia, Italy
| | - Angelo Valetto
- Section of Cytogenetics, Medicine of Laboratory Department, Santa Chiara University Hospital, Pisa, Italy
| | - Benedetta Toschi
- Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, Pisa, Italy
| | - Irene Sardelli
- Section of Cytogenetics, Medicine of Laboratory Department, Santa Chiara University Hospital, Pisa, Italy
| | - Susanna Cappelli
- Section of Pediatric, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Section of Pediatric, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Veronica Bertini
- Section of Cytogenetics, Medicine of Laboratory Department, Santa Chiara University Hospital, Pisa, Italy
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Bertini V, Valetto A, Baldinotti F, Azzarà A, Cambi F, Toschi B, Giacomina A, Gatti GL, Gana S, Caligo MA, Bertelloni S. Blepharophimosis, Ptosis, Epicanthus Inversus Syndrome: New Report with a 197-kb Deletion Upstream of FOXL2 and Review of the Literature. Mol Syndromol 2019; 10:147-153. [PMID: 31191203 DOI: 10.1159/000497092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/19/2022] Open
Abstract
Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is due to heterozygous FOXL2 intragenic mutations in about 70% of the patients, whereas total or partial gene deletions account for a minority of cases. Alteration of FOXL2 regulatory elements has been rarely described in patients with BPES. In this study, a prepubertal girl with BPES due to a 197-kb de novo deletion of the regulatory elements upstream of FOXL2 is reported. This girl presented with additional clinical features such as a soft cleft palate and microcephaly; thus, this copy number variant might have other somatic effects. The present deletion encompasses 2 coding genes (MRPS22 and COPB2), whose homozygous mutations have been associated with microcephaly. In our case, the sequences of the non-deleted allele were normal, ruling out a compound genetic defect. Normal levels of new biomarkers of ovarian reserve (anti-müllerian hormone, inhibin B) likely indicate an early diagnosis of type 2 BPES, but an evolutive gonadal damage will be excluded only by long-term follow-up. Additional reports of microdeletions upstream of FOXL2 are needed to better define the underlying genetic mechanism and the related phenotypic spectrum; the ability of the new hormonal markers to predict ovarian function in adolescence and adulthood should be confirmed.
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Affiliation(s)
- Veronica Bertini
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Angelo Valetto
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fulvia Baldinotti
- SOD Genetica Molecolare, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessia Azzarà
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Cambi
- SOD Citogenetica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Benedetta Toschi
- Sezione Genetica Medica, Medicina Interna 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Gian L Gatti
- U.O. Chirurgia Plastica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Simone Gana
- Sezione Genetica Medica, Medicina Interna 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maria A Caligo
- SOD Genetica Molecolare, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Silvano Bertelloni
- Pediatric Division, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Aretini P, Mazzanti CM, La Ferla M, Franceschi S, Lessi F, De Gregorio V, Nesti C, Valetto A, Bertini V, Toschi B, Battini R, Caligo MA. Next generation sequencing technologies for a successful diagnosis in a cold case of Leigh syndrome. BMC Neurol 2018; 18:99. [PMID: 30029642 PMCID: PMC6054728 DOI: 10.1186/s12883-018-1103-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/12/2018] [Indexed: 01/30/2023] Open
Abstract
Background Leigh Syndrome (LS, OMIM 256000) is an early-onset, progressive neurodegenerative disorder characterized by broad clinical and genetic heterogeneity; it is the most frequent disorder of mitochondrial energy production in children. LS inheritance is complex because patients may present mutations in mitochondrial DNA (mtDNA) or in nuclear genes, which predominantly encode proteins involved in respiratory chain structure and assembly or in coenzyme Q10 biogenesis. However, during the last 15 years, the discovery of several genetic mutations and improved knowledge of the natural history of LS has significantly increased our understanding of this mitochondrial disorder. Case presentation Here we describe a 19-year-old male with clinical and neuroimaging LS diagnosed at 3 years of age. Genetic analyses of the whole mtDNA for maternally inherited LS (MILS) and neuropathy ataxia retinitis pigmentosa (NARP) syndrome failed to reveal any pathogenic mutations. Conclusions Recently, a missense mutation in ECHS1 and a ~ 35 kb deletion in 10q26.3 involving the region including the gene were identified by WES (whole exome sequencing), uncovering the genetic diagnosis clinically hypothesized for 15 years. We also report the long-term follow-up of this patient, showing a comparison with classical LS or other Leigh-like pictures. Electronic supplementary material The online version of this article (10.1186/s12883-018-1103-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paolo Aretini
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Chiara Maria Mazzanti
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Marco La Ferla
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Sara Franceschi
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Francesca Lessi
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Veronica De Gregorio
- Fondazione Pisana per la Scienza ONLUS, Via Ferruccio Giovannini, 13, 56017, San Giuliano Terme, Pisa, Italy
| | - Claudia Nesti
- Molecular Medicine, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128, Calambrone, Pisa, Italy
| | - Angelo Valetto
- Cytogenetics Laboratory, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Veronica Bertini
- Cytogenetics Laboratory, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Benedetta Toschi
- Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa , Via Savi P, 56126, Pisa, Italy. .,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128, Calambrone, Pisa, Italy.
| | - Maria Adelaide Caligo
- Molecular Genetics Laboratory, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy
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Baroncelli GI, Ferretti E, Pini CM, Toschi B, Consolini R, Bertelloni S. Significant Improvement of Clinical Symptoms, Bone Lesions, and Bone Turnover after Long-Term Zoledronic Acid Treatment in Patients with a Severe Form of Camurati-Engelmann Disease. Mol Syndromol 2017; 8:294-302. [PMID: 29230158 DOI: 10.1159/000479859] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
Camurati-Engelmann disease (CED) is an ultrarare autosomal dominant bone dysplasia. Cortical thickening of the diaphyses of the long bones with narrowing of the medullary cavity are associated with bone pain, waddling gait, muscular weakness, easy fatigability, and a marfanoid body habitus. There is no specific treatment for CED. Nonsteroidal anti-inflammatory drugs or glucocorticoids are ineffective in improving bone lesions. A family with a mild to severe form of CED is described. Two patients received long-term bisphosphonate treatment: the 19-year-old female proband was treated with zoledronic acid for 2.2 years; the 4-year-old male proband was treated with neridronic acid for 16 months and with zoledronic acid for an additional 18 months. In both probands, zoledronic acid treatment significantly improved the clinical symptoms, bone lesions, ambulation, and body habitus. Before treatment, both probands showed a marked increase in serum levels of osteocalcin, procollagen type I N-terminal propeptide, and cross-linked carboxyterminal telopeptide of type I collagen, reflecting an increased bone turnover. Bone marker levels returned to their normal values during treatment. Zoledronic acid treatment may be an important therapeutic option in patients with severe CED. Biochemical markers of bone turnover could be considered as surrogate indexes of CED activity.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Elena Ferretti
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Cecilia M Pini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Benedetta Toschi
- Laboratory of Molecular Genetics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Rita Consolini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Silvano Bertelloni
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
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Bertini V, Azzarà A, Toschi B, Gana S, Valetto A. 3p26.3 terminal deletions: a challenge for prenatal genetic counseling. Prenat Diagn 2017; 37:197-200. [PMID: 27933663 DOI: 10.1002/pd.4978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/06/2016] [Accepted: 11/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Veronica Bertini
- Laboratory of Medical Genetics, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy
| | - Alessia Azzarà
- Laboratory of Medical Genetics, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy
| | - Benedetta Toschi
- Laboratory of Medical Genetics, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy
| | - Simone Gana
- Laboratory of Medical Genetics, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy
| | - Angelo Valetto
- Laboratory of Medical Genetics, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy
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Bertini V, Orsini A, Bonuccelli A, Cambi F, Del Pistoia M, Vannozzi I, Toschi B, Saggese G, Simi P, Valetto A. 17q12 microduplications: a challenge for clinicians. Am J Med Genet A 2016; 167A:674-6. [PMID: 25691423 DOI: 10.1002/ajmg.a.36905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/24/2014] [Accepted: 11/14/2014] [Indexed: 11/10/2022]
Abstract
In the recent years, some cases of 17q12 deletions and duplications have been reported, but the clinical impact of these imbalances is still to be fully elucidated. In particular, 17q12 duplications elude syndrome classification, since they are associated with a wide phenotypic spectrum, ranging from very mild to quite severe phenotypes. Here, two unrelated patients with the same 1.2 Mb microduplication of 17q12 are reported. Comparing these patients' phenotype with those previously published, it emerges that the more patients reported, the more difficult is finding common characteristics, even in presence of exactly the same genetic anomaly. The role of the genes duplicated in this region and the impact of this chromosomal imbalance are discussed.
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Affiliation(s)
- V Bertini
- Cytogenetics and Molecular Genetics Unit, Children Department, AOUP, Pisa, Italy
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Valetto A, Bertini V, Michelucci A, Toschi B, Dati E, Baroncelli GI, Bertelloni S. Short Stature in Isodicentric Y Chromosome and Three Copies of the SHOX Gene: Clinical Report and Review of Literature. Mol Syndromol 2016; 7:19-25. [PMID: 27194969 PMCID: PMC4862393 DOI: 10.1159/000444430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/19/2022] Open
Abstract
Short stature homeobox gene (SHOX) mutations and pseudoautosomal region 1 (PAR1) deletions encompassing SHOX are known causes of Léri-Weill dyschondrosteosis and isolated short stature, while 3 copies of SHOX in cases with triple sex chromosome constitution are responsible for tall stature. Duplications involving SHOX have been rarely reported, and they were found in individuals with short, normal and tall stature. An adopted boy with short stature, isodicentric Y chromosome and 3 copies of SHOX is described. Normal growth hormone (GH) secretion and insulin-like growth factor 1 (IGF1) increase during an IGF1 generation test were found, ruling out impaired GH-IGF1 axis. No other organic or psychiatric causes of impaired growth were found. GH treatment improved linear growth, as reported in children with SHOX haploinsufficiency. This new report and the review of literature support that SHOX duplication may cause short stature, especially in those children with duplications of the 5'SHOX regulatory elements. Chromosome analysis and detailed molecular characterization of the duplicated region should be warranted in individuals with SHOX duplications in order to investigate the presence of occult chromosome imbalance. Additional reports and follow-up till adult height are needed to give conclusions on long-term efficacy and safety of GH treatment in short children with SHOX duplication.
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Affiliation(s)
- Angelo Valetto
- Division of Cytogenetic and Molecular Biology, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Veronica Bertini
- Division of Cytogenetic and Molecular Biology, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Angela Michelucci
- Division of Cytogenetic and Molecular Biology, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Benedetta Toschi
- Division of Cytogenetic and Molecular Biology, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Eleonora Dati
- Division of Pediatrics, San Giuseppe Hospital, ASL 11, Empoli, Italy
| | - Giampietro I. Baroncelli
- Adolescent Medicine, Pediatric Division, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Silvano Bertelloni
- Adolescent Medicine, Pediatric Division, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
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13
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Bertelloni S, Baroncelli GI, Massart F, Toschi B. Growth in Boys with 45,X/46,XY Mosaicism: Effect of Growth Hormone Treatment on Statural Growth. Sex Dev 2015; 9:183-9. [DOI: 10.1159/000441342] [Citation(s) in RCA: 10] [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] [Accepted: 09/15/2015] [Indexed: 11/19/2022] Open
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14
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Bruno R, Valetto A, Bertini V, Cosini C, Toschi B, Congregati C, Rossi S, Simi P. A 17q duplication prenatally detected. Taiwan J Obstet Gynecol 2015; 54:326-9. [PMID: 26166353 DOI: 10.1016/j.tjog.2014.05.008] [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] [Accepted: 05/27/2014] [Indexed: 10/23/2022] Open
Affiliation(s)
- Rossella Bruno
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Angelo Valetto
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy.
| | - Veronica Bertini
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Cinzia Cosini
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Benedetta Toschi
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Caterina Congregati
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Simona Rossi
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
| | - Paolo Simi
- Cytogenetics and Molecular Genetic Unit, Azienda Ospedaliera Universitaria Pisana, S. Chiara Hospital, 56100 Pisa, Italy
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Bertelloni S, Dati E, Baldinotti F, Toschi B, Marrocco G, Sessa MR, Michelucci A, Simi P, Baroncelli GI. NR5A1 gene mutations: clinical, endocrine and genetic features in two girls with 46,XY disorder of sex development. Horm Res Paediatr 2015; 81:104-8. [PMID: 24434652 DOI: 10.1159/000354990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Steroidogenic factor 1, encoded by the NR5A1 gene, is a key regulator of endocrine function within the hypothalamic-pituitary-steroidogenic axis. Both homozygous, compound heterozygous and heterozygous mutations in the NR5A1 gene may determine 46,XY disorders of sex development (DSD). PATIENTS AND METHODS NR5A1 gene sequencing was performed in a cohort of 6 patients with 46,XY DSD without specific diagnosis. RESULTS Heterozygous NR5A1 gene mutations were found in 2 girls, aged 0.5 years and 14 years. The older girl harbored the c.250C>T transition in exon 4 (p.Arg84Cys), previously reported in a Japanese girl. The younger girl presented a de novo novel exon 6 heterozygous frameshift mutation (c.1074dupG) in codon 359 associated with the p.Gly146Ala polymorphism the latter inherited from her father. This baby showed severe impairment of androgen secretion from the first months of life. Overt adrenal insufficiency did not occur, but the older girl showed subnormal cortisol peak after ACTH stimulation. CONCLUSIONS NR5A1 gene mutations are a relatively frequent cause of 46,XY DSD in humans. Clear indications for management of these individuals remain elusive, mainly when diagnosis is made in infancy. Long-term monitoring of adrenal function should be recommended.
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Affiliation(s)
- Silvano Bertelloni
- Adolescent Medicine, Division of Pediatrics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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16
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Micale L, Augello B, Maffeo C, Selicorni A, Zucchetti F, Fusco C, De Nittis P, Pellico MT, Mandriani B, Fischetto R, Boccone L, Silengo M, Biamino E, Perria C, Sotgiu S, Serra G, Lapi E, Neri M, Ferlini A, Cavaliere ML, Chiurazzi P, Monica MD, Scarano G, Faravelli F, Ferrari P, Mazzanti L, Pilotta A, Patricelli MG, Bedeschi MF, Benedicenti F, Prontera P, Toschi B, Salviati L, Melis D, Di Battista E, Vancini A, Garavelli L, Zelante L, Merla G. Molecular analysis, pathogenic mechanisms, and readthrough therapy on a large cohort of Kabuki syndrome patients. Hum Mutat 2014; 35:841-50. [PMID: 24633898 PMCID: PMC4234006 DOI: 10.1002/humu.22547] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/05/2014] [Indexed: 12/04/2022]
Abstract
Kabuki syndrome (KS) is a multiple congenital anomalies syndrome characterized by characteristic facial features and varying degrees of mental retardation, caused by mutations in KMT2D/MLL2 and KDM6A/UTX genes. In this study, we performed a mutational screening on 303 Kabuki patients by direct sequencing, MLPA, and quantitative PCR identifying 133 KMT2D, 62 never described before, and four KDM6A mutations, three of them are novel. We found that a number of KMT2D truncating mutations result in mRNA degradation through the nonsense-mediated mRNA decay, contributing to protein haploinsufficiency. Furthermore, we demonstrated that the reduction of KMT2D protein level in patients’ lymphoblastoid and skin fibroblast cell lines carrying KMT2D-truncating mutations affects the expression levels of known KMT2D target genes. Finally, we hypothesized that the KS patients may benefit from a readthrough therapy to restore physiological levels of KMT2D and KDM6A proteins. To assess this, we performed a proof-of-principle study on 14 KMT2D and two KDM6A nonsense mutations using specific compounds that mediate translational readthrough and thereby stimulate the re-expression of full-length functional proteins. Our experimental data showed that both KMT2D and KDM6A nonsense mutations displayed high levels of readthrough in response to gentamicin treatment, paving the way to further studies aimed at eventually treating some Kabuki patients with readthrough inducers.
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Affiliation(s)
- Lucia Micale
- Medical Genetics Unit, IRCCS Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
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Terrier R, Rose-Dulcina K, Toschi B, Forestier N. Impaired control of weight bearing ankle inversion in subjects with chronic ankle instability. Clin Biomech (Bristol, Avon) 2014; 29:439-43. [PMID: 24485883 DOI: 10.1016/j.clinbiomech.2014.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 09/04/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have proposed that evertor muscle weakness represents an important factor affecting chronic ankle instability. For research purposes, ankle evertor strength is assessed by means of isokinetic evaluations. However, this methodology is constraining for daily clinical use. The present study proposes to assess ankle evertor muscle weakness using a new procedure, one that is easily accessible for rehabilitation specialists. To do so, we compared weight bearing ankle inversion control between patients suffering from chronic ankle instability and healthy subjects. METHODS 12 healthy subjects and 11 patients suffering from chronic ankle instability conducted repetitions of one leg weight bearing ankle inversion on a specific ankle destabilization device equipped with a gyroscope. Ankle inversion control was performed by means of an eccentric recruitment of evertor muscles. Instructions were to perform, as slow as possible, the ankle inversion while resisting against full body weight applied on the tested ankle. RESULTS Data clearly showed higher angular inversion velocity peaks in patients suffering from chronic ankle instability. This illustrates an impaired control of weight bearing ankle inversion and, by extension, an eccentric weakness of evertor muscles. INTERPRETATION The present study supports the hypothesis of a link between the decrease of ankle joint stability and evertor muscle weakness. Moreover, it appears that the new parameter is of use in a clinical setting.
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Affiliation(s)
- R Terrier
- CEVRES Santé, Savoie Technolac, BP 322 Le Bourget du lac cedex, France; Laboratoire de Physiologie de l'Exercice (E.A. 4338), Département des Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Savoie, France.
| | - K Rose-Dulcina
- Laboratoire de Physiologie de l'Exercice (E.A. 4338), Département des Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Savoie, France
| | - B Toschi
- Laboratoire de Physiologie de l'Exercice (E.A. 4338), Département des Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Savoie, France
| | - N Forestier
- Laboratoire de Physiologie de l'Exercice (E.A. 4338), Département des Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Savoie, France
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Valetto A, Bertini V, Toschi B, Simi P. A 47,XX,+der(21)t(8;21)(q24.2;q21.1) karyotype in a patient with mild intellectual disability, cleft lip, Hashimoto thyroiditis and hirsutism. Am J Med Genet A 2013; 161A:2389-92. [PMID: 23897865 DOI: 10.1002/ajmg.a.36039] [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] [Received: 09/26/2012] [Accepted: 04/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo Valetto
- Medical Genetic Unit, A.O.U. Pisana, Ospedale S. Chiara, Pisa, Italy.
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Esposito G, De Falco F, Neri I, Graziano C, Toschi B, Auricchio L, Gouveia C, Sousa AB, Salvatore F. Different TGM1 mutation spectra in Italian and Portuguese patients with autosomal recessive congenital ichthyosis: evidence of founder effects in Portugal. Br J Dermatol 2013; 168:1364-7. [PMID: 23278109 DOI: 10.1111/bjd.12179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bertelloni S, Baroncelli GI, Dati E, Ghione S, Baldinotti F, Toschi B, Simi P. IGF-I generation test in prepubertal children with Noonan syndrome due to mutations in the PTPN11 gene. Hormones (Athens) 2013; 12:86-92. [PMID: 23624134 DOI: 10.1007/bf03401289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Short stature represents one of the main features of children with Noonan syndrome. The reason for impaired growth remains largely unknown. OBJECTIVE To assess GH and IGF1 secretion in children with Noonan syndrome. PATIENTS 12 prepubertal children with Noonan syndrome due to mutations in the PTPN11 gene [7 males, 6 females; median age, years: 8.6 (range 5.1-13.4)] were studied; 12 prepubertal children with short stature (SS) [7 males, 5 females; median age, years: 8.1 (range 4.8-13.1)] served as the control group. MEASUREMENTS GH secretion after arginine stimulation test; IGF1 generation test by measurement of IGF1 levels before and after recombinant GH (rGH) administration (0.05 mg/kg/day for 4 days). RESULTS Baseline and stimulated peak values of GH were not significantly different between the two groups. At +120 minutes, GH levels remained significantly higher (p = 0.0121) in comparison with baseline values in children with Noonan syndrome. Baseline IGFI levels in patients and in SS controls were not significantly different, in contrast to values after the rGH generation test [205 ng/mL (interquartiles 138.2-252.5 ng/mL) and 284.5 ng/mL (interquartiles 172-476 ng/mL), respectively; p = 0.0248]. IGF1 values were significantly related to height (baseline: r = 773, p = 0.0320; peak: r = 0.591, p = 0.0428) in children with Noonan syndrome. CONCLUSIONS Blunted increase of IGF1 after the rGH generation test was present in children with Noonan syndrome due to mutations in the PTPN11 gene in comparison with SS children. This finding may be due to partial GH resistance in the former likely related to altered Ras-MAPK signaling pathway.
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Affiliation(s)
- Silvano Bertelloni
- Adolescent Medicine, I Pediatric Division, Department of Obstetrics, Gynaecology and Pediatrics, University Hospital, Pisa, Italy.
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Abstract
PURPOSE OF REVIEW Description of the recent advances on the regulation of phosphate metabolism, gene mutations, and new approaches to treatment in patients with hypophosphatemic rickets. RECENT FINDINGS Fibroblast growth factor 23 (FGF23) overproduction may be a primary cause of hypophosphatemic rickets. Inactivating mutations of phosphate-regulating gene with homologies to endopeptidases on the X chromosome, dentin matrix acidic phosphoprotein 1, and ectonucleotide pyrophosphatase/phosphodiesterase 1 are associated with X-linked hypophosphatemic rickets, autosomal recessive hypophosphatemic rickets 1, and autosomal recessive hypophosphatemic rickets 2, respectively. Activating mutations of FGF23 gene is the cause of autosomal dominant hypophosphatemic rickets. Iron deficiency may affect autosomal dominant hypophosphatemic rickets phenotype by regulating FGF23 production.Current treatment with activated vitamin D metabolites and oral inorganic phosphate salts may partially correct skeletal lesions and linear growth in patients with hypophosphatemic rickets. However, some patients have poor improvement by the current treatment. SUMMARY Identification of the causative mutation in patients with hypophosphatemic rickets may be useful to confirm the diagnosis and probably for prognosis. Inhibition of FGF23 overproduction by anti-FGF23 neutralizing antibodies could be a future approach for treatment of patients with FGF23-dependent hypophosphatemic rickets.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric Unit I, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy.
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Toschi B, Valetto A, Bertini V, Congregati C, Cantinotti M, Assanta N, Simi P. Acro-cardio-facial syndrome: a microdeletion syndrome? Am J Med Genet A 2012; 158A:1994-9. [PMID: 22740423 DOI: 10.1002/ajmg.a.35444] [Citation(s) in RCA: 11] [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] [Received: 02/03/2012] [Accepted: 04/07/2012] [Indexed: 11/06/2022]
Abstract
Acro-cardio-facial syndrome (ACFS) is an infrequently reported, variable condition characterized by split-hand and split-foot malformation and congenital heart defect (CHD), along with cleft lip and palate, genital anomalies, unusual face and intellectual disability. An autosomal recessive pattern of inheritance has been suggested because of affected sibs born to unaffected parents and parental consanguinity; the cause is unknown. We describe a newborn with the clinical manifestations of ACFS in whom a deletion of the region 6q21-q22.3 was detected by array CGH. We compare the clinical features of the present patient with earlier reported patients with similar 6q deletions and patients diagnosed with ACFS. The similarities between these patient groups suggest that ACFS may be a microdeletion syndrome caused by loss of the 6q21-22.3 region. The recurrence in families may be explained by prenatal germline mosaicism. Alternatively, ACFS may be a genetically heterogeneous disorder which can also be caused by biallelic mutations of an autosomal recessive gene.
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Affiliation(s)
- Benedetta Toschi
- U.O. Laboratorio Genetica Medica, Santa Chiara Hospital, Pisa, Italy.
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Valetto A, Orsini A, Bertini V, Toschi B, Bonuccelli A, Simi F, Sammartino I, Taddeucci G, Simi P, Saggese G. Molecular cytogenetic characterization of an interstitial deletion of chromosome 21 (21q22.13q22.3) in a patient with dysmorphic features, intellectual disability and severe generalized epilepsy. Eur J Med Genet 2012; 55:362-6. [DOI: 10.1016/j.ejmg.2012.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
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Micale L, Augello B, Fusco C, Selicorni A, Loviglio MN, Silengo MC, Reymond A, Gumiero B, Zucchetti F, D'Addetta EV, Belligni E, Calcagnì A, Digilio MC, Dallapiccola B, Faravelli F, Forzano F, Accadia M, Bonfante A, Clementi M, Daolio C, Douzgou S, Ferrari P, Fischetto R, Garavelli L, Lapi E, Mattina T, Melis D, Patricelli MG, Priolo M, Prontera P, Renieri A, Mencarelli MA, Scarano G, della Monica M, Toschi B, Turolla L, Vancini A, Zatterale A, Gabrielli O, Zelante L, Merla G. Mutation spectrum of MLL2 in a cohort of Kabuki syndrome patients. Orphanet J Rare Dis 2011; 6:38. [PMID: 21658225 PMCID: PMC3141365 DOI: 10.1186/1750-1172-6-38] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 06/09/2011] [Indexed: 12/30/2022] Open
Abstract
Background Kabuki syndrome (Niikawa-Kuroki syndrome) is a rare, multiple congenital anomalies/mental retardation syndrome characterized by a peculiar face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies, and immunological defects. Recently mutations in the histone methyl transferase MLL2 gene have been identified as its underlying cause. Methods Genomic DNAs were extracted from 62 index patients clinically diagnosed as affected by Kabuki syndrome. Sanger sequencing was performed to analyze the whole coding region of the MLL2 gene including intron-exon junctions. The putative causal and possible functional effect of each nucleotide variant identified was estimated by in silico prediction tools. Results We identified 45 patients with MLL2 nucleotide variants. 38 out of the 42 variants were never described before. Consistently with previous reports, the majority are nonsense or frameshift mutations predicted to generate a truncated polypeptide. We also identified 3 indel, 7 missense and 3 splice site. Conclusions This study emphasizes the relevance of mutational screening of the MLL2 gene among patients diagnosed with Kabuki syndrome. The identification of a large spectrum of MLL2 mutations possibly offers the opportunity to improve the actual knowledge on the clinical basis of this multiple congenital anomalies/mental retardation syndrome, design functional studies to understand the molecular mechanisms underlying this disease, establish genotype-phenotype correlations and improve clinical management.
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Affiliation(s)
- Lucia Micale
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza Hospital, 71013 San Giovanni Rotondo, Italy
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Maffé A, Toschi B, Circo G, Giachino D, Giglio S, Rizzo A, Carloni A, Poletti V, Tomassetti S, Ginardi C, Ungari S, Genuardi M. Constitutional FLCN mutations in patients with suspected Birt-Hogg-Dubé syndrome ascertained for non-cutaneous manifestations. Clin Genet 2011; 79:345-54. [DOI: 10.1111/j.1399-0004.2010.01480.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tricarico R, Bet P, Ciambotti B, Di Gregorio C, Gatteschi B, Gismondi V, Toschi B, Tonelli F, Varesco L, Genuardi M. Endometrial cancer and somatic G>T KRAS transversion in patients with constitutional MUTYH biallelic mutations. Cancer Lett 2008; 274:266-70. [PMID: 18980800 DOI: 10.1016/j.canlet.2008.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 09/09/2008] [Accepted: 09/16/2008] [Indexed: 12/17/2022]
Abstract
MUTYH-associated polyposis (MAP) is an autosomal recessive condition predisposing to colorectal cancer, caused by constitutional biallelic mutations in the base excision repair (BER) gene MUTYH. Colorectal tumours from MAP patients display an excess of somatic G>T mutations in the APC and KRAS genes due to defective BER function. To date, few extracolonic manifestations have been observed in MAP patients, and the clinical spectrum of this condition is not yet fully established. Recently, one patient with a diagnosis of endometrial cancer and biallelic MUTYH mutations has been described. We here report on two additional unrelated MAP patients with biallelic MUTYH germline mutations who developed endometrioid endometrial carcinoma. The endometrial tumours were evaluated for PTEN, PIK3CA, KRAS, BRAF and CTNNB1 mutations. A G>T transversion at codon 12 of the KRAS gene was observed in one tumour. A single 1bp frameshift deletion of PTEN was observed in the same sample. Overall, these findings suggest that endometrial carcinoma is a phenotypic manifestations of MAP and that inefficient repair of oxidative damage can be involved in its pathogenesis.
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Affiliation(s)
- Rossella Tricarico
- Department of Clinical Pathophysiology, Medical Genetics Unit, University of Florence Medical School, Viale G. Pieraccini 6, 50139 Florence, Italy
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