1
|
Schwartz CE, Aylsworth AS, Allanson J, Battaglia A, Carey JC, Curry CJ, Davies KE, Eichler EE, Graham JM, Hall B, Hall JG, Holmes LB, Hoyme HE, Hunter A, Innis J, Johnson J, Keppler-Noreuil KM, Leroy JG, Moore C, Nelson DL, Neri G, Opitz JM, Picketts D, Raymond FL, Shalev SA, Stevenson RE, Stumpel CTRM, Sutherland G, Viskochil DH, Weaver DD, Zackai EH. Personal journeys to and in human genetics and dysmorphology. Am J Med Genet A 2024; 194:e63514. [PMID: 38329159 DOI: 10.1002/ajmg.a.63514] [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: 11/05/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
Genetics has become a critical component of medicine over the past five to six decades. Alongside genetics, a relatively new discipline, dysmorphology, has also begun to play an important role in providing critically important diagnoses to individuals and families. Both have become indispensable to unraveling rare diseases. Almost every medical specialty relies on individuals experienced in these specialties to provide diagnoses for patients who present themselves to other doctors. Additionally, both specialties have become reliant on molecular geneticists to identify genes associated with human disorders. Many of the medical geneticists, dysmorphologists, and molecular geneticists traveled a circuitous route before arriving at the position they occupied. The purpose of collecting the memoirs contained in this article was to convey to the reader that many of the individuals who contributed to the advancement of genetics and dysmorphology since the late 1960s/early 1970s traveled along a journey based on many chances taken, replying to the necessities they faced along the way before finding full enjoyment in the practice of medical and human genetics or dysmorphology. Additionally, and of equal importance, all exhibited an ability to evolve with their field of expertise as human genetics became human genomics with the development of novel technologies.
Collapse
Affiliation(s)
- Charles E Schwartz
- Senior Research Scientist Emeritus, Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Arthur S Aylsworth
- Emeritus Professor of Pediatrics and Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Judith Allanson
- Professor of Paediatrics, University of Ottawa, Ottawa, Canada
- Clinical Geneticist, Children's Hospital of Eastern Ontario (Retired), Ottawa, Canada
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Cynthia J Curry
- Professor of Pediatrics, Emerita, UCSF, Adjunct Professor of Pediatrics, Stanford, Medical Director Genetic Medicine, Community Regional Medical Center, Fresno, California, USA
| | - Kay E Davies
- Department of Physiology, Anatomy and Genetics, MDUK Oxford Neuromuscular Centre, Oxford, UK
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, Washington, USA
| | - John M Graham
- Professor Emeritus, Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, and David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Bryan Hall
- Emeritus, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA
| | - Judith G Hall
- University of British Columbia and Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics and Medical Genetics, British Columbia Children's Hospital, Vancouver, Canada
| | - Lewis B Holmes
- Emeritus Chief, Medical Genetics and Metabolism Unit, Mass General for Children; Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - H Eugene Hoyme
- Medical Director, Sanford Children's Genomic Medicine Consortium, Senior Advisor, Sanford Imagenetics, Sanford Health, Emeritus Professor and Past Chair, Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
- Adjunct Professor and Medical Director, Genetic Counseling Graduate Program, Augustana University, Sioux Falls, South Dakota, USA
- Extraordinary Professor of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alasdair Hunter
- Emeritus Clinical Geneticist, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jeffrey Innis
- Staff Physician, Pediatric Genetics, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida, USA
- Professor Emeritus of Human Genetics, Pediatrics and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John Johnson
- Emeritus Clinical Geneticist, Department of Medical Genetics, Shodair Hospital, Helena, Montana, USA
| | - Kim M Keppler-Noreuil
- Professor of Pediatrics Division of Genetics & Metabolism, Program Director, Medical Genetics & Genomics Residency Training Program, Co-Director of the UW NORD Center of Excellence for Rare Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jules G Leroy
- Professor Emeritus, Ghent University School of Medicine, Ghent, Belgium
| | - Cynthia Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control, Atlanta, Georgia, USA
| | - David L Nelson
- Department of Molecular and Human Genetics, Jan and Dan Duncan Neurological Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Giovanni Neri
- Institute of Genomic Medicine, Catholic University School of Medicine, Rome, Italy
| | - John M Opitz
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Picketts
- Senior Scientist, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Professor, Departments of Medicine, Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - F Lucy Raymond
- Department of Medical Genetics, University of Cambridge, Cambridge, England
| | - Stavit Allon Shalev
- The Genetics Institute, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Connie T R M Stumpel
- Emeritus Professor of Clinical Genetics, Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Grant Sutherland
- Emeritus Geneticist, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Emeritus Professor, University of Adelaide, Adelaide, South Australia, Australia
| | - David H Viskochil
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David D Weaver
- Professor Emeritus of Medical and Molecular Genetics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
St Louis JD, Bhat A, Carey JC, Lin AE, Mann PC, Smith LM, Wilfond BS, Kosiv KA, Sorabella RA, Alsoufi B. The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Recommendation for the care of children with trisomy 13 or trisomy 18 and a congenital heart defect. J Thorac Cardiovasc Surg 2024; 167:1519-1532. [PMID: 38284966 DOI: 10.1016/j.jtcvs.2023.11.054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Recommendations for surgical repair of a congenital heart defect in children with trisomy 13 or trisomy 18 remain controversial, are subject to biases, and are largely unsupported with limited empirical data. This has created significant distrust and uncertainty among parents and could potentially lead to suboptimal care for patients. A working group, representing several clinical specialties involved with the care of these children, developed recommendations to assist in the decision-making process for congenital heart defect care in this population. The goal of these recommendations is to provide families and their health care teams with a framework for clinical decision making based on the literature and expert opinions. METHODS This project was performed under the auspices of the AATS Congenital Heart Surgery Evidence-Based Medicine Taskforce. A Patient/Population, Intervention, Comparison/Control, Outcome process was used to generate preliminary statements and recommendations to address various aspects related to cardiac surgery in children with trisomy 13 or trisomy 18. Delphi methodology was then used iteratively to generate consensus among the group using a structured communication process. RESULTS Nine recommendations were developed from a set of initial statements that arose from the Patient/Population, Intervention, Comparison/Control, Outcome process methodology following the groups' review of more than 500 articles. These recommendations were adjudicated by this group of experts using a modified Delphi process in a reproducible fashion and make up the current publication. The Class (strength) of recommendations was usually Class IIa (moderate benefit), and the overall level (quality) of evidence was level C-limited data. CONCLUSIONS This is the first set of recommendations collated by an expert multidisciplinary group to address specific issues around indications for surgical intervention in children with trisomy 13 or trisomy 18 with congenital heart defect. Based on our analysis of recent data, we recommend that decisions should not be based solely on the presence of trisomy but, instead, should be made on a case-by-case basis, considering both the severity of the baby's heart disease as well as the presence of other anomalies. These recommendations offer a framework to assist parents and clinicians in surgical decision making for children who have trisomy 13 or trisomy 18 with congenital heart defect.
Collapse
Affiliation(s)
- James D St Louis
- Department of Surgery, Children's Hospital of Georgia, Augusta University, Augusta, Ga.
| | - Aarti Bhat
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Wash
| | - John C Carey
- Department of Pediatrics, University of Utah Health and Primary Children's Hospital, Salt Lake City, Utah
| | - Angela E Lin
- Department of Pediatrics, Mass General Hospital for Children, Boston, Mass
| | - Paul C Mann
- Department of Surgery, Children's Hospital of Georgia, Augusta University, Augusta, Ga
| | - Laura Miller Smith
- Department of Pediatrics, Oregon Health and Science University, Portland, Ore
| | - Benjamin S Wilfond
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Wash
| | - Katherine A Kosiv
- Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Robert A Sorabella
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Bahaaldin Alsoufi
- Department of Surgery, University of Louisville and Norton Children's Hospital, Louisville, Ky
| |
Collapse
|
3
|
Carey JC, Spranger J, Lewin S, Neri G. John M Opitz: Physician, morphologist, scholar, editor (1935-2023). Am J Med Genet A 2024; 194:e63482. [PMID: 37990419 DOI: 10.1002/ajmg.a.63482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Affiliation(s)
- John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Susan Lewin
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Giovanni Neri
- Institute of Genomic Medicine, Catholic University School of Medicine, Rome, Italy
| |
Collapse
|
4
|
Mehl JM, Gelfond J, Carey JC, Cody JD. Causes of death in individuals with trisomy 18 after the first year of life. Am J Med Genet A 2024; 194:279-287. [PMID: 37822198 DOI: 10.1002/ajmg.a.63436] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Mortality in individuals with trisomy 18 has significantly decreased over the past 20 years, but there is scant literature addressing the prognosis and cause of death in individuals with trisomy 18 and survival past the first year of life (YOL). This study analyzed factors associated with mortality and cause of death in a retrospective cohort of 174 individuals with trisomy 18 and survival past the first YOL, the largest such series to date. Data were collected via retrospective survey of parents of affected individuals. Prenatal diagnosis of trisomy 18; postnatal respiratory distress; maternal age > 35 years; birthweight <2000 g; brain and spinal cord defect(s); atrial and/or ventricular septal defect(s); inability to feed orally without medical assistance; and failure to meet sitting and rolling milestones were associated with mortality in this sample. Cause of death was compared between our cohort of individuals with trisomy 18 and existing literature on those with mortality before the first YOL. Individuals with trisomy 18 with mortality after the first YOL demonstrated a predominance of infectious (n = 10/22) and postoperative (n = 6/22) contributing causes of death, in contrast to the existing literature, which shows a predominance of cardiopulmonary causes of death (e.g., cardiopulmonary arrest, pulmonary hypertension). These findings demonstrate that individuals with trisomy 18 and survival past the first YOL have unique medical needs, but further research is needed to develop clinical guidelines for this growing population.
Collapse
Affiliation(s)
- Justin M Mehl
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jonathan Gelfond
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - John C Carey
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jannine D Cody
- University of Texas Health Science Center, San Antonio, Texas, USA
- The Chromosome 18 Registry and Research Society, San Antonio, Texas, USA
| |
Collapse
|
5
|
Kosiv KA, Mercurio MR, Carey JC. The common trisomy syndromes, their cardiac implications, and ethical considerations in care. Curr Opin Pediatr 2023; 35:531-537. [PMID: 37551160 DOI: 10.1097/mop.0000000000001278] [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] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To review the incidence of congenital heart disease in the trisomies, highlight the history of cardiac surgery in trisomy 21 comparing it to the increase in cardiac surgery in trisomies 13 and 18, discuss ethical issues specific to trisomies 13 and 18, and suggest a pathway of shared decision-making in the management of congenital heart disease in trisomy 13 and 18, specifically congenital heart surgery. RECENT FINDINGS Congenital heart disease is prevalent in the trisomies and the management of these defects, especially surgical intervention, has changed. In the late 20th century, survival after cardiac surgery in trisomy 21 vastly improved, significantly decreasing morbidity and mortality secondary to pulmonary hypertension. Similarly, procedures and surgeries have been performed with increasing frequency in trisomy 13 and 18 patients and concomitantly, survival in this patient population is increasing. Yet across the United States, the willingness to perform cardiac surgery in trisomy 13 and 18 is variable, and there is ethical controversy about the correct action to take. To address this concern, a shared decision-making approach with an informed parent(s) is advised. SUMMARY As the care and management of congenital heart disease changed in trisomy 21, so too it has with trisomy 13 and 18. Physicians and parents should develop goal-directed treatment plans balancing the risk versus benefit and consider cardiac surgical repair if feasible and beneficial.
Collapse
|
6
|
Langford J, Vukadin L, Carey JC, Botto LD, Velinder M, Mao R, Miller CE, Filloux F, Ahn EYE. SON-Related Zhu-Tokita-Takenouchi-Kim Syndrome With Recurrent Hemiplegic Migraine: Putative Role of PRRT2. Neurol Genet 2023; 9:e200062. [PMID: 37057295 PMCID: PMC10091367 DOI: 10.1212/nxg.0000000000200062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/20/2023] [Indexed: 04/15/2023]
Abstract
Background and Objectives Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome (OMIM 617140) is a recently identified neurodevelopmental disorder caused by heterozygous loss-of-function (LoF) variants in SON. Because the SON protein functions as an RNA-splicing regulator, it has been shown that some clinical features of ZTTK syndrome can be attributed to abnormal RNA splicing. Several neurologic features have been observed in patients with ZTTK syndrome, including seizure/epilepsy and other EEG abnormalities. However, a relationship between SON LoF in ZTTK syndrome and hemiplegic migraine remains unknown. Methods We identified a patient with a pathogenic variant in SON who shows typical clinical features of ZTTK syndrome and experienced recurrent episodes of hemiplegic migraine. To define clinical features, brain MRI and EEG during and after episodes of hemiplegic migraine were characterized. To identify molecular mechanisms for this clinical presentation, we investigated the impact of small interfering RNA (siRNA)-mediated SON knockdown on mRNA expression of the CACNA1A, ATP1A2, SCN1A, and PRRT2 genes, known to be associated with hemiplegic migraine, by quantitative RT-PCR. Pre-mRNA splicing of PRRT2 on SON knockdown was further examined by RT-PCR using primers targeting specific exons. Results Recurrent episodes of hemiplegic migraine in our patient typically followed modest closed head injuries, and recurrent seizures occurred during the most severe of these episodes. Transient hemispheric cortical interstitial edema and asymmetric EEG slowing were identified during episodes. Our siRNA experiments revealed that SON knockdown significantly reduces PRRT2 mRNA levels in U87MG and SH-SY5Y cell lines, although a reduction in CACNA1A, ATP1A2, and SCN1A mRNA expression was not observed. We further identified that SON knockdown leads to failure in intron 2 removal from PRRT2 pre-mRNA, resulting in a premature termination codon that blocks the generation of functionally intact full-length PRRT2. Discussion This report identifies recurrent hemiplegic migraine as a novel clinical manifestation of ZTTK syndrome, further characterizes this clinical feature, and provides evidence for downregulation of PRRT2 caused by SON LoF as a mechanism causing hemiplegic migraine. Examination of the SON gene may be indicated in individuals with recurrent hemiplegic migraine.
Collapse
Affiliation(s)
- Jordan Langford
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Lana Vukadin
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - John C Carey
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Lorenzo D Botto
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Matt Velinder
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Rong Mao
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Christine E Miller
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Francis Filloux
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| | - Eun-Young Erin Ahn
- University of Utah School of Medicine, University of Utah (J.L.), Salt Lake City, UT; Department of Pathology, Division of Molecular and Cellular Pathology (L.V., E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL; Division of Medical Genetics (L.D.B.), Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Utah Center for Genetic Discovery, Eccles Institute of Human Genetics (M.V.), University of Utah School of Medicine; Department of Pathology (R.M.), University of Utah School of Medicine, Salt Lake City, UT; Division of Integrated Oncology and Genetics (R.M., C.E.M.), Molecular Genetics, ARUP Laboratories, Salt Lake City, UT; Division of Pediatric Neurology (F.F.), University of Utah School of Medicine, Salt Lake City, UT; and O'Neal Comprehensive Cancer Center (E.-Y.E.A.), University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
7
|
Martin-Giacalone BA, Lin AE, Rasmussen SA, Kirby RS, Nestoridi E, Liberman RF, Agopian AJ, Carey JC, Cragan JD, Forestieri N, Leedom V, Boyce A, Nembhard WN, Piccardi M, Sandidge T, Shan X, Shumate CJ, Stallings EB, Stevenson R, Lupo PJ. Prevalence and descriptive epidemiology of Turner syndrome in the United States, 2000-2017: A report from the National Birth Defects Prevention Network. Am J Med Genet A 2023; 191:1339-1349. [PMID: 36919524 PMCID: PMC10405780 DOI: 10.1002/ajmg.a.63181] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
The lack of United States population-based data on Turner syndrome limits assessments of prevalence and associated characteristics for this sex chromosome abnormality. Therefore, we collated 2000-2017 data from seven birth defects surveillance programs within the National Birth Defects Prevention Network. We estimated the prevalence of karyotype-confirmed Turner syndrome diagnosed within the first year of life. We also calculated the proportion of cases with commonly ascertained birth defects, assessed associations with maternal and infant characteristics using prevalence ratios (PR) with 95% confidence intervals (CI), and estimated survival probability. The prevalence of Turner syndrome of any pregnancy outcome was 3.2 per 10,000 female live births (95% CI = 3.0-3.3, program range: 1.0-10.4), and 1.9 for live birth and stillbirth (≥20 weeks gestation) cases (95% CI = 1.8-2.1, program range: 0.2-3.9). Prevalence was lowest among cases born to non-Hispanic Black women compared to non-Hispanic White women (PR = 0.5, 95% CI = 0.4-0.6). Coarctation of the aorta was the most common defect (11.6% of cases), and across the cohort, individuals without hypoplastic left heart had a five-year survival probability of 94.6%. The findings from this population-based study may inform surveillance practices, prenatal counseling, and diagnosis. We also identified racial and ethnic disparities in prevalence, an observation that warrants further investigation.
Collapse
Affiliation(s)
- Bailey A. Martin-Giacalone
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Angela E. Lin
- Medical Genetics Unit, Mass General for Children, Boston, Massachusetts, USA
| | - Sonja A. Rasmussen
- Department of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Russell S. Kirby
- Chiles Center, University of South Florida College of Public Health, Tampa, Florida, USA
| | - Eirini Nestoridi
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Rebecca F. Liberman
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - A. J. Agopian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - John C. Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Janet D. Cragan
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Forestieri
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Vinita Leedom
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Aubree Boyce
- Utah Birth Defect Network, Utah Department of Health and Human Services, Salt Lake City, Utah, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Monika Piccardi
- Office of Genetics and People with Special Health Care Needs, Maryland Department of Health, Baltimore, Maryland, USA
| | - Theresa Sandidge
- Division of Epidemiologic Studies, Illinois Department of Public Health, Springfield, Illinois, USA
| | - Xiaoyi Shan
- Arkansas Reproductive Health Monitoring System, Arkansas Children’s Research Institute, Little Rock, Arkansas, USA
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Erin B. Stallings
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Philip J. Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
8
|
Jaspersen SL, Bruns DA, Candee MS, Battaglia A, Carey JC, Fishler KP. Seizures in trisomy 18: Prevalence, description, and treatment. Am J Med Genet A 2023; 191:1026-1037. [PMID: 36601988 DOI: 10.1002/ajmg.a.63113] [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] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
Changes in medical intervention over the last decade have improved outcomes for individuals with trisomy 18, the second most common human aneuploidy syndrome at birth. As children with trisomy 18 live longer, a shared concern of medical experts and parents is the occurrence and treatment of seizures. Previously published surveillance guidelines for this condition have not addressed seizure management. Using parent-reported data collected as part of the Tracking Rare Incidence Syndromes project, we report on the prevalence, course, and management of seizures in individuals with trisomy 18. Twenty-eight percent (52/186) of individuals diagnosed with trisomy 18 in our retrospective cohort experienced generalized, focal, or mixed seizures at some point in their lifetime. For many individuals, seizures were effectively managed by broad-spectrum anti-seizure medications. Correlation analysis showed that focal and generalized seizures were more likely to occur in individuals who had previously experienced infantile spasms or central apnea. Electroencephalogram testing should be considered as part of a standard screening approach in individuals with trisomy 18 to enable early diagnosis and treatment of seizures. An international registry that incorporates parent-reported and clinical data for patients with trisomy 18 may facilitate ongoing research and recruitment into clinical trials for seizure management.
Collapse
Affiliation(s)
- Sue L Jaspersen
- Genetic Counseling Program, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deborah A Bruns
- Special Education Program, School of Education, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - Meghan S Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
9
|
Feldkamp ML, Carey JC. The pathogenesis of gastroschisis. Birth Defects Res 2023; 115:515-516. [PMID: 36541834 DOI: 10.1002/bdr2.2140] [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: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
10
|
Douglas TC, May C, Dent K, Carey JC, Mladucky J. Prenatal patient perceptions of receiving difficult news over the telephone. J Genet Couns 2023. [PMID: 36843230 DOI: 10.1002/jgc4.1694] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
Difficult news has been described as any news that adversely and seriously affects an individual's view of their future. Research in oncology genetic counseling demonstrated that individuals do not prefer in-person or telephone delivery of their genetic test results. However, in the prenatal setting, there is limited research examining how patients prefer news related to their pregnancies be disclosed. This study aimed to assess the experiences and preferences of prenatal patients who received difficult news by telephone. A semi-structured interview guide was developed to assess patients' personal definitions of difficult news and their experiences receiving the news by telephone. Fifteen patients seen prenatally by a genetic counselor were interviewed. Interviews were transcribed and consensus-coded, using inductive content analysis to identify several themes. The most common definition of difficult news included unexpected, life-changing, or devastating information. Participants described aspects of their experience and strategies employed by their genetic counselor that was helpful when receiving the news, which was found to align with the SPIKES protocol, a six-step process of delivering difficult news to patients. Additional techniques that participants identified as beneficial and satisfactory included the genetic counselor's use of empathy, non-directiveness, and continuity and coordination of care. Participants also provided recommendations for improvement, including a discussion of the mode of result disclosure during pretest counseling, an option to follow up with their genetic counselor, personalized resources, and a summary of the results call. The findings of this study demonstrate that a patient-centered approach is preferred by patients who receive difficult news by telephone in the prenatal setting. Patients' identification of beneficial communication techniques and suggestions for improvement can be implemented by any healthcare provider responsible for delivering difficult news to prenatal patients.
Collapse
Affiliation(s)
| | - Caitlyn May
- Certified Genetic Counselor, GeneScreen Counseling, Bernardsville, New Jersey, USA
| | - Karin Dent
- University of Utah Graduate Program in Genetic Counseling, Salt Lake City, Utah, USA.,Department of Pediatrics, Division of Medical Genetics, University of Utah, Utah, Salt Lake City, USA
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Utah, Salt Lake City, USA
| | - Janessa Mladucky
- Intermountain Healthcare, Precision Genomics, Salt Lake City, Utah, USA
| |
Collapse
|
11
|
Carey JC, Opitz JM. Evolution in the clinic: Maladaptive units and "minor anomalies". Am J Med Genet A 2023; 191:640-646. [PMID: 36331276 DOI: 10.1002/ajmg.a.63028] [Citation(s) in RCA: 1] [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] [Received: 04/06/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
It is here argued that the application of the term "minor anomalies" is often imprecise and likely outdated. In the past, the designation was used indiscriminately to refer to a great variety of unrelated morphogenetic phenomena. Also, the term does not discriminate between mild qualitative defects of development (mild malformations) and quantitative variants of normal structure. The human face was formed by natural and sexual selection. Morphological and morphogenetic analyses have shown that the human face with its skin, muscles, nerves, arteries, veins, glands, and lymphatics is a complex structure made up of progeny of ectoderm and mesoderm. Holoprosencephaly demonstrates graphically how these embryonic derivatives fit together sequentially. These derivatives are the adaptive units of the human organism, the result of stringent evolutionary forces uniting essential function to a minimum of structure. Before an "unusual" facial appearance is diagnosed as "abnormal", phenotype analysis is required to determine if there is a family resemblance or if it is a pleiotropic structure. The facial structures of chimps and humans are homologous by virtue of descent from a common ancestor (Darwin, 1859). Differences in the appearance of these species reflect adaptive divergence over some 6-7 million years of evolution while retaining over 98-99% genetic identity. Both species may develop Down syndrome, evidence of similarly retained developmental plasticity. It has occurred to us that Dobzhansky's axiom ("Nothing in biology makes sense except in the light of evolution") applies not only to genetics, but to all of medicine.
Collapse
Affiliation(s)
- John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| | - John M Opitz
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
12
|
Vanasse AM, Weiler T, Roth EA, Upadhya S, Toriello HV, VanLeuven AJ, Norris JR, Carey JC, Sobering AK. Teaching perspectives on the communication of difficult news of genetic conditions to medical students. Am J Med Genet A 2023; 191:299-305. [PMID: 36286987 PMCID: PMC10092636 DOI: 10.1002/ajmg.a.63003] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.
Collapse
Affiliation(s)
- Ashley M Vanasse
- Department of Biochemistry, St. George's University, St. George's, Grenada.,Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
| | - Tracey Weiler
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Elizabeth A Roth
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - Sharmila Upadhya
- Department of Biochemistry, St. George's University, St. George's, Grenada
| | - Helga V Toriello
- Department of Pediatrics and Human Development, Michigan State University - College of Human Medicine, East Lansing, Michigan, USA
| | - Ariel J VanLeuven
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John R Norris
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada.,AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
| |
Collapse
|
13
|
Biesecker LG, Adam MP, Chung BH, Kosaki K, Menke LA, White SM, Carey JC, Hennekam RC. Elements of morphology: Standard terminology for the trunk and limbs. Am J Med Genet A 2022; 188:3191-3228. [PMID: 36062894 PMCID: PMC9582996 DOI: 10.1002/ajmg.a.62965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Additional discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the trunk and limbs and define and illustrate the terms that describe the major characteristics of these body regions.
Collapse
Affiliation(s)
- Leslie G. Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brian H.Y. Chung
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, and Hong Kong Genome Institute, Hong Kong Special Administrative Region, China
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, 108-8345, Japan
| | - Leonie A. Menke
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Susan M. White
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, and Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - John C. Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Raoul C.M. Hennekam
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Carey JC. Survival Outcomes of Infants with the Trisomy 13 or Trisomy 18 Syndromes. J Pediatr 2022; 247:11-13. [PMID: 35640673 DOI: 10.1016/j.jpeds.2022.05.043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Affiliation(s)
- John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah.
| |
Collapse
|
15
|
Di Sera T, Velinder M, Ward A, Qiao Y, Georges S, Miller C, Pitman A, Richards W, Ekawade A, Viskochil D, Carey JC, Pace L, Bale J, Clardy SL, Andrews A, Botto L, Marth G. Author Correction: Gene.iobio: an interactive web tool for versatile, clinically-driven variant interrogation and prioritization. Sci Rep 2022; 12:5800. [PMID: 35388139 PMCID: PMC8986806 DOI: 10.1038/s41598-022-09959-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Yi Qiao
- University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | - Laura Pace
- University of Utah, Salt Lake City, UT, USA
| | - Jim Bale
- University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Gabor Marth
- University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
16
|
Nicholas TJ, Al‐Sweel N, Farrell A, Mao R, Bayrak‐Toydemir P, Miller CE, Bentley D, Palmquist R, Moore B, Hernandez EJ, Cormier MJ, Fredrickson E, Noble K, Rynearson S, Holt C, Karren M, Bonkowsky JL, Tristani‐Firouzi M, Yandell M, Marth G, Quinlan AR, Brunelli L, Toydemir R, Shayota BJ, Carey JC, Boyden SE, Malone Jenkins S. Comprehensive variant calling from whole-genome sequencing identifies a complex inversion that disrupts ZFPM2 in familial congenital diaphragmatic hernia. Mol Genet Genomic Med 2022; 10:e1888. [PMID: 35119225 PMCID: PMC9000945 DOI: 10.1002/mgg3.1888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Genetic disorders contribute to significant morbidity and mortality in critically ill newborns. Despite advances in genome sequencing technologies, a majority of neonatal cases remain unsolved. Complex structural variants (SVs) often elude conventional genome sequencing variant calling pipelines and will explain a portion of these unsolved cases. METHODS As part of the Utah NeoSeq project, we used a research-based, rapid whole-genome sequencing (WGS) protocol to investigate the genomic etiology for a newborn with a left-sided congenital diaphragmatic hernia (CDH) and cardiac malformations, whose mother also had a history of CDH and atrial septal defect. RESULTS Using both a novel, alignment-free and traditional alignment-based variant callers, we identified a maternally inherited complex SV on chromosome 8, consisting of an inversion flanked by deletions. This complex inversion, further confirmed using orthogonal molecular techniques, disrupts the ZFPM2 gene, which is associated with both CDH and various congenital heart defects. CONCLUSIONS Our results demonstrate that complex structural events, which often are unidentifiable or not reported by clinically validated testing procedures, can be discovered and accurately characterized with conventional, short-read sequencing and underscore the utility of WGS as a first-line diagnostic tool.
Collapse
Affiliation(s)
- Thomas J. Nicholas
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Najla Al‐Sweel
- ARUP LaboratoriesSalt Lake CityUSA
- Department of PathologyUniversity of UtahSalt Lake CityUSA
| | - Andrew Farrell
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Rong Mao
- ARUP LaboratoriesSalt Lake CityUSA
- Department of PathologyUniversity of UtahSalt Lake CityUSA
| | - Pinar Bayrak‐Toydemir
- ARUP LaboratoriesSalt Lake CityUSA
- Department of PathologyUniversity of UtahSalt Lake CityUSA
| | | | - Dawn Bentley
- Division of Neonatology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
- Primary Children's Center for Personalized MedicineSalt Lake CityUSA
| | - Barry Moore
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Edgar J. Hernandez
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Michael J. Cormier
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | | | | | - Shawn Rynearson
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Carson Holt
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Mary Anne Karren
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
- Primary Children's Center for Personalized MedicineSalt Lake CityUSA
| | - Martin Tristani‐Firouzi
- Division of Pediatric Cardiology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| | - Mark Yandell
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Gabor Marth
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Aaron R. Quinlan
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUSA
| | - Luca Brunelli
- Division of Neonatology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| | - Reha M. Toydemir
- ARUP LaboratoriesSalt Lake CityUSA
- Department of PathologyUniversity of UtahSalt Lake CityUSA
| | - Brian J. Shayota
- Division of Medical Genetics, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| | - John C. Carey
- Division of Medical Genetics, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| | - Steven E. Boyden
- Department of Human Genetics, Utah Center for Genetic DiscoveryUniversity of UtahSalt Lake CityUSA
| | - Sabrina Malone Jenkins
- Division of Neonatology, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
| |
Collapse
|
17
|
Biesecker LG, Adam MP, Alkuraya FS, Amemiya AR, Bamshad MJ, Beck AE, Bennett JT, Bird LM, Carey JC, Chung B, Clark RD, Cox TC, Curry C, Dinulos MBP, Dobyns WB, Giampietro PF, Girisha KM, Glass IA, Graham JM, Gripp KW, Haldeman-Englert CR, Hall BD, Innes AM, Kalish JM, Keppler-Noreuil KM, Kosaki K, Kozel BA, Mirzaa GM, Mulvihill JJ, Nowaczyk MJM, Pagon RA, Retterer K, Rope AF, Sanchez-Lara PA, Seaver LH, Shieh JT, Slavotinek AM, Sobering AK, Stevens CA, Stevenson DA, Tan TY, Tan WH, Tsai AC, Weaver DD, Williams MS, Zackai E, Zarate YA. Response to Hamosh et al. Am J Hum Genet 2021; 108:1809-1810. [PMID: 34478656 DOI: 10.1016/j.ajhg.2021.07.006] [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: 11/17/2022] Open
Affiliation(s)
- Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Margaret P Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Fowzan S Alkuraya
- Department of Translational Genomics, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | - Michael J Bamshad
- Department of Pediatrics and Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA
| | - Anita E Beck
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA; Seattle Children's Hospital, Seattle, WA 98015, USA
| | - James T Bennett
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute and Division Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98101, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California San Diego, San Diego 92123, USA; Rady Children's Hospital, San Diego, CA 92123, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Queen Mary Hospital, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Robin D Clark
- Loma Linda University School of Medicine, Department of Pediatrics, Division of Medical Genetics, Loma Linda, CA 92354, USA
| | - Timothy C Cox
- Department of Oral and Craniofacial Sciences, School of Dentistry and Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Cynthia Curry
- Genetic Medicine, Department of Pediatrics, University of California, Fresno, Fresno, CA 93701, USA
| | - Mary Beth Palko Dinulos
- The Geisel School of Medicine at Dartmouth, Department of Pediatrics, Section of Genetics and Child Development, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - William B Dobyns
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Ian A Glass
- Department of Pediatrics and Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - John M Graham
- Cedars-Sinai Medical Center and Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA
| | - Karen W Gripp
- Division of Medical Genetics, Department of Pediatrics, AI DuPont Hospital for Children/Nemours, Wilmington, DE 19803, USA
| | | | - Bryan D Hall
- Greenwood Genetic Center, Greenwood, SC 29646, USA
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Jennifer M Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Departments of Pediatrics and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Kenjiro Kosaki
- Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Beth A Kozel
- Translational Vascular Medicine Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ghayda M Mirzaa
- Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA; Center for Integrative Brain Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA 98101, USA
| | - John J Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Malgorzata J M Nowaczyk
- Molecular Medicine & Pathology and Pediatrics, McMaster University, Hamilton, ON L8S 3K9, Canada
| | - Roberta A Pagon
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA
| | | | - Alan F Rope
- Genome Medical, South San Francisco, CA 94080, USA
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90048, USA
| | - Laurie H Seaver
- Spectrum Health Medical Genetics and Genomics/Helen Devos Children's Hospital, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA
| | - Joseph T Shieh
- Institute for Human Genetics and Division of Medical Genetics, Department of Pediatrics Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Anne M Slavotinek
- Institute for Human Genetics and Division of Medical Genetics, Department of Pediatrics Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Andrew K Sobering
- Augusta University/University of Georgia Athens, Medical Partnership, Athens, GA 30606, USA
| | - Cathy A Stevens
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, TN 37403, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Palo Alto, CA 94305, USA
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Anne C Tsai
- Section of Genetics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - David D Weaver
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street, Indianapolis, IN 46202, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Elaine Zackai
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA
| | - Yuri A Zarate
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA
| |
Collapse
|
18
|
Abstract
OBJECTIVE The conventional view toward the management of infants with the trisomy 18 and trisomy 13 syndromes has been to recommend pure comfort care and the avoidance of technological interventions. This commentary aims to address the recently raised question about whether there has been a shift in the paradigm of the management of infants with the two conditions. STUDY DESIGN The study design includes narrative review of the literature. RESULTS A body of opinion pieces and evidence has emerged indicating that there has been a recent increase in the administration of interventions, including ventilatory support and surgery, in the management of children with these syndromes. CONCLUSION Based on the evidence in the literature, the author concludes that there has been a type of paradigm shift described by philosopher of science, Thomas Kuhn, in the treatment of infants with trisomy 18 and 13. More parents are being offered and choosing technological interventions, including cardiac surgery. Future investigation of the question whether intervention improves outcome, including the quality of life, is crucial in addressing the unanswered questions in this dialogue. KEY POINTS · The conventional approach to the treatment of trisomy 18 and 13 has been to avoid interventions.. · There is a growing body of evidence that this traditional view of management is changing.. · Future investigation of whether intervention improves outcome is crucial in addressing the unanswered questions..
Collapse
Affiliation(s)
- John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health, Salt Lake City, Utah
| |
Collapse
|
19
|
D'Cunha Burkardt D, Sanchez-Lara PA, Girisha KM, Golden JA, Carey JC. A celebration in honor of John M. Graham, Jr, MD, ScD. Am J Med Genet A 2021; 185:2617-2619. [PMID: 34245497 DOI: 10.1002/ajmg.a.62404] [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: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Deepika D'Cunha Burkardt
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center, California, Los Angeles, USA.,Department of Pediatrics, David Geffen School of Medicine, University of California, California, Los Angeles, USA
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Jeffrey A Golden
- Research and Graduate Education, Cedars-Sinai Medical Center, California, Los Angeles, USA
| | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
20
|
Battaglia A, Carey JC. The delineation of the Wolf-Hirschhorn syndrome over six decades: Illustration of the ongoing advances in phenotype analysis and cytogenomic technology. Am J Med Genet A 2021; 185:2748-2755. [PMID: 34002939 DOI: 10.1002/ajmg.a.62341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/19/2021] [Revised: 03/24/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022]
Abstract
Since Hirschhorn's description in 1961, the history and chronology of the clinical, cytogenetic, and molecular characterization of Wolf-Hirschhorn syndrome (WHS) elegantly demonstrates the remarkable advances in genetic technology over the last six decades that have paralleled the delineation of the phenotype. After mention in the Human Chromosome Newsletter of a child with a visible deletion of the top of a B chromosome group, 4-5, Hirschhorn and colleagues companioned their report with that of Wolf et al. in Humangenetik in 1965, and the condition was recognized and named. The 1960-1970s witnessed the description of many of the now classic chromosome disorders, including WHS, while HRB allowed for the recognition of chromosome syndromes with smaller deletions/duplications. FISH probes, developed in the next two decades, enabled the characterization of the critical region of WHS and improved clinical diagnosis with subtelomeric probes. Cytogenomic microarray in the early-mid 2000s led to both improved diagnosis of WHS patients and documentation of microdeletions of <5 megabases, helping to characterize the critical regions for specific component phenotypes (e.g., seizures, face). Recently exome sequencing technology has led to the discovery of WHS patients with WHSC1 loss of function variants, displaying some cardinal features of the phenotype (face, growth, and developmental delay).
Collapse
Affiliation(s)
- Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Utah, USA
| |
Collapse
|
21
|
Battaglia A, Carey JC. Reflections on observing faces in art. Am J Med Genet C Semin Med Genet 2021; 187:144-147. [PMID: 33982855 DOI: 10.1002/ajmg.c.31912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
The experience of art provides the visitor of a museum or gallery with the opportunity to contemplate and share the human condition both from the physical and psychological point of view. Because of the accessibility and the number of museums throughout Europe, classical European art as both sculpture and painting, affords the viewer the opportunity to experience life from one part of the world over centuries of history. These museums occasionally exhibit pieces showing a person with a human disorder and physical differences. On viewing such artwork, practitioners of health care, especially dysmorphologists, usually find themselves observing such pieces within the context of their practice. In this essay, the coauthors reflect on paintings and sculptures which remind us of our patients with similar physical and medical conditions. Various works of art also provide the opportunity to observe and view the human face from many vantage points and times in history. Several paintings are cited to illustrate the central themes of the Commentary: the human circumstance of disease and differences and the skill of observing and describing the human face.
Collapse
Affiliation(s)
- Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
22
|
Carey JC, Lortz A, Mendel A, Battaglia A. Natural history study of adults with Wolf-Hirschhorn syndrome 2: Patient-reported outcomes study. Am J Med Genet A 2021; 185:2065-2069. [PMID: 33949758 DOI: 10.1002/ajmg.a.62220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/19/2021] [Accepted: 03/19/2021] [Indexed: 12/22/2022]
Abstract
Wolf-Hirschhorn syndrome (WHS) is a contiguous gene disorder consisting of prenatal and postnatal growth deficiency, distinctive craniofacial features, intellectual disability, and seizures. The condition is caused by a partial loss of material from the distal portion of the short arm of chromosome 4 (4p16.3). While there are many reports of individuals with WHS, useful data on long-term survival and life status of adults with the syndrome are very limited. There are only 11 reports of individuals over the age of 18 years in the literature. Establishing the medical manifestations of adults with WHS would be helpful in establishing appropriate health supervision guidelines. This study was one component of a two-part investigation on adults with WHS. This patient-reported outcomes study (PROS) was accomplished by using the registry of rare diseases at Sanford Research, Coordination of Rare Diseases (CoRDS)at Sanford. Thirty family members or caretakers of 30 adults with WHS/4p- entered into the CoRDS registry and completed some or all of the survey data. Twelve caretakers completed the recently-added survey on activities of daily living. Two of the individuals with WHS were partly independent while 10 required total care. The results provide novel information on daily life and independence in adults with WHS. Importantly, the majority of caretakers reported that the adults were in good health. The data from both parts of the study will contribute to our knowledge of the natural history of the syndrome and guide in establishing appropriate health supervision guidelines for adults with WHS.
Collapse
Affiliation(s)
- John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| |
Collapse
|
23
|
Sanchez-Lara PA, Grand K, Haanpää MK, Curry CJ, Wang R, Ezgü F, Rose CM, D'Cunha Burkardt D, Conway RL, Relan A, Carey JC. Thinking outside "The Box": Case-based didactics for medical education and the instructional legacy of Dr John M. Graham, Jr. Am J Med Genet A 2021; 185:2636-2645. [PMID: 33913595 DOI: 10.1002/ajmg.a.62202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/04/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/23/2022]
Abstract
The increasing demand for advanced genomic services has finally come to the attention of healthcare systems and stakeholders who are now eager to find creative solutions to increase the pool of genomic literate providers. Training in genetics and dysmorphology has historically been conducted as a self-driven practice in pattern recognition, ideally within a formal or informal apprenticeship supervised by a master diagnostician. In recent times, case-based learning, framed by flipped classroom pedagogy have become the preferred teaching methods for complex medical topics such as genetics and genomics. To illuminate this perspective, our article was written in honor of the teaching style and pedagogy of Dr John M. Graham Jr and his lifelong commitment to medical education and mentoring.
Collapse
Affiliation(s)
- Pedro A Sanchez-Lara
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Katheryn Grand
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maria K Haanpää
- Department of Genomics and Clinical Genetics, Turku University Hospital, Turku, Finland.,Department of Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Cynthia J Curry
- Genetic Medicine, Department of Pediatrics, University of California San Francisco, Fresno, California, USA
| | - Raymond Wang
- Division of Metabolic Disorders, CHOC, Children's Hospital Orange County, Orange, California, USA.,Department of Pediatrics, University of California-Irvine School of Medicine, Orange, California, USA
| | - Fatih Ezgü
- Faculty of Medicine, Department and Laboratory of Pediatric Metabolic Disorders, Gazi University, Ankara, Turkey
| | - Catherine M Rose
- Victorian Clinical Genetic Service, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Deepika D'Cunha Burkardt
- Medical Genomics and Metabolic Genetics Branch, National Human genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert L Conway
- Department of Pediatric Neurosciences, Spectrum Health/Helen DeVos Children's Hospital Medical Genetics, Grand Rapids, Michigan, USA
| | - Anju Relan
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - John C Carey
- Department of Pediatrics, Division of Medical genetics, The University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
24
|
Battaglia A, Lortz A, Carey JC. Natural history study of adults with Wolf-Hirschhorn syndrome 1: Case series of personally observed 35 individuals. Am J Med Genet A 2021; 185:1794-1802. [PMID: 33760347 DOI: 10.1002/ajmg.a.62176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022]
Abstract
Wolf-Hirschhorn syndrome (WHS) is a contiguous gene disorder, clinically delineated by prenatal and postnatal growth deficiency, distinctive craniofacial features, intellectual disability, and seizures. The disorder is caused by partial loss of material from the distal portion of the short arm of chromosome 4 (4p16.3). Although more than 300 persons with WHS have been reported in the literature, there is sparse, if any, long-term follow-up of these individuals and thus little knowledge about course and potential further complications and health risks during adulthood and advanced age. This study attempted to assess medical conditions and function of adult individuals with WHS. It was one component of a two-part investigation on adults with WHS. The other part of the study is the patient-reported outcomes study reported elsewhere. About 35 individuals with WHS (26 females; nine males), aged between 19 and 55 years were recruited. About 25 individuals were personally observed at the IRCCS Stella Maris Foundation by A.B. and followed up between 5 and 20 years; and 10 were recruited from the 4p-Support Group, The United States. Of note, 23/35 (66%) are close to total care. About 11 out of 35 (31%) were partly self-independent, requiring supervision on certain daily routines, and 1 out of 35 (3%) was fully independent. However, a positive perspective is given by the overall good health enjoyed by the 66% of our cohort of individuals. Overall, quality of life and level of function into adulthood appear to be less critical than anticipated from previous studies.
Collapse
Affiliation(s)
- Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | | | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
25
|
Abstract
Clinical histories and outcome data of long-term survivors with trisomy 13 are rare. The goal of this study was to collect the medical histories of adult individuals (≥18 years old) with apparent non-mosaic trisomy 13/Patau syndrome to help gain further insight in to the clinical course for individuals with this condition and to characterize the manifestations for surveillance and management. We collected 11 families through a contact person with the LWT13 (Living with Trisomy 13) LIFE support group. We performed telephone interviews to gather their medical histories and report these data in system-based summaries, tables, and clinical vignettes. In instances where parents retained copies of genetic testing reports or clinicians currently taking care of the individual with trisomy 13 were able to provide documentation, we confirmed diagnosis. All clinical histories and reported manifestations were consistent with a diagnosis of trisomy 13. We also elicited comments from parents on their personal experiences of raising an individual with trisomy 13.
Collapse
Affiliation(s)
- Amy N Lebedoff
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
26
|
Carey JC. Parent-authored memoirs: Lessons in the practice of narrative medicine. Am J Med Genet A 2021; 185:2846-2848. [PMID: 33599369 DOI: 10.1002/ajmg.a.62107] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022]
Abstract
Healthcare professionals, including practitioners of medical genetics and genetic counseling, have much to learn about the experiences of parents who are raising and caring for a child with a rare disease or developmental disability. Knowledge and understanding of the challenges in the care of a child with conditions such as Down syndrome and Wolf-Hirschhorn syndrome are at the core of the practice of genetic medicine. Insights into this experience can come from active listening to stories and from deep reading of memoirs and narratives authored by parents of children having these challenges. A recent book, Raising a rare girl: A memoir, by writer, poet, and teacher, Heather Lanier, represents a relevant and prototypic example of this genre. Spending the effort in the contemplation of the parental stories provides a valuable lesson in narrative medicine and the experience of empathy for the plight of the family.
Collapse
Affiliation(s)
- John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
27
|
Tidwell T, Deshotel M, Palumbos J, Miller C, Bayrak-Toydemir P, Carey JC. Novel de novo ARCN1 intronic variant causes rhizomelic short stature with microretrognathia and developmental delay. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a005728. [PMID: 33154040 PMCID: PMC7784487 DOI: 10.1101/mcs.a005728] [Citation(s) in RCA: 4] [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: 07/29/2020] [Accepted: 10/16/2020] [Indexed: 12/31/2022] Open
Abstract
The archain 1 (ARCN1) gene encodes the coatomer subunit delta protein and is a component of the COPI coatomer complex, which is involved in retrograde vesical trafficking from the Golgi complex to the endoplasmic reticulum. Variants in ARCN1 have recently been associated with rhizomelic short stature with microcephaly, microretrognathia, and developmental delay. Here we report a 3.5-yr-old boy with microcephaly, global developmental delay, and multiple congenital abnormalities and the ARCN1-related syndrome caused by a novel de novo intronic variant. Whole-exome sequencing of the proband and his parents was utilized to determine the genetic origin of the patient's disorder and identified a de novo variant, NM_001655.5:c.654-15A > G, in the ARCN1 gene. Follow-up functional characterization of mRNA from the patient demonstrated that this variant creates a splicing defect of the ARCN1 mRNA. ARCN1-related syndrome represents an emerging disorder of developmental delay, and this report represents the sixth described patient. Despite the few instances reported in literature, the phenotype is consistent between our patient and previously reported individuals.
Collapse
Affiliation(s)
| | | | - Janice Palumbos
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA
| | - Chris Miller
- ARUP Laboratories, Salt Lake City, Utah 84108, USA
| | - Pinar Bayrak-Toydemir
- ARUP Laboratories, Salt Lake City, Utah 84108, USA.,Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah 84113, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA
| |
Collapse
|
28
|
Affiliation(s)
- Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | | | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City
| |
Collapse
|
29
|
Sobering AK, Li D, Beighley JS, Carey JC, Donald T, Elsea SH, Figueroa KP, Gerdts J, Hamlet A, Mirzaa GM, Nelson B, Pulst SM, Smith JL, Tassone F, Toriello HV, Walker RH, Yearwood KR, Bhoj EJ. Experiences with offering pro bono medical genetics services in the West Indies: Benefits to patients, physicians, and the community. Am J Med Genet C Semin Med Genet 2020; 184:1030-1041. [PMID: 33274544 DOI: 10.1002/ajmg.c.31871] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.
Collapse
Affiliation(s)
- Andrew K Sobering
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer S Beighley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tyhiesia Donald
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Andre Hamlet
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Beverly Nelson
- Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, School of Medicine, Sacramento, California, USA.,MIND Institute, University of California Davis Medical Center, Sacramento, California, USA
| | - Helga V Toriello
- Department of Pediatrics/Human Development College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA
| | | | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
30
|
Orbain MM, Johnson J, Nance A, Romeo AN, Silver MA, Martinez L, Leen-Mitchell M, Carey JC. Maternal diabetes-related malformations in Utah: A population study of birth prevalence 2001-2016. Birth Defects Res 2020; 113:152-160. [PMID: 33226174 DOI: 10.1002/bdr2.1843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/11/2022]
Abstract
Maternal pregestational diabetes mellitus is associated with an increased risk for congenital malformations of about 2-4 times the background risk. Notably, the types and patterns of congenital malformations associated with maternal diabetes are nonrandom, with a well-established increased risk for specific classes of malformations, especially of the heart, central nervous system, and skeleton. While the increased risk in clinical and epidemiological studies is well documented in the literature, a precise estimate of overall birth prevalence of these specific congenital malformations among women with maternal pregestational diabetes, is lacking. The purpose of this study was to determine total prevalence of structural malformations associated with maternal pregestational diabetes mellitus in a population-based study. We identified infants with specific birth defects whose mother had pregestational diabetes mellitus in the Utah Birth Defect Network (UBDN), an active birth defects surveillance program that registers the occurrence of selected structural defects in the state of Utah. We defined specific maternal diabetes-related malformations based on epidemiologic and clinical studies in the literature. Of the 825,138 recorded Utah births between 2001 and 2016, a total of 91 cases were identified as likely having diabetic embryopathy within UBDN data. The prevalence of diabetes-related congenital malformation cases was calculated per year; the overall prevalence of diabetes-related malformations 2001-2016 was 1.1 per 10,000 births in Utah (95% CI, 0.9-1.3). Knowledge of the overall prevalence of diabetes-related malformations is important in predicting the number of cases that are potentially prevented with the implementation of programs to foster preconceptional management of maternal pregestational diabetes.
Collapse
Affiliation(s)
- Matthew M Orbain
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defect Network, Salt Lake City, Utah, USA
| | - Jane Johnson
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defect Network, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defect Network, Salt Lake City, Utah, USA
| | - Alfred N Romeo
- Utah Department of Health, Bureau of Maternal and Child Health, Mother To Baby Utah, Salt Lake City, Utah, USA
| | - Michelle A Silver
- Utah Department of Health, Bureau of Maternal and Child Health, Data Resources Program, Salt Lake City, Utah, USA
| | - Lynn Martinez
- Utah Department of Health, Bureau of Maternal and Child Health, Mother To Baby Utah, Salt Lake City, Utah, USA
| | - Marsha Leen-Mitchell
- Utah Department of Health, Bureau of Maternal and Child Health, Mother To Baby Utah, Salt Lake City, Utah, USA.,Department of Pediatrics, Division of Medical Genetics, The University of Utah, Salt Lake City, Utah, USA
| | - John C Carey
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defect Network, Salt Lake City, Utah, USA.,Utah Department of Health, Bureau of Maternal and Child Health, Mother To Baby Utah, Salt Lake City, Utah, USA.,Department of Pediatrics, Division of Medical Genetics, The University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
31
|
Di Sera T, Velinder M, Ward A, Qiao Y, Georges S, Miller C, Pitman A, Richards W, Ekawade A, Viskochil D, Carey JC, Pace L, Bale J, Clardy SL, Andrews A, Botto L, Marth G. gene.iobio: an interactive web tool for versatile, clinically-driven variant interrogation and prioritization. medRxiv 2020:2020.11.05.20224865. [PMID: 33173897 PMCID: PMC7654889 DOI: 10.1101/2020.11.05.20224865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
With increasing utilization of comprehensive genomic data to guide clinical care, anticipated to become the standard of care in many clinical settings, the practice of diagnostic medicine is undergoing a notable shift. However, the move from single-gene or panel-based genetic testing to exome and genome sequencing has not been matched by the development of tools to enable diagnosticians to interpret increasingly complex genomic findings. A new paradigm has emerged, where genome-based tests are often evaluated by a large multi-disciplinary collaborative team, typically including a diagnostic pathologist, a bioinformatician, a genetic counselor, and often a subspeciality clinician. This team-based approach calls for new computational tools to allow every member of the clinical care provider team, at varying levels of genetic knowledge and diagnostic expertise, to quickly and easily analyze and interpret complex genomic data. Here, we present gene.iobio , a real-time, intuitive and interactive web application for clinically-driven variant interrogation and prioritization. We show gene.iobio is a novel and effective approach that significantly improves upon and reimagines existing methods. In a radical departure from existing methods that present variants and genomic data in text and table formats, gene.iobio provides an interactive, intuitive and visually-driven analysis environment. We demonstrate that adoption of gene.iobio in clinical and research settings empowers clinical care providers to interact directly with patient genomic data both for establishing clinical diagnoses and informing patient care, using sophisticated genomic analyses that previously were only accessible via complex command line tools.
Collapse
|
32
|
Affiliation(s)
- Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City
| |
Collapse
|
33
|
Thompson W, Carey PZ, Donald T, Nelson B, Bhoj EJ, Li D, Hakonarson H, Ramirez M, Elsea SH, Smith JL, Carey JC, Sobering AK. Application of exome sequencing to diagnose a novel presentation of the Cornelia de Lange syndrome in an Afro-Caribbean family. Mol Genet Genomic Med 2020; 8:e1318. [PMID: 32511891 PMCID: PMC7434751 DOI: 10.1002/mgg3.1318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cornelia de Lange syndrome (CdLS) comprises a recognizable pattern of multiple congenital anomalies caused by variants of the DNA cohesion complex. Affected individuals may display a wide range of phenotypic severity, even within the same family. METHODS Exome sequencing and confirmatory Sanger sequencing showed the same previously described p.Arg629Ter NIPBL variant in two half-brothers affected with CdLS. Clinical evaluations were obtained in a pro bono genetics clinic. RESULTS One brother had relatively mild proportionate limb shortening; the other had complete bilateral hypogenesis of the upper arm with absence of lower arm structures, terminal transverse defects, and no digit remnants. His complex lower limb presentation included long bone deficiency and a deviated left foot. The mother had intellectual disability and microcephaly but lacked facial features diagnostic of the CdLS. CONCLUSION We describe a collaboration between a pediatrics team from a resource-limited nation and USA-based medical geneticists. Reports describing individuals of West Indian ancestry are rarely found in the medical literature. Here, we present a family of Afro-Caribbean ancestry with CdLS presenting with phenotypic variability, including unusual lower limb abnormalities. The observation of this novel family adds to our knowledge of the phenotypic and molecular aspects of CdLS.
Collapse
Affiliation(s)
- Wayne Thompson
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada
| | - Patrick Z Carey
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada
| | - Tyhiesia Donald
- Pediatrics Ward, Grenada General Hospital, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Beverly Nelson
- Pediatrics Ward, Grenada General Hospital, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maricela Ramirez
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada
| |
Collapse
|
34
|
Zhang LX, Lemire G, Gonzaga-Jauregui C, Molidperee S, Galaz-Montoya C, Liu DS, Verloes A, Shillington AG, Izumi K, Ritter AL, Keena B, Zackai E, Li D, Bhoj E, Tarpinian JM, Bedoukian E, Kukolich MK, Innes AM, Ediae GU, Sawyer SL, Nair KM, Soumya PC, Subbaraman KR, Probst FJ, Bassetti JA, Sutton RV, Gibbs RA, Brown C, Boone PM, Holm IA, Tartaglia M, Ferrero GB, Niceta M, Dentici ML, Radio FC, Keren B, Wells CF, Coubes C, Laquerrière A, Aziza J, Dubucs C, Nampoothiri S, Mowat D, Patel MS, Bracho A, Cammarata-Scalisi F, Gezdirici A, Fernandez-Jaen A, Hauser N, Zarate YA, Bosanko KA, Dieterich K, Carey JC, Chong JX, Nickerson DA, Bamshad MJ, Lee BH, Yang XJ, Lupski JR, Campeau PM. Further delineation of the clinical spectrum of KAT6B disorders and allelic series of pathogenic variants. Genet Med 2020; 22:1338-1347. [PMID: 32424177 DOI: 10.1038/s41436-020-0811-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/30/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Genitopatellar syndrome and Say-Barber-Biesecker-Young-Simpson syndrome are caused by variants in the KAT6B gene and are part of a broad clinical spectrum called KAT6B disorders, whose variable expressivity is increasingly being recognized. METHODS We herein present the phenotypes of 32 previously unreported individuals with a molecularly confirmed diagnosis of a KAT6B disorder, report 24 new pathogenic KAT6B variants, and review phenotypic information available on all published individuals with this condition. We also suggest a classification of clinical subtypes within the KAT6B disorder spectrum. RESULTS We demonstrate that cerebral anomalies, optic nerve hypoplasia, neurobehavioral difficulties, and distal limb anomalies other than long thumbs and great toes, such as polydactyly, are more frequently observed than initially reported. Intestinal malrotation and its serious consequences can be present in affected individuals. Additionally, we identified four children with Pierre Robin sequence, four individuals who had increased nuchal translucency/cystic hygroma prenatally, and two fetuses with severe renal anomalies leading to renal failure. We also report an individual in which a pathogenic variant was inherited from a mildly affected parent. CONCLUSION Our work provides a comprehensive review and expansion of the genotypic and phenotypic spectrum of KAT6B disorders that will assist clinicians in the assessment, counseling, and management of affected individuals.
Collapse
Affiliation(s)
- Li Xin Zhang
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Lemire
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Sirinart Molidperee
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Carolina Galaz-Montoya
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - David S Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Alain Verloes
- Department of Genetics and INSERM UMR1141, APHP-Nord Université de Paris, Robert DEBRE Hospital, Paris and ERN-ITHACA, Paris, France
| | - Amelle G Shillington
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kosuke Izumi
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alyssa L Ritter
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Beth Keena
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elaine Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Bhoj
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer M Tarpinian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emma Bedoukian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Grace U Ediae
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sarah L Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Para Chottil Soumya
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | | | - Frank J Probst
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Jennifer A Bassetti
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Reid V Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chester Brown
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Philip M Boone
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Boris Keren
- Genetic department, AP-HP, Sorbonne Université, Paris, France
| | - Constance F Wells
- Service de Génétique Clinique, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU de Montpellier, Montpellier, France
| | - Christine Coubes
- Service de Génétique Clinique, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU de Montpellier, Montpellier, France
| | - Annie Laquerrière
- Department of Pathology, Centre for Genomic and Personalized Medicine, UNIROUEN Normandie University, Inserm U1245, Normandy, Rouen, France
| | - Jacqueline Aziza
- Département anatomie et cytologie pathologiques, CHU Toulouse, Toulouse, France
| | - Charlotte Dubucs
- Département anatomie et cytologie pathologiques, CHU Toulouse, Toulouse, France
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Millan S Patel
- BC Children's Hospital Research Institute and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Ana Bracho
- Genetic Research Institute, University of Zulia, Maracaibo, Venezuela
| | | | - Alper Gezdirici
- Department of Medical Genetics, Istanbul Health Science University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Alberto Fernandez-Jaen
- Department of Pediatric Neurology, Hospital Quirónsalud School of Medicine, Universidad Europea, Madrid, Spain
| | | | - Yuri A Zarate
- Department of Pediatrics, Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Katherine A Bosanko
- Department of Pediatrics, Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Klaus Dieterich
- Medical Genetics, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm, U1216, GIN, Grenoble, France
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Jessica X Chong
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Deborah A Nickerson
- Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA.,Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Xiang-Jiao Yang
- Goodman Cancer Center, Department of Medicine, McGill University, Montreal, QC, Canada
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Philippe M Campeau
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
| |
Collapse
|
35
|
Braddock SR, Lipinski RJ, Carey JC. 40th Annual David W Smith Workshop on Malformations and Morphogenesis: Abstracts of the 2019 Annual Meeting. Am J Med Genet A 2020; 182:877-942. [PMID: 32153128 DOI: 10.1002/ajmg.a.61514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/11/2022]
Abstract
The 40th Annual David W. Smith Workshop on Malformations and Morphogenesis occurred August 23rd -28th, 2019 at the Snowbird Resort in Snowbird, Utah. The Workshop, which honors the legacy of David W. Smith, brought together clinicians and researchers interested in congenital malformations and their underlying mechanisms of morphogenesis from around the world. In addition to mechanisms of morphogenesis and delineation of new syndromes, the Workshop highlighted five themes: deformations, disruptions and fetal dysmorphology; orofacial clefting; central nervous system malformations; ciliopathies; and X-linked intellectual disabilities. This Conference Report includes the abstracts presented at the 2019 Workshop.
Collapse
Affiliation(s)
- Stephen R Braddock
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Robert J Lipinski
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
36
|
Lebedoff AN, Carey JC. Robin D.Clark, Cynthia J.Curry. (2019). Genetic Consultations in the Newborn. Oxford University Press, ISBN 978‐0‐19‐999099‐3 Price: Hardback: £65.00/$99.95. Am J Med Genet A 2020. [DOI: 10.1002/ajmg.a.61458] [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: 11/10/2022]
Affiliation(s)
- Amy N. Lebedoff
- Division of Medical Genetics, Department of PediatricsUniversity of Utah health Salt Lake City Utah
| | - John C. Carey
- Division of Medical Genetics, Department of PediatricsUniversity of Utah health Salt Lake City Utah
| |
Collapse
|
37
|
Nevado J, Ho KS, Zollino M, Blanco R, Cobaleda C, Golzio C, Beaudry‐Bellefeuille I, Berrocoso S, Limeres J, Barrúz P, Serrano‐Martín C, Cafiero C, Málaga I, Marangi G, Campos‐Sánchez E, Moriyón‐Iglesias T, Márquez S, Markham L, Twede H, Lortz A, Olson L, Sheng X, Weng C, Wassman ER, Newcomb T, Wassman ER, Carey JC, Battaglia A, López‐Granados E, Douglas D, Lapunzina P. International meeting on Wolf‐Hirschhorn syndrome: Update on the nosology and new insights on the pathogenic mechanisms for seizures and growth delay. Am J Med Genet A 2019; 182:257-267. [DOI: 10.1002/ajmg.a.61406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Julián Nevado
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
- Basic Research Center in the Rare Diseases Network (CIBERER) Madrid Spain
| | - Karen S. Ho
- Lineagen, Inc. Salt Lake City Utah
- University of Utah School of Medicine Utah
- Hopeful Science, Inc. Salt Lake City Utah
| | - Marcella Zollino
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | - Raquel Blanco
- Hospital Universitario Central de Asturias Oviedo Spain
| | - César Cobaleda
- Centro de Biología Molecular “Severo Ochoa,” CSIC/UAM Madrid Spain
| | | | | | - Sarah Berrocoso
- Neuro‐e‐Motion Research Team—University of Deusto Bilbao Spain
| | - Jacobo Limeres
- Facultad de Medicina y Odontología Universidad de Santiago de Compostela Santiago Galicia Spain
| | - Pilar Barrúz
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
| | - Candela Serrano‐Martín
- Facultad de Medicina y Odontología Universidad de Santiago de Compostela Santiago Galicia Spain
| | - Concetta Cafiero
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | | | - Giuseppe Marangi
- Institute of Genomic Medicine Catholic University, A. Gemelli Foundation Rome Italy
| | | | | | | | | | | | | | | | | | - Cindy Weng
- University of Utah School of Medicine Utah
| | | | | | | | | | - Agatino Battaglia
- Department of Developmental Neuroscience IRCCS Stella Maris Foundation Pisa Italy
| | | | - Damien Douglas
- Wolf‐Hirschhorn Syndrome Trust of the UK and Ireland, Dublin UK
| | - Pablo Lapunzina
- Medical and Molecular Genetics Institute (INGEMM) La Paz University Hospital, IdiPAZ Madrid Spain
- Basic Research Center in the Rare Diseases Network (CIBERER) Madrid Spain
| | | |
Collapse
|
38
|
Carey JC. Emerging evidence that medical and surgical interventions improve the survival and outcome in the trisomy 13 and 18 syndromes. Am J Med Genet A 2019; 182:13-14. [DOI: 10.1002/ajmg.a.61370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- John C. Carey
- Department of Pediatrics, Division of Medical Genetics University of Utah Health Salt Lake City Utah
| |
Collapse
|
39
|
Pekkinen M, Terhal PA, Botto LD, Henning P, Mäkitie RE, Roschger P, Jain A, Kol M, Kjellberg MA, Paschalis EP, van Gassen K, Murray M, Bayrak-Toydemir P, Magnusson MK, Jans J, Kausar M, Carey JC, Somerharju P, Lerner UH, Olkkonen VM, Klaushofer K, Holthuis JC, Mäkitie O. Osteoporosis and skeletal dysplasia caused by pathogenic variants in SGMS2. JCI Insight 2019; 4:126180. [PMID: 30779713 PMCID: PMC6483641 DOI: 10.1172/jci.insight.126180] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 11/26/2018] [Accepted: 02/14/2019] [Indexed: 12/30/2022] Open
Abstract
Mechanisms leading to osteoporosis are incompletely understood. Genetic disorders with skeletal fragility provide insight into metabolic pathways contributing to bone strength. We evaluated 6 families with rare skeletal phenotypes and osteoporosis by next-generation sequencing. In all the families, we identified a heterozygous variant in SGMS2, a gene prominently expressed in cortical bone and encoding the plasma membrane–resident sphingomyelin synthase SMS2. Four unrelated families shared the same nonsense variant, c.148C>T (p.Arg50*), whereas the other families had a missense variant, c.185T>G (p.Ile62Ser) or c.191T>G (p.Met64Arg). Subjects with p.Arg50* presented with childhood-onset osteoporosis with or without cranial sclerosis. Patients with p.Ile62Ser or p.Met64Arg had a more severe presentation, with neonatal fractures, severe short stature, and spondylometaphyseal dysplasia. Several subjects had experienced peripheral facial nerve palsy or other neurological manifestations. Bone biopsies showed markedly altered bone material characteristics, including defective bone mineralization. Osteoclast formation and function in vitro was normal. While the p.Arg50* mutation yielded a catalytically inactive enzyme, p.Ile62Ser and p.Met64Arg each enhanced the rate of de novo sphingomyelin production by blocking export of a functional enzyme from the endoplasmic reticulum. SGMS2 pathogenic variants underlie a spectrum of skeletal conditions, ranging from isolated osteoporosis to complex skeletal dysplasia, suggesting a critical role for plasma membrane–bound sphingomyelin metabolism in skeletal homeostasis. The identification of 6 families with childhood-onset osteoporosis with mutations in SGMS2 suggests a critical role for plasma membrane–bound sphingomyelin metabolism in skeletal homeostasis.
Collapse
Affiliation(s)
- Minna Pekkinen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland, and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paulien A Terhal
- Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Petra Henning
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Riikka E Mäkitie
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland, and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Amrita Jain
- Molecular Cell Biology Division, Department of Biology/Chemistry, University of Osnabrück, Osnabrück, Germany
| | - Matthijs Kol
- Molecular Cell Biology Division, Department of Biology/Chemistry, University of Osnabrück, Osnabrück, Germany
| | - Matti A Kjellberg
- Department of Biochemistry and Developmental Biology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Koen van Gassen
- Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mary Murray
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Pinar Bayrak-Toydemir
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA, and ARUP Laboratories, Salt Lake City, Utah, USA
| | - Maria K Magnusson
- Department of Microbiology and Immunology, Institute for Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Judith Jans
- Laboratory of Metabolic Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mehran Kausar
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland, and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Pentti Somerharju
- Department of Biochemistry and Developmental Biology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ulf H Lerner
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vesa M Olkkonen
- Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland, and Department of Anatomy, Faculty of Medicine, University of Helsinki, Helsinki,Finland
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Joost Cm Holthuis
- Molecular Cell Biology Division, Department of Biology/Chemistry, University of Osnabrück, Osnabrück, Germany.,Biochemistry and Biophysics Division, Bijvoet Center and Institute of Biomembranes, Utrecht University, Utrecht, Netherlands
| | - Outi Mäkitie
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland, and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
40
|
Burrage LC, Reynolds JJ, Baratang NV, Phillips JB, Wegner J, McFarquhar A, Higgs MR, Christiansen AE, Lanza DG, Seavitt JR, Jain M, Li X, Parry DA, Raman V, Chitayat D, Chinn IK, Bertuch AA, Karaviti L, Schlesinger AE, Earl D, Bamshad M, Savarirayan R, Doddapaneni H, Muzny D, Jhangiani SN, Eng CM, Gibbs RA, Bi W, Emrick L, Rosenfeld JA, Postlethwait J, Westerfield M, Dickinson ME, Beaudet AL, Ranza E, Huber C, Cormier-Daire V, Shen W, Mao R, Heaney JD, Orange JS, Bertola D, Yamamoto GL, Baratela WAR, Butler MG, Ali A, Adeli M, Cohn DH, Krakow D, Jackson AP, Lees M, Offiah AC, Carlston CM, Carey JC, Stewart GS, Bacino CA, Campeau PM, Lee B. Bi-allelic Variants in TONSL Cause SPONASTRIME Dysplasia and a Spectrum of Skeletal Dysplasia Phenotypes. Am J Hum Genet 2019; 104:422-438. [PMID: 30773277 PMCID: PMC6408318 DOI: 10.1016/j.ajhg.2019.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/17/2019] [Indexed: 12/14/2022] Open
Abstract
SPONASTRIME dysplasia is an autosomal-recessive spondyloepimetaphyseal dysplasia characterized by spine (spondylar) abnormalities, midface hypoplasia with a depressed nasal bridge, metaphyseal striations, and disproportionate short stature. Scoliosis, coxa vara, childhood cataracts, short dental roots, and hypogammaglobulinemia have also been reported in this disorder. Although an autosomal-recessive inheritance pattern has been hypothesized, pathogenic variants in a specific gene have not been discovered in individuals with SPONASTRIME dysplasia. Here, we identified bi-allelic variants in TONSL, which encodes the Tonsoku-like DNA repair protein, in nine subjects (from eight families) with SPONASTRIME dysplasia, and four subjects (from three families) with short stature of varied severity and spondylometaphyseal dysplasia with or without immunologic and hematologic abnormalities, but no definitive metaphyseal striations at diagnosis. The finding of early embryonic lethality in a Tonsl-/- murine model and the discovery of reduced length, spinal abnormalities, reduced numbers of neutrophils, and early lethality in a tonsl-/- zebrafish model both support the hypomorphic nature of the identified TONSL variants. Moreover, functional studies revealed increased amounts of spontaneous replication fork stalling and chromosomal aberrations, as well as fewer camptothecin (CPT)-induced RAD51 foci in subject-derived cell lines. Importantly, these cellular defects were rescued upon re-expression of wild-type (WT) TONSL; this rescue is consistent with the hypothesis that hypomorphic TONSL variants are pathogenic. Overall, our studies in humans, mice, zebrafish, and subject-derived cell lines confirm that pathogenic variants in TONSL impair DNA replication and homologous recombination-dependent repair processes, and they lead to a spectrum of skeletal dysplasia phenotypes with numerous extra-skeletal manifestations.
Collapse
Affiliation(s)
- Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA
| | - John J Reynolds
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nissan Vida Baratang
- Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, QC H3T1J4, Canada
| | | | - Jeremy Wegner
- Institute of Neuroscience, University of Oregon, Eugene, OR 97403, USA
| | - Ashley McFarquhar
- Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, QC H3T1J4, Canada
| | - Martin R Higgs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Audrey E Christiansen
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Denise G Lanza
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - John R Seavitt
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mahim Jain
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Xiaohui Li
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - David A Parry
- Medical Research Council Institute of Genetics & Molecular Medicine, the University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Vandana Raman
- Division of Pediatric Endocrinology and Diabetes, University of Utah, Salt Lake City, UT 84112, USA
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1Z5, Canada; Department of Pediatrics, Division of Clinical and Metabolic Genetics, the Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ivan K Chinn
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Division of Pediatric Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, TX 77030, USA
| | - Alison A Bertuch
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lefkothea Karaviti
- Division of Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX 77030, USA
| | - Alan E Schlesinger
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX 77030, USA; Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dawn Earl
- Seattle Children's Hospital, Seattle, WA 98195, USA
| | - Michael Bamshad
- Seattle Children's Hospital, Seattle, WA 98195, USA; Departments of Pediatrics and Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
| | - Harsha Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Donna Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor Genetics, Houston, TX 77030, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Weimin Bi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor Genetics, Houston, TX 77030, USA
| | - Lisa Emrick
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Division of Neurology and Developmental Neuroscience and Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - John Postlethwait
- Institute of Neuroscience, University of Oregon, Eugene, OR 97403, USA
| | - Monte Westerfield
- Institute of Neuroscience, University of Oregon, Eugene, OR 97403, USA
| | - Mary E Dickinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Emmanuelle Ranza
- Service of Genetic Medicine, University of Geneva Medical School, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Celine Huber
- Department of Genetics, INSERM UMR1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, AP-HP, Hôpital Necker Enfants Malades, Paris 75015, France
| | - Valérie Cormier-Daire
- Department of Genetics, INSERM UMR1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, AP-HP, Hôpital Necker Enfants Malades, Paris 75015, France
| | - Wei Shen
- Associated Regional and University Pathologists Laboratories, Salt Lake City, UT 84108, USA; Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Rong Mao
- Associated Regional and University Pathologists Laboratories, Salt Lake City, UT 84108, USA; Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason D Heaney
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jordan S Orange
- Division of Pediatric Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, TX 77030, USA; Current affiliation: Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian, New York, NY 10032, USA
| | - Débora Bertola
- Clinical Genetics Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências da Universidade de São Paulo, SP 05508-0900, Brazil
| | - Guilherme L Yamamoto
- Clinical Genetics Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; Centro de Pesquisa sobre o Genoma Humano e Células-Tronco, Instituto de Biociências da Universidade de São Paulo, SP 05508-0900, Brazil
| | - Wagner A R Baratela
- Clinical Genetics Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil
| | - Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, KS 66160, USA
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, the Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Mehdi Adeli
- Department of Allergy and Immunology, Sidra Medicine, Hamad Medical Corporation, Weill Cornell Medicine, Qatar, Doha, Qatar
| | - Daniel H Cohn
- Department of Molecular, Cell, and Developmental Biology and Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Deborah Krakow
- Department of Orthopaedic Surgery, Department of Human Genetics and Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Andrew P Jackson
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Melissa Lees
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Amaka C Offiah
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield S10 2TH, UK
| | - Colleen M Carlston
- Associated Regional and University Pathologists Laboratories, Salt Lake City, UT 84108, USA; Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Grant S Stewart
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Carlos A Bacino
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA
| | - Philippe M Campeau
- Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, QC H3T1J4, Canada
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA.
| |
Collapse
|
41
|
Domingo L, Carey JC, Eckhauser A, Wilkes J, Menon SC. Mortality and Resource Use Following Cardiac Interventions in Children with Trisomy 13 and Trisomy 18 and Congenital Heart Disease. Pediatr Cardiol 2019; 40:349-356. [PMID: 30291384 DOI: 10.1007/s00246-018-2001-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 06/05/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
We sought to evaluate the mortality, risk factors for mortality, and resource utilization following cardiac interventions in trisomy 13 (T13) and 18 (T18) children. All T13 and T18 children who underwent a cardiac intervention from January 1999 to March 2015 were identified from the Pediatric Health Information System database. Data collected included demographics, type of congenital heart disease (CHD), cardiac interventions, comorbidities, length of stay (LOS), hospital charges, and deaths (within 30 days). Logistic regression analysis was used to determine factors associated with mortality. There were 49 (47% females) T13 and 140 (67% females) T18 subjects. The two cohorts were similar in distribution for race, geographic region, insurance type, and median household income. The most common CHD in both groups was a shunt lesion followed by conotruncal defects. Compared to T18, the T13 cohort had higher mortality (29% vs. 12%), tracheostomies (12% vs. 4%), gastrostomies (18% vs. 6%), and overall resource use (P < 0.05 for all). White race (OR 0.23, 95% CI 0.06-0.81) in T13 and older age (in weeks) at surgery in T18 (OR 0.75, 95% CI 0.64-0.86) were associated with lower mortality. A select group of T13 and T18 CHD patients can undergo successful cardiac interventions, albeit with a higher mortality and resource use. T13 patients have higher mortality and resource use compared to T18. In T13 and T18 patients, interventions for CHD may be an acceptable and ethical option following a careful individualized selection and counseling by a team of experts.
Collapse
Affiliation(s)
- Liezl Domingo
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
- Division of Pediatric Cardiology, Augusta University, 1120 15th Street BA, 8300, Augusta, GA, 30909, USA.
| | - John C Carey
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Aaron Eckhauser
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob Wilkes
- Pediatric Specialties Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
42
|
Farmakis SG, Barnes AM, Carey JC, Braddock SR. Solid tumor screening recommendations in trisomy 18. Am J Med Genet A 2019; 179:455-466. [DOI: 10.1002/ajmg.a.61029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/22/2018] [Accepted: 12/09/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Shannon G. Farmakis
- Department of RadiologySaint Louis University School of Medicine and SSM Health Cardinal Glennon Children's Hospital St. Louis Missouri
| | - Ann M. Barnes
- The Support Organization for Trisomy 18, 13 and Related Disorders Rochester New York
| | - John C. Carey
- Department of PediatricsUniversity of Utah Salt Lake City Utah
| | - Stephen R. Braddock
- Division of Medical Genetics, Department of PediatricsSaint Louis University School of Medicine and SSM Cardinal Glennon Children's Hospital St. Louis Missouri
| |
Collapse
|
43
|
Affiliation(s)
- Elizabeth J. Kvach
- Department of Family Medicine, Denver Health, Denver, Colorado
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer S. Hyer
- Department of Obstetrics and Gynecology, Denver Health, Denver, Colorado
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - John C. Carey
- Department of Obstetrics and Gynecology, Denver Health, Denver, Colorado
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Marci Bowers
- Department of Obstetrics and Gynecology, Denver Health, Denver, Colorado
- Mills-Peninsula Hospital, Burlingame, California
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
44
|
Paulraj P, Palumbos JC, Openshaw A, Carey JC, Toydemir RM. Multiple Congenital Anomalies and Global Developmental Delay in a Patient with Interstitial 6q25.2q26 Deletion: A Diagnostic Odyssey. Cytogenet Genome Res 2018; 156:191-196. [PMID: 30439704 DOI: 10.1159/000494871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 12/17/2022] Open
Abstract
Interstitial deletions involving 6q25 are rare chromosomal abnormalities associated with distinctive phenotypic features. We describe a 9-year-old boy who was followed from his infancy due to his multiple congenital anomalies and complex medical history. Over the years, a number of diagnoses were considered including Cornelia de Lange syndrome, Rubinstein-Taybi syndrome, as well as "a novel genetic disorder." Various genetic tests, including a BAC-based array-CGH analysis, were reported as normal. Recently, a SNP-based microarray analysis was performed and showed an 11.1-Mb deletion from 6q25.2 to 6q26, including ARID1B and ZDHHC14. Recent literature suggests that the 6q25 deletion syndrome is a recognizable entity characterized by growth delay, developmental disabilities, microcephaly, hearing loss, and variable other malformations including cleft palate. These features overlap with those of Coffin-Siris syndrome, which is caused by deletions and loss-of-function mutations of ARID1B. Retrospectively, this patient has features resembling both Coffin-Siris and 6q25 microdeletion syndromes.
Collapse
|
45
|
Battaglia A, Calhoun ARUL, Lortz A, Carey JC. Risk of hepatic neoplasms in Wolf-Hirschhorn syndrome (4p-): Four new cases and review of the literature. Am J Med Genet A 2018; 176:2389-2394. [PMID: 30289612 DOI: 10.1002/ajmg.a.40469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/08/2017] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 01/02/2023]
Abstract
Wolf-Hirschhorn syndrome (WHS) is a rare contiguous gene deletion disorder characterized by distinctive craniofacial features, prenatal/postnatal growth deficiency, intellectual disability, and seizures. Various malformations of internal organs are also seen. Neoplasia has not been documented as a typical feature of WHS. We review the three prior reports of hepatic neoplasia in WHS and add four previously unreported individuals. We propose that, in the context of the rarity of WHS, these seven cases suggest that hepatocellular neoplasia may be a feature of WHS.
Collapse
Affiliation(s)
- Agatino Battaglia
- The Stella Maris Clinical Research Institute for Child and Adolescent Neurology and Psychiatry, Pisa, Italy
| | - Amy R U L Calhoun
- Stead Family Department of Pediatrics, Division of Medical Genetics, University of Iowa, Iowa City, Iowa
| | | | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
46
|
Carey JC, Hennekam RCM, Lin AE, Barr M. M. Michael Cohen, Jr.: Author, diagnostician, geneticist, teacher, mentor, syndrome scholar extraordinaire (1937-2018). Am J Med Genet A 2018; 176:1703-1705. [PMID: 30055082 DOI: 10.1002/ajmg.a.38845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022]
Affiliation(s)
- John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah
| | - Raoul C M Hennekam
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela E Lin
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Mason Barr
- Teratology Unit, Departments of Pediatrics, Pathology and Obstetrics, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
47
|
Carey JC, Fleming SD, Roberts DY. The Myers-Briggs Type Indicator as a Measure of Aspects of Cognitive Style. Measurement and Evaluation in Counseling and Development 2018. [DOI: 10.1080/07481756.1989.12022917] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- John C. Carey
- John C. Carey is an assistant professor in School, Consulting and Counseling Psychology at the University of Massachusetts, Amherst
| | | | - Dayton Y. Roberts
- Dayton Y. Roberts is a professor of Higher Education at Texas Tech University, Lubbock
| |
Collapse
|
48
|
Carey JC, Fox EA, Spraggins EF. Replication of Structure Findings Regarding the Interpersonal Reactivity Index. Measurement and Evaluation in Counseling and Development 2018. [DOI: 10.1080/07481756.1988.12022890] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- John C. Carey
- John C. Carey is an assistant professor in School, Consulting, and Counseling Psychology at the University of Massachusetts, Amherst
| | - Elizabeth A. Fox
- Elizabeth A. Fox is an assistant professor, and Elizabeth F. Spraggins is a graduate student in the Department of Food and Nutrition at Texas Tech University, Lubbock
| | - Elizabeth F. Spraggins
- Elizabeth A. Fox is an assistant professor, and Elizabeth F. Spraggins is a graduate student in the Department of Food and Nutrition at Texas Tech University, Lubbock
| |
Collapse
|
49
|
Carey JC, Stanley DA, Werring CJ, Yarbrough DW. Development of a Short Form of the Roommate Rapport Scale. Measurement and Evaluation in Counseling and Development 2018. [DOI: 10.1080/07481756.1988.12022869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- John C. Carey
- John C. Carey is an assistant professor, Department of School, Consulting and Counseling Psychology, University of Massachusetts at Amherst
| | - D'Lisa A. Stanley
- D'Lisa A. Stanley is a doctoral student in educational psychology, Texas Tech University, and Charles J. Werring is assistant director of housing, Housing and Dining Services, Texas Tech University, Lubbock
| | - Charles J. Werring
- D'Lisa A. Stanley is a doctoral student in educational psychology, Texas Tech University, and Charles J. Werring is assistant director of housing, Housing and Dining Services, Texas Tech University, Lubbock
| | - Douglas W. Yarbrough
- Douglas W. Yarbrough is an assistant professor, College of Education, University of Montana, Missoula
| |
Collapse
|
50
|
Andoni L, Hobson WL, Carey JC, Dent KM. Training Methods for Delivering Difficult News in Genetic Counseling and Genetics Residency Training Programs. J Genet Couns 2018; 27:1497-1505. [DOI: 10.1007/s10897-018-0271-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
|