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Thomas AT, Waite J, Williams CA, Kirk J, Oliver C, Richards C. Phenotypic characteristics and variability in CHARGE syndrome: a PRISMA compliant systematic review and meta-analysis. J Neurodev Disord 2022; 14:49. [PMID: 36045324 PMCID: PMC9429597 DOI: 10.1186/s11689-022-09459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background CHARGE syndrome (OMIM #214800) is a phenotypically complex genetic condition characterised by multi-system, multi-sensory impairments. Behavioural, psychological, cognitive and sleep difficulties are not well delineated and are likely associated with biopsychosocial factors. Methods This meta-analysis investigated the prevalence of clinical features, physical characteristics and conditions, behavioural, psychological, cognitive and sleep characteristics in CHARGE syndrome, and statistically evaluated directional associations between these characteristics. Pooled prevalence estimates were calculated using reliable, prespecified quality weighting criteria, and meta-regression was conducted to identify associations between characteristics. Results Of the 42 eligible studies, data could be extracted for 1675 participants. Prevalence estimates were highest for developmental delay (84%), intellectual disability (64%), aggressive behaviour (48%), self-injurious behaviour (44%) and sleep difficulties (45%). Meta-regression indicated significant associations between intellectual disability and choanal atresia, intellectual disability and inner ear anomalies, sleep difficulties and growth deficiency, and sleep difficulties and gross motor difficulties. Conclusions Our comprehensive review of clinical features, behavioural, psychological, cognitive and physical characteristics, conditions and comorbidities in CHARGE syndrome provides an empirically based foundation to further research and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09459-5.
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Affiliation(s)
- Andrea T Thomas
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. .,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.
| | - Jane Waite
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.,Aston University, Birmingham, UK
| | - Caitlin A Williams
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Jeremy Kirk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
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2
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da Costa Monsanto R, Knoll RM, de Oliveira Penido N, Song G, Santos F, Paparella MM, Cureoglu S. Otopathologic Abnormalities in CHARGE Syndrome. Otolaryngol Head Neck Surg 2021; 166:363-372. [PMID: 33874787 DOI: 10.1177/01945998211008911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome. STUDY DESIGN Otopathologic study of human TB specimens. SETTING Otopathology laboratories. METHODS From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed. RESULTS Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa's ganglion neurons were decreased in all specimens (versus normative data). CONCLUSIONS In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil.,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Renata Malimpensa Knoll
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, Massachusetts, USA
| | - Norma de Oliveira Penido
- Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Grace Song
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Felipe Santos
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Mauro Paparella
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sebahattin Cureoglu
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Granadillo JL, Wegner DJ, Paul AJ, Willing M, Sisco K, Tedder ML, Sadikovic B, Wambach JA, Baldridge D, Cole FS. Discovery of a novel CHD7 CHARGE syndrome variant by integrated omics analyses. Am J Med Genet A 2020; 185:544-548. [PMID: 33184947 DOI: 10.1002/ajmg.a.61962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022]
Abstract
Chromodomain helicase DNA-binding protein 7 (CHD7) pathogenic variants are identified in more than 90% of infants and children with CHARGE (Coloboma of the iris, retina, and/or optic disk; congenital Heart defects, choanal Atresia, Retardation of growth and development, Genital hypoplasia, and characteristic outer and inner Ear anomalies and deafness) syndrome. Approximately, 10% of cases have no known genetic cause identified. We report a male child with clinical features of CHARGE syndrome and nondiagnostic genetic testing that included chromosomal microarray, CHD7 sequencing and deletion/duplication analysis, SEMA3E sequencing, and trio exome and whole-genome sequencing (WGS). We used a comprehensive clinical assessment, genome-wide methylation analysis (GMA), reanalysis of WGS data, and CHD7 RNA studies to discover a novel variant that causes CHD7 haploinsufficiency. The 7-year-old Hispanic male proband has typical phenotypic features of CHARGE syndrome. GMA revealed a CHD7-associated epigenetic signature. Reanalysis of the WGS data with focused bioinformatic analysis of CHD7 detected a novel, de novo 15 base pair deletion in Intron 4 of CHD7 (c.2239-20_2239-6delGTCTTGGGTTTTTGT [NM_017780.3]). Using proband RNA, we confirmed that this novel deletion causes CHD7 haploinsufficiency by disrupting the canonical 3' splice site and introducing a premature stop codon. Integrated genomic, epigenomic, and transcriptome analyses discovered a novel CHD7 variant that causes CHARGE syndrome.
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Affiliation(s)
- Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Daniel J Wegner
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Alexander J Paul
- McDonnell Genome Institute, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Marcia Willing
- Division of Genetics and Genomic Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Kathleen Sisco
- Division of Genetics and Genomic Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | | | - Bekim Sadikovic
- Molecular Diagnostics Division, Pathology and Laboratory Medicine. London Health Sciences Centre and St. Joseph's Health Care, London, Ontario, Canada
| | - Jennifer A Wambach
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Dustin Baldridge
- Division of Genetics and Genomic Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Francis Sessions Cole
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, Missouri, USA
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4
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Simpson BN, Khattar D, Saal H, Prada CE, Choo D, Marcheschi L, Wiley S, Hopkin RJ. CHARGE syndrome in the era of molecular diagnosis: Similar outcomes in those without coloboma or choanal atresia. Eur J Med Genet 2020; 64:104103. [PMID: 33189935 DOI: 10.1016/j.ejmg.2020.104103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
CHARGE syndrome (OMIM 214800) is a condition characterized by multisystem involvement with CHD7 pathogenic mutations leading to disease in the majority of patients. Discovery of the molecular cause of CHARGE unmasked a larger phenotypic spectrum than was previously appreciated. Within our interdisciplinary CHARGE syndrome program, we sought to characterize our CHD7-positive CHARGE cohort without coloboma or choanal atresia, highlighting complications and outcomes. We describe 18 individuals with CHD7-confirmed diagnosis from 15 families. The most sensitive finding in the cohort was temporal bone malformations, present in 13/15 individuals. Individuals had an average of 1.6 major features and 3.3 minor features defined by the Blake et al. guidelines. Despite lack of major features or major malformations, the majority of individuals continued to have difficulties with pneumonia, aspiration, secretion management and motility issues that greatly impacted their lives. Our findings illustrate the need for molecular testing and timely recognition given that the major co-morbidities are frequently experienced by patients with the mildest clinical spectrum of CHARGE syndrome.
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Affiliation(s)
- Brittany N Simpson
- Cincinnati Children's Hospital Medical Center: Division of Human Genetics, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, University of Cincinnati College of Medicine, United States.
| | - Divya Khattar
- Cincinnati Children's Hospital Medical Center: Division of Human Genetics, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Howard Saal
- Cincinnati Children's Hospital Medical Center: Division of Human Genetics, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Carlos E Prada
- Cincinnati Children's Hospital Medical Center: Division of Human Genetics, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Daniel Choo
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Department of Otolaryngology Head and Neck Surgery, United States
| | - Lucy Marcheschi
- Cincinnati Children's Hospital Medical Center: Division of Pediatric Otolaryngology, United States
| | - Susan Wiley
- Cincinnati Children's Hospital Medical Center: Division of Developmental and Behavioral Pediatrics, United States
| | - Robert J Hopkin
- Cincinnati Children's Hospital Medical Center: Division of Human Genetics, United States; Cincinnati Children's Hospital Medical Center: Department of Pediatrics, University of Cincinnati College of Medicine, United States
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5
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Bedeschi MF, Crippa BL, Colombo L, Buscemi M, Rossi C, Villa R, Gangi S, Picciolini O, Cinnante C, Fergnani VGC, Ajmone PF, Scola E, Triulzi F, Mosca F. A case series of CHARGE syndrome: identification of key features for a neonatal diagnosis. Ital J Pediatr 2020; 46:53. [PMID: 32326958 PMCID: PMC7181484 DOI: 10.1186/s13052-020-0806-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An early diagnosis of CHARGE syndrome is challenging, especially for the primary care physicians who often take care of neonates with multiple congenital anomalies. Here we report eight cases of CHARGE syndrome whose diagnosis was made early in life with the intent to identify the most helpful features allowing a prompt clinical diagnosis. METHODS Medical records of patients with CHARGE syndrome whose diagnosis was made at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy were retrospectively reviewed. RESULTS Taken together, these patients reflect the considerable phenotypic variability of the syndrome; in one patient, the diagnosis was made immediately after birth because all the major criteria were met. In six patients, presenting with relatively nonspecific defects, a temporal bone computerized tomography scan was essential to achieve the correct diagnosis. In one patient, the diagnosis was made later than the others were. A careful examination revealed the presence of outer, middle, and inner ear anomalies: these elements, in the absence of any additional major criteria, represented for us an important diagnostic clue. CONCLUSIONS This article suggests that an accurate evaluation of the ear should be made every time CHARGE syndrome is considered as a likely diagnosis even when the standard criteria are not fulfilled.
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Affiliation(s)
| | - Beatrice Letizia Crippa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Martina Buscemi
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Cesare Rossi
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Roberta Villa
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Clinical Genetics Unit, Milan, Italy
| | - Silvana Gangi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Odoardo Picciolini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Unit, Milan, Italy
| | - Claudia Cinnante
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | | | - Paola Francesca Ajmone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Child and Adolescent Neuropsychiatric Service (UONPIA), Milan, Italy
| | - Elisa Scola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Fabio Triulzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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6
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Seal HE, Lilian SJ, Popratiloff A, Hirsch JC, Peusner KD. Implementing the chick embryo model to study vestibular developmental disorders. J Neurophysiol 2019; 122:2272-2283. [PMID: 31577516 PMCID: PMC7327228 DOI: 10.1152/jn.00434.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Children with congenital vestibular disorders show delayed motor development and challenges in maintaining posture and balance. Computed tomography images reveal that these children have abnormal inner ears in the form of a sac, with the semicircular canals missing or truncated. Little is known about how this inner ear abnormality affects central vestibular development. At present, mice with the chromodomain helicase DNA-binding protein 7 mutation are the most common model for studying congenital vestibular disorders, despite forming multiple diverse inner ear phenotypes and inducing abnormal cerebellar and visual system development. To identify the effects of a sac-like inner ear on central vestibular development, we have designed and implemented a new model, the anterior-posterior axis rotated otocyst (ARO) chick, which forms a sac-like inner ear in 85% of cases. The ARO chick is produced by anterior-posterior rotation of the otocyst at embryonic day 2. Here, we describe for the first time the 15% of ARO chicks that form three small semicircular canals and rename the ARO chicks forming sacs (ARO/s chicks). The basic features of the vestibular sensory organs in ARO/s chicks are similar to those found in patients’ sacs, and ARO/s hatchlings experience balance and walking problems like patients. Thus, ARO/s chicks have a reproducible inner ear phenotype without abnormalities in vestibular-related structures, making the model a relatively simple one to evaluate the relationship between the sac-like inner ear pathology and formation of the central vestibular neural circuitry. Here, we describe unpublished details on the surgical approaches to produce ARO chicks, including pitfalls and difficulties to avoid. NEW & NOTEWORTHY This paper describes simple techniques for chick otocyst rotation resulting in a sac-like inner ear (85%), the common phenotype in congenital vestibular disorders. We now describe anterior-posterior axis rotated otocyst chicks, which form three small canals (15%), and rename chicks forming a sac (ARO/s chicks). Basic protocols and potential complications of otocyst rotation are described. With the use of ARO/s chicks, it will be possible to determine how the vestibular neural circuit is modified by sac-like inner ear formation.
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Affiliation(s)
- Hayley E Seal
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sigmund J Lilian
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anastas Popratiloff
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - June C Hirsch
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kenna D Peusner
- Department of Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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7
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Morphometric properties of the facial canal in children: A retrospective computed tomography study. Int J Pediatr Otorhinolaryngol 2019; 124:59-67. [PMID: 31163359 DOI: 10.1016/j.ijporl.2019.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The main objective of the study was to examine the morphometric development of the facial canal in temporal bones aged from one to 18 years for pediatric otosurgeons and neurosurgeons. METHODS The study was performed on 41 patients including cochlear implantation cases (20 females and 21 males) with a mean age of 6.44 ± 5.79 years. All the measurements belonging to the facial canal including the length, width and angles of its segments were performed using the data of computed tomography assessment. RESULTS The numerical data of the facial canal segments were not different in terms of sexes or sides, statistically (p > 0.05). The width of the labyrinthine segment (p = 0.145), the length of the tympanic segment (p = 0.555), the first (p = 0.067) and second (p = 0.060) genu angles seemed to reach adult size at two years of age. In addition, the length of the labyrinthine segment (p = 0.064) and the width of the mastoid segment (p = 0.264) seemed to attain adult size at four years, while the width of the meatal foramen (p = 0.264) seemed to arrive adult size at seven years. However, the length of the mastoid segment and the width of the tympanic segment were developing independently of increasing age between 1 and 18 years. CONCLUSION Our data suggested that, contrary to the general acceptance in the literature, the dimension of the facial canal segments show remarkable changes during the transition from intrauterine life to adult life. The regression equations representing the facial canal growth dynamic in children may be useful for otosurgeons to estimate the size of its segments and to prevent iatrogenic injury during early childhood surgeries such as cochlear implantation.
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8
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Millischer AE, Sonigo P, Attie T, Spaggiari E, O'Gorman N, Bessieres B, Kermorvant E, Boddaert N, Salomon LJ, Grevent D. Fetal MRI findings in a retrospective cohort of 26 cases of prenatally diagnosed CHARGE syndrome individuals. Prenat Diagn 2019; 39:781-791. [PMID: 30715739 DOI: 10.1002/pd.5429] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
"CHARGE syndrome" (CS) is a multifaceted syndrome associated with a poor prognosis. The prenatal diagnosis remains challenging especially as the fetal anomalies that may evoke suspicion of CS are not comprehensively described. OBJECTIVE This study aims to identify the anomalies in MRI with suspected CHARGE syndrome and to propose a possible standardization in the image-based prenatal diagnosis of CS. METHODS This was a retrospective study of 26 fetuses who underwent MRI and had a confirmed diagnosis of CS, as proven by histopathological and/or neonatal examinations and/or the presence of the CHD7 gene mutation. RESULTS The three most frequent MRI anomalies confirmed at histopathological and/or neonatal examinations were arhinencephaly in 100% (26 of 26), dysplasia of the semicircular canals agenesis (SCA) in 100% (24 of 24), and posterior fossa anomalies in 100% (22 of 22). Our study also revealed short petrous bones with a particular triangular shape in 24 of 24 cases of SCA. Other relevant findings included external ear anomalies in 36% (9 of 25), cleft lip and palate (9 of 9), ventriculomegaly (VMG) (6 of 6), short corpus callosum (3 of 3), and ocular asymmetry in 36.6% (4 of 11). CONCLUSION Our study emphasizes the interest of fetal MRI in the diagnosis of CS with an adapted knowledge of semiology.
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Affiliation(s)
- Anne-Elodie Millischer
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,EA fetus, Necker Hospital, Paris, France
| | - Pascale Sonigo
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Tania Attie
- Service de Génétique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Emmanuel Spaggiari
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Neil O'Gorman
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Bettina Bessieres
- Service d'anatomopathologie, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Elsa Kermorvant
- Service de néonatologie, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Nathalie Boddaert
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Laurent-Julien Salomon
- EA fetus, Necker Hospital, Paris, France.,Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - David Grevent
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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9
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Tawfik KO, Leader BA, Walters ZA, Choo DI. Relative Preservation of Superior Semicircular Canal Architecture in CHARGE Syndrome. Otolaryngol Head Neck Surg 2019; 160:1095-1100. [PMID: 30667318 DOI: 10.1177/0194599818824306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Describe common patterns of semicircular canal (SCC) anomalies in CHARGE syndrome (CS) and (2) recognize that in CS, the architecture of the superior SCC may be relatively preserved. STUDY DESIGN This is a retrospective review of temporal bone imaging studies. SETTING Quaternary care center. SUBJECTS AND METHODS A sample of 37 patients with CS. All subjects met clinical diagnostic criteria for CS. The presence/absence of anomalies of the middle ear, mastoid, temporal bone venous anatomy, inner ear, and internal auditory canal was recorded. Anomalies of each SCC were considered separately and by severity (normal, dysplasia, aplasia). RESULTS Thirty-seven subjects (74 temporal bones) were reviewed. Thirty-four (92.0%) patients demonstrated bilateral SCC anomalies. Three (8.0%) had normal SCCs. In patients with SCC anomalies, all canals demonstrated bilateral abnormalities. Thirty-two (86.5%) patients had bilateral horizontal SCC aplasia. These 32 patients also demonstrated posterior SCC aplasia in at least 1 ear. Of 74 temporal bones, 37 (50.0%) had superior SCC dysplasia. All dysplastic superior SCCs showed preservation of the anterior limb. Complete superior SCC aplasia was found in 28 (37.8%) temporal bones. CONCLUSION SCC anomalies occur with high frequency in CS. Complete absence of the horizontal and posterior canals is typical and usually bilateral. By contrast, the superior SCC often demonstrates relative preservation of the anterior limb.
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Affiliation(s)
- Kareem O Tawfik
- 1 Division of Otolaryngology-Head & Neck Surgery, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Brittany A Leader
- 2 Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zoe A Walters
- 3 University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel I Choo
- 2 Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,4 Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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10
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Talas DÜ, Beger O, Koç T, Hamzaoğlu V, Özalp H, Mavruk M, Yıldırım C, Güzelyüz İ, Vayisoğlu Y, Uzmansel D, Farsak M, Dağtekin A. Morphometric properties of the facial nerve in fetal temporal bones. Int J Pediatr Otorhinolaryngol 2019; 116:7-14. [PMID: 30554711 DOI: 10.1016/j.ijporl.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective. METHODS The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75 ± 4.36 (range, 20-34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software. RESULTS Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = -1.206 + 0.200 × Age (weeks), y = -1.868 + 0.153 × Age (weeks), y = -2.327 + 0.325 × Age (weeks), and y = -1.507 + 0.246 × Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475-0.117 × Age (weeks) and y = 140.446-0.042 × Age (weeks), respectively. CONCLUSION The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.
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Affiliation(s)
- Derya Ümit Talas
- Mersin University Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Orhan Beger
- Mersin University Faculty of Medicine, Department of Anatomy, Mersin, Turkey.
| | - Turan Koç
- Mersin University Faculty of Medicine, Department of Anatomy, Mersin, Turkey
| | - Vural Hamzaoğlu
- Mersin University Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Hakan Özalp
- Mersin University Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Melike Mavruk
- Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - İrem Güzelyüz
- Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Mersin University Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Deniz Uzmansel
- Mersin University Faculty of Medicine, Department of Anatomy, Mersin, Turkey
| | - Mehmet Farsak
- Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Dağtekin
- Mersin University Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
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11
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Abstract
Objective: Infants with syndromic cleft lip and/or cleft palate (CL/P) often require more complex care than their nonsyndromic counterparts. Our purpose was to (1) determine the prevalence of CL/P in patients with CHARGE syndrome and (2) highlight factors that affect management in this subset of children. Design: This is a retrospective review from 1998 to 2016. Patients: Patients with CHARGE syndrome were diagnosed clinically and genetically. Main Outcomes Measures: Prevalence of CL/P was determined and clinical details tabulated: phenotypic anomalies, cleft types, operative treatment, and results of repair. Results: CHARGE syndrome was confirmed in 44 patients: 11 (25%) had cleft lip and palate and 1 had cleft palate only. Surgical treatment followed our usual protocols. Two patients with cardiac anomalies had prolonged recovery following surgical correction, necessitating palatal closure prior to nasolabial repair. One of these patients was too old for dentofacial orthopedics and underwent combined premaxillary setback and palatoplasty, prior to labial closure. Velopharyngeal insufficiency was frequent (n = 3/7). All patients had feeding difficulty and required a gastrostomy tube. All patients had neurosensory hearing loss; anomalies of the semicircular canals were frequent (n = 3/4). External auricular anomalies, colobomas, and cardiovascular anomalies were also common (n = 8/11). Other associated anomalies were choanal atresia (n = 4/11) and tracheoesophageal fistula (n = 2/11). Conclusions: CHARGE syndrome is an under-recognized genetic cause of cleft lip and palate. Hearing loss and speech and feeding difficulties often occur in these infants. Diagnosis can be delayed if the child presents with covert phenotypic features, such as chorioretinal colobomas, semicircular canal hypoplasia, and unilateral choanal atresia.
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12
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Legendre M, Abadie V, Attié-Bitach T, Philip N, Busa T, Bonneau D, Colin E, Dollfus H, Lacombe D, Toutain A, Blesson S, Julia S, Martin-Coignard D, Geneviève D, Leheup B, Odent S, Jouk PS, Mercier S, Faivre L, Vincent-Delorme C, Francannet C, Naudion S, Mathieu-Dramard M, Delrue MA, Goldenberg A, Héron D, Parent P, Touraine R, Layet V, Sanlaville D, Quélin C, Moutton S, Fradin M, Jacquette A, Sigaudy S, Pinson L, Sarda P, Guerrot AM, Rossi M, Masurel-Paulet A, El Chehadeh S, Piguel X, Rodriguez-Ballesteros M, Ragot S, Lyonnet S, Bilan F, Gilbert-Dussardier B. Phenotype and genotype analysis of a French cohort of 119 patients with CHARGE syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:417-430. [DOI: 10.1002/ajmg.c.31591] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marine Legendre
- Service de Génétique, CHU de Poitiers; Poitiers France
- EA 3808, Université de Poitiers; Poitiers France
| | - Véronique Abadie
- Service de Pédiatrie Générale, Hôpital Universitaire Necker-Enfants Malades, AP-HP; Paris France
- Unité INSERM 1178/1018-CESP, Université Paris Descartes; Paris France
| | - Tania Attié-Bitach
- INSERM U1163, Laboratoire d'Embryologie et de Génétique des Malformations Congénitales; Sorbonne Paris Cité et Institut Imagine, Université Paris Descartes; Paris France
- Département de Génétique; Hôpital Universitaire Necker-Enfants Malades; AP-HP Paris France
| | | | | | | | | | - Hélène Dollfus
- Service de Génétique, CHU de Strasbourg; Strasbourg France
| | - Didier Lacombe
- Service de Génétique, CHU de Bordeaux, INSERM U1211, Université de Bordeaux; Bordeaux France
| | | | | | - Sophie Julia
- Service de Génétique, CHU de Toulouse; Toulouse France
| | | | - David Geneviève
- Service de Génétique Clinique, Département de génétique médicale, maladies rares et médecine personnalisée, Unité Inserm U1183, Université Montpellier, CHU Montpellier; Montpellier France
| | - Bruno Leheup
- Service de Génétique, CHU de Nancy; Nancy France
| | - Sylvie Odent
- Service de Génétique, CHU de Rennes; Rennes France
| | | | | | - Laurence Faivre
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon; Dijon France
| | | | | | - Sophie Naudion
- Service de Génétique, CHU de Bordeaux, INSERM U1211, Université de Bordeaux; Bordeaux France
| | | | - Marie-Ange Delrue
- Service de Génétique, CHU de Bordeaux, INSERM U1211, Université de Bordeaux; Bordeaux France
| | | | - Delphine Héron
- Service de Génétique, CHU Pitié-Salpêtrière, AP-HP; Paris France
| | | | - Renaud Touraine
- Service de Génétique, CHU de Saint-Etienne; Saint-Etienne France
| | | | | | - Chloé Quélin
- Service de Génétique, CHU de Rennes; Rennes France
| | - Sébastien Moutton
- Service de Génétique, CHU de Bordeaux, INSERM U1211, Université de Bordeaux; Bordeaux France
| | | | | | | | - Lucile Pinson
- Service de Génétique Clinique, Département de génétique médicale, maladies rares et médecine personnalisée, Unité Inserm U1183, Université Montpellier, CHU Montpellier; Montpellier France
| | - Pierre Sarda
- Service de Génétique Clinique, Département de génétique médicale, maladies rares et médecine personnalisée, Unité Inserm U1183, Université Montpellier, CHU Montpellier; Montpellier France
| | | | | | - Alice Masurel-Paulet
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon; Dijon France
| | - Salima El Chehadeh
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon; Dijon France
| | - Xavier Piguel
- Service d'Endocrinologie, CHU de Poitiers; Poitiers France
| | | | - Stéphanie Ragot
- Centre d'Investigation Clinique, CHU de Poitiers; Poitiers France
- INSERM CIC 1402; Poitiers France
| | - Stanislas Lyonnet
- INSERM U1163, Laboratoire d'Embryologie et de Génétique des Malformations Congénitales; Sorbonne Paris Cité et Institut Imagine, Université Paris Descartes; Paris France
- Département de Génétique; Hôpital Universitaire Necker-Enfants Malades; AP-HP Paris France
| | - Frédéric Bilan
- Service de Génétique, CHU de Poitiers; Poitiers France
- EA 3808, Université de Poitiers; Poitiers France
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13
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Rapid Discovery of De Novo Deleterious Mutations in Cattle Enhances the Value of Livestock as Model Species. Sci Rep 2017; 7:11466. [PMID: 28904385 PMCID: PMC5597596 DOI: 10.1038/s41598-017-11523-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 08/23/2017] [Indexed: 01/17/2023] Open
Abstract
In humans, the clinical and molecular characterization of sporadic syndromes is often hindered by the small number of patients and the difficulty in developing animal models for severe dominant conditions. Here we show that the availability of large data sets of whole-genome sequences, high-density SNP chip genotypes and extensive recording of phenotype offers an unprecedented opportunity to quickly dissect the genetic architecture of severe dominant conditions in livestock. We report on the identification of seven dominant de novo mutations in CHD7, COL1A1, COL2A1, COPA, and MITF and exploit the structure of cattle populations to describe their clinical consequences and map modifier loci. Moreover, we demonstrate that the emergence of recessive genetic defects can be monitored by detecting de novo deleterious mutations in the genome of bulls used for artificial insemination. These results demonstrate the attractiveness of cattle as a model species in the post genomic era, particularly to confirm the genetic aetiology of isolated clinical case reports in humans.
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14
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Trevisi P, Ciorba A, Aimoni C, Bovo R, Martini A. Outcomes of long-term audiological rehabilitation in charge syndrome. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2016; 36:206-14. [PMID: 27214832 PMCID: PMC4977008 DOI: 10.14639/0392-100x-837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022]
Abstract
The aim of this paper is to assess the long-term audiological features and outcomes of hearing rehabilitation in a large group of individuals with CHARGE Syndrome. The study has been conducted retrospectively, on a paediatric patient database, at the Audiology Department of the University Hospitals of Ferrara and Padua. The study sample included 31 children presenting with different degrees of hearing impairment associated with CHARGE syndrome. Hearing was assessed using auditory brainstem responses (ABRs) and/or electrocochleography, or conditioned audiometry (visual reinforcement audiometry [VRA] or play audiometry). Auditory-perceptual outcomes in terms of communication skills and expressive language were also recorded. The effects of hearing rehabilitation (with hearing aids or cochlear implants) in this group of children and language outcomes after rehabilitation were monitored during long-term follow-up. The outcomes of rehabilitation measures differed in relation to the heterogeneous and often severe disabilities associated with CHARGE syndrome, e.g. developmental delay, intellectual delay, visual impairment, thin 8th nerve with retrocochlear auditory dysfunction (as described in cases of auditory neuropathy/dyssynchrony). Oral expressive language was severely impaired in most cases, even after lengthy follow-up, suggesting the need for alternative augmentative communication modes. The early identification of sensorineural hearing loss, and carefully planned rehabilitation treatments, can be of some benefit in children with CHARGE syndrome.
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Affiliation(s)
- P Trevisi
- Audiology Department, Padua University Hospital, Italy
| | - A Ciorba
- Audiology Department, Ferrara University Hospital, Italy
| | - C Aimoni
- Audiology Department, Ferrara University Hospital, Italy
| | - R Bovo
- Audiology Department, Padua University Hospital, Italy
| | - A Martini
- Audiology Department, Padua University Hospital, Italy
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15
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A case of mild CHARGE syndrome associated with a splice site mutation in CHD7. Eur J Med Genet 2016; 59:195-7. [DOI: 10.1016/j.ejmg.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/31/2023]
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16
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Chd7 cooperates with Sox10 and regulates the onset of CNS myelination and remyelination. Nat Neurosci 2016; 19:678-689. [PMID: 26928066 PMCID: PMC4846514 DOI: 10.1038/nn.4258] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022]
Abstract
Mutations in CHD7, encoding ATP-dependent chromodomain-helicase-DNA-binding protein 7, in CHARGE syndrome leads to multiple congenital anomalies including craniofacial malformations, neurological dysfunction and growth delay. Currently, mechanisms underlying the CNS phenotypes remain poorly understood. Here, we show that Chd7 is a direct transcriptional target of oligodendrogenesis-promoting factors Olig2 and Smarca4/Brg1, and is required for proper onset of CNS myelination and remyelination. Genome-occupancy analyses, coupled with transcriptome profiling, reveal that Chd7 interacts with Sox10 and targets the enhancers of key myelinogenic genes, and identify novel Chd7 targets including bone formation regulators Osterix/Sp7 and Creb3l2, which are also critical for oligodendrocyte maturation. Thus, Chd7 coordinates with Sox10 to regulate the initiation of myelinogenesis and acts as a molecular nexus of regulatory networks that account for the development of a seemingly diverse array of lineages including oligodendrocytes and osteoblasts, pointing to the hitherto previously uncharacterized Chd7 functions in white matter pathogenesis in CHARGE syndrome.
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17
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Silipigni R, Cattaneo E, Baccarin M, Fumagalli M, Bedeschi MF. Rare interstitial deletion of chromosome 2p11.2p12. Report of a new patient with developmental delay and unusual clinical features. Eur J Med Genet 2015; 59:39-42. [PMID: 26700408 DOI: 10.1016/j.ejmg.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
De novo interstitial deletions of the short arm of chromosome 2 are rare chromosomal abnormalities. Patients showing these kind of microdeletions have developmental delay/intellectual disability, minor facial anomalies including high forehead, frontal bossing, broad nasal bridge, abnormal ears and congenital defects such as skeletal and genital malformations. We describe the second child of a healthy and non consanguineous couple presenting at birth multiple malformations and minor facial anomalies. Because of the clinical findings, an array CGH analysis was performed using Agilent 60K microarray oligonucleotide. The analysis detected a 9.3 Mb deletion on the short arm of chromosome 2 at band p11.2p12 spanning the bases 77,946,599-87,277,610. The five patients previously described display a minimal common deleted region which explains the clinical features shared by all of them, while their individual characteristics might be explained by the different sizes of the deletion. The common deleted region involves several genes (CTNNA2, LRRTM1, REEP1), highly expressed in the nervous system. The deletion found in this case overlaps with most of those reported in literature but our patient displays extra clinical signs such as bilateral choanal atresia and atrial septal defect. It was impossible to find any direct correlation between the genes involved in the deletion and the choanal atresia and the heart defect. The question remains open as to whether these clinical features are a consequence of the deletion or are due to a second pathogenic event. Our case emphasizes the difficulties to find a close correlation between a large deletion and a well defined clinical picture. As only five patients with 2p11.2p12 deletions, reported in the literature are characterized by array CGH, further reports will be necessary to well define a clinical phenotype related to the 2p11.2p12 microdeletion.
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Affiliation(s)
- Rosamaria Silipigni
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Elisa Cattaneo
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Baccarin
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Università degli Studi di Milano and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Abstract
OBJECTIVE To determine whether patients with semicircular canal dysplasia have mutations in CHD7. BACKGROUND CHARGE syndrome is a nonrandom clustering of congenital anomalies, including ocular coloboma, heart defects, choanal atresia or stenosis, retarded growth and development, genital hypoplasia, and inner and outer ear anomalies including deafness. Semicircular canal dysplasia has been included as a major diagnostic criterion for CHARGE syndrome. Mutations in the gene CHD7 on chromosome 8q12.1 are a major cause of CHARGE syndrome, but the extent to which patients with semicircular canal dysplasia have CHD7 mutations is not fully understood. STUDY DESIGN Cross-sectional analysis of CHD7 in 12 patients with semicircular canal dysplasia and variable clinical features of CHARGE syndrome. RESULTS We identified 6 CHD7 mutations, 5 of which occurred in patients who fulfilled Verloes' diagnostic criteria for typical CHARGE syndrome, and three of which were previously unreported. Of the 3 remaining CHD7 mutation-positive patients, one had atypical CHARGE by diagnostic criteria. Four MRI records were available, which revealed 2 patients with cochlear nerve aplasia and 1 patient with Chiari 1 malformation. CONCLUSION These data provide additional evidence that CHD7 mutations are a significant cause of semicircular canal atresia in children with full or partial CHARGE syndrome.
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Birman CS, Brew JA, Gibson WPR, Elliott EJ. CHARGE syndrome and Cochlear implantation: difficulties and outcomes in the paediatric population. Int J Pediatr Otorhinolaryngol 2015; 79:487-92. [PMID: 25649713 DOI: 10.1016/j.ijporl.2015.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES CHARGE syndrome is a complex cluster of congenital abnormalities, these children may have absent or hypoplastic auditory nerves. Our objective was to assess preoperative factors and outcomes for paediatric cochlear implant recipients with CHARGE syndrome, to enable better surgical preparation and family counselling. METHODS The Sydney Cochlear Implant Centre database was searched for children with CHARGE syndrome who had received a cochlear implant at ages 16 and less. Data were collected regarding clinical history; hearing assessments; MRI and CT scan findings; preoperative transtympanic electrical Auditory Brainstem Response (ABR); intraoperative findings and intraoperative electrical ABR and Neural Response Telemetry; and language outcomes in terms of main language used and Categories of Auditory Performance scores (0-7 ranking). RESULTS Ten children were identified. All seven prelingual profoundly deaf children with CHARGE syndrome had hypoplastic or absent auditory nerves bilaterally on MRI scans. Middle ear anatomy was often abnormal, affecting surgical landmarks and making identification of the cochlea very difficult in some cases. Three cases required repeated surgery to obtain successful cochlear implant insertion, one under CT scan image guided technique. All seven children used sign language, or simpler gestures, as their main mode of communication. Two children of of these children, who were implanted early, also attained some spoken language. CAP scores ranged from 0 to 6. The three children with CHARGE syndrome and progressive sensorineural hearing loss had a normal auditory nerve in at least one ear on MRI scans. All had preoperative verbal language, with CAP scores of 6, and continued with CAP scores of 6 following receipt of the cochlear implant. CONCLUSION Children with CHARGE and congenital profound hearing loss all had hypoplasia or absent auditory nerves, affecting their outcomes with cochlear implants. They often had markedly abnormal middle ear anatomy and CT image guided surgery can be helpful. These children should be offered a bilingual early intervention approach, using sign language and verbal language, to ensure best language outcomes. Children with CHARGE syndrome and progressive profound hearing loss did well with cochlear implants and continue to be able to use verbal language.
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Affiliation(s)
- Catherine S Birman
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia; Sydney Children's Hospital Network (Children's Hospital at Westmead), Hawkesbury Road, Westmead 2145, NSW, Australia; The Sydney Cochlear Implant Centre, Royal Institute for Deaf and Blind Children, PO Box 188, Gladesville 1675, NSW, Australia; Department of Linguistics, Faculty of Human Sciences, Macquarie University, North Ryde, Australia.
| | - Jane A Brew
- The Sydney Cochlear Implant Centre, Royal Institute for Deaf and Blind Children, PO Box 188, Gladesville 1675, NSW, Australia
| | - William P R Gibson
- Sydney Children's Hospital Network (Children's Hospital at Westmead), Hawkesbury Road, Westmead 2145, NSW, Australia; The Sydney Cochlear Implant Centre, Royal Institute for Deaf and Blind Children, PO Box 188, Gladesville 1675, NSW, Australia; Emeritus Professor, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia; Sydney Children's Hospital Network (Children's Hospital at Westmead), Hawkesbury Road, Westmead 2145, NSW, Australia
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Hsu P, Ma A, Wilson M, Williams G, Curotta J, Munns CF, Mehr S. CHARGE syndrome: a review. J Paediatr Child Health 2014; 50:504-11. [PMID: 24548020 DOI: 10.1111/jpc.12497] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 11/30/2022]
Abstract
CHARGE syndrome is a complex genetic syndrome, owing to the wide range of tissues/systems affected by mutations in the CHD7 gene. In this review, we discuss the diagnosis, clinical features and management of CHARGE syndrome.
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Affiliation(s)
- Peter Hsu
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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21
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Hughes SS, Welsh HI, Safina NP, Bejaoui K, Ardinger HH. Family history and clefting as major criteria for CHARGE syndrome. Am J Med Genet A 2013; 164A:48-53. [PMID: 24214489 DOI: 10.1002/ajmg.a.36192] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/16/2013] [Indexed: 11/09/2022]
Abstract
CHARGE syndrome is an autosomal dominant malformation syndrome associated with mutations in CHD7. The condition is typically sporadic with few familial cases reported. The diagnosis of CHARGE syndrome is based on a combination of major and minor criteria comprised of structural and functional abnormalities, most of which are part of the original CHARGE acronym, although additional anomalies have been added. To date, family history has not been considered in the diagnostic criteria. Here we report a family with a previously unreported missense mutation in exon 31 of CHD7, in which family history played a role in the diagnosis of CHARGE syndrome. Given the tremendous phenotypic variability and the dominant nature of CHARGE syndrome, we propose that family history be included as a major diagnostic criterion. A positive family history would include any individual with an apparently isolated unilateral major CHARGE anomaly or someone with a few of the minor features. Our cases support this proposal; had family history not been considered in this case, CHD7 testing might not have been pursued, leading to incomplete medical follow-up and erroneous genetic counseling. Additionally, with the increased incidence of orofacial clefting in this family, as well as in the literature, we suggest that cleft lip and/or palate be added to the major diagnostic criteria for CHARGE syndrome.
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Abstract
CHARGE syndrome is a condition that has historically been diagnosed on the basis of the clinical findings of coloboma, heart disease, choanal atresia, restricted growth, and/or central nervous system anomalies, genital hypoplasia, and ear anomalies and/or deafness. Recently, researchers have discovered a genetic link, specifically, a strong association between the CHARGE phenotype and a mutation of the CHD 7 gene on the long arm of chromosome 8. Diagnosis now can be confirmed but not excluded with a positive mutation of this gene. This article offers an explanation of the diagnostic process as well as a description of the physical assessment and corresponding clinical implications of CHARGE syndrome in the neonatal population.
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Obstructive Sleep Apnea in a Patient with CHARGE Syndrome. Case Rep Otolaryngol 2012; 2012:907032. [PMID: 22970397 PMCID: PMC3434378 DOI: 10.1155/2012/907032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/02/2012] [Indexed: 11/17/2022] Open
Abstract
CHARGE syndrome is a genetic disorder characterized by choanal atresia, coloboma of the eye, and ear and cranial nerve abnormalities. We report a child with CHARGE syndrome and obstructive sleep apnea. We highlight difficulties in discerning obstructive sleep apnea-related symptoms from typical features of CHARGE syndrome. Treatment options are discussed with regard to our patient. Tonsillectomy and adenoidectomy improved physical symptoms of obstructive sleep apnea in the patient.
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Understanding obstructive sleep apnea in children with CHARGE syndrome. Int J Pediatr Otorhinolaryngol 2012; 76:947-53. [PMID: 22542139 DOI: 10.1016/j.ijporl.2012.02.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/24/2012] [Accepted: 02/26/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CHARGE syndrome occurs in approximately 1 in 8500 live births and is diagnosed clinically by combinations of major characteristics: choanal atresia, coloboma, characteristic ears, cranial nerve abnormalities and distinct temporal bone anomalies. More than 50% of children with CHARGE syndrome experience sleep disturbances, with obstructive sleep apnea being one diagnosis. Objectives of this study were to develop a better understanding of the prevalence, symptomatology and treatments of sleep apnea in CHARGE syndrome. Secondary aims were to determine the usefulness of questionnaires examining obstructive sleep apnea in a CHARGE syndrome population. METHODS Parents of 51 children with CHARGE syndrome (aged 0-14 years) were recruited between May 2010 and July 2011. Genetic testing and/or clinical criteria confirmed diagnosis of CHARGE syndrome. Questionnaires completed by parents included one covering CHARGE characteristics and three previously validated questionnaires: the Brouilette Score Questionnaire, the Pediatric Sleep Questionnaire and the OSA-18 Quality of Life Questionnaire. SPSS 19.0 was used for statistical calculations. RESULTS Previous diagnosis of obstructive sleep apnea was present in 65% of the study population. Treatments included continuous positive airway pressure, tonsillectomy and/or adenoidectomy, and tracheostomy. Brouilette scores identified the presence of obstructive sleep apnea in the CHARGE syndrome population studied and indicated statistically significant (p=<0.001) improvements following treatment, which were comparable to the general population. Only the subscales of snoring and daytime sleepiness were useful in identifying obstructive sleep apnea using the Pediatric Sleep Questionnaire. The OSA-18 Questionnaire indicated that residual symptoms affecting quality of life may be present in the CHARGE syndrome population after treatment for obstructive sleep apnea. CONCLUSIONS Obstructive sleep apnea appears to be prevalent in children with CHARGE syndrome. All conventional treatments for obstructive sleep apnea reduce symptomatology. Brouilette scores are useful in identifying obstructive sleep apnea in the CHARGE syndrome population. The Pediatric Sleep Questionnaire could be useful once modified. The OSA-18 Questionnaire would be most useful as a means to measure quality of life gains following treatment.
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Janssen N, Bergman JEH, Swertz MA, Tranebjaerg L, Lodahl M, Schoots J, Hofstra RMW, van Ravenswaaij-Arts CMA, Hoefsloot LH. Mutation update on the CHD7 gene involved in CHARGE syndrome. Hum Mutat 2012; 33:1149-60. [DOI: 10.1002/humu.22086] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 03/06/2012] [Indexed: 12/17/2022]
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Blake KD, MacCuspie J, Corsten G. Botulinum toxin injections into salivary glands to decrease oral secretions in CHARGE syndrome: prospective case study. Am J Med Genet A 2012; 158A:828-31. [PMID: 22419601 DOI: 10.1002/ajmg.a.33241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 11/21/2009] [Indexed: 01/15/2023]
Abstract
CHARGE syndrome is a genetic disorder caused by a mutation in the CHD7 gene on chromosome 8. Major clinical diagnostic criteria for this heterogeneous disorder include ocular coloboma, choanal atresia/stenosis, characteristic external and internal ear abnormalities, and cranial nerve abnormalities. Patients with CHARGE syndrome often have dysphagia and are at high risk for aspiration of both upper and lower gastrointestinal secretions. The following case-report describes the use of Botulinum toxin A (Botox) to reduce excess salivary secretions in a ventilator dependant infant who would have required a tracheotomy. Thereafter, Botox was used regularly (4-5 months) to decrease the salivary secretions. This case-report is unique in that it describes the intermittent and prospective use of Botox to reduce excess salivary secretions and prevent the resulting aspiration-related complications in an infant with CHARGE syndrome.
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Affiliation(s)
- Kim D Blake
- Department of Pediatrics, IWK Health Center, Halifax, Nova Scotia, Canada.
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Hamizan AW, Yean KT, Abdullah A. Congenital bilateral facial nerve hypoplasia with sensorineural hearing loss: a case report. Int J Pediatr Otorhinolaryngol 2012; 76:455-9. [PMID: 22281372 DOI: 10.1016/j.ijporl.2012.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/31/2011] [Accepted: 01/02/2012] [Indexed: 11/16/2022]
Abstract
A 3-year-old child presented with congenital bilateral facial nerve palsy with bilateral profound sensorineural hearing loss. High Resolution Computed Tomogram (HRCT) of the temporal bones found bilateral atresia of cochlear nerve canals, incomplete partition of the cochleae and narrow facial nerve canals. Magnetic resonance imaging (MRI) revealed bilateral hypoplasia of facial nerves and aplasia of both vestibulocochlear nerves. There have been no other reported cases with this presentation. The possible aetiology and treatment options for the patient are discussed. We highlighted the review of aplasia/hypoplasia of the facial nerve and hypoplasia of cochlear nerve canal.
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Affiliation(s)
- Aneeza W Hamizan
- Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
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Patten SA, Jacobs-McDaniels NL, Zaouter C, Drapeau P, Albertson RC, Moldovan F. Role of Chd7 in zebrafish: a model for CHARGE syndrome. PLoS One 2012; 7:e31650. [PMID: 22363697 PMCID: PMC3282775 DOI: 10.1371/journal.pone.0031650] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/10/2012] [Indexed: 11/19/2022] Open
Abstract
CHARGE syndrome is caused by mutations in the CHD7 gene. Several organ systems including the retina, cranial nerves, inner ear and heart are affected in CHARGE syndrome. However, the mechanistic link between mutations in CHD7 and many of the organ systems dysfunction remains elusive. Here, we show that Chd7 is required for the organization of the neural retina in zebrafish. We observe an abnormal expression or a complete absence of molecular markers for the retinal ganglion cells and photoreceptors, indicating that Chd7 regulates the differentiation of retinal cells and plays an essential role in retinal cell development. In addition, zebrafish with reduced Chd7 display an abnormal organization and clustering of cranial motor neurons. We also note a pronounced reduction in the facial branchiomotor neurons and the vagal motor neurons display aberrant positioning. Further, these fish exhibit a severe loss of the facial nerves. Knock-down of Chd7 results in a curvature of the long body axis and these fish develop irregular shaped vertebrae and have a reduction in bone mineralization. Chd7 knockdown also results in a loss of proper segment polarity illustrated by flawed efnb2a and ttna expression, which is associated with later vascular segmentation defects. These critical roles for Chd7 in retinal and vertebral development were previously unrecognized and our results provide new insights into the role of Chd7 during development and in CHARGE syndrome pathogenesis.
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Affiliation(s)
- Shunmoogum A. Patten
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- Faculty of Dentistry, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Pierre Drapeau
- Department of Pathology and Cell Biology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - R. Craig Albertson
- Department of Biology, Syracuse University, Syracuse, New York, USA
- Department of Biology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Florina Moldovan
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- Faculty of Dentistry, University of Montreal, Montreal, Quebec, Canada
- * E-mail:
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Bilan F, Legendre M, Charraud V, Manière B, Couet D, Gilbert-Dussardier B, Kitzis A. Complete Screening of 50 Patients with CHARGE Syndrome for Anomalies in the CHD7 Gene Using a Denaturing High-Performance Liquid Chromatography–Based Protocol. J Mol Diagn 2012; 14:46-55. [DOI: 10.1016/j.jmoldx.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/07/2011] [Accepted: 08/02/2011] [Indexed: 10/16/2022] Open
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Prades JM, Elmaleh-Berges M, Chatard S, Veyret C, Martin C, Richard C. [Computed tomography of the normal and pathologic temporal bone]. Morphologie 2011; 95:159-169. [PMID: 22079599 DOI: 10.1016/j.morpho.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
High-resolution computed tomography scanning (CT) allows depiction of microanatomic structures of the temporal bone. CT is useful for detecting several pathologic conditions of the temporal bone such as congenital malformations, particularly in young children with sensorineural hearing loss. Some external, middle and inner ear structures are difficult to evaluate. The objective of this study has been to provide the key planes in coronal and axial planes (five coronal planes and three axial planes) but also with oblique planes reconstruction (two planes) for normal temporal bones evaluation. These standardized planes help to improve visualization of the main congenital malformations. Identification of obvious morphogenetic malformations (Michel aplasia, Mondini deformity….) is not difficult. However, less severe dysplasia may be missed or normal micro anatomic structures in newborn misreaded.
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Affiliation(s)
- J-M Prades
- Laboratoire d'anatomie, service d'ORL et de chirurgie cervico-faciale, faculté de médecine J.-Lisfranc, hôpital Nord, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.
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Seyyedi M, Eddington DK, Nadol JB. Interaural comparison of spiral ganglion cell counts in profound deafness. Hear Res 2011; 282:56-62. [PMID: 22008826 DOI: 10.1016/j.heares.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/23/2011] [Accepted: 10/04/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study is designed to measure the degree to which spiral ganglion cell (SGC) survival in the left and right ears is similar in profoundly hearing-impaired human patients with symmetric (right/left) etiology and sensitivity. This is of interest because a small difference between ears would imply that one ear could be used as a control ear in temporal bone studies evaluating the impact on SGC survival of a medical intervention in the other ear. MATERIALS AND METHODS Forty-two temporal bones from 21 individuals with bilaterally symmetric profound hearing impairment were studied. Both ears in each individual were impaired by the same etiology. Rosenthal's canal was reconstructed in two dimensions and segmental and total SGCs were counted. Correlation analysis and t-tests were used to compare segmental and total counts of left and right ears. Statistical power calculations illustrate how the results can be used to estimate the effect size (right/left difference in SGC count) that can be reliably identified as a function of sample size. RESULTS Left counts (segmental and total) were significantly correlated with those in the right ears (p < 0.01) and the coefficients of determination for segments 1 to 4 and total count were respectively 0.64, 0.91, 0.93, 0.91 and 0.98. The hypothesis that mean segmental and total counts of right and left are the same could not be rejected by paired t-test. CONCLUSION The variance in the between-ear difference across the temporal bones studied indicates that useful effect sizes can be reliably identified using subject numbers that are practical for temporal bone studies. For instance, there is 95% likelihood that an interaural difference in SGC count of approximately 1000 cells associated with a treatment/manipulation of one ear will be reliably detected in a bilaterally-symmetric profound hearing loss population of temporal bones from approximately 10 subjects.
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Affiliation(s)
- Mohammad Seyyedi
- Department of Otology and Laryngology, 243 Charles Street, Harvard Medical School, Boston, MA 02114, USA
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Hurd EA, Adams ME, Layman WS, Swiderski DL, Beyer LA, Halsey KE, Benson JM, Gong TW, Dolan DF, Raphael Y, Martin DM. Mature middle and inner ears express Chd7 and exhibit distinctive pathologies in a mouse model of CHARGE syndrome. Hear Res 2011; 282:184-95. [PMID: 21875659 DOI: 10.1016/j.heares.2011.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/15/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
Heterozygous mutations in the gene encoding chromodomain-DNA-binding-protein 7 (CHD7) cause CHARGE syndrome, a multiple anomaly condition which includes vestibular dysfunction and hearing loss. Mice with heterozygous Chd7 mutations exhibit semicircular canal dysgenesis and abnormal inner ear neurogenesis, and are an excellent model of CHARGE syndrome. Here we characterized Chd7 expression in mature middle and inner ears, analyzed morphological features of mutant ears and tested whether Chd7 mutant mice have altered responses to noise exposure and correlated those responses to inner and middle ear structure. We found that Chd7 is highly expressed in mature inner and outer hair cells, spiral ganglion neurons, vestibular sensory epithelia and middle ear ossicles. There were no obvious defects in individual hair cell morphology by prestin immunostaining or scanning electron microscopy, and cochlear innervation appeared normal in Chd7(Gt)(/+) mice. Hearing thresholds by auditory brainstem response (ABR) testing were elevated at 4 and 16 kHz in Chd7(Gt)(/+) mice, and there were reduced distortion product otoacoustic emissions (DPOAE). Exposure of Chd7(Gt)(/+) mice to broadband noise resulted in variable degrees of hair cell loss which inversely correlated with severity of stapedial defects. The degrees of hair cell loss and threshold shifts after noise exposure were more severe in wild type mice than in mutants. Together, these data indicate that Chd7(Gt)(/+) mice have combined conductive and sensorineural hearing loss, correlating with changes in both middle and inner ears.
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Affiliation(s)
- Elizabeth A Hurd
- Department of Pediatrics, 3520A MSRB I, University of Michigan, Ann Arbor, MI 48109-5652, USA.
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Lin AE, Singh KE, Strauss A, Nguyen S, Rawson K, Kimonis VE. An additional patient with mycophenolate mofetil embryopathy: Cardiac and facial analyses. Am J Med Genet A 2011; 155A:748-56. [DOI: 10.1002/ajmg.a.33934] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/17/2011] [Indexed: 11/12/2022]
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Milunsky JM, Maher TM, Zhao G, Wang Z, Mulliken JB, Chitayat D, Clemens M, Stalker HJ, Bauer M, Burch M, Chénier S, Cunningham ML, Drack AV, Janssens S, Karlea A, Klatt R, Kini U, Klein O, Lachmeijer AM, Megarbane A, Mendelsohn NJ, Meschino WS, Mortier GR, Parkash S, Ray CR, Roberts A, Roberts A, Reardon W, Schnur RE, Smith R, Splitt M, Tezcan K, Whiteford ML, Wong DA, Zori R, Lin AE. Genotype-phenotype analysis of the branchio-oculo-facial syndrome. Am J Med Genet A 2010; 155A:22-32. [DOI: 10.1002/ajmg.a.33783] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bergman JEH, Blake KD, Bakker MK, du Marchie Sarvaas GJ, Free RH, van Ravenswaaij-Arts CMA. Death in CHARGE syndrome after the neonatal period. Clin Genet 2010; 77:232-40. [PMID: 20447140 DOI: 10.1111/j.1399-0004.2009.01334.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CHARGE syndrome is a multiple congenital anomaly syndrome that can be life-threatening in the neonatal period. Complex heart defects, bilateral choanal atresia, esophageal atresia, severe T-cell deficiency, and brain anomalies can cause neonatal death. As little is known about the causes of death in childhood and adolescence, we studied post-neonatal death in patients with CHARGE syndrome. We collected medical data on three deceased children from a follow-up cohort of 48 CHARGE patients and retrospectively on an additional four deceased patients (age at death 11 months to 22 years). We analyzed the factors that had contributed to their death. In five patients respiratory aspiration had most likely contributed to premature death, one died of post-operative complications, and another choked during eating. From our findings and a literature review, we suggest that swallowing problems, gastro-esophageal reflux disease, respiratory aspiration and post-operative airway events are important contributors to post-neonatal death in CHARGE syndrome. Cranial nerve dysfunction is proposed as the underlying pathogenic mechanism. We recommend every CHARGE patient with feeding difficulties to be assessed by a multidisciplinary team to evaluate cranial nerve function and swallowing. Timely treatment of swallowing problems and gastro-esophageal reflux disease is important. Surgical procedures on these patients should be combined whenever possible because of their increased risk of post-operative complications and intubation problems. Finally, we recommend performing autopsy in deceased CHARGE patients in order to gain more insight into causes of death.
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Affiliation(s)
- J E H Bergman
- Department of Genetics, University of Groningen, Groningen, the Netherlands
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CHARGE: an association or a syndrome? Int J Pediatr Otorhinolaryngol 2010; 74:719-22. [PMID: 20363513 DOI: 10.1016/j.ijporl.2010.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/03/2010] [Accepted: 03/08/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION CHARGE "association" is a rare clinical entity with multiple congenital anomalies that necessitates a multidisciplinary approach. Its diagnosis is important not only for the pediatric surgery practice but also for the otorhinolaryngology practice as it complicates with a number of major surgical anomalies. The aim of this paper is to present the latest evidences on the genetic basis of the disease. MATERIALS AND METHODS In order to evaluate, a computed literature review was undertaken using PubMed and OMIM databases. RESULTS Heterozygous mutations within the chromodomain helicase DNA binding protein 7 (CHD7) were reported in every two of three CHARGE patients. CHD protein family is located on chromosome 8q11.2 and is known to regulate chromatin remodeling which plays an essential role in the developmental gene expression. That is why the haploinsufficiency of CHD7 gene due to heterozygous mutations results in not only the postnatal but also the prenatal developmental regulation errors. The wide expression of this gene in the prenatal period overlaps with the broad spectrum of the phenotypic symptoms of the disease. CONCLUSION CHD7 gene haploinsufficiency is expected to be the underlying basis of CHARGE. Even though the genetic basis is unsolved in one-third of the patients, the current evidence supports the term "syndrome" rather than an "association" should be more appropriate for CHARGE.
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Glueckert R, Rask-Andersen H, Sergi C, Schmutzhard J, Mueller B, Beckmann F, Rittinger O, Hoefsloot LH, Schrott-Fischer A, Janecke AR. Histology and synchrotron radiation-based microtomography of the inner ear in a molecularly confirmed case of CHARGE syndrome. Am J Med Genet A 2010; 152A:665-73. [PMID: 20186814 DOI: 10.1002/ajmg.a.33321] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CHARGE (Coloboma of the iris or retina, heart defects, atresia of the choanae, retardation of growth and/or development, genital anomalies, ear anomalies) syndrome (OMIM #214800) affects about 1 in 10,000 children and is most often caused by chromodomain helicase DNA-binding protein-7 (CHD7) mutations. Inner ear defects and vestibular abnormalities are particularly common. Specifically, semicircular canal (SCC) hypoplasia/aplasia and the presence of a Mondini malformation can be considered pathognomonic in the context of congenital malformations of the CHARGE syndrome. We obtained a temporal bone (TB) of a patient with CHARGE syndrome who died from bacteremia at 3 months of age. The clinical diagnosis was confirmed in the patient by direct DNA sequencing and the detection of a de novo, truncating CHD7 mutation, c.6169dup (p.R2057fs). We assessed changes of the TB and the degree of neural preservation, which may influence the potential benefit of cochlear implantation. The TB was analyzed using synchrotron radiation-based micro computed tomography, and by light microscopy. The vestibular partition consisted of a rudimentary vestibule with agenesis of the SCCs. The cochlea was hypoplastic with poor or deficient interscaling and shortened (Mondini dysplasia). The organ of Corti had near normal structure and innervation. Modiolus and Rosenthal's canal were hypoplastic with perikarya displaced along the axon bundles into the internal acoustic meatus, which may be explained by the arrest or limited migration and translocation of the cell nuclei into the cochlear tube during development.
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Affiliation(s)
- Rudolf Glueckert
- Department of Otolaryngology, Medical University Innsbruck, Innsbruck, Austria
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Abstract
OBJECTIVE The CHARGE syndrome is associated with ear anomalies and deafness in addition to other malformations. Deformations of the ossicles or aplasia of the semicircular canals, cochlear hypoplasia, hypoplasia or aplasia of the VIIIth cranial nerve and abnormal routing of the VIIth cranial nerve, sigmoid sinus, and emissaries are typical findings. The aim of this study is to explore the feasibility and procedure of cochlear implantation in patients with CHARGE syndrome and to assess the outcome. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center; cochlear implant program. PATIENTS Ten patients with CHARGE syndrome and 3 patients with CHARGE-like syndrome treated in our center due to hearing impairment. Eleven patients were congenitally deaf, 1 patient had progressive hearing loss, and 1 patient had mixed hearing loss. INTERVENTION Computed tomography of temporal bones and magnetic resonance imaging of the brain; bone-anchored hearing aid surgery, cochlear implantation, rehabilitation results. MAIN OUTCOME MEASURES Surgical suitability and hearing rehabilitation. RESULTS We illustrate the management of preoperative diagnostics, surgical planning, and hearing rehabilitation. One patient with mixed hearing loss underwent bilateral bone-anchored hearing aid surgery. Because 2 patients had bilateral aplasia of the auditory nerves, we recommended an auditory brainstem implant. The unilateral cochlear implantation was performed in 9 patients and bilateral in 1 patient. In selected cases, it was helpful to plan the operation using a simulator for temporal bone surgery. Complex malformations, such as in CHARGE syndrome, with an increased intraoperative risk for complications should be facilitated by using intraoperative digital volume tomography-assisted navigation and intraoperative digital volume tomography control of electrode position. The results after CI surgery vary due to the differing extent of additional disabilities such as developmental delay, intellectual delay, and visual impairment. Nine of our patients showed improved responsiveness with the cochlear implant. Open speech comprehension could not be observed in 8 patients, whereas the follow-up period was less than 1 year in 4 patients. The relatively high age of our patients at implantation might be an important factor. CONCLUSION Careful planning of the treatment of CHARGE syndrome patients with sensorineural hearing loss can, to a limited extent, lead to auditory benefit without increasing surgical complications. Cochlear implantation is therefore indicated after critical assessment.
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Bergman JEH, Bosman EA, van Ravenswaaij-Arts CMA, Steel KP. Study of smell and reproductive organs in a mouse model for CHARGE syndrome. Eur J Hum Genet 2009; 18:171-7. [PMID: 19809474 PMCID: PMC2987182 DOI: 10.1038/ejhg.2009.158] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
CHARGE syndrome is a multiple congenital anomaly syndrome characterised by Coloboma, Heart defects, Atresia of choanae, Retardation of growth and/or development, Genital hypoplasia, and Ear anomalies often associated with deafness. It is caused by heterozygous mutations in the CHD7 gene and shows a highly variable phenotype. Anosmia and hypogonadotropic hypogonadism occur in the majority of the CHARGE patients, but the underlying pathogenesis is unknown. Therefore, we studied the ability to smell and aspects of the reproductive system (reproductive performance, gonadotropin-releasing hormone (GnRH) neurons and anatomy of testes and uteri) in a mouse model for CHARGE syndrome, the whirligig mouse (Chd7Whi/+). We showed that Chromodomain Helicase DNA-binding protein 7 (Chd7) is expressed in brain areas involved in olfaction and reproduction during embryonic development. We observed poorer performance in the smell test in adult Chd7Whi/+ mice, secondary either to olfactory dysfunction or to balance disturbances. Olfactory bulb and reproductive organ abnormalities were observed in a proportion of Chd7Whi/+ mice. Hypothalamic GnRH neurons were slightly reduced in Chd7Whi/+ females and reproductive performance was slightly less in Chd7Whi/+ mice. This study shows that the penetrance of anosmia and hypogonadotropic hypogonadism is lower in Chd7Whi/+ mice than in CHARGE patients. Interestingly, many phenotypic features of the Chd7 mutation showed incomplete penetrance in our model mice, despite the use of inbred, genetically identical mice. This supports the theory that the extreme variability of the CHARGE phenotype in both humans and mice might be attributed to variations in the fetal microenvironment or to purely stochastic events.
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Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Stoetzel C, Riehm S, Bennouna Greene V, Pelletier V, Vigneron J, Leheup B, Marion V, Hellé S, Danse J, Thibault C, Moulinier L, Veillon F, Dollfus H. Confirmation ofTFAP2Agene involvement in branchio-oculo-facial syndrome (BOFS) and report of temporal bone anomalies. Am J Med Genet A 2009; 149A:2141-6. [DOI: 10.1002/ajmg.a.33015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vervloed MPJ, Hoevenaars-van den Boom MAA, Knoors H, van Ravenswaaij CMA, Admiraal RJC. CHARGE syndrome: relations between behavioral characteristics and medical conditions. Am J Med Genet A 2009; 140:851-62. [PMID: 16532469 DOI: 10.1002/ajmg.a.31193] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The behaviors and medical problems in 27 persons with CHARGE syndrome were studied, because it was hypothesized that their behavior might be partly dependent on the heterogeneous medical status. With the exception of more tics, cardiac surgery was associated with positive behaviors: less withdrawn behavior, better mood, and a more easy temperament. Tube feeding was also related to positive behavior, since participants with a history of tube feeding showed less intense behavior. Cerebral deficits were associated with three problem behaviors: more intense and withdrawn behavior and a worse mood. Deaf-blindness was associated with developmental delays in expressive and overall communication level, and recurrent middle ear infections correlated with delays in written language. Of all medical conditions, only the presence or absence of heart defects and cardiac surgery could differentiate between the participants with regard to the number of behavioral problems. Participants with heart surgery especially, had less behavior problems. The number of operations and hospitalizations was not associated with behavior, but the total length of the hospitalizations was. Long hospital stays were associated with less problem behavior, especially internalizing behaviors. Cerebral and heart problems did not result in longer hospital stays, whereas esophageal reflux did. Age effects were reflected in older participants, who showed more internalizing problems. Heart surgery and hospitalization may be protective factors, but the protection might not be the actual surgery or hospital stay, as there may be other variables that are the actual cause, such as reduced vitality or altered parent child interactions after heart surgery. The study could not confirm a significant association between medical conditions and autism found in previous studies.
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Affiliation(s)
- Mathijs P J Vervloed
- Department of Special Education, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Lee YW, Kim SC, Shin YL, Kim JW, Hong HS, Lee YK, Ki CS. Clinical and genetic analysis of the CHD7 gene in Korean patients with CHARGE syndrome. Clin Genet 2009; 75:290-3. [PMID: 19159393 DOI: 10.1111/j.1399-0004.2008.01127.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bault JP, Quarello E. Retinal coloboma: prenatal diagnosis using a new technique, the 'virtual fetal eyeground'. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:495-496. [PMID: 19308931 DOI: 10.1002/uog.6360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J-P Bault
- Centre d'Echographie Ambroise Paré, Les Mureaux, France.
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Blake K, MacCuspie J, Hartshorne TS, Roy M, Davenport SLH, Corsten G. Postoperative airway events of individuals with CHARGE syndrome. Int J Pediatr Otorhinolaryngol 2009; 73:219-26. [PMID: 19058860 DOI: 10.1016/j.ijporl.2008.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 10/07/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE CHARGE syndrome is a heterogeneous genetic disorder comprising multiple congenital anomalies. Major clinical diagnostic criteria include ocular coloboma, choanal atresia/stenosis, characteristic ear abnormalities, and cranial nerve abnormalities. CHARGE syndrome is caused by a mutation in the gene CHD7 located on chromosome 8. Patients with CHARGE syndrome require multiple anesthetics for surgical and otorhinolaryngology procedures. This study describes the postoperative anesthetic related airway events (i.e. re-intubations for apneas and desaturations, airway obstruction due to excessive secretions) of nine individuals with CHARGE syndrome. METHODS Detailed chart audits were performed on nine patients diagnosed clinically with CHARGE syndrome who had undergone surgery at a single tertiary health centre. The CHARGE characteristics present in each individual, the number and types of surgeries and anesthetics, and the related postoperative airway events were determined. RESULTS The mean+/-age of the population at chart review was 11.8 years (+/-8.0). The total number of anesthetics was 147, with a mean of 16.2(+/-8.4). Of the 215 surgical procedures (mean 21.9, +/-12.2), 30% were otorhinolaryngological. Postoperative airway events occurred after 35% of anesthetics. Surgeries resulting in the most airway events involved the heart (65%), the gastrointestinal tract (39%), and airway diagnostic scopes, i.e., bronchoscopy, laryngoscopy, and nasopharyngoscopy (36%). Combining multiple surgical procedures under one anesthetic did not increase the risk of postoperative airway events. As individuals aged, they had fewer surgeries and anesthetics, as well as a lower risk of postoperative airway events. CONCLUSION Individuals with CHARGE syndrome face a significant risk of postoperative airway events with anesthesia, and this is exacerbated by the high number of surgeries they require. Surgeons and anesthesiologists should be aware of potential for postoperative airway events in individuals with CHARGE syndrome and plan accordingly.
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Affiliation(s)
- Kim Blake
- Department of Pediatrics, Dalhousie University, Canada.
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Hoover-Fong J, Savage WJ, Lisi E, Winkelstein J, Thomas GH, Hoefsloot LH, Loeb DM. Congenital T cell deficiency in a patient with CHARGE syndrome. J Pediatr 2009; 154:140-2. [PMID: 19187738 PMCID: PMC4293037 DOI: 10.1016/j.jpeds.2008.07.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 06/17/2008] [Accepted: 07/22/2008] [Indexed: 12/14/2022]
Abstract
CHARGE syndrome is an autosomal dominant condition caused by mutations in chromodomain helicase DNA-binding 7. We report a patient with molecularly confirmed CHARGE syndrome, which included a congenital T cell deficiency, who was treated with peripheral blood mononuclear cell transplantation.
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Affiliation(s)
- Julie Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.
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McMain K, Blake K, Smith I, Johnson J, Wood E, Tremblay F, Robitaille J. Ocular features of CHARGE syndrome. J AAPOS 2008; 12:460-5. [PMID: 18455933 DOI: 10.1016/j.jaapos.2008.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 01/25/2008] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To detail the presence and severity of ocular and cranial nerve abnormalities found in individuals with CHARGE syndrome in a distinct geographic area. METHODS Nine individuals with CHARGE syndrome from Maritime Canada identified from a Canadian database were prospectively examined. Structural and sensorial defects associated with functional visual deficits were defined with ophthalmic and neurological evaluation. RESULTS Consistent with current diagnostic criteria and the literature, colobomas were the major ophthalmic manifestation. These were typically bilateral chorioretinal colobomas involving the optic nerve. All subjects had bilateral severe sensorineural deafness (cranial nerve VIII), and 8 of 9 (89%) had facial nerve (cranial nerve VII) involvement (7 of 9 had unilateral involvement; 1 of 9 had bilateral involvement). Unique to this group of participants were the findings of anisometropia in 8 of the 9 (89%) patients, severe myopic astigmatism in 13 of the 18 eyes (72%), and limited elevation in adduction in 3 of 9 (33%) participants. Associated findings were strabismus, cataracts, microcornea, keratopathy, staphyloma, reduced stereopsis, superior visual field defects, and reduced visual acuity. CONCLUSIONS The presence of coloboma plus another CHARGE feature warrants further investigation, including genetic screening for the CHD7 gene. Early recognition and management of sensory problems (visual, auditory, and vestibular) are crucial to ensure best psychomotor and cognitive development.
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Affiliation(s)
- Karen McMain
- Clinical Vision Science, Dalhousie University, Halifax, Nova Scotia, Canada.
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Bergman JEH, de Wijs I, Jongmans MCJ, Admiraal RJ, Hoefsloot LH, van Ravenswaaij-Arts CMA. Exon copy number alterations of the CHD7 gene are not a major cause of CHARGE and CHARGE-like syndrome. Eur J Med Genet 2008; 51:417-25. [PMID: 18472328 DOI: 10.1016/j.ejmg.2008.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 03/27/2008] [Indexed: 11/27/2022]
Abstract
CHARGE syndrome is a multiple congenital anomaly syndrome caused by mutations in the CHD7 gene. Mutations in this gene are found in 60-70% of patients suspected of having CHARGE syndrome. However, if only typical CHARGE patients are taken into account, mutations in the CHD7 gene are found in over 90% of cases. The remaining 10% might be caused by hitherto undetected alterations of the CHD7 gene, including whole exon duplications and deletions that are missed by the currently used diagnostic procedures. Therefore we looked for these kinds of alterations by multiplex ligation-dependent probe amplification in 54 patients suspected of having CHARGE syndrome without a CHD7 mutation. In one patient a partial deletion of the CHD7 gene (exons 13-38) was identified, while in the other patients no abnormalities were found. The frequency of exon deletions in our cohort was 1.9% (1/54) and 5.6% (1/18) in all patients and in typical CHARGE patients, respectively. We conclude that exon copy number alterations of the CHD7 gene are not a major cause of CHARGE and CHARGE-like syndrome.
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Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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Skull base vascular anomaly in CHARGE syndrome: a case report and review. Int J Pediatr Otorhinolaryngol 2008; 72:535-9. [PMID: 18282615 DOI: 10.1016/j.ijporl.2008.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/27/2007] [Accepted: 01/05/2008] [Indexed: 01/31/2023]
Abstract
CHARGE syndrome was first described by Pagon, and was named for its six major clinical features, which are; coloboma of the eye, heart defects, atresia of the choanae, retarded growth and developmental anomalies, which include CNS anomalies, genital hypoplasia and/or urinary tract anomalies, and ear anomalies and/or hearing loss. The authors experienced a case of CHARGE syndrome that displayed bilateral jugular foramen atresia and a collateral emissary vein. In addition, the authors reviewed the literatures pertaining to CHARGE syndrome.
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Van de Laar I, Dooijes D, Hoefsloot L, Simon M, Hoogeboom J, Devriendt K. Limb anomalies in patients with CHARGE syndrome: an expansion of the phenotype. Am J Med Genet A 2008; 143A:2712-5. [PMID: 17937444 DOI: 10.1002/ajmg.a.32008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CHARGE syndrome is characterized by a wide clinical variability. During the past years the phenotypic spectrum was markedly expanded. Limb anomalies were initially not recognized as part of the phenotype but more recently mild limb anomalies were described in approximately 30% of the patients. We report on three patients with several major features of CHARGE syndrome who, in addition, presented severe limb anomalies including monodactyly, tibia aplasia, and bifid femora. Three different heterozygous truncating mutations in the CHD7 gene were detected. It has been hypothesized before that the CHARGE syndrome is caused by a disruption of mesenchymal-epithelial interaction. Given the expression of the CHD7 gene in the developing limb bud, it was anticipated that limb defects would belong to the spectrum of manifestations of CHARGE syndrome. The present observations provide further support to this hypothesis.
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Affiliation(s)
- Ingrid Van de Laar
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Blake KD, Hartshorne TS, Lawand C, Dailor AN, Thelin JW. Cranial nerve manifestations in CHARGE syndrome. Am J Med Genet A 2008; 146A:585-92. [DOI: 10.1002/ajmg.a.32179] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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