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Spaziani G, Surace FC, Girolami F, Bianco F, Bucciarelli V, Bonanni F, Bennati E, Arcieri L, Favilli S. Hereditary Thoracic Aortic Diseases. Diagnostics (Basel) 2024; 14:112. [PMID: 38201421 PMCID: PMC10795846 DOI: 10.3390/diagnostics14010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Advances in both imaging techniques and genetics have led to the recognition of a wide variety of aortic anomalies that can be grouped under the term 'hereditary thoracic aortic diseases'. The present review aims to summarize this very heterogeneous population's clinical, genetic, and imaging characteristics and to discuss the implications of the diagnosis for clinical counselling (on sports activity or pregnancy), medical therapies and surgical management.
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Affiliation(s)
- Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesca Chiara Surace
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Girolami
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Francesca Bonanni
- Department of Experimental and Clinical Medicine, School of Cardiology, Faculty of Medicine, University of Study of Florence, 50121 Florence, Italy;
| | - Elena Bennati
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
| | - Luigi Arcieri
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy; (F.C.S.); (F.B.); (V.B.); (L.A.)
| | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (F.G.); (E.B.); (S.F.)
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Montalva L, Cheng LS, Kapur R, Langer JC, Berrebi D, Kyrklund K, Pakarinen M, de Blaauw I, Bonnard A, Gosain A. Hirschsprung disease. Nat Rev Dis Primers 2023; 9:54. [PMID: 37828049 DOI: 10.1038/s41572-023-00465-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Hirschsprung disease (HSCR) is a rare congenital intestinal disease that occurs in 1 in 5,000 live births. HSCR is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the intestine. Most patients present during the neonatal period with the first meconium passage delayed beyond 24 h, abdominal distension and vomiting. Syndromes associated with HSCR include trisomy 21, Mowat-Wilson syndrome, congenital central hypoventilation syndrome, Shah-Waardenburg syndrome and cartilage-hair hypoplasia. Multiple putative genes are involved in familial and isolated HSCR, of which the most common are the RET proto-oncogene and EDNRB. Diagnosis consists of visualization of a transition zone on contrast enema and confirmation via rectal biopsy. HSCR is typically managed by surgical removal of the aganglionic bowel and reconstruction of the intestinal tract by connecting the normally innervated bowel down to the anus while preserving normal sphincter function. Several procedures, namely Swenson, Soave and Duhamel procedures, can be undertaken and may include a laparoscopically assisted approach. Short-term and long-term comorbidities include persistent obstructive symptoms, enterocolitis and soiling. Continued research and innovation to better understand disease mechanisms holds promise for developing novel techniques for diagnosis and therapy, and improving outcomes in patients.
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Affiliation(s)
- Louise Montalva
- Department of Paediatric Surgery, Robert-Debré Children's University Hospital, Paris, France.
- Faculty of Health, Paris-Cité University, Paris, France.
- NeuroDiderot, INSERM UMR1141, Paris, France.
| | - Lily S Cheng
- Division of Paediatric Surgery, Texas Children's Hospital, Houston, TX, USA
- Division of Paediatric Surgery, University of Virginia, Charlottesville, VA, USA
| | - Raj Kapur
- Department of Pathology, Seattle Children's Hospital, Seattle, WA, USA
| | - Jacob C Langer
- Division of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominique Berrebi
- Department of Pathology, Robert-Debré and Necker Children's University Hospital, Paris, France
| | - Kristiina Kyrklund
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mikko Pakarinen
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ivo de Blaauw
- Department of Surgery, Division of Paediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands
| | - Arnaud Bonnard
- Department of Paediatric Surgery, Robert-Debré Children's University Hospital, Paris, France
- Faculty of Health, Paris-Cité University, Paris, France
- NeuroDiderot, INSERM UMR1141, Paris, France
| | - Ankush Gosain
- Department of Paediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
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Almpani K, Liberton DK, Jani P, Keyvanfar C, Mishra R, Curry N, Orzechowski P, Frischmeyer-Guerrerio PA, Lee JS. Loeys-Dietz and Shprintzen-Goldberg syndromes: analysis of TGF-β-opathies with craniofacial manifestations using an innovative multimodality method. J Med Genet 2021; 59:938-946. [PMID: 34916229 PMCID: PMC9554024 DOI: 10.1136/jmedgenet-2021-107695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/02/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Elevated transforming growth factor-beta (TGF-β) signalling has been implicated in the pathogenesis of Loeys-Dietz syndrome (LDS) and Shprintzen-Goldberg syndrome (SGS). In this study, we provide a qualitative and quantitative analysis of the craniofacial and functional features among the LDS subtypes and SGS. METHODS We explore the variability within and across a cohort of 44 patients through deep clinical phenotyping, three-dimensional (3D) facial photo surface analysis, cephalometric and geometric morphometric analyses of cone-beam CT scans. RESULTS The most common craniofacial features detected in this cohort include mandibular retrognathism (84%), flat midface projection (84%), abnormal eye shape (73%), low-set ears (73%), abnormal nose (66%) and lip shape (64%), hypertelorism (41%) and a relatively high prevalence of nystagmus/strabismus (43%), temporomandibular joint disorders (38%) and obstructive sleep apnoea (23%). 3D cephalometric analysis demonstrated an increased cranial base angle with shortened anterior cranial base and underdevelopment of the maxilla and mandible, with evidence of a reduced pharyngeal airway in 55% of those analysed. Geometric morphometric analysis confirmed that the greatest craniofacial shape variation was among patients with LDS type 2, with distinct clustering of patients with SGS. CONCLUSIONS This comprehensive phenotypic approach identifies developmental abnormalities that segregate to mutation variants along the TGF-β signalling pathway, with a particularly severe phenotype associated with TGFBR2 and SKI mutations. Multimodality assessment of craniofacial anomalies objectively reveals the impact of mutations of the TGF-β pathway with perturbations associated with the cranium and cranial base with severe downstream effects on the orbit, maxilla and mandible with the resultant clinical phenotypes.
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Affiliation(s)
- Konstantinia Almpani
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Denise K Liberton
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Priyam Jani
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Cyrus Keyvanfar
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Rashmi Mishra
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Natasha Curry
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | - Pamela Orzechowski
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
| | | | - Janice S Lee
- Craniofacial Anomalies and Regeneration Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
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4
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Billar RJ, Manoubi W, Kant SG, Wijnen RMH, Demirdas S, Schnater JM. Association between pectus excavatum and congenital genetic disorders: A systematic review and practical guide for the treating physician. J Pediatr Surg 2021; 56:2239-2252. [PMID: 34039477 DOI: 10.1016/j.jpedsurg.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pectus excavatum (PE) could be part of a genetic disorder, which then has implications regarding comorbidity, the surgical correction of PE, and reproductive choices. However, referral of a patient presenting with PE for genetic analysis is often delayed because additional crucial clinical signs may be subtle or even missed in syndromic patients. We reviewed the literature to inventory known genetic disorders associated with PE and create a standardized protocol for clinical evaluation. METHODS A systematic literature search was performed in electronic databases. Genetic disorders were considered associated with PE if studies reported at least five cases with PE. Characteristics of each genetic disorder were extracted from the literature and the OMIM database in order to create a practical guide for the clinician. RESULTS After removal of duplicates from the initial search, 1632 citations remained. Eventually, we included 119 full text articles, representing 20 different genetic disorders. Relevant characteristics and important clinical signs of each genetic disorder were summarized providing a standardized protocol in the form of a scoring list. The most important clinical sign was a positive family history for PE and/or congenital heart defect. CONCLUSIONS Twenty unique genetic disorders have been found associated with PE. We have created a scoring list for the clinician that systematically evaluates crucial clinical signs, thereby facilitating decision making for referral to a clinical geneticist.
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Affiliation(s)
- Ryan J Billar
- Erasmus University Medical Center - Sophia Children's Hospital, department of Paediatric Surgery Rotterdam, Netherlands
| | - Wiem Manoubi
- Erasmus University Medical Centre, department of Neuroscience, Rotterdam, Netherlands
| | - Sarina G Kant
- Erasmus University Medical Centre, department of Clinical Genetics, Rotterdam, Netherlands
| | - René M H Wijnen
- Erasmus University Medical Center - Sophia Children's Hospital, department of Paediatric Surgery Rotterdam, Netherlands
| | - Serwet Demirdas
- Erasmus University Medical Centre, department of Clinical Genetics, Rotterdam, Netherlands
| | - Johannes M Schnater
- Erasmus University Medical Center - Sophia Children's Hospital, department of Paediatric Surgery Rotterdam, Netherlands.
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5
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Connective Tissue Disorders and Cardiovascular Complications: The Indomitable Role of Transforming Growth Factor-β Signaling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:161-184. [PMID: 34807419 DOI: 10.1007/978-3-030-80614-9_7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Marfan Syndrome (MFS) and Loeys-Dietz Syndrome (LDS) represent heritable connective tissue disorders that segregate with a similar pattern of cardiovascular defects (thoracic aortic aneurysm, mitral valve prolapse/regurgitation, and aortic dilatation with regurgitation). This pattern of cardiovascular defects appears to be expressed along a spectrum of severity in many heritable connective tissue disorders and raises suspicion of a relationship between the normal development of connective tissues and the cardiovascular system. With overwhelming evidence of the involvement of aberrant Transforming Growth Factor-beta (TGF-β) signaling in MFS and LDS, this signaling pathway may represent the common link in the relationship between connective tissue disorders and their associated cardiovascular complications. To further explore this hypothetical link, this chapter will review the TGF-β signaling pathway, the heritable connective tissue syndromes related to aberrant TGF-β signaling, and will discuss the pathogenic contribution of TGF-β to these syndromes with a primary focus on the cardiovascular system.
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6
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AL KAISSI A, BETADOLOVA Z, GANGER R, WUNN R, RUSTAMOV G, KENIS V, KIRCHER SG. The clinical and radiographic phenotypic characterization of a girl with multiple malformation complex resembling Idaho Syndrome. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Chaurasia S, Sharma P, Surve A, Chaurasia S. Intraoperative absent bilateral medial recti in syndromic craniosynostosis. BMJ Case Rep 2021; 14:14/1/e233557. [PMID: 33461988 PMCID: PMC7816931 DOI: 10.1136/bcr-2019-233557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Patients with syndromic craniosynostosis are usually associated with the complexity of the malformation complex. We describe here detailed oculo-motility disorder and a remarkable finding of hypoplastic bilateral media recti on imaging and its intraoperative absence in patients with phenotypic features resembling Shprintzen-Goldberg syndrome (SGS). SGS is a rare congenital disorder with craniosynostosis affecting multiple systems including mentation and having a considerable overlap of its phenotypic features with Marfan syndrome. Large A-pattern exotropia found in these patients may be related to the craniofacial features and their bearing on extraocular muscle development and function. In this paper, we aimed to sensitise ophthalmologists and strabismologists concerning the necessity to recognise syndromic associations of patients with craniosynostosis presenting with a large squint, be aware of the intraoperative surprises and consider the challenges in its management.
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Affiliation(s)
- Shweta Chaurasia
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradeep Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abhidnya Surve
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Chaurasia
- Department of Medicine, Sanjay Gandhi Memorial Hospital, New Delhi, India
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8
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Landry NM, Dixon IMC. Fibroblast mechanosensing, SKI and Hippo signaling and the cardiac fibroblast phenotype: Looking beyond TGF-β. Cell Signal 2020; 76:109802. [PMID: 33017619 DOI: 10.1016/j.cellsig.2020.109802] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022]
Abstract
Cardiac fibroblast activation to hyper-synthetic myofibroblasts following a pathological stimulus or in response to a substrate with increased stiffness may be a key tipping point for the evolution of cardiac fibrosis. Cardiac fibrosis per se is associated with progressive loss of heart pump function and is a primary contributor to heart failure. While TGF-β is a common cytokine stimulus associated with fibroblast activation, a druggable target to quell this driver of fibrosis has remained an elusive therapeutic goal due to its ubiquitous use by different cell types and also in the signaling complexity associated with SMADs and other effector pathways. More recently, mechanical stimulus of fibroblastic cells has been revealed as a major point of activation; this includes cardiac fibroblasts. Further, the complexity of TGF-β signaling has been offset by the discovery of members of the SKI family of proteins and their inherent anti-fibrotic properties. In this respect, SKI is a protein that may bind a number of TGF-β associated proteins including SMADs, as well as signaling proteins from other pathways, including Hippo. As SKI is also known to directly deactivate cardiac myofibroblasts to fibroblasts, this mode of action is a putative candidate for further study into the amelioration of cardiac fibrosis. Herein we provide a synthesis of this topic and highlight novel candidate pathways to explore in the treatment of cardiac fibrosis.
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Affiliation(s)
- Natalie M Landry
- Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ian M C Dixon
- Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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Takahashi Y, Watanabe K, Yagi M, Suzuki S, Nori S, Tsuji O, Nagoshi N, Okada E, Fujita N, Nakamura M, Matsumoto M. Early-Onset Scoliosis Associated with Shprintzen-Goldberg Syndrome Treated with Growing Rods and Required Multiple Unplanned Surgeries: A Case Report. Spine Surg Relat Res 2020; 5:214-217. [PMID: 34179561 PMCID: PMC8208954 DOI: 10.22603/ssrr.2020-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/18/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yoshiyuki Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Fujita Health University, Nagoya, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Eye Manifestations of Shprintzen–Goldberg Craniosynostosis Syndrome: A Case Report and Systematic Review. Case Rep Genet 2020; 2020:7353452. [PMID: 33628537 PMCID: PMC7895601 DOI: 10.1155/2020/7353452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Shprintzen–Goldberg craniosynostosis syndrome (SGS) is a rare autosomal dominant condition that was first documented in literature in 1982. The disorder is caused by pathogenic variants in the proto-oncogene SKI gene, a known suppressor of TGF-β activity, located on chromosome 1p36. There is considerable phenotypic overlap with Marfan and Loeys–Dietz syndromes. Common clinical features of SGS include craniosynostosis, marfanoid habitus, hypotonia, dysmorphic facies, cardiovascular anomalies, and other skeletal and connective tissue abnormalities. Ocular manifestations may include hypertelorism, downslanting palpebral fissures, proptosis, myopia, and ectopia lentis. We describe a 25-year-old male with the syndrome. Genetic analysis revealed a novel c.350G>A (p.Arg117His) de novo variant, which was predicted to be pathogenic by the CTGT laboratory. The patient presented with dysmorphic features, marfanoid habitus, severe joint contractures, mitral valve insufficiency, aortic root dilatation, and a history of seizures. His ocular manifestations included hypertelorism, downslanting palpebral fissures, bilateral ptosis, and high myopia. Ophthalmic manifestations are an integral component of the syndrome; however, they have not been well characterized in the literature. From a systematic review of previously published cases to date, we summarize the eye and ocular adnexa manifestations reported.
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O'Dougherty GR, Fulkerson DH, Kern M, Haldar K, Calhoun B. Complications of Insufficient Dura and Blood Loss During Surgical Intervention in Shprintzen-Goldberg Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1159-1169. [PMID: 31391415 PMCID: PMC6698069 DOI: 10.12659/ajcr.914924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Shprintzen-Goldberg syndrome (SGS) is an extremely rare collagenopathy, most often caused by autosomal-dominant mutations in the SKI proto-oncogene, which is a component of the transforming growth factor beta (TGF-ß) signaling pathway. Approximately 50-60 cases of SGS have been recorded in the literature worldwide since its discovery in 1982. This collagen disorder affects bone and vascular development throughout the body, resulting in craniosynostosis, scoliosis, chest deformities, and aortic root dilation. Patients may have problems in the central nervous system, including Chiari 1 malformation, hydrocephalus, and dilation of the lateral ventricles. Unfortunately, the symptoms of SGS closely parallel those of related collagenopathies involving mutations in the TGF-ß signaling pathway, which makes accurate diagnosis difficult without genetic testing, especially in cases with complex presentation. CASE REPORT In this report we present the unique and complex disease manifestations in a 9-year-old girl with SGS. The patient had severe cervical spinal instability that resolved after surgical occipital-C4 fusion with an autograft from the rib. Midface distraction surgery was used to treat the patient's craniosynostosis and related facial deformities. This surgery was complicated by loss of 750 mL of blood due to insufficient dura and prominent vasculature. CONCLUSIONS Connective tissue symptoms associated with SGS can involve dural and vascular problems, as seen in this case report. Thus, the risk of extreme blood loss should be anticipated any time midface distraction surgery is performed on an SGS patient. Continued research is needed to define how this case relates to the SGS patient population.
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Affiliation(s)
- Gabrielle R O'Dougherty
- Boler-Parseghian Center for Rare and Neglected Diseases, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | | | - Melissa Kern
- Memorial Hospital South Bend, South Bend, IN, USA
| | - Kasturi Haldar
- Boler-Parseghian Center for Rare and Neglected Diseases, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | - Barbara Calhoun
- Boler-Parseghian Center for Rare and Neglected Diseases, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
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12
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Zhang L, Xu X, Sun K, Sun J, Wang Y, Liu Y, Yang N, Tao C, Cai B, Shi G, Zhang F, Shi J. A de novo mutation in DHD domain of SKI causing spina bifida with no craniofacial malformation or intellectual disability. Am J Med Genet A 2019; 179:936-939. [PMID: 30883014 DOI: 10.1002/ajmg.a.61088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/05/2022]
Abstract
Shprintzen-Goldberg syndrome (SGS) is a rare systemic connective tissue disorder characterized by craniofacial, skeletal, and cardiovascular manifestations. It is associated with a significant risk of intellectual disability, a feature which distinguishes it from Marfan and Loeys-Dietz syndromes. SGS is mainly caused by mutations in the SKI gene, a repressor of TGF-β activity. Most SKI mutations are found in exon 1 of the gene and are located in the R-SMAD domain, a proposed hotspot for de novo mutations. Here, we report on a de novo SKI mutation located in the DHD domain of SKI. By adding our finding to previously reported de novo SKI mutations, a new mutational hotspot in the DHD domain is proposed. Our patient presented with a lipomeningomyelocele, tethered cord, and spina bifida but with no SGS-related clinical findings apart from a marfanoid habitus and long slender fingers. Specifically, she did not have an intellectual disability, craniofacial, or cardiovascular abnormalities. By comparing the clinical findings on patients with mutations in the R-SMAD and DHD domains of SKI, we propose that mutations in those domains have different effects on TGF-β activity during embryonic development with resulting phenotypic differences.
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Affiliation(s)
- Ling Zhang
- Obstetrics and Gynecology Hospital, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Ximing Xu
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Kaiqiang Sun
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Jingchuan Sun
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Yuan Wang
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Yang Liu
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Nan Yang
- Obstetrics and Gynecology Hospital, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Chengqiu Tao
- Obstetrics and Gynecology Hospital, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Baozhu Cai
- Obstetrics and Gynecology Hospital, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Guodong Shi
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
| | - Feng Zhang
- Obstetrics and Gynecology Hospital, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Jiangang Shi
- Department of orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical Univerisity, Shanghai 20003, People's Republic of China
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13
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Craniofacial and Dental Manifestations of Melnick-Needles Syndrome: Literature Review and Orthodontic Management. Case Rep Pediatr 2018; 2018:5891024. [PMID: 30534457 PMCID: PMC6252208 DOI: 10.1155/2018/5891024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this article was to present a characteristic clinical image of Melnick–Needles syndrome using an example of an 11.5-year-old female patient treated at the Facial Congenital Disorders Outpatient Clinic as well as to present the actual literature review of the surgical treatment. The patient was diagnosed with several characteristics typical for Melnick–Needles syndrome: single-sided hearing loss, malocclusion, and facial dysmorphism, among others. Due to malocclusion and facial dysmorphism, the patient with Melnick–Needles syndrome requires orthodontic treatment with surgical intervention. Mandibular distraction with fixed appliance treatment is a recommended treatment protocol.
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14
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Kurosaka H. Choanal atresia and stenosis: Development and diseases of the nasal cavity. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2018; 8:e336. [PMID: 30320458 DOI: 10.1002/wdev.336] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 09/10/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022]
Abstract
Proper craniofacial development in vertebrates depends on growth and fusion of the facial processes during embryogenesis. Failure of any step in this process could lead to craniofacial anomalies such as facial clefting, which has been well studied with regard to its molecular etiology and cellular pathogenesis. Nasal cavity invagination is also a critical event in proper craniofacial development, and is required for the formation of a functional nasal cavity and airway. The nasal cavity must connect the nasopharynx with the primitive choanae to complete an airway from the nostril to the nasopharynx. In contrast to orofacial clefts, defects in nasal cavity and airway formation, such as choanal atresia (CA), in which the connection between the nasal airway and nasopharynx is physically blocked, have largely been understudied. This is also true for a narrowed connection between the nasal cavity and the nasopharynx, which is known as choanal stenosis (CS). CA occurs in approximately 1 in 5,000 live births, and can present in isolation but typically arises as part of a syndrome. Despite the fact that CA and CS usually require immediate intervention, and substantially affect the quality of life of affected individuals, the etiology and pathogenesis of CA and CS have remained elusive. In this review I focus on the process of nasal cavity development with respect to forming a functional airway and discuss the cellular behavior and molecular networks governing this process. Additionally, the etiology of human CA is discussed using examples of disorders which involve CA or CS. This article is categorized under: Signaling Pathways > Cell Fate Signaling Comparative Development and Evolution > Model Systems Birth Defects > Craniofacial and Nervous System Anomalies.
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Affiliation(s)
- Hiroshi Kurosaka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan
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15
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Sinha A, Kaur S, Raheel SA, Kaur K, Alshehri M, Kujan O. Oral manifestations of a rare variant of Marfan syndrome. Clin Case Rep 2017; 5:1429-1434. [PMID: 28878896 PMCID: PMC5582241 DOI: 10.1002/ccr3.1058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/18/2017] [Accepted: 06/02/2017] [Indexed: 01/20/2023] Open
Abstract
This article reports the oral manifestations of an unusual presentation of Marfan syndrome (MFS) and provides an evidence to the importance of recognizing the oral features in confirming the diagnosis of MFS. Dentists have a vital role in confirming the diagnosis of developmental disorders that involve the craniofacial compendium.
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Affiliation(s)
- Abhishek Sinha
- Department of Orthodontics Hazaribag College of Dental Sciences and Hospital Hazaribag Jharkhand India
| | - Sandeep Kaur
- Department of Oral Medicine & Radiology Indira Gandhi Government Dental College & Hospital Jammu Jammu and Kashmir India
| | - Syed Ahmed Raheel
- Department of Oral Medicine & Diagnostic sciences Al-Farabi College for Dentistry and Nursing Al-Farabi Colleges Riyadh Saudi Arabia
| | - Kirandeep Kaur
- Department of Periodontology Institute of Dental Studies & Technologies Modi Nagar Uttar Pradesh India
| | - Mohammed Alshehri
- Dental Department King Khaled University Hospital King Saud University Riyadh Saudi Arabia
| | - Omar Kujan
- Department of Oral Medicine & Diagnostic sciences Al-Farabi College for Dentistry and Nursing Al-Farabi Colleges Riyadh Saudi Arabia.,School of Dentistry The University of Western Australia Nedlands Western Australia Australia
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16
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Frequency of Benign Joint Hypermobility Syndrome in Patients Undergoing Inguinal Hernia Repair: A Prospective Study. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00100.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this prospective study is to investigate the frequency and associated clinical findings of benign joint hypermobility syndrome (BJHS) in adult patients who were diagnosed with inguinal hernia. Benign joint hypermobility syndrome (BJHS) is defined as a clinical condition consisting of musculoskeletal symptoms such as arthralgia, pain, recurrent soft tissue disorders, joint dislocation, as well as increased normal range of motion. We hypothesized that the frequency of BHJS may increase in the patients who underwent surgery for groin hernias due to the hypermobility in connective tissue. We evaluated 66 patients in terms of BHJS prospectively in a 6-month period. The patients were divided into 2 groups. The first group consisted of 33 patients who underwent inguinal hernia repair surgery. The second group also included 33 healthy volunteers who did not have inguinal hernia operation. General joint hypermobility (GJH) was assessed using Beighton hypermobility scoring criteria, and BJHS was scored by Brighton scoring criteria. The data were assessed statistically. BJHS was diagnosed in 22 (66%) patients with inguinal hernia and in 4 (12%) healthy volunteers, respectively. Prevalence of BJHS and Beighton scores in patients with inguinal hernia were significantly higher (P < 0.05). GJH was found in 20 (60%) of the inguinal hernia patients (Beighton score ≥ 4; P < 0.05). BJHS should be considered when evaluating patients with inguinal hernia. We believe that further studies are needed in big cohorts to verify the relationship between inguinal hernia in adults and BJHS.
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17
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Al Kaissi A, Marrakchi Z, Nassib NM, Hofstaetter J, Grill F, Ganger R, Kircher SG. Craniosynostosis, Scheuermann's disease, and intellectual disability resembling Shprintzen-Goldberg syndrome: a report on a family over 4 generations: Case report. Medicine (Baltimore) 2017; 96:e6199. [PMID: 28328806 PMCID: PMC5371443 DOI: 10.1097/md.0000000000006199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Craniosynostosis is a disorder characterized by premature fusion of cranial sutures with subsequent development of abnormal craniofacial contour associated with variable skeletal and extra-skeletal abnormalities. In this family syndromic type of craniosynostosis was recognized and the etiology behind diverse forms of deformities have been diagnosed. PATIENT CONCERNS The negative impact of the disorder on the child and his family is enormous. Particularly when the diagnosis is late and little can be done. Though counselling the family through discussing the whole picture of the disorder might lessens their concern. DIAGNOSES Diagnosis is the corner stone of management. In this paper we aimed to sensitize pediatricians, physicians, and orthopedic surgeons concerning the necessity to recognize syndromic associations early on. INTERVENTIONS Patients with syndromic craniosynostosis are usually associated with a complexity of malformation complex. Craniofacial surgery can be of remarkable help if the diagnosis is made early. It requires a series of corrections to avoid intellectual disability and other neurological deficits.The timing of interventions is strongly correlated on the timing of diagnosis. OUTCOMES The earliest the diagnoses, the much better the outcomes are. And consequently avert the psychological and the financial cost on the patient and his family. LESSONS The golden principle of medicine should prevail in all medical disciplines, which states: The more you see, the more you know and conversely the more you know is the more you see.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
| | - Zahra Marrakchi
- Department of Neonatology, Charles Nicolle Hospital, Tunisia
| | - Nabil M. Nassib
- Department of Pediatric Orthopedic Surgery, Children Hospital of Tunis, Tunisia
| | | | - Franz Grill
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
| | - Rudolf Ganger
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
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18
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Bahíllo-Curieses MP, Galbis Soto S, Tellería Orriols JJ. Relevance of new genetic tests in the diagnosis of short stature with dysmorphic features. Med Clin (Barc) 2016; 147:e67-e68. [PMID: 27823796 DOI: 10.1016/j.medcli.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M Pilar Bahíllo-Curieses
- Servicio de Pediatría y Endocrinología Pediátrica, Hospital Clínico Universitario, Valladolid, España.
| | - Sofía Galbis Soto
- Servicio de Pediatría y Endocrinología Pediátrica, Hospital Clínico Universitario, Valladolid, España
| | - Juan José Tellería Orriols
- Instituto de Biología y Genética Molecular, Universidad de Valladolid/Consejo Superior de Investigaciones Científicas, Valladolid, España
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19
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Niederhoffer KY, Fahiminiya S, Eydoux P, Mawson J, Nishimura G, Jerome-Majewska LA, Patel MS. Diagnosis of Van den Ende-Gupta syndrome: Approach to the Marden-Walker-like spectrum of disorders. Am J Med Genet A 2016; 170:2310-21. [DOI: 10.1002/ajmg.a.37831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/16/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Karen Y. Niederhoffer
- Department of Medical Genetics; University of British Columbia; Vancouver British Columbia Canada
| | - Somayyeh Fahiminiya
- Department of Human Genetics; Pediatrics, McGill University; Montreal Quebec Canada
| | - Patrice Eydoux
- Department of Pathology Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - John Mawson
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Gen Nishimura
- Department of Orthopaedic Surgery; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Loydie A. Jerome-Majewska
- Department of Human Genetics; Pediatrics, McGill University; Montreal Quebec Canada
- Pediatrics, McGill University; Montreal Quebec Canada
| | - Millan S. Patel
- Department of Medical Genetics; University of British Columbia; Vancouver British Columbia Canada
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20
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Yadav S, Rawal G. Shprintzen-Goldberg syndrome: a rare disorder. Pan Afr Med J 2016; 23:227. [PMID: 27761171 PMCID: PMC5052323 DOI: 10.11604/pamj.2016.23.227.7482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 04/03/2016] [Indexed: 12/18/2022] Open
Abstract
Shprintzen-Goldberg Syndrome is an extremely infrequent disorder of connective tissue, characterized by craniosynostosis and marfanoid features, also known as Marfanoid Craniosynostosis syndrome. The syndrome was first introduced by Sugarman and Vogel’ (1981) however, Shprintzen and Goldberg established this as a separate clinical entity in the year 1982. Since then, approximately sixty such cases have been set down in writing in the medical literature. Herein, we present a short review of literature of this rare connective disorder, in order to create awareness about this condition, as the magnitude of this disorder is not measured properly due to the paucity of literature.
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Affiliation(s)
- Sankalp Yadav
- General Duty Medical Officer-II, Chest Clinic Moti Nagar, North Delhi Municipal Corporation, New Delhi, India
| | - Gautam Rawal
- Critical Care Department, Rockland Hospital, Qutab Institutional Area, New Delhi, India
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21
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Al-Qattan MM, Abou Al-Shaar H, Alkattan WM. The pathogenesis of congenital radial head dislocation/subluxation. Gene 2016; 586:69-76. [PMID: 27050104 DOI: 10.1016/j.gene.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/28/2016] [Accepted: 04/01/2016] [Indexed: 01/02/2023]
Abstract
The pathogenesis of congenital radial head dislocation/subluxation is unknown and has not been previously investigated. In this review, we explore the pathogenesis and define five different primary insults: collagen abnormalities, abnormal endochondral ossification of the developing growth plate, abnormalities of forearm ossification outside the growth plate, disproportionate growth of the radius and ulna, and altered HOX D expression/activity. Finally, the clinical relevance of our review is discussed.
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Affiliation(s)
- Mohammad M Al-Qattan
- Division of Plastic and Hand Surgery at King Saud University, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Hussam Abou Al-Shaar
- Division of Plastic and Hand Surgery at King Saud University, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Wael M Alkattan
- Division of Plastic and Hand Surgery at King Saud University, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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22
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Abstract
Deletions of chromosome 1p36 affect approximately 1 in 5,000 newborns and are the most common terminal deletions in humans. Medical problems commonly caused by terminal deletions of 1p36 include developmental delay, intellectual disability, seizures, vision problems, hearing loss, short stature, distinctive facial features, brain anomalies, orofacial clefting, congenital heart defects, cardiomyopathy, and renal anomalies. Although 1p36 deletion syndrome is considered clinically recognizable, there is significant phenotypic variation among affected individuals. This variation is due, at least in part, to the genetic heterogeneity seen in 1p36 deletions which include terminal and interstitial deletions of varying lengths located throughout the 30 Mb of DNA that comprise chromosome 1p36. Array-based copy number variant analysis can easily identify genomic regions of 1p36 that are deleted in an affected individual. However, predicting the phenotype of an individual based solely on the location and extent of their 1p36 deletion remains a challenge since most of the genes that contribute to 1p36-related phenotypes have yet to be identified. In addition, haploinsufficiency of more than one gene may contribute to some phenotypes. In this article, we review recent successes in the effort to map and identify the genes and genomic regions that contribute to specific 1p36-related phenotypes. In particular, we highlight evidence implicating MMP23B, GABRD, SKI, PRDM16, KCNAB2, RERE, UBE4B, CASZ1, PDPN, SPEN, ECE1, HSPG2, and LUZP1 in various 1p36 deletion phenotypes.
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Affiliation(s)
- Valerie K Jordan
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Hitisha P Zaveri
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Daryl A Scott
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA ; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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23
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Elmistekawy E, Hudson CC, Williams A, Mesana T. Double-valve surgery in Shprintzen-Goldberg syndrome. Asian Cardiovasc Thorac Ann 2014; 22:842-5. [PMID: 24887819 DOI: 10.1177/0218492313485070] [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] [Indexed: 11/15/2022]
Abstract
We describe the challenging case of a 28-year-old Jehovah's Witness patient who presented with symptomatic mitral and tricuspid valve disease and Shprintzen-Goldberg syndrome. This is the first reported double-valve surgery in such a patient who, apart from chest deformity, had a small body size, severe lung disease, difficult airway and vascular access, and to add to the complexity, refused blood and blood product use. The patient underwent a successful mitral valve replacement and tricuspid valve repair through a right thoracotomy. Apart from atrial fibrillation, he had a smooth hospital course and was discharged home on postoperative day 9.
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Affiliation(s)
- Elsayed Elmistekawy
- Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | | | - Anne Williams
- Cardiology Department, Health Science Center, St. John's, Newfoundland, Canada
| | - Thierry Mesana
- Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada
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24
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Schepers D, Doyle AJ, Oswald G, Sparks E, Myers L, Willems PJ, Mansour S, Simpson MA, Frysira H, Maat-Kievit A, Van Minkelen R, Hoogeboom JM, Mortier GR, Titheradge H, Brueton L, Starr L, Stark Z, Ockeloen C, Lourenco CM, Blair E, Hobson E, Hurst J, Maystadt I, Destrée A, Girisha KM, Miller M, Dietz HC, Loeys B, Van Laer L. The SMAD-binding domain of SKI: a hotspot for de novo mutations causing Shprintzen-Goldberg syndrome. Eur J Hum Genet 2014; 23:224-8. [PMID: 24736733 DOI: 10.1038/ejhg.2014.61] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/24/2014] [Accepted: 03/05/2014] [Indexed: 01/10/2023] Open
Abstract
Shprintzen-Goldberg syndrome (SGS) is a rare, systemic connective tissue disorder characterized by craniofacial, skeletal, and cardiovascular manifestations that show a significant overlap with the features observed in the Marfan (MFS) and Loeys-Dietz syndrome (LDS). A distinguishing observation in SGS patients is the presence of intellectual disability, although not all patients in this series present this finding. Recently, SGS was shown to be due to mutations in the SKI gene, encoding the oncoprotein SKI, a repressor of TGFβ activity. Here, we report eight recurrent and three novel SKI mutations in eleven SGS patients. All were heterozygous missense mutations located in the R-SMAD binding domain, except for one novel in-frame deletion affecting the DHD domain. Adding our new findings to the existing data clearly reveals a mutational hotspot, with 73% (24 out of 33) of the hitherto described unrelated patients having mutations in a stretch of five SKI residues (from p.(Ser31) to p.(Pro35)). This implicates that the initial molecular testing could be focused on mutation analysis of the first half of exon 1 of SKI. As the majority of the known mutations are located in the R-SMAD binding domain of SKI, our study further emphasizes the importance of TGFβ signaling in the pathogenesis of SGS.
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Affiliation(s)
- Dorien Schepers
- Center for Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Alexander J Doyle
- 1] McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA [2] Howard Hughes Medical Institute, Baltimore, MD, USA
| | - Gretchen Oswald
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Sparks
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Loretha Myers
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sahar Mansour
- SW Thames Regional Genetics Service, St George's, University of London, London, UK
| | - Michael A Simpson
- Division of Genetics and Molecular Medicine, Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
| | - Helena Frysira
- Department of Medical Genetics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anneke Maat-Kievit
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rick Van Minkelen
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jeanette M Hoogeboom
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Geert R Mortier
- Center for Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Hannah Titheradge
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, UK
| | - Louise Brueton
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, UK
| | - Lois Starr
- Clinical Genetics, Munroe-Meyer Institute for Genetics and Rehabilitation, Nebraska Medical Center, Omaha, NE, USA
| | - Zornitza Stark
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Charlotte Ockeloen
- Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Charles Marques Lourenco
- Department of Medical Genetics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Ed Blair
- Department of Clinical Genetics, Churchill Hospital, Oxford, UK
| | - Emma Hobson
- Department of Clinical Genetics, Chapel Allerton Hospital, Leeds, UK
| | - Jane Hurst
- Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
| | - Isabelle Maystadt
- Center for Human Genetics, Institute for Pathology and Genetics (IPG), Gosselies, Belgium
| | - Anne Destrée
- Center for Human Genetics, Institute for Pathology and Genetics (IPG), Gosselies, Belgium
| | - Katta M Girisha
- Division of Medical Genetics, Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal, India
| | - Michelle Miller
- Department of Cardiology, All Childrens Hospital, St. Petersburg, FL, USA
| | - Harry C Dietz
- 1] McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA [2] Howard Hughes Medical Institute, Baltimore, MD, USA
| | - Bart Loeys
- Center for Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Lut Van Laer
- Center for Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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25
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Shah B, Sahu S, Kalakoti P, Yadav S, Syed MMA, Bhattad VB, Shaikh M. Shprintzen-Goldberg syndrome presenting as umbilical hernia in an Indian child. Australas Med J 2014; 7:51-7. [PMID: 24611072 DOI: 10.4066/amj.2014.1888] [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] [Indexed: 11/09/2022]
Abstract
Shprintzen-Goldberg syndrome (S-G) is a rare connective tissue disorder characterised by craniosynostosis, craniofacial dysmorphism, skeletal, cardiovascular, neurological, and other abnormalities. We herein present a case of a five-year-old Indian child who presented to our clinic with reducible umbilical hernia since birth, mental retardation, and delayed developmental milestones. After meticulous clinical examination with subsequent integration of clinical findings and investigations, we diagnosed her to possibly have Shprintzen-Goldberg syndrome. An attempt to compare the findings of our index case with the classical features as described by Greally et al. has been made. Given the rarity of this syndrome and the paucity of medical literature measuring the magnitude of this condition in the Indian population, this case serves to promote awareness of this rare entity.
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Affiliation(s)
- Bhushan Shah
- Department of General Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India ; Contributed equally to the work
| | - Suman Sahu
- Hebei Medical University, Shijiazhuang, Hebei, China 050017 ; Contributed equally to the work
| | - Piyush Kalakoti
- Department of General Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India
| | - Sankalp Yadav
- Department of General Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India
| | - M M Aarif Syed
- Department of General Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India
| | | | - Meena Shaikh
- Department of General Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India
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26
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Pinto JT, Cooper AJL. From cholesterogenesis to steroidogenesis: role of riboflavin and flavoenzymes in the biosynthesis of vitamin D. Adv Nutr 2014; 5:144-63. [PMID: 24618756 PMCID: PMC3951797 DOI: 10.3945/an.113.005181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Flavin-dependent monooxygenases and oxidoreductases are located at critical branch points in the biosynthesis and metabolism of cholesterol and vitamin D. These flavoproteins function as obligatory intermediates that accept 2 electrons from NAD(P)H with subsequent 1-electron transfers to a variety of cytochrome P450 (CYP) heme proteins within the mitochondria matrix (type I) and the (microsomal) endoplasmic reticulum (type II). The mode of electron transfer in these systems differs slightly in the number and form of the flavin prosthetic moiety. In the type I mitochondrial system, FAD-adrenodoxin reductase interfaces with adrenodoxin before electron transfer to CYP heme proteins. In the microsomal type II system, a diflavin (FAD/FMN)-dependent cytochrome P450 oxidoreductase [NAD(P)H-cytochrome P450 reductase (CPR)] donates electrons to a multitude of heme oxygenases. Both flavoenzyme complexes exhibit a commonality of function with all CYP enzymes and are crucial for maintaining a balance of cholesterol and vitamin D metabolites. Deficits in riboflavin availability, imbalances in the intracellular ratio of FAD to FMN, and mutations that affect flavin binding domains and/or interactions with client proteins result in marked structural alterations within the skeletal and central nervous systems similar to those of disorders (inborn errors) in the biosynthetic pathways that lead to cholesterol, steroid hormones, and vitamin D and their metabolites. Studies of riboflavin deficiency during embryonic development demonstrate congenital malformations similar to those associated with genetic alterations of the flavoenzymes in these pathways. Overall, a deeper understanding of the role of riboflavin in these pathways may prove essential to targeted therapeutic designs aimed at cholesterol and vitamin D metabolism.
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27
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Wheeler JB, Ikonomidis JS, Jones JA. Connective tissue disorders and cardiovascular complications: the indomitable role of transforming growth factor-beta signaling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 802:107-27. [PMID: 24443024 PMCID: PMC4410689 DOI: 10.1007/978-94-007-7893-1_8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Marfan Syndrome (MFS) and Loeys-Dietz Syndrome (LDS) represent heritable connective tissue disorders that cosegregate with a similar pattern of cardiovascular defects (thoracic aortic aneurysm, mitral valve prolapse/regurgitation, and aortic root dilatation with regurgitation). This pattern of cardiovascular defects appears to be expressed along a spectrum of severity in many heritable connective tissue disorders and raises suspicion of a relationship between the normal development of connective tissues and the cardiovascular system. Given the evidence of increased transforming growth factor-beta (TGF-β) signaling in MFS and LDS, this signaling pathway may represent the common link in this relationship. To further explore this hypothetical link, this chapter will review the TGF-β signaling pathway, heritable connective tissue syndromes related to TGF-β receptor (TGFBR) mutations, and discuss the pathogenic contribution of TGF-β to these syndromes with a primary focus on the cardiovascular system.
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MESH Headings
- Adrenergic beta-Antagonists/therapeutic use
- Angiotensin II Type 1 Receptor Blockers/therapeutic use
- Antibodies, Neutralizing/pharmacology
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/genetics
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/surgery
- Aortic Valve/pathology
- Aortic Valve/surgery
- Bicuspid Aortic Valve Disease
- Gene Expression Regulation
- Heart Defects, Congenital/drug therapy
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/surgery
- Heart Valve Diseases/drug therapy
- Heart Valve Diseases/genetics
- Heart Valve Diseases/pathology
- Heart Valve Diseases/surgery
- Humans
- Loeys-Dietz Syndrome/drug therapy
- Loeys-Dietz Syndrome/genetics
- Loeys-Dietz Syndrome/pathology
- Loeys-Dietz Syndrome/surgery
- Marfan Syndrome/drug therapy
- Marfan Syndrome/genetics
- Marfan Syndrome/pathology
- Marfan Syndrome/surgery
- Mutation
- Receptors, Transforming Growth Factor beta/genetics
- Signal Transduction/genetics
- Smad Proteins/genetics
- Transforming Growth Factor beta/antagonists & inhibitors
- Transforming Growth Factor beta/genetics
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Affiliation(s)
- Jason B. Wheeler
- Division of Cardiothoracic Surgery, Medical University of South Carolina
| | - John S. Ikonomidis
- Division of Cardiothoracic Surgery, Medical University of South Carolina
| | - Jeffrey A. Jones
- Division of Cardiothoracic Surgery, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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Au PYB, Racher HE, Graham JM, Kramer N, Lowry RB, Parboosingh JS, Innes AM. De novo exon 1 missense mutations of SKI and Shprintzen-Goldberg syndrome: two new cases and a clinical review. Am J Med Genet A 2013; 164A:676-84. [PMID: 24357594 DOI: 10.1002/ajmg.a.36340] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/06/2013] [Indexed: 01/21/2023]
Abstract
Shprintzen-Goldberg syndrome (OMIM #182212) is a connective tissue disorder characterized by craniosynostosis, distinctive craniofacial features, skeletal abnormalities, marfanoid body habitus, aortic dilatation, and intellectual disability. Mutations in exon 1 of SKI have recently been identified as being responsible for approximately 90% of reported individuals diagnosed clinically with Shprintzen-Goldberg syndrome. SKI is a known regulator of TGFβ signaling. Therefore, like Marfan syndrome and Loeys-Dietz syndrome, Shprintzen-Goldberg syndrome is likely caused by deregulated TGFβ signals, explaining the considerable phenotypic overlap between these three disorders. We describe two additional patients with exon 1 SKI mutations and review the clinical features and literature of Shprintzen-Goldberg syndrome.
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Affiliation(s)
- P Y Billie Au
- Department of Medical Genetics, Alberta Children's Hospital, University of Calgary, Alberta, Canada
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29
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Jezela-Stanek A, Krajewska-Walasek M. Genetic causes of syndromic craniosynostoses. Eur J Paediatr Neurol 2013; 17:221-4. [PMID: 23062756 DOI: 10.1016/j.ejpn.2012.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022]
Abstract
Syndromic craniosynostose exhibit variable clinical and genetic heterogeneity. Many of this disorders are caused by mutations in the fibroblast growth factor receptor genes: FGFR2, FGFR3 (encoding fibroblast growth factor receptors), TWIST1 (functions as an upstream regulator of FGFRs) and EFNB1 (gene encoding fibrillin1). However recent advances in molecular genetics have led to a discover of other genes implicated in different craniosynostosis syndromes.
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Affiliation(s)
- Aleksandra Jezela-Stanek
- Department of Medical Genetics, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, Warsaw, Poland.
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30
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Callier P, Aral B, Hanna N, Lambert S, Dindy H, Ragon C, Payet M, Collod-Beroud G, Carmignac V, Delrue MA, Goizet C, Philip N, Busa T, Dulac Y, Missotte I, Sznajer Y, Toutain A, Francannet C, Megarbane A, Julia S, Edouard T, Sarda P, Amiel J, Lyonnet S, Cormier-Daire V, Gilbert B, Jacquette A, Heron D, Collignon P, Lacombe D, Morice-Picard F, Jouk PS, Cusin V, Willems M, Sarrazin E, Amarof K, Coubes C, Addor MC, Journel H, Colin E, Khau Van Kien P, Baumann C, Leheup B, Martin-Coignard D, Doco-Fenzy M, Goldenberg A, Plessis G, Thevenon J, Pasquier L, Odent S, Vabres P, Huet F, Marle N, Mosca-Boidron AL, Mugneret F, Gauthier S, Binquet C, Thauvin-Robinet C, Jondeau G, Boileau C, Faivre L. Systematic molecular and cytogenetic screening of 100 patients with marfanoid syndromes and intellectual disability. Clin Genet 2013; 84:507-21. [PMID: 23506379 DOI: 10.1111/cge.12094] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/04/2013] [Accepted: 01/04/2013] [Indexed: 01/13/2023]
Abstract
The association of marfanoid habitus (MH) and intellectual disability (ID) has been reported in the literature, with overlapping presentations and genetic heterogeneity. A hundred patients (71 males and 29 females) with a MH and ID were recruited. Custom-designed 244K array-CGH (Agilent®; Agilent Technologies Inc., Santa Clara, CA) and MED12, ZDHHC9, UPF3B, FBN1, TGFBR1 and TGFBR2 sequencing analyses were performed. Eighty patients could be classified as isolated MH and ID: 12 chromosomal imbalances, 1 FBN1 mutation and 1 possibly pathogenic MED12 mutation were found (17%). Twenty patients could be classified as ID with other extra-skeletal features of the Marfan syndrome (MFS) spectrum: 4 pathogenic FBN1 mutations and 4 chromosomal imbalances were found (2 patients with both FBN1 mutation and chromosomal rearrangement) (29%). These results suggest either that there are more loci with genes yet to be discovered or that MH can also be a relatively non-specific feature of patients with ID. The search for aortic complications is mandatory even if MH is associated with ID since FBN1 mutations or rearrangements were found in some patients. The excess of males is in favour of the involvement of other X-linked genes. Although it was impossible to make a diagnosis in 80% of patients, these results will improve genetic counselling in families.
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Affiliation(s)
- P Callier
- Service de Cytogénétique, Plateau technique de Biologie, CHU, Dijon, France; Equipe GAD, EA 4271, Université de Bourgogne, Dijon, France
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31
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Carmignac V, Thevenon J, Adès L, Callewaert B, Julia S, Thauvin-Robinet C, Gueneau L, Courcet JB, Lopez E, Holman K, Renard M, Plauchu H, Plessis G, De Backer J, Child A, Arno G, Duplomb L, Callier P, Aral B, Vabres P, Gigot N, Arbustini E, Grasso M, Robinson PN, Goizet C, Baumann C, Di Rocco M, Sanchez Del Pozo J, Huet F, Jondeau G, Collod-Beroud G, Beroud C, Amiel J, Cormier-Daire V, Rivière JB, Boileau C, De Paepe A, Faivre L. In-frame mutations in exon 1 of SKI cause dominant Shprintzen-Goldberg syndrome. Am J Hum Genet 2012; 91:950-7. [PMID: 23103230 DOI: 10.1016/j.ajhg.2012.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 09/20/2012] [Accepted: 10/10/2012] [Indexed: 11/17/2022] Open
Abstract
Shprintzen-Goldberg syndrome (SGS) is characterized by severe marfanoid habitus, intellectual disability, camptodactyly, typical facial dysmorphism, and craniosynostosis. Using family-based exome sequencing, we identified a dominantly inherited heterozygous in-frame deletion in exon 1 of SKI. Direct sequencing of SKI further identified one overlapping heterozygous in-frame deletion and ten heterozygous missense mutations affecting recurrent residues in 18 of the 19 individuals screened for SGS; these individuals included one family affected by somatic mosaicism. All mutations were located in a restricted area of exon 1, within the R-SMAD binding domain of SKI. No mutation was found in a cohort of 11 individuals with other marfanoid-craniosynostosis phenotypes. The interaction between SKI and Smad2/3 and Smad 4 regulates TGF-β signaling, and the pattern of anomalies in Ski-deficient mice corresponds to the clinical manifestations of SGS. These findings define SGS as a member of the family of diseases associated with the TGF-β-signaling pathway.
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Affiliation(s)
- Virginie Carmignac
- Equipe d'Accueil 4271, Equipe Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
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32
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Doyle AJ, Doyle JJ, Bessling SL, Maragh S, Lindsay ME, Schepers D, Gillis E, Mortier G, Homfray T, Sauls K, Norris RA, Huso ND, Leahy D, Mohr DW, Caulfield MJ, Scott AF, Destrée A, Hennekam RC, Arn PH, Curry CJ, Van Laer L, McCallion AS, Loeys BL, Dietz HC. Mutations in the TGF-β repressor SKI cause Shprintzen-Goldberg syndrome with aortic aneurysm. Nat Genet 2012; 44:1249-54. [PMID: 23023332 PMCID: PMC3545695 DOI: 10.1038/ng.2421] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/04/2012] [Indexed: 01/15/2023]
Abstract
Increased transforming growth factor beta (TGF-β) signaling has been implicated in the pathogenesis of syndromic presentations of aortic aneurysm, including Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS)1-4. However, the location and character of many of the causal mutations in LDS would intuitively infer diminished TGF-β signaling5. Taken together, these data have engendered controversy regarding the specific role of TGF-β in disease pathogenesis. Shprintzen-Goldberg syndrome (SGS) has considerable phenotypic overlap with MFS and LDS, including aortic aneurysm6-8. We identified causative variation in 10 patients with SGS in the proto-oncogene SKI, a known repressor of TGF-β activity9,10. Cultured patient dermal fibroblasts showed enhanced activation of TGF-β signaling cascades and increased expression of TGF-β responsive genes. Morpholino-induced silencing of SKI paralogs in zebrafish recapitulated abnormalities seen in SGS patients. These data support the conclusion that increased TGF-β signaling is the mechanism underlying SGS and contributes to multiple syndromic presentations of aortic aneurysm.
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Affiliation(s)
- Alexander J Doyle
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hoffjan S. Genetic dissection of marfan syndrome and related connective tissue disorders: an update 2012. Mol Syndromol 2012; 3:47-58. [PMID: 23326250 PMCID: PMC3542934 DOI: 10.1159/000339441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2012] [Indexed: 12/22/2022] Open
Abstract
Marfan syndrome (MFS) is an autosomal dominant disorder of the connective tissue characterized by early development of thoracic aortic aneurysms/dissections together with symptoms of the ocular and skeletal systems. While most patients/families with a classic phenotypic expression of MFS harbour mutations in the gene encoding fibrillin-1 (FBN1), genetic studies of the recent years revealed that the clinical features, as well as the mutated genes, show a high degree of overlap between MFS and other connective tissue diseases (e.g. Loeys-Dietz syndrome, Ehlers-Danlos syndrome, familial thoracic aneurysms and dissections and others). We summarize herein the current knowledge about the wide spectrum of differential diagnoses and their genetic background as well as novel therapeutic approaches in order to provide appropriate counselling and clinical follow-up for the patients.
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Affiliation(s)
- S. Hoffjan
- Department of Human Genetics, Ruhr-University, Bochum, Germany
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Abstract
PURPOSE The aim of this study was to characterize the clinical phenotype of patients with tetrasomy of the distal 15q chromosome in the form of a neocentric marker chromosome and to evaluate whether the phenotype represents a new clinical syndrome or is a phenocopy of Shprintzen-Goldberg syndrome. METHODS We carried out comprehensive clinical evaluation of four patients who were identified with a supernumerary marker chromosome. The marker chromosome was characterized by G-banding, fluorescence in situ hybridization, single nucleotide polymorphism oligonucleotide microarray analysis, and immunofluorescence with antibodies to centromere protein C. RESULTS The marker chromosomes were categorized as being neocentric with all showing tetrasomy for regions distal to 15q25 and the common region of overlap being 15q26→qter. CONCLUSION Tetrasomy of 15q26 likely results in a distinct syndrome as the patients with tetrasomy 15q26 share a strikingly more consistent phenotype than do the patients with Shprintzen-Goldberg syndrome, who show remarkable clinical variation.
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Shanske AL, Goodrich JT, Ala-Kokko L, Baker S, Frederick B, Levy B. Germline mosacism in Shprintzen-Goldberg syndrome. Am J Med Genet A 2012; 158A:1574-8. [DOI: 10.1002/ajmg.a.35388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/04/2012] [Indexed: 01/20/2023]
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36
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Das Marfan-Syndrom und verwandte monogene Krankheiten der Aorta. MED GENET-BERLIN 2011. [DOI: 10.1007/s11825-011-0285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Zusammenfassung
Das Marfan-Syndrom (MFS) ist eine autosomal-dominant vererbte, pleiotrope Erkrankung des Bindegewebes mit einer Prävalenz von etwa 1:5000 Personen. Zwischen und auch innerhalb von Familien weisen betroffene Personen variable Kombinationen von Manifestationen im Herz-Kreislauf-System, Auge, Skelett sowie in der Lunge, Haut und Dura mater auf. Beim klassischen MFS treten viele Manifestationen während oder kurz vor der Pubertät auf; schwerwiegende Komplikationen sind vor dem Erwachsenenalter eher selten.
Viele Patienten imponieren durch einen sog. marfanoiden Körperhabitus mit Hochwuchs, langen und schmalen Gliedmaßen (Dolichostenomelie), einer langen und schmalen Kopfform (Dolichozephalie) und anderen skelettalen Auffälligkeiten wie Pes planus oder Skoliose. Eine Skoliose tritt bei etwa 60% der Betroffenen auf, Pectus excavatum oder carinatum bei etwa zwei Dritteln. Eine fast immer beidseitige Ectopia lentis kommt bei vielen Patienten vor (etwa 60%).
Bei manchen Patienten bestehen therapiepflichtige Komplikationen wie schwerwiegende Skoliose oder Trichterbrust, Spontanpneumothorax, Netzhautablösung oder ein durch Linsenluxation hervorgerufenes akutes Glaukom. Die gefährlichste Komplikation ist jedoch die akute Dissektion der aufsteigenden Aorta, die in aller Regel die Folge einer langsam fortschreitenden Aortendilatation darstellt. Vor der Einführung moderner Therapieformen, die in diesem Artikel behandelt werden, betrug die durchschnittliche Lebenserwartung MFS-Betroffener nur 32 Jahre. Heute kann bei Betreuung in multidisziplinären Zentren von einer durchschnittlichen Lebenserwartung von über 60 Jahren ausgegangen werden. Dieser Artikel bietet dem Leser einen Überblick über bewährte und neue Diagnose- und Therapiekonzepte für MFS und andere hereditäre Erkrankungen der Aorta.
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Panigrahi I. Craniosynostosis genetics: The mystery unfolds. INDIAN JOURNAL OF HUMAN GENETICS 2011; 17:48-53. [PMID: 22090712 PMCID: PMC3214317 DOI: 10.4103/0971-6866.86171] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Craniosynsostosis syndromes exhibit considerable phenotypic and genetic heterogeneity. Sagittal synostosis is common form of isolated craniosynostosis. The sutures involved, the shape of the skull and associated malformations give a clue to the specific diagnosis. Crouzon syndrome is one of the most common of the craniosynostosis syndromes. Apert syndrome accounts for 4.5% of all craniosynostoses and is one of the most serious of these syndromes. Most syndromic craniosynostosis require multidisciplinary management. The following review provides a brief appraisal of the various genes involved in craniosynostosis syndromes, and an approach to diagnosis and genetic counseling.
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Affiliation(s)
- Inusha Panigrahi
- Department of Pediatrics, Genetic and Metabolic Unit, Advanced Pediatric Center, PGIMER, Chandigarh, India
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Jain D, Dietz HC, Oswald GL, Maleszewski JJ, Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol 2011; 20:15-25. [PMID: 19926309 DOI: 10.1016/j.carpath.2009.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/02/2009] [Accepted: 09/25/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ascending aortic diseases (aneurysms, dissections, and stenosis) and associated aortic valve disease are rare but important causes of morbidity and mortality in children and young adults. Certain genetic causes, such as Marfan syndrome and congenital bicuspid aortic valve disease, are well known. However, other rarer genetic and nongenetic causes of aortic disease exist. METHODS We performed an extensive literature search to identify known causes of ascending aortic pathology in children and young adults. We catalogued both aortic pathologies and other defining systemic features of these diseases. RESULTS We describe 17 predominantly genetic entities that have been associated with thoracic aortic disease in this age group. CONCLUSIONS While extensive literature on the common causes of ascending aortic disease exists, there is a need for better histologic documentation of aortic pathology in rarer diseases.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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39
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Hereditary disorders of connective tissue: a guide to the emerging differential diagnosis. Genet Med 2010; 12:344-54. [PMID: 20467323 DOI: 10.1097/gim.0b013e3181e074f0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To create a practical desk reference for clinicians focused on the differential diagnosis of individuals presenting with features that suggest an inherited disorder of connective tissue. METHODS We searched the medical literature for distinct clinical entities that shared clinical features with Marfan syndrome and other classical inherited disorders of connective tissue. RESULTS Thirty-six distinct heritable disorders of connective tissue were identified that have overlapping features. These disorders were organized into two matrices according to clinical characteristics and according to causative genes. CONCLUSIONS A broad differential diagnosis is emerging for individuals presenting with features suggestive of altered connective tissue. Recent advances in molecular genetics have aided in the delineation of these disorders.
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Gupta AK, Divekar DS, Shah B, Dhulkhed VK. Anesthetic management of a rare case of Shprintzen-Goldberg craniosynostosis syndrome. Paediatr Anaesth 2010; 20:771-3. [PMID: 20670243 DOI: 10.1111/j.1460-9592.2010.03340.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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van Steensel MA, van Geel M, Parren LJ, Schrander-Stumpel CT, Marcus-Soekarman D. Shprintzen-Goldberg syndrome associated with a novel missense mutation in TGFBR2. Exp Dermatol 2008; 17:362-5. [DOI: 10.1111/j.1600-0625.2007.00648.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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von Kodolitsch Y, Rybczynski M, Detter C, Robinson PN. Diagnosis and management of Marfan syndrome. Future Cardiol 2008; 4:85-96. [PMID: 19804274 DOI: 10.2217/14796678.4.1.85] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Marfan syndrome is a disorder of the connective tissue that is inherited in an autosomal-dominant fashion and is caused by mutations in the gene coding for fibrillin-1, FBN1. Although complications of the syndrome may involve the eye, the lung and the skeleton, the high mortality of untreated cases results almost exclusively from cardiovascular complications, including aortic dissection and rupture. Recently, a series of experiments has begun to elucidate the complex molecular etiology of Marfan syndrome, and a number of new heritable syndromes with an associated risk for aortic complications, such as Loeys–Dietz syndrome types I and II, have been described. The multiorgan involvement of many of these syndromes requires multidisciplinary expert centers that can increase the average life expectancy of affected patients from only 32 years to over 60 years. The present article both reviews classical standards of managing cardiovascular manifestations and outlines significant advances in recent research with focus on their impact on future diagnostic and therapeutic options.
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Affiliation(s)
- Yskert von Kodolitsch
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, Department of Cardiology/Angiology, University Hospital Hamburg – Eppendorf, Hamburg Martinistrasse 52, 20246 Hamburg, Germany
| | - Meike Rybczynski
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, Department of Cardiology/Angiology, University Hospital Eppendorf, Hamburg, Germany
| | - Christian Detter
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Peter N Robinson
- Humboldt University, Institute of Medical Genetics, Charité Universitätsmedizin, Humboldt University, Berlin, Germany
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43
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Van Lierde KM, Mortier G, Loeys B, Baudonck N, De Ley S, Marks LA, Van Borsel J. Overall intelligibility, language, articulation, voice and resonance characteristics in a child with Shprintzen-Goldberg syndrome. Int J Pediatr Otorhinolaryngol 2007; 71:721-8. [PMID: 17303258 DOI: 10.1016/j.ijporl.2007.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 01/05/2007] [Accepted: 01/05/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Recognition of the phenotypic spectrum and prognosis of a genetic disorder is critical to proper patient care. A 7-year-old boy with Sphrintzen-Goldberg syndrome (SGS) was studied to investigate speech, language and voice patterns associated with this syndrome. METHODS The child's language (expressive and receptive) and speech was characterized with regard to overall intelligibility, articulation (phonetic and phonological errors), voice (flexible videolaryngostroboscopy, quality, pitch and loudness) and resonance (type of disorders). RESULTS Based on this detailed study the most striking communication characteristics in this child with SGS appear to be a delayed speech and language onset, an expressive and receptive language disorder, a moderately impaired speech intelligbility, relatively good phonetic but poorer phonological abilities, an oral hypotonia, a high-pitched soft voice and a slight hypernasality. CONCLUSIONS The explanation for this communication disorder is not completely straightforward. It is not clear either to what extent the present case can be considered as typical for SGS. Only more data will allow to determine whether or not SGS is associated with a typical syndrome specific pattern of communication disorders. Not only detailed speech and language analyses of additional cases of SGS are necessary, but also studies that compare the speech and language of individuals with SGS with that of individuals with other genetic syndrome.
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Affiliation(s)
- Kristiane M Van Lierde
- Department of Otorhinolaryngology, Head and Neck Surgery and Speech Language Pathology, University Hospital Gent, 2P1, De Pintelaan 185, 9000 Gent Belgium.
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44
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Mizuguchi T, Matsumoto N. Recent progress in genetics of Marfan syndrome and Marfan-associated disorders. J Hum Genet 2006; 52:1-12. [PMID: 17061023 DOI: 10.1007/s10038-006-0078-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 09/26/2006] [Indexed: 12/11/2022]
Abstract
Marfan syndrome (MFS, OMIM #154700) is a hereditary connective tissue disorder, clinically presenting with cardinal features of skeletal, ocular, and cardiovascular systems. In classical MFS, changes in connective tissue integrity can be explained by defects in fibrillin-1, a major component of extracellular microfibrils. However, some of the clinical manifestations of MFS cannot be explained by mechanical properties alone. Recent studies manipulating mouse Fbn1 have provided new insights into the molecular pathogenesis of MFS. Dysregulation of transforming growth factor beta (TGFbeta) signaling in lung, mitral valve and aortic tissues has been implicated in mouse models of MFS. TGFBR2 and TGFBR1 mutations were identified in a subset of patients with MFS (MFS2, OMIM #154705) and other MFS-related disorders, including Loeys-Dietz syndrome (LDS, #OMIM 609192) and familial thoracic aortic aneurysms and dissections (TAAD2, #OMIM 608987). These data indicate that genetic heterogeneity exists in MFS and its related conditions and that regulation of TGFbeta signaling plays a significant role in these disorders.
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Affiliation(s)
- Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama, 236-0004, Japan
- Solution-Oriented Research for Science and Technology (SORST), JST, Kawaguchi, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama, 236-0004, Japan.
- Solution-Oriented Research for Science and Technology (SORST), JST, Kawaguchi, Japan.
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45
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Jödicke A, Hahn A, Berthold LD, Scharbrodt W, Böker DK. Dysplasia of C-1 and craniocervical instability in patients with Shprintzen-Goldberg syndrome. Case report and review of the literature. J Neurosurg 2006; 105:238-41. [PMID: 16970241 DOI: 10.3171/ped.2006.105.3.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Shprintzen-Goldberg syndrome is a rare connective tissue disorder characterized by marfanoid habitus and additional dysmorphic stigmata. Craniocervical anomalies occur in fewer than 30% of cases. Serious vertebral instability can also occur, albeit rarely. The authors report on the first patient treated with surgical fusion at the craniocervical junction because of a C-1 dysplasia and severe instability. The skeletal and cardiovascular anomalies that can pose additional problems for surgical treatment and perioperative care are discussed in detail.
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Affiliation(s)
- Andreas Jödicke
- Department of Neurosurgery, University Medical Centre Giessen and Marburg, Giessen, Germany.
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