1
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Mangels R, Blumenfeld YJ, Homeyer M, Mrazek-Pugh B, Hintz SR, Hudgins L. RASopathies: A significant cause of polyhydramnios? Prenat Diagn 2020; 41:362-367. [PMID: 33150592 DOI: 10.1002/pd.5862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the study is to determine the prevalence of RASopathies in a polyhydramnios cohort selected by postnatal medical genetics evaluation. METHODS In this retrospective study, we reviewed 622 pregnancies with polyhydramnios seen at Lucile Packard Children's Hospital between 2008 and 2017. The findings from 131 cases evaluated by Medical Genetics were included in our final analysis. Genetic testing information was extracted to determine the rate of chromosomal or single gene conditions focusing on the RASopathies. Additional variables collected were: maternal characteristics, ultrasound findings, and the severity and timing of diagnosis of polyhydramnios. RESULTS Postnatal genetic testing or clinical examination identified a genetic disorder in 63 (48.1%) cases, more than half (n = 33) of which had a single gene condition. Postnatal testing revealed an underlying RASopathy in 15 (11.5%) cases. An underlying RASopathy was significantly associated with the severity and timing of polyhydramnios (p < 0.05). CONCLUSION Focusing on a selected cohort postnatally evaluated by Medical Genetics, our study identified a chromosomal or genetic disorder in almost half of pregnancies complicated by polyhydramnios. Specifically, an underlying RASopathy was found in 11.5% of cases with 13/15 of these cases having additional ultrasound findings.
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Affiliation(s)
- Rachel Mangels
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Yair J Blumenfeld
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.,Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Margaret Homeyer
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Barbora Mrazek-Pugh
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Susan R Hintz
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Louanne Hudgins
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.,Divison of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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2
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Nwakalor C, Said-Delgado S, Krinshpun S, Velinov M. De novo HRAS gene mutation associated with Costello syndrome identified by non-invasive cell-free fetal DNA screening. Prenat Diagn 2020; 41:11-14. [PMID: 32681669 DOI: 10.1002/pd.5798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Chidinma Nwakalor
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten, The Netherlands
| | - Sara Said-Delgado
- Department of Obstetrics and Gynecology, Bronx Care, Bronx, New York, USA
| | | | - Milen Velinov
- Department of Pediatrics, Bronx Care, Bronx, New York, USA.,Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, USA
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3
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Orlova AA, Dadali EL, Polyakov AV. Clinical and Genetic Characteristics of Noonan Syndrome and Noonan-like Diseases. RUSS J GENET+ 2020. [DOI: 10.1134/s1022795420050117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Gripp KW, Morse LA, Axelrad M, Chatfield KC, Chidekel A, Dobyns W, Doyle D, Kerr B, Lin AE, Schwartz DD, Sibbles BJ, Siegel D, Shankar SP, Stevenson DA, Thacker MM, Weaver KN, White SM, Rauen KA. Costello syndrome: Clinical phenotype, genotype, and management guidelines. Am J Med Genet A 2019; 179:1725-1744. [PMID: 31222966 PMCID: PMC8238015 DOI: 10.1002/ajmg.a.61270] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/22/2019] [Accepted: 06/01/2019] [Indexed: 12/16/2022]
Abstract
Costello syndrome (CS) is a RASopathy caused by activating germline mutations in HRAS. Due to ubiquitous HRAS gene expression, CS affects multiple organ systems and individuals are predisposed to cancer. Individuals with CS may have distinctive craniofacial features, cardiac anomalies, growth and developmental delays, as well as dermatological, orthopedic, ocular, and neurological issues; however, considerable overlap with other RASopathies exists. Medical evaluation requires an understanding of the multifaceted phenotype. Subspecialists may have limited experience in caring for these individuals because of the rarity of CS. Furthermore, the phenotypic presentation may vary with the underlying genotype. These guidelines were developed by an interdisciplinary team of experts in order to encourage timely health care practices and provide medical management guidelines for the primary and specialty care provider, as well as for the families and affected individuals across their lifespan. These guidelines are based on expert opinion and do not represent evidence-based guidelines due to the lack of data for this rare condition.
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Affiliation(s)
- Karen W. Gripp
- Division of Medical Genetics, Department of Pediatrics, A.I. duPont Hospital for Children, Wilmington, Delaware
| | | | - Marni Axelrad
- Psychology Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kathryn C. Chatfield
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Aaron Chidekel
- Division of Pulmonology, Department of Pediatrics, A.I. duPont Hospital for Children, Wilmington, Delaware
| | - William Dobyns
- Division of Medical Genetics, Seattle Children’s Hospital, Seattle, Washington
| | - Daniel Doyle
- Division of Endocrinology, A.I. duPont Hospital for Children, Wilmington, Delaware
| | - Bronwyn Kerr
- Manchester Center for Genomic Medicine, University of Manchester, Manchester, UK
| | - Angela E. Lin
- Medical Genetics Unit, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - David D. Schwartz
- Psychology Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Barbara J. Sibbles
- Division of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Dawn Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Suma P. Shankar
- Division of Genomic Medicine, Department of Pediatrics, University of California Davis, Sacramento, California
| | - David A. Stevenson
- Division of Medical Genetic, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Mihir M. Thacker
- Department of Orthopedic Surgery, Nemoirs-Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - K. Nicole Weaver
- Division of Human Genetics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sue M. White
- Victorian Clinical Genetics Services, Royal Children’s Hospital, Victoria, Australia
| | - Katherine A. Rauen
- Division of Genomic Medicine, Department of Pediatrics, University of California Davis, Sacramento, California
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5
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Choi N, Ko JM, Shin SH, Kim EK, Kim HS, Song MK, Choi CW. Phenotypic and Genetic Characteristics of Five Korean Patients with Costello Syndrome. Cytogenet Genome Res 2019; 158:184-191. [PMID: 31394527 DOI: 10.1159/000502045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/27/2022] Open
Abstract
Costello syndrome (CS) is a rare genetic disorder characterized by distinctive facial appearance, cardiopulmonary complications, severe growth retardation, skin and skeletal defects, developmental delay, and tumor predisposition. CS is caused by heterozygous de novo mutations in the proto-oncogene HRAS, which is a component of the RAS/mitogen-activated protein kinase pathway. Herein, we reviewed the phenotypic and genetic features of 5 Korean patients who were genetically diagnosed with CS. Atrial tachycardia and polyhydramnios, which are important prenatal features for CS, were observed in 4 and 5 patients, respectively. The distinctive coarse facial appearances of the patients and presence of deep palmoplantar creases supported the clinical diagnosis of CS, which was confirmed by HRAS sequence analysis. Extremely poor postnatal growth was observed in all 5 patients. Further, all patients exhibited cardiac abnormalities; left ventricular hypertrophy and hypertrophic cardiomyopathy were observed in 3 patients. All 5 patients suffered from airway problems; 3 of them required intubation right after birth, and 2 of them received tracheostomy. One patient with a p.Gly12Ser mutation was diagnosed with retroperitoneal rhabdomyosarcoma alveolar type at the age of 5 years. Consistent with previous reports, both patients with p.Gly12Cys mutations died within the first year of life due to cardiopulmonary failure. Our study summarizes the characteristics of these 5 Korean patients with CS and, along with previous studies, provides clues for genotype-phenotype correlation in patients with CS.
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6
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Fetal edema, not overgrowth, is associated with neonatal lethal Costello syndrome due to the HRAS p.Gly12Val mutation. Clin Dysmorphol 2019; 28:71-73. [PMID: 30664540 DOI: 10.1097/mcd.0000000000000260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Kuehne B, Heine E, Dafsari HS, Irwin R, Heller R, Bangen U, Brockmeier K, Kribs A, Oberthuer A, Cirak S. Use of whole exome sequencing in the NICU: Case of an extremely low birth weight infant with syndromic features. Mol Cell Probes 2019; 45:89-93. [DOI: 10.1016/j.mcp.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022]
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8
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Leppävirta J, Kallionpää RA, Uusitalo E, Vahlberg T, Pöyhönen M, Peltonen J, Peltonen S. Neurofibromatosis type 1 of the child increases birth weight. Am J Med Genet A 2019; 179:1173-1183. [PMID: 31016862 PMCID: PMC6618292 DOI: 10.1002/ajmg.a.61161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 12/30/2022]
Abstract
Neurofibromatosis type 1 (NF1) is associated with reduced adult height, but there are no cohort studies on birth size. This retrospective study includes a cohort of 1,410 persons with NF1 and a matched comparison cohort from the general population. Figures for birth size were retrieved from the administrative registers of Finland, and the data were converted to standard deviation scores (SDS), defined as standard deviation difference to the reference population. The birth weight among infants with NF1 was higher than among infants without the disorder (adjusted mean difference [95% confidence interval]: 0.53 SDS [0.19–0.87]), as was the head circumference at birth (0.58 SDS [0.26–0.90]). The birth length of the NF1 infants did not differ significantly from the comparison cohort. The birth weight in the group consisting of NF1 and non‐NF1 infants of NF1 mothers was lower than among infants of mothers in the comparison cohort (−0.28 SDS [−0.51 to −0.06]), as was the birth length (−0.22 SDS [−0.45 to 0.00]). In conclusion, the birth weight and head circumference of persons with NF1 are significantly higher than those of persons without the disorder. NF1 of the mother reduces birth weight and birth length of the infant.
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Affiliation(s)
- Jussi Leppävirta
- Department of Dermatology and VenereologyUniversity of TurkuTurkuFinland
- Department of DermatologyTurku University HospitalTurkuFinland
| | - Roope A. Kallionpää
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
| | - Elina Uusitalo
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
| | - Tero Vahlberg
- Department of Clinical MedicineUniversity of TurkuTurkuFinland
| | - Minna Pöyhönen
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
- Department of Clinical GeneticsHUSLAB and Helsinki University Central HospitalHelsinkiFinland
| | - Juha Peltonen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
| | - Sirkku Peltonen
- Department of Dermatology and VenereologyUniversity of TurkuTurkuFinland
- Department of DermatologyTurku University HospitalTurkuFinland
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9
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Hague J, Hackett G, Acerini C, Park SM. Prenatal genetic diagnosis of Costello syndrome in a male fetus with recurrent HRAS mutation p.Gly12Ser. Prenat Diagn 2017; 37:409-411. [PMID: 28141901 DOI: 10.1002/pd.5009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/04/2017] [Accepted: 01/20/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Jennifer Hague
- East Anglian Genetics Service, Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gerald Hackett
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Soo-Mi Park
- East Anglian Genetics Service, Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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10
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Novel pathogenic variant in the HRAS gene with lethal outcome and a broad phenotypic spectrum among Polish patients with Costello syndrome. Clin Dysmorphol 2016; 26:83-90. [PMID: 28027064 DOI: 10.1097/mcd.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Costello syndrome (CS) is a rare congenital disorder from the group of RASopathies, characterized by a distinctive facial appearance, failure to thrive, cardiac and skin anomalies, intellectual disability, and a predisposition to neoplasia. CS is associated with germline mutations in the proto-oncogene HRAS, a small GTPase from the Ras family. In this study, a molecular and clinical analysis was carried out in eight Polish patients with the Costello phenotype. A molecular test showed two known heterozygous mutations in the first coding exon of the gene in seven patients: p.G12S (n=4) and p.G12A (n=3), and a novel pathogenic variant p.G60V in one child with an unusually severe, lethal course of the syndrome. In addition, a fatal course of CS was present in one patient with the p.G12A mutation and in another with p.G12S, there was a co-occurrence of Turner syndrome because of the distal Xp deletion. A severe clinical manifestation with a lethal outcome in an individual with p.G60V in HRAS and contrary observations of an attenuated phenotype in CS patients with other mutations at glycine-60 residue may suggest that the nature of the substituted amino acid plays a significant role in the clinical variability observed in some CS cases.
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11
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Next Generation Sequencing Approach in a Prenatal Case of Cardio-Facio-Cutaneus Syndrome. Int J Mol Sci 2016; 17:ijms17060952. [PMID: 27322245 PMCID: PMC4926485 DOI: 10.3390/ijms17060952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/19/2016] [Accepted: 06/01/2016] [Indexed: 12/03/2022] Open
Abstract
Cardiofaciocutaneous syndrome (CFCS) belongs to a group of developmental disorders due to defects in the Ras/Mitogen-Activated Protein Kinase (RAS/MAPK) signaling pathway named RASophaties. While postnatal presentation of these disorders is well known, the prenatal and neonatal characteristics are less recognized. Noonan syndrome, Costello syndrome, and CFCS diagnosis should be considered in pregnancies with a normal karyotype and in the case of ultrasound findings such as increased nuchal translucency, polyhydramnios, macrosomia and cardiac defect. Because all the RASopathies share similar clinical features, their molecular characterization is complex, time consuming and expensive. Here we report a case of CFCS prenatally diagnosed through Next Generation Prenatal Diagnosis (NGPD), a new targeted approach that allows us to concurrently investigate all the genes involved in the RASophaties.
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12
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Human iPS Cell-Derived Neurons Uncover the Impact of Increased Ras Signaling in Costello Syndrome. J Neurosci 2016; 36:142-52. [PMID: 26740656 DOI: 10.1523/jneurosci.1547-15.2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Increasing evidence implicates abnormal Ras signaling as a major contributor in neurodevelopmental disorders, yet how such signaling causes cortical pathogenesis is unknown. We examined the consequences of aberrant Ras signaling in the developing mouse brain and uncovered several critical phenotypes, including increased production of cortical neurons and morphological deficits. To determine whether these phenotypes are recapitulated in humans, we generated induced pluripotent stem (iPS) cell lines from patients with Costello syndrome (CS), a developmental disorder caused by abnormal Ras signaling and characterized by neurodevelopmental abnormalities, such as cognitive impairment and autism. Directed differentiation toward a neuroectodermal fate revealed an extended progenitor phase and subsequent increased production of cortical neurons. Morphological analysis of mature neurons revealed significantly altered neurite length and soma size in CS patients. This study demonstrates the synergy between mouse and human models and validates the use of iPS cells as a platform to study the underlying cellular pathologies resulting from signaling deficits. SIGNIFICANCE STATEMENT Increasing evidence implicates Ras signaling dysfunction as a major contributor in psychiatric and neurodevelopmental disorders, such as cognitive impairment and autism, but the underlying cortical cellular pathogenesis remains unclear. This study is the first to reveal human neuronal pathogenesis resulting from abnormal Ras signaling and provides insights into how these phenotypic abnormalities likely contribute to neurodevelopmental disorders. We also demonstrate the synergy between mouse and human models, thereby validating the use of iPS cells as a platform to study underlying cellular pathologies resulting from signaling deficits. Recapitulating human cellular pathologies in vitro facilitates the future high throughput screening of potential therapeutic agents that may reverse phenotypic and behavioral deficits.
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13
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Gomez-Ospina N, Kuo C, Ananth AL, Myers A, Brennan ML, Stevenson DA, Bernstein JA, Hudgins L. Respiratory system involvement in Costello syndrome. Am J Med Genet A 2016; 170:1849-57. [PMID: 27102959 DOI: 10.1002/ajmg.a.37655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/16/2016] [Indexed: 11/09/2022]
Abstract
Costello syndrome (CS) is a multisystem disorder caused by heterozygous germline mutations in the HRAS proto-oncogene. Respiratory system complications have been reported in individuals with CS, but a comprehensive description of the full spectrum and incidence of respiratory symptoms in these patients is not available. Here, we report the clinical course of four CS patients with respiratory complications as a major cause of morbidity. Review of the literature identified 56 CS patients with descriptions of their neonatal course and 17 patients in childhood/adulthood. We found that in the neonatal period, respiratory complications are seen in approximately 78% of patients with transient respiratory distress reported in 45% of neonates. Other more specific respiratory diagnoses were reported in 62% of patients, the majority of which comprised disorders of the upper and lower respiratory tract. Symptoms of upper airway obstruction were reported in CS neonates but were more commonly diagnosed in childhood/adulthood (71%). Analysis of HRAS mutations and their respiratory phenotype revealed that the common p.Gly12Ser mutation is more often associated with transient respiratory distress and other respiratory diagnoses. Respiratory failure and dependence on mechanical ventilation occurs almost exclusively with rare mutations. In cases of prenatally diagnosed CS, the high incidence of respiratory complications in the neonatal period should prompt anticipatory guidance and development of a postnatal management plan. This may be important in cases involving rarer mutations. Furthermore, the high frequency of airway obstruction in CS patients suggests that otorhinolaryngological evaluation and sleep studies should be considered. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Natalia Gomez-Ospina
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Christin Kuo
- Division of Pulmonary Medicine, Stanford University School of Medicine, Stanford, California
| | - Amitha Lakshmi Ananth
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Angela Myers
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | | | - David A Stevenson
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Jonathan A Bernstein
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
| | - Louanne Hudgins
- Division of Medical Genetics, Stanford University School of Medicine, Stanford, California
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14
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Waelchli R, Williams J, Cole T, Dattani M, Hindmarsh P, Kennedy H, Martinez A, Khan S, Semple RK, White A, Sebire N, Healy E, Moore G, Kinsler VA. Growth and hormone profiling in children with congenital melanocytic naevi. Br J Dermatol 2015; 173:1471-8. [PMID: 26286459 PMCID: PMC4737097 DOI: 10.1111/bjd.14091] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/15/2022]
Abstract
Background Multiple congenital melanocytic naevi (CMN) is a rare mosaic RASopathy, caused by postzygotic activating mutations in NRAS. Growth and hormonal disturbances are described in germline RASopathies, but growth and hormone status have not previously been investigated in individuals with CMN. Objectives To explore premature thelarche, undescended testes, and a clinically abnormal fat distribution with CMN through prospective endocrinological assessment of a cohort of subjects with CMN, and a retrospective review of longitudinal growth of a larger group of patients with CMN from outpatient clinics (which included all subjects in the endocrinological assessment group). Patients and methods Longitudinal growth in a cohort of 202 patients with single or multiple CMN was compared with the U.K. National Child Measurement Programme 2010. Forty‐seven children had hormonal profiling including measurement of circulating luteinizing hormone, follicle‐stimulating hormone, thyroid stimulating hormone, adrenocorticotrophic hormone, growth hormone, prolactin, pro‐opiomelanocortin, estradiol, testosterone, cortisol, thyroxine, insulin‐like growth factor‐1 and leptin; 10 had oral glucose tolerance testing 25 had dual‐energy X‐ray absorptiometry scans for body composition. Results Body mass index increased markedly with age (coefficient 0·119, SE 0·016 standard deviation scores per year), at twice the rate of the U.K. population, due to increased adiposity. Three per cent of girls had premature thelarche variant and 6% of boys had persistent undescended testes. Both fat and muscle mass were reduced in areas underlying large naevi, resulting in limb asymmetry and abnormal truncal fat distribution. Anterior pituitary hormone profiling revealed subtle and variable abnormalities. Oral glucose tolerance tests revealed moderate–severe insulin insensitivity in five of 10, and impaired glucose tolerance in one. Conclusions Interpersonal variation may reflect the mosaic nature of this disease and patients should be considered individually. Postnatal weight gain is potentially related to the underlying genetic defect; however, environmental reasons cannot be excluded. Naevus‐related reduction of fat and muscle mass suggests local hormonal or metabolic effects on development or growth of adjacent tissues, or mosaic involvement of these tissues at the genetic level. Premature thelarche and undescended testes should be looked for, and investigated, as for any child. What's already known about this topic? CMN are caused by postzygotic mutations in the gene NRAS in the majority of cases, classifying it within the group of mosaic RASopathies. Other germline and mosaic RASopathies are known to have growth and hormonal abnormalities. No studies have been done on growth or endocrinology in children with CMN.
What does this study add? Average body mass index increases markedly with age compared with the normal population; this is due to increased adiposity, and can be associated with insulin insensitivity. Premature thelarche variant and persistent undescended testes are not infrequent findings, but puberty appears to develop normally. Both fat and muscle mass can be reduced in areas underlying large naevi, resulting in asymmetry.
Linked Comment:Millington, Br J Dermatol 2015; 173: 1366–67.
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Affiliation(s)
- R Waelchli
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - J Williams
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, U.K
| | - T Cole
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, U.K
| | - M Dattani
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K.,Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - P Hindmarsh
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K.,Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - H Kennedy
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - A Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - S Khan
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K
| | - R K Semple
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - A White
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K
| | - N Sebire
- Department of Paediatric Histopathology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K
| | - E Healy
- Department of Dermatopharmacology, Sir Henry Wellcome Laboratories, University of Southampton, Southampton, U.K
| | - G Moore
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K
| | - V A Kinsler
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, WC1N 3JH, U.K.,Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K
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15
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Templin L, Baumann C, Busa T, Heckenroth H, Pouvreau N, Toutain A, Cave H, Verloes A, Sigaudy S, Philip N. Prenatal findings in cardio-facio-cutaneous syndrome. Am J Med Genet A 2015; 170A:441-445. [DOI: 10.1002/ajmg.a.37420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 09/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ludivine Templin
- Centre de référence des anomalies du développement et syndrome malformatif PACA, Département de Génétique Médicale; Hôpital de la Timone Enfant, AP-HM; Marseille France
| | - Clarisse Baumann
- Département de Génétique; APHP-Hôpital Robert DEBRE; Paris France
| | - Tiffany Busa
- Centre de référence des anomalies du développement et syndrome malformatif PACA, Département de Génétique Médicale; Hôpital de la Timone Enfant, AP-HM; Marseille France
| | - Hélène Heckenroth
- Centre pluridisciplinaire de diagnostic prénatal; hôpital de la Timone Enfants, AP-HM; Marseille France
| | | | - Annick Toutain
- Service de Génétique clinique; Centre Hospitalier Universitaire, Unité INSERM U930, Faculté de Médecine; Tours France
| | - Hélène Cave
- Département de Génétique, AP-HP-Hôpital Robert DEBRE, INSERM UMR 1131; Institut Universitaire d'Hématologie, Université Paris Diderot, Paris Sorbonne Cité; Paris France
| | - Alain Verloes
- Département de Génétique, APHP-Hôpital Robert DEBRE; Université Sorbonne-Paris Cité; INSERM UMR1141 Paris France
| | - Sabine Sigaudy
- Centre de référence des anomalies du développement et syndrome malformatif PACA, Département de Génétique Médicale; Hôpital de la Timone Enfant, AP-HM; Marseille France
- Centre pluridisciplinaire de diagnostic prénatal; hôpital de la Timone Enfants, AP-HM; Marseille France
| | - Nicole Philip
- Centre de référence des anomalies du développement et syndrome malformatif PACA, Département de Génétique Médicale; Hôpital de la Timone Enfant, AP-HM; Marseille France
- Centre pluridisciplinaire de diagnostic prénatal; hôpital de la Timone Enfants, AP-HM; Marseille France
- Université Aix-Marseille; INSERM, Génétique Médicale et Génomique Fonctionnelle, UMR_S 910; Marseille France
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16
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Myers A, Bernstein JA, Brennan ML, Curry C, Esplin ED, Fisher J, Homeyer M, Manning MA, Muller EA, Niemi AK, Seaver LH, Hintz SR, Hudgins L. Perinatal features of the RASopathies: Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome. Am J Med Genet A 2014; 164A:2814-21. [PMID: 25250515 DOI: 10.1002/ajmg.a.36737] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/24/2014] [Indexed: 11/08/2022]
Abstract
The RASopathies are a family of developmental disorders caused by heritable defects of the RAS/MAPK signaling pathway. While the postnatal presentation of this group of disorders is well known, the prenatal and neonatal findings are less widely recognized. We report on the perinatal presentation of 10 patients with Noonan syndrome (NS), nine with Cardiofaciocutaneous syndrome (CFCS) and three with Costello syndrome (CS), in conjunction with the results of a comprehensive literature review. The majority of perinatal findings in NS, CS, and CFCS are shared: polyhydramnios; prematurity; lymphatic dysplasia; macrosomia; relative macrocephaly; respiratory distress; hypotonia, as well as cardiac and renal anomalies. In contrast, fetal arrhythmia and neonatal hypoglycemia are relatively specific to CS. NS, CS, and CFCS should all be considered as a possible diagnosis in pregnancies with a normal karyotype and ultrasound findings of a RASopathy. Recognition of the common perinatal findings of these disorders should facilitate both their prenatal and neonatal diagnosis.
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Affiliation(s)
- Angela Myers
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, California
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17
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Peterson TA, Park D, Kann MG. A protein domain-centric approach for the comparative analysis of human and yeast phenotypically relevant mutations. BMC Genomics 2013; 14 Suppl 3:S5. [PMID: 23819456 PMCID: PMC3665522 DOI: 10.1186/1471-2164-14-s3-s5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The body of disease mutations with known phenotypic relevance continues to increase and is expected to do so even faster with the advent of new experimental techniques such as whole-genome sequencing coupled with disease association studies. However, genomic association studies are limited by the molecular complexity of the phenotype being studied and the population size needed to have adequate statistical power. One way to circumvent this problem, which is critical for the study of rare diseases, is to study the molecular patterns emerging from functional studies of existing disease mutations. Current gene-centric analyses to study mutations in coding regions are limited by their inability to account for the functional modularity of the protein. Previous studies of the functional patterns of known human disease mutations have shown a significant tendency to cluster at protein domain positions, namely position-based domain hotspots of disease mutations. However, the limited number of known disease mutations remains the main factor hindering the advancement of mutation studies at a functional level. In this paper, we address this problem by incorporating mutations known to be disruptive of phenotypes in other species. Focusing on two evolutionarily distant organisms, human and yeast, we describe the first inter-species analysis of mutations of phenotypic relevance at the protein domain level. Results The results of this analysis reveal that phenotypic mutations from yeast cluster at specific positions on protein domains, a characteristic previously revealed to be displayed by human disease mutations. We found over one hundred domain hotspots in yeast with approximately 50% in the exact same domain position as known human disease mutations. Conclusions We describe an analysis using protein domains as a framework for transferring functional information by studying domain hotspots in human and yeast and relating phenotypic changes in yeast to diseases in human. This first-of-a-kind study of phenotypically relevant yeast mutations in relation to human disease mutations demonstrates the utility of a multi-species analysis for advancing the understanding of the relationship between genetic mutations and phenotypic changes at the organismal level.
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Affiliation(s)
- Thomas A Peterson
- Department of Biological Sciences, University of Maryland, Baltimore County, Baltimore, MD, USA
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18
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Lorenz S, Lissewski C, Simsek-Kiper PO, Alanay Y, Boduroglu K, Zenker M, Rosenberger G. Functional analysis of a duplication (p.E63_D69dup) in the switch II region of HRAS: new aspects of the molecular pathogenesis underlying Costello syndrome. Hum Mol Genet 2013; 22:1643-53. [PMID: 23335589 DOI: 10.1093/hmg/ddt014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Costello syndrome is a congenital disorder comprising a characteristic face, severe feeding difficulties, skeletal, cardiac and skin abnormalities, intellectual disability and predisposition to malignancies. It is caused by heterozygous germline HRAS mutations mostly affecting Gly(12) or Gly(13), which impair HRAS-GTPase activity and result in increased downstream signal flow independent of incoming signals. Functional analyses of rarer HRAS mutations identified in individuals with attenuated Costello syndrome phenotypes revealed altered GDP/GTP nucleotide affinities (p.K117R) and inefficient effector binding (p.E37dup). Thus, both phenotypic and functional variability associated with HRAS mutations are evident. Here, we report on a novel heterozygous HRAS germline mutation (c.187_207dup, p.E63_D69dup) in a girl presenting with a phenotype at the milder end of the Costello syndrome spectrum. The p.E63_D69dup mutation impaired co-precipitation of recombinant HRAS with NF1 GTPase-activating protein (GAP) suggesting constitutive HRAS(E63_D69dup) activation due to GAP insensitivity. Indeed, we identified strongly augmented active HRAS(E63_D69dup) that co-precipitated with effectors RAF1, RAL guanine nucleotide dissociation stimulator and phospholipase C1. However, we could not pull down active HRAS(E63_D69dup) using the target protein PIK3CA, indicating a compromised association between active HRAS(E63_D69dup) and PIK3CA. Accordingly, overexpression of HRAS(E63_D69dup) increased steady-state phosphorylation of MEK1/2 and ERK1/2 downstream of RAF, whereas AKT phosphorylation downstream of phosphoinositide 3-kinase (PI3K) was not enhanced. By analyzing signaling dynamics, we found that HRAS(E63_D69dup) has impaired reagibility to stimuli resulting in reduced and disrupted capacity to transduce incoming signals to the RAF-MAPK and PI3K-AKT cascade, respectively. We suggest that disrupted HRAS reagibility, as we demonstrate for the p.E63_D69dup mutation, is a previously unappreciated molecular pathomechanism underlying Costello syndrome.
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Affiliation(s)
- Sybille Lorenz
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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19
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Prenatal diagnostic testing of the Noonan syndrome genes in fetuses with abnormal ultrasound findings. Eur J Hum Genet 2013; 21:936-42. [PMID: 23321623 DOI: 10.1038/ejhg.2012.285] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/28/2012] [Accepted: 11/28/2012] [Indexed: 12/20/2022] Open
Abstract
In recent studies on prenatal testing for Noonan syndrome (NS) in fetuses with an increased nuchal translucency (NT) and a normal karyotype, mutations have been reported in 9-16% of cases. In this study, DNA of 75 fetuses with a normal karyotype and abnormal ultrasound findings was tested in a diagnostic setting for mutations in (a subset of) the four most commonly mutated NS genes. A de novo mutation in either PTPN11, KRAS or RAF1 was detected in 13 fetuses (17.3%). Ultrasound findings were increased NT, distended jugular lymphatic sacs (JLS), hydrothorax, renal anomalies, polyhydramnios, cystic hygroma, cardiac anomalies, hydrops fetalis and ascites. A second group, consisting of anonymized DNA of 60 other fetuses with sonographic abnormalities, was tested for mutations in 10 NS genes. In this group, five possible pathogenic mutations have been identified (in PTPN11 (n=2), RAF1, BRAF and MAP2K1 (each n=1)). We recommend prenatal testing of PTPN11, KRAS and RAF1 in pregnancies with an increased NT and at least one of the following additional features: polyhydramnios, hydrops fetalis, renal anomalies, distended JLS, hydrothorax, cardiac anomalies, cystic hygroma and ascites. If possible, mutation analysis of BRAF and MAP2K1 should be considered.
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20
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Lorenz S, Petersen C, Kordaß U, Seidel H, Zenker M, Kutsche K. Two cases with severe lethal course of Costello syndrome associated with HRAS p.G12C and p.G12D. Eur J Med Genet 2012; 55:615-9. [DOI: 10.1016/j.ejmg.2012.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/16/2012] [Indexed: 11/24/2022]
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21
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Chung B, Hinek A, Keating S, Weksberg R, Shah V, Blaser S, Hawkins C, Chitayat D. Overgrowth with increased proliferation of fibroblast and matrix metalloproteinase activity related to reduced TIMP1: A newly recognized syndrome? Am J Med Genet A 2012; 158A:2373-81. [DOI: 10.1002/ajmg.a.35570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 06/17/2012] [Indexed: 01/11/2023]
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22
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Sala V, Gallo S, Leo C, Gatti S, Gelb BD, Crepaldi T. Signaling to cardiac hypertrophy: insights from human and mouse RASopathies. Mol Med 2012; 18:938-47. [PMID: 22576369 DOI: 10.2119/molmed.2011.00512] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 05/04/2012] [Indexed: 12/19/2022] Open
Abstract
Cardiac hypertrophy is the heart's response to a variety of extrinsic and intrinsic stimuli, some of which might finally lead up to a maladaptive state. An integral part of the pathogenesis of the hypertrophic cardiomyopathy disease (HCM) is the activation of the rat sarcoma (RAS)/RAF/MEK (mitogen-activated protein kinase kinase)/MAPK (mitogen-activated protein kinase) cascade. Therefore, the molecular signaling involving RAS has been the subject of intense research efforts, particularly after the identification of the RASopathies. These constitute a class of developmental disorders caused by germline mutations affecting proteins contributing to the RAS pathway. Among other phenotypic features, a subset of these syndromes is characterized by HCM, prompting researchers and clinicians to delve into the chief signaling constituents of cardiac hypertrophy. In this review, we summarize current advances in the knowledge of the molecular signaling events involved in the pathogenesis of cardiac hypertrophy through work completed on patients and on genetically manipulated animals with HCM and RASopathies. Important insights are drawn from the recognition of parallels between cardiac hypertrophy and cancer. Future research promises to further elucidate the complex molecular interactions responsible for cardiac hypertrophy, possibly pointing the way for the identification of new specific targets for the treatment of HCM.
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Affiliation(s)
- Valentina Sala
- Department of Anatomy, Pharmacology and Forensic Medicine, University of Turin, Turin, Italy
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23
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Gripp KW, Lin AE. Costello syndrome: a Ras/mitogen activated protein kinase pathway syndrome (rasopathy) resulting from HRAS germline mutations. Genet Med 2012; 14:285-92. [PMID: 22261753 DOI: 10.1038/gim.0b013e31822dd91f] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Costello syndrome (OMIM# 218040) is a distinctive rare multisystem disorder comprising a characteristic coarse facial appearance, intellectual disabilities, and tumor predisposition. Although the diagnosis can be suspected clinically, confirmation requires identification of a heterozygous mutation in the proto-oncogene HRAS. In contrast to somatic oncogenic mutations in neoplasia, the Costello syndrome changes are typically introduced in the paternal germline. The predicted amino acid substitutions allow for constitutive or prolonged activation of the HRAS protein, resulting in dysregulation of the Ras/mitogen activated protein kinase pathway. Dysregulation of this signaling pathway is the disease mechanism shared among Costello syndrome and other rasopathies, including neurofibromatosis type 1, Noonan syndrome, cardio-facio-cutaneous syndrome, and Legius syndrome. The Ras/mitogen activated protein kinase pathway governs cell proliferation and differentiation, and its dysregulation affects cardiac and brain development, accounting for the significant overlap in physical and developmental differences and common medical problems among rasopathies. Unlike the genetically heterogeneous Noonan syndrome and cardio-facio-cutaneous syndrome, Costello syndrome is caused by HRAS mutations only. Patients, clinicians, and researchers may benefit from a multidisciplinary "rasopathy clinic," which serves patients with more common conditions such as Noonan syndrome and neurofibromatosis and those affected by rare conditions such as Costello syndrome.
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Affiliation(s)
- Karen W Gripp
- Division of Medical Genetics, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
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24
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Tumor disease and associated congenital abnormalities on prenatal MRI. Eur J Radiol 2012; 81:e115-22. [DOI: 10.1016/j.ejrad.2010.12.095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/19/2010] [Accepted: 12/28/2010] [Indexed: 11/19/2022]
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25
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Chen CP, Lin YH, Au HK, Su YN, Hsu CY, Liu YP, Wu PC, Chern SR, Chen YT, Chen LF, Hsieh AHM, Wang W. Chromosome 15q overgrowth syndrome: Prenatal diagnosis, molecular cytogenetic characterization, and perinatal findings in a fetus with dup(15)(q26.2q26.3). Taiwan J Obstet Gynecol 2011; 50:359-65. [DOI: 10.1016/j.tjog.2011.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2011] [Indexed: 12/11/2022] Open
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26
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Sinico M, Bassez G, Touboul C, Cavé H, Vergnaud A, Zirah C, Fleury-Feith J, Gettler S, Vojtek AM, Chevalier N, Amram D, Alsamad IA, Haddad B, Encha-Razavi F. Excess of neuromuscular spindles in a fetus with Costello syndrome: a clinicopathological report. Pediatr Dev Pathol 2011; 14:218-23. [PMID: 20658932 DOI: 10.2350/09-06-0664-cr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The neuromuscular spindle (NMS) is a proprioceptive myofibrillar component of skeletal muscles that is necessary to maintain normal muscle tone and coordination. Recently, an excess of NMS has been reported as a congenital neuromuscular syndrome with a Noonan phenotype, now linked to Costello syndrome (CS). The vast majority of patients with CS have a de novo heterozygous mutation in the HRAS gene involved in the Ras/mitogen-activated protein kinase (MAPK) pathway. CS has many features in common with Noonan and cardiofaciocutaneous syndromes, also linked to activating mutations (but in other genes) of the Ras/MAPK pathway. This makes the orientation of molecular screening difficult. The observation of excess NMS in a 26-weeks'-gestation stillborn prompted us to screen the HRAS gene for mutation. The identification of a HRAS mutation made it possible to establish a diagnosis of CS. We conclude that the excess of NMS is the most reliable sign for the diagnosis of CS. Our findings also show the instrumental role of histological study of the skeletal muscles in the context of polyhydramnios and fetal hydrops.
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27
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Lin AE, Alexander ME, Colan SD, Kerr B, Rauen KA, Noonan J, Baffa J, Hopkins E, Sol-Church K, Limongelli G, Digilio MC, Marino B, Innes AM, Aoki Y, Silberbach M, Delrue MA, White SM, Hamilton RM, O'Connor W, Grossfeld PD, Smoot LB, Padera RF, Gripp KW. Clinical, pathological, and molecular analyses of cardiovascular abnormalities in Costello syndrome: a Ras/MAPK pathway syndrome. Am J Med Genet A 2011; 155A:486-507. [PMID: 21344638 DOI: 10.1002/ajmg.a.33857] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 11/26/2010] [Indexed: 01/01/2023]
Abstract
Cardiovascular abnormalities are important features of Costello syndrome and other Ras/MAPK pathway syndromes ("RASopathies"). We conducted clinical, pathological and molecular analyses of 146 patients with an HRAS mutation including 61 enrolled in an ongoing longitudinal study and 85 from the literature. In our study, the most common (84%) HRAS mutation was p.G12S. A congenital heart defect (CHD) was present in 27 of 61 patients (44%), usually non-progressive valvar pulmonary stenosis. Hypertrophic cardiomyopathy (HCM), typically subaortic septal hypertrophy, was noted in 37 (61%), and 5 also had a CHD (14% of those with HCM). HCM was chronic or progressive in 14 (37%), stabilized in 10 (27%), and resolved in 5 (15%) patients with HCM; follow-up data was not available in 8 (22%). Atrial tachycardia occurred in 29 (48%). Valvar pulmonary stenosis rarely progressed and atrial septal defect was uncommon. Among those with HCM, the likelihood of progressing or remaining stable was similar (37%, 41% respectively). The observation of myocardial fiber disarray in 7 of 10 (70%) genotyped specimens with Costello syndrome is consistent with sarcomeric dysfunction. Multifocal atrial tachycardia may be distinctive for Costello syndrome. Potentially serious atrial tachycardia may present in the fetus, and may continue or worsen in about one-fourth of those with arrhythmia, but is generally self-limited in the remaining three-fourths of patients. Physicians should be aware of the potential for rapid development of severe HCM in infants with Costello syndrome, and the need for cardiovascular surveillance into adulthood as the natural history continues to be delineated.
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Affiliation(s)
- Angela E Lin
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts, USA.
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28
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Approche de la dysmorphologie fœtale in utero. ACTA ACUST UNITED AC 2010; 38:677-85. [DOI: 10.1016/j.gyobfe.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/07/2010] [Indexed: 11/20/2022]
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29
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:166-75. [PMID: 20216348 DOI: 10.1097/gco.0b013e328338c956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Vora N, Bianchi DW. Genetic considerations in the prenatal diagnosis of overgrowth syndromes. Prenat Diagn 2009; 29:923-9. [PMID: 19609940 DOI: 10.1002/pd.2319] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Large (>90%) for gestational age (LGA) fetuses are usually identified incidentally. Detection of the LGA fetus should first prompt the provider to rule out incorrect dates and maternal diabetes. Once this is done, consideration should be given to certain overgrowth syndromes, especially if anomalies are present. The overgrowth syndromes have significant clinical and molecular overlap, and are associated with developmental delay, tumors, and other anomalies. Although genetic causes of overgrowth are considered postnatally, they are infrequently diagnosed prenatally. Here, we review prenatal sonographic findings in fetal overgrowth syndromes, including Pallister-Killian, Beckwith-Wiedemann, Sotos, Perlman, and Simpson-Golabi-Behmel. We also discuss prenatal diagnosis options and recurrence risks.
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Affiliation(s)
- Neeta Vora
- Division of Genetics, Department of Pediatrics, Department of Obstetrics, Floating Hospital for Children and Tufts Medical Center, Boston, MA 02111, USA
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