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Karremann M, Neumaier-Probst E, Schlichtenbrede F, Beier F, Brümmendorf TH, Cremer FW, Bader P, Dürken M. Revesz syndrome revisited. Orphanet J Rare Dis 2020; 15:299. [PMID: 33097095 PMCID: PMC7583287 DOI: 10.1186/s13023-020-01553-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background Revesz syndrome (RS) is an extremely rare variant of dyskeratosis congenita (DKC) with only anecdotal reports in the literature. Methods To further characterize the typical features and natural course of the disease, we screened the English literature and summarized the clinical and epidemiological features of previously published RS cases. In addition, we herein describe the first recorded patient in central Europe. Results The literature review included 18 children. Clinical features are summarized, indicating a low prevalence of the classical DKC triad. All patients experienced early bone marrow failure, in most cases within the second year of life (median age 1.5 years; 95% CI 1.4–1.6). Retinopathy occurred typically between 6 and 18 months of age (median age 1.1 years; 95% CI 0.7–1.5). The incidence of seizures was low and was present in an estimated 20% of patients. The onset of seizures was exclusively during early childhood. The Kaplan–Meier estimate of survival was dismal (median survival 6.5 years; 95% CI 3.6–9.4), and none of the patients survived beyond the age of 12 years. Stem cell transplantation (SCT) was performed in eight children, and after a median of 22 months from SCT four of these patients were alive at the last follow up visit. Conclusion RS is a severe variant of DKC with early bone marrow failure and retinopathy in all patients. Survival is dismal, but stem cell transplantation may be performed successfully and might improve prognosis in the future.
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Affiliation(s)
- Michael Karremann
- Department of Pediatrics, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Eva Neumaier-Probst
- Department of Neuroradiology, University Medical Center Mannheim, Mannheim, Germany
| | | | - Fabian Beier
- Department of Hematology and Oncology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology and Oncology, University Hospital of RWTH Aachen, Aachen, Germany
| | | | - Peter Bader
- Department of Pediatrics, Pediatric Stem Cell Transplantation, University Hospital Frankfurt, Frankfurt, Germany
| | - Matthias Dürken
- Department of Pediatrics, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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2
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Sargolzaeiaval F, Zhang J, Schleit J, Lessel D, Kubisch C, Precioso DR, Sillence D, Hisama FM, Dorschner M, Martin GM, Oshima J. CTC1 mutations in a Brazilian family with progeroid features and recurrent bone fractures. Mol Genet Genomic Med 2018; 6:1148-1156. [PMID: 30393977 PMCID: PMC6305643 DOI: 10.1002/mgg3.495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/23/2018] [Accepted: 10/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is an autosomal recessive disorder caused by pathogenic variants of the conserved telomere maintenance component 1 (CTC1) gene. The CTC1 forms the telomeric capping complex, CST, which functions in telomere homeostasis and replication. METHODS A Brazilian pedigree and an Australian pedigree were referred to the International Registry of Werner Syndrome (Seattle, WA, USA), with clinical features of accelerated aging and recurrent bone fractures. Whole exome sequencing was performed to identify the genetic causes. RESULTS Whole exome sequencing of the Brazilian pedigree revealed compound heterozygous pathogenic variants in CTC1: a missense mutation (c.2959C>T, p.Arg987Trp) and a novel stop codon change (c.322C>T, p.Arg108*). The Australian patient carried two novel heterozygous CTC1 variants, c.2916G>T, p.Val972Gly and c.2926G>T, p.Val976Phe within the same allele. Both heterozygous variants were inherited from the unaffected father, excluding the diagnosis of CRMCC in this pedigree. Cell biological studies demonstrated accumulation of double strand break foci in lymphoblastoid cell lines derived from the patients. Increased DSB foci were extended to non-telomeric regions of the genome, in agreement with previous biochemical studies showing a preferential binding of CTC1 protein to GC-rich sequences. CONCLUSION CTC1 pathogenic variants can present with unusual manifestations of progeria accompanied with recurrent bone fractures. Further studies are needed to elucidate the disease mechanism leading to the clinical presentation with intra-familial variations of CRMCC.
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Affiliation(s)
| | - Jiaming Zhang
- Department of Pathology, University of Washington, Seattle, Washington
| | - Jennifer Schleit
- Department of Pathology, University of Washington, Seattle, Washington
| | - Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Kubisch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - David Sillence
- Discipline of Genetic Medicine, Westmead Clinical School, Sydney Faculty of Medicine and Health, Westmead, Australia
| | - Fuki M Hisama
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
| | - Michael Dorschner
- Department of Pathology, University of Washington, Seattle, Washington
| | - George M Martin
- Department of Pathology, University of Washington, Seattle, Washington
| | - Junko Oshima
- Department of Pathology, University of Washington, Seattle, Washington.,Department of Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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3
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Mansukhani S, Ho ML, Gavrilova RH, Mohney BG, Quiram PA, Brodsky MC. Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) or "Coats Plus": when peripheral retinal vasculature signals neurologic disease. J AAPOS 2017; 21:420-422. [PMID: 28864049 DOI: 10.1016/j.jaapos.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
An 8-month-old girl presented with vitreous hemorrhage, peripheral retinal arteriovenous anastomosis, and hypoplasia of the thumb. Magnetic resonance imaging of the brain showed multiple hyperintensities, cysts, and calcifications in the white matter. DNA testing showed a mutation in one allele of the CTC gene, supporting the diagnosis of cerebroretinal microangiopathy with calcifications and cysts (CRMCC), or Coats plus disease, despite which designation this condition can present without subretinal exudate. In infants with peripheral retinal vascular disease, neuroimaging can identify the characteristic abnormalities of CRMCC.
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Affiliation(s)
| | - Mai Lan Ho
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ralitza H Gavrilova
- Department of Neurology and Clinical Genomics, Mayo Clinic, Rochester, Minnesota
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Iwama K, Mizuguchi T, Takanashi J, Shibayama H, Shichiji M, Ito S, Oguni H, Yamamoto T, Sekine A, Nagamine S, Ikeda Y, Nishida H, Kumada S, Yoshida T, Awaya T, Tanaka R, Chikuchi R, Niwa H, Oka Y, Miyatake S, Nakashima M, Takata A, Miyake N, Ito S, Saitsu H, Matsumoto N. Identification of novel
SNORD118
mutations in seven patients with leukoencephalopathy with brain calcifications and cysts. Clin Genet 2017; 92:180-187. [DOI: 10.1111/cge.12991] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Kazuhiro Iwama
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
- Department of Pediatrics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Jun‐ichi Takanashi
- Department of Pediatrics and Pediatric Neurology Tokyo Women's Medical University, Yachiyo Medical Center Yachiyo Japan
| | | | - Minobu Shichiji
- Department of Pediatrics Tokyo Women's Medical University Tokyo Japan
| | - Susumu Ito
- Department of Pediatrics Tokyo Women's Medical University Tokyo Japan
| | - Hirokazu Oguni
- Department of Pediatrics Tokyo Women's Medical University Tokyo Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics Tokyo Women's Medical University Tokyo Japan
| | - Akiko Sekine
- Department of Neurology Gunma University Graduate School of Medicine Maebashi Japan
| | - Shun Nagamine
- Department of Neurology Gunma University Graduate School of Medicine Maebashi Japan
| | - Yoshio Ikeda
- Department of Neurology Gunma University Graduate School of Medicine Maebashi Japan
| | - Hiroya Nishida
- Department of Neuropediatrics Tokyo Metropolitan Neurological Hospital Tokyo Japan
| | - Satoko Kumada
- Department of Neuropediatrics Tokyo Metropolitan Neurological Hospital Tokyo Japan
| | - Takeshi Yoshida
- Department of Pediatrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Tomonari Awaya
- Department of Pediatrics Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Anatomy and Developmental Biology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Ryuta Tanaka
- Department of Child Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Ryo Chikuchi
- Department of Neurology Kariya Toyota General Hospital Kariya Japan
| | - Hisayoshi Niwa
- Department of Neurology Kariya Toyota General Hospital Kariya Japan
| | - Yu‐ichi Oka
- Department of Neurosurgery Nagoya City University Hospital Nagoya Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Mitsuko Nakashima
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Atsushi Takata
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Noriko Miyake
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Hirotomo Saitsu
- Department of Biochemistry Hamamatsu University School of Medicine Hamamatsu Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine Yokohama City University Yokohama Japan
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5
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Abstract
RATIONAL Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is believed to be an autosomal recessive genetic disease, with disorders in multisystem organs. Its characteristic neurological disorders manifested on neuroimaging are a triad of leukoencephalopathy, intracranial calcifications, and parenchymal cysts. In this paper, we report a CRMCC patient with multisystem involvement, focusing on the neuroimaging features, to get a better understanding of the rare disease and improve our diagnostic ability. PATIENT CONCERNS The 23-year-old female patient firstly presented with an adolescence onset of ophthalmological manifestations. Four years later, hematological and neurological disorders occurred, the latter of which demonstrated a relatively slow progression in the following 7 years preceding her presentation to our hospital. INTERVENTIONS During hospitalization, disorders involving digestive, cardiovascular and respiratory systems were also detected. In addition, a more comprehensive depiction of neurological disorders on neuroimaging was also obtained. DIAGNOSES On the basis of multiple system disorders and the detection of mutations in conserved telomere maintenance component 1(CTC1) gene, a diagnosis of CRMCC was made. OUTCOMES After supportive therapy during her 4-week hospitalization, the patient's general condition improved and was released from the hospital. LESSONS CRMCC could be primarily diagnosed with the aid of its multiple system disorders and remarkable neuroimaging features. Cerebral micro hemorrhages determined by the combination of CT and T2-weighted magnetic resonance images in our case could provide some additional information for diagnosis. Furthermore, several other associated disorders were depicted for the first time in our case, expanding the clinical spectrum of CRMCC.
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Affiliation(s)
| | | | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences (PUMC&CAMS), Beijing, People's Republic of China
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Leukoencephalopathy, cerebral calcifications and cysts: a family study. J Neurol 2014; 261:1911-6. [DOI: 10.1007/s00415-014-7393-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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7
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Orcesi S, Tonduti D, La Piana R. Calcifying leukoencephalopathies: new overlapping phenotypes. Am J Med Genet A 2012; 158A:964-5. [PMID: 22419650 DOI: 10.1002/ajmg.a.35242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/16/2011] [Indexed: 11/06/2022]
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Polvi A, Linnankivi T, Kivelä T, Herva R, Keating J, Mäkitie O, Pareyson D, Vainionpää L, Lahtinen J, Hovatta I, Pihko H, Lehesjoki AE. Mutations in CTC1, encoding the CTS telomere maintenance complex component 1, cause cerebroretinal microangiopathy with calcifications and cysts. Am J Hum Genet 2012; 90:540-9. [PMID: 22387016 PMCID: PMC3309194 DOI: 10.1016/j.ajhg.2012.02.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 01/26/2023] Open
Abstract
Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is a rare multisystem disorder characterized by extensive intracranial calcifications and cysts, leukoencephalopathy, and retinal vascular abnormalities. Additional features include poor growth, skeletal and hematological abnormalities, and recurrent gastrointestinal bleedings. Autosomal-recessive inheritance has been postulated. The pathogenesis of CRMCC is unknown, but its phenotype has key similarities with Revesz syndrome, which is caused by mutations in TINF2, a gene encoding a member of the telomere protecting shelterin complex. After a whole-exome sequencing approach in four unrelated individuals with CRMCC, we observed four recessively inherited compound heterozygous mutations in CTC1, which encodes the CTS telomere maintenance complex component 1. Sanger sequencing revealed seven more compound heterozygous mutations in eight more unrelated affected individuals. Two individuals who displayed late-onset cerebral findings, a normal fundus appearance, and no systemic findings did not have CTC1 mutations, implying that systemic findings are an important indication for CTC1 sequencing. Of the 11 mutations identified, four were missense, one was nonsense, two resulted in in-frame amino acid deletions, and four were short frameshift-creating deletions. All but two affected individuals were compound heterozygous for a missense mutation and a frameshift or nonsense mutation. No individuals with two frameshift or nonsense mutations were identified, which implies that severe disturbance of CTC1 function from both alleles might not be compatible with survival. Our preliminary functional experiments did not show evidence of severely affected telomere integrity in the affected individuals. Therefore, determining the underlying pathomechanisms associated with deficient CTC1 function will require further studies.
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Affiliation(s)
- Anne Polvi
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Molecular Medicine Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Neuroscience Center, University of Helsinki, Helsinki 00290, Finland
| | - Tarja Linnankivi
- Department of Pediatric Neurology, Children's Castle, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Tero Kivelä
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Riitta Herva
- Department of Pathology, Oulu University Hospital, Oulu 90029, Finland
| | - James P. Keating
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri 63110, USA
| | - Outi Mäkitie
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Davide Pareyson
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences, Fondazione Instituto di Ricovero e Cura a Carattere Scientifico, C. Besta Neurological Institute, Milan 20133, Italy
| | - Leena Vainionpää
- Department of Pediatrics, Oulu University Hospital, Oulu 90029, Finland
| | - Jenni Lahtinen
- Molecular Neurology Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
| | - Iiris Hovatta
- Molecular Neurology Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Helena Pihko
- Department of Pediatric Neurology, Children's Castle, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Anna-Elina Lehesjoki
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Molecular Medicine Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Neuroscience Center, University of Helsinki, Helsinki 00290, Finland
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