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Kim HY, Lee YA, Shin CH, Cho TJ, Ko JM. Clinical Manifestations and Outcomes of 20 Korean Hypochondroplasia Patients with the FGFR3 N540K variant. Exp Clin Endocrinol Diabetes 2023; 131:123-131. [PMID: 36442838 DOI: 10.1055/a-1988-9734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypochondroplasia is a skeletal dysplasia caused by activating pathologic variants of FGFR3. The N540K variant accounts for 60-70% of reported cases and is associated with severe manifestations. Here, we analyze the clinical manifestations and outcomes of Korean patients with hypochondroplasia harboring the FGFR3 N540K variant. METHODS Medical records of 20 unrelated patients with genetically confirmed N540K-related hypochondroplasia were retrospectively reviewed. All individuals were diagnosed with hypochondroplasia by Sanger sequencing for FGFR3, or target-panel sequencing for skeletal dysplasia. The effectiveness of growth hormone therapy was analyzed in 16 patients treated with growth hormones. RESULTS Among 20 patients (7 men, 13 women), the mean age at first visit was 3.5±1.0 years, and the mean follow-up duration was 6.8±0.6 years. The patients presented with a short stature and/or short limbs. Genu varum, macrocephaly, and developmental delay were observed in 11 (55.0%), 9 (45.0%), and 5 (25.0%) patients, respectively. Of the 12 patients who underwent neuroimaging, five (41.7%) showed abnormal findings (one required operation for obstructive hydrocephalus). Among 16 growth-hormone-treated patients (two were growth-hormone deficient), the increase in height standard deviation scores was significant after a mean 5.4±0.7 years of treatment (+0.6 and+1.8 using growth references for healthy controls and achondroplasia children, respectively). Four patients underwent surgical limb lengthening at a mean age of 8.8±3.3 years. CONCLUSIONS Neurodevelopmental abnormalities are frequently observed in patients with N540K-related hypochondroplasia. Close monitoring of skeletal manifestations and neurodevelopmental status is necessary for hypochondroplasia.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopaedics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
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Molecular Basis for Hypochondroplasia in Japan. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypochondroplasia is an autosomal dominant genetic disorder due to a heterozygous pathogenic variant of the FGFR3 gene. The early diagnosis of hypochondroplasia is necessary, since growth hormone is effective for improving adult height. The genetic test for the FGFR3 gene could help the early diagnosis. The detailed characteristics of FGFR3 genotypes have not been widely investigated in Japan, except for a common pathogenic variant, p.Asn540Lys. This study retrospectively analyzed the FGFR3 genotypes of 35 patients from 30 families with hypochondroplasia (age, range 0–6 years, median 1 year) in Japan. The pathogenic variants of FGFR3 were identified in all the patients: p.Asn540Lys in 23 probands (76.7%), p.Lys650Gln in 2 (6.7%), p.Leu324His in 2 (6.7%), p.Leu324Val, p.Ser351Cys, and p.Lys650Thr in 1 each (3.2%). The median age at diagnosis, height SD score at diagnosis, or the severity of radiologic findings was not significantly different between probands with p.Asn540Lys and those with other variants. Intellectual disability or epilepsy was identified in seven patients with p.Asn540Lys, but none with other variants. The genetic test of FGFR3 can be useful for assessing the potential risk of neurological sequela in children with hypochondroplasia.
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Sabir AH, Sheikh J, Singh A, Morley E, Cocca A, Cheung MS, Irving M. Earlier detection of hypochondroplasia: A large single-center UK case series and systematic review. Am J Med Genet A 2020; 185:73-82. [PMID: 33051983 DOI: 10.1002/ajmg.a.61912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022]
Abstract
Hypochondroplasia (HCH) is a rare autosomal dominant skeletal dysplasia condition caused by FGFR3 mutations leading to disproportionate short stature. Classically HCH presents in toddlers or school-age children, as limb-to-trunk disproportion and is often mild and easily overlooked during infancy. We report experiences from a single-center UK HCH-cohort of 31 patients, the rate of antenatal HCH detection in our cohort (13/31, 41.9%) and describe relevant case-data for this subset of 13 patients. Inclusion criteria were patients with confirmed molecular HCH diagnosis (by age 3 years) and presenting with short long-bones or large head size on antenatal ultrasound scan. We then conducted a systematic literature review using PUBMED and MEDLINE, analyzing patients with HCH and related antenatal findings. Antenatally suspected (with subsequent molecular confirmation) HCH has been reported 15 times in the literature (2004-2019). Key markers (consistent in both groups) included reduced; femur length, humeral length and increased; biparietal diameter and head circumference. HCH is increasingly detected both antenatally and in infancy, contrary to previous descriptions. This is likely due to greater HCH awareness, improved imaging, and easier molecular testing. Thus, one should consider HCH outside the classical presenting period. Studying the natural history of younger patients with HCH is important with the advent of several targeted FGFR3 therapies currently in trials for Achondroplasia, that may soon be trialed in HCH.
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Affiliation(s)
- Ataf H Sabir
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Clinical Genetics, Birmingham Women's and Children's Hospital NHS Trust & Birmingham Health Partners, Birmingham, UK.,Medical School, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Medical School, University of Birmingham, Birmingham, UK
| | - Ananya Singh
- Medical School, University of Birmingham, Birmingham, UK
| | - Elizabeth Morley
- Department of Trauma and Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Alessandra Cocca
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Moira S Cheung
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melita Irving
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Yao G, Wang G, Wang D, Su G. Identification of a novel mutation of FGFR3 gene in a large Chinese pedigree with hypochondroplasia by next-generation sequencing: A case report and brief literature review. Medicine (Baltimore) 2019; 98:e14157. [PMID: 30681580 PMCID: PMC6358355 DOI: 10.1097/md.0000000000014157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Hypochondroplasia (HCH) is the mildest form of chondrodysplasia characterized by disproportionate short stature, short extremities, and variable lumbar lordosis. It is caused by mutations in fibroblast growth factor receptor 3 (FGFR3) gene. Up to date, at least thirty mutations of FGFR3 gene have been found to be related to HCH. However, mutational screening of the FGFR3 gene is still far from completeness. Identification of more mutations is particularly important in diagnosis of HCH and will gain more insights into the molecular basis for the pathogenesis of HCH. PATIENT CONCERNS A large Chinese family consisting of 53 affected individuals with HCH phenotypes was examined. DIAGNOSES A novel missense mutation, c.1052C>T, in FGFR3 gene was identified in a large Chinese family with HCH. On the basis of this finding and clinical manifestations, the final diagnosis of HCH was made. INTERVENTIONS Next-generation sequencing (NGS) of DNA samples was performed to detect the mutation in the chondrodysplasia-related genes on the proband and her parents, which was confirmed by Sanger sequencing in the proband and most of other living affected family members. OUTCOMES A novel missense mutation, c.1052C>T, in the extracellular, ligand-binding domain of FGFR3 was identified in a large Chinese family with HCH. This heterozygous mutation results in substitution of serine for phenylalanine at amino acid 351 (p.S351F) and co-segregates with the phenotype in this family. Molecular docking analysis reveals that this unique FGFR3 mutation results in an enhancement of ligand-binding affinity between FGFR3 and its main ligand, fibroblast growth factor 9. LESSONS This novel mutation is the first mutation displaying an increase in ligand-binding affinity, therefore it may serve as a model to investigate ligand-dependent activity of FGF-FGFR complex. Our data also expanded the mutation spectrum of FGFR3 gene and facilitated clinic diagnosis and genetic counseling for this family with HCH.
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Affiliation(s)
- Guixiang Yao
- Institute of Translational Medicine, Jinan Central Hospital Affiliated to Shandong University
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Guangxin Wang
- Institute of Translational Medicine, Jinan Central Hospital Affiliated to Shandong University
| | - Dawei Wang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Guohai Su
- Institute of Translational Medicine, Jinan Central Hospital Affiliated to Shandong University
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Takahashi I, Kondo D, Oyama C, Yano T, Tamura H, Noguchi A, Takahashi T. A novel S269C mutation in fibroblast growth factor receptor 3 in a Japanese child with hypochondroplasia. Hum Genome Var 2018; 5:1. [PMID: 29736252 PMCID: PMC5933720 DOI: 10.1038/s41439-018-0001-2] [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: 10/25/2017] [Revised: 01/11/2018] [Accepted: 01/30/2018] [Indexed: 11/12/2022] Open
Abstract
Functionally activating mutations in fibroblast growth factor receptor 3 (FGFR3) can cause four types of autosomal dominant skeletal dysplasia with short-limbed dwarfism that include the mildest phenotype, hypochondroplasia (HCH). A novel mutation (c.805A>T, p.S269C) was identified in a Japanese infant with HCH through direct sequencing of all FGFR3 exons and exon/intron boundaries. This mutation creates an additional cysteine residue in the extracellular region of FGFR3 that results in the functional activation of FGFR3.
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Affiliation(s)
- Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Daiki Kondo
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Chikako Oyama
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamami Yano
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroaki Tamura
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Tsutomu Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
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Epileptic phenotype of FGFR3-related bilateral medial temporal lobe dysgenesis. Brain Dev 2017; 39:67-71. [PMID: 27485793 DOI: 10.1016/j.braindev.2016.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022]
Abstract
Hypochondroplasia (HCH) is a skeletal dysplasia, characterized by short stature and macrocephaly. Clinical symptoms and radiological and histopathological features of HCH are similar, but milder than those seen in achondroplasia. Particularly, HCH patients with Asn540Lys mutation in the FGFR3 gene are reported to have medial temporal lobe dysgenesis and epilepsy. We report a 3-year-old girl who developed recurrent epileptic apnea, which started immediately after birth. The apneic seizures were refractory to antiepileptic medications; ictal electroencephalography showed rhythmic activity originating from the left or right temporal areas and rarely from the right frontal area. Macrocephaly was noted since birth. Neuroimaging revealed bilateral dysgenesis and hypometabolism of the medial temporal structures as well as perfusion changes in the left lateral temporofrontal areas during the ictal period. Clonazepam was initiated and acetazolamide dosage was increased at 6months, resulting in complete seizure control after 8months of age. Genetic analysis identified an Asn540Lys (c.1620 C>A) mutation in the FGFR3 gene. Characteristic bone findings on the lumbar spine, iliac bone, and femur were retrospectively confirmed on X-rays during infancy. This was the first report that delineated the epilepsy phenotype in FGFR3-related bilateral medial temporal lobe dysgenesis; such findings would lead to an early diagnosis and better epilepsy management.
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Nagahara K, Harada Y, Futami T, Takagi M, Nishimura G, Hasegawa Y. A Japanese familial case of hypochondroplasia with a novel mutation in FGFR3. Clin Pediatr Endocrinol 2016; 25:103-6. [PMID: 27507911 PMCID: PMC4965510 DOI: 10.1297/cpe.25.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keiko Nagahara
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yuki Harada
- Department of Orthopedic Surgery, Shiga Medical Center for Children, Shiga, Japan
| | - Tohru Futami
- Department of Orthopedic Surgery, Shiga Medical Center for Children, Shiga, Japan
| | - Masaki Takagi
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Gen Nishimura
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yukihiro Hasegawa
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Criteria for radiologic diagnosis of hypochondroplasia in neonates. Pediatr Radiol 2016; 46:513-8. [PMID: 26867606 DOI: 10.1007/s00247-015-3518-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 10/20/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radiologic diagnosis of hypochondroplasia is hampered by the absence of age-dependent radiologic criteria, particularly in the neonatal period. OBJECTIVE To establish radiologic criteria and scoring system for identifying neonates with fibroblast growth factor receptor 3 (FGFR3)-associated hypochondroplasia. MATERIALS AND METHODS This retrospective study included 7 hypochondroplastic neonates and 30 controls. All subjects underwent radiologic examination within 28 days after birth. We evaluated parameters reflecting the presence of (1) short ilia, (2) squared ilia, (3) short greater sciatic notch, (4) horizontal acetabula, (5) short femora, (6) broad femora, (7) metaphyseal flaring, (8) lumbosacral interpedicular distance narrowing and (9) ovoid radiolucency of the proximal femora. RESULTS Only parameters 1, 3, 4, 5 and 6 were statistically different between the two groups. Parameters 3, 5 and 6 did not overlap between the groups, while parameters 1 and 4 did. Based on these results, we propose a scoring system for hypochondroplasia. Two major criteria (parameters 3 and 6) were assigned scores of 2, whereas 4 minor criteria (parameters 1, 4, 5 and 9) were assigned scores of 1. All neonates with hypochondroplasia in our material scored ≥6. CONCLUSION Our set of diagnostic radiologic criteria might be useful for early identification of hypochondroplastic neonates.
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Detection of a de novo Y278C mutation in FGFR3 in a pregnancy with severe fetal hypochondroplasia: Prenatal diagnosis and literature review. Taiwan J Obstet Gynecol 2013; 52:580-5. [DOI: 10.1016/j.tjog.2013.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
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