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Mustacich DJ, Lai LW, Bernas MJ, Jones JA, Myles RJ, Kuo PH, Williams WH, Witte CL, Erickson RP, Witte MH. Digenic Inheritance of a FOXC2 Mutation and Two PIEZO1 Mutations Underlies Congenital Lymphedema in a Multigeneration Family. Am J Med 2022; 135:e31-e41. [PMID: 34656527 PMCID: PMC8939301 DOI: 10.1016/j.amjmed.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The lymphatic system is essential for maintaining the balance of interstitial fluid in tissues and for returning protein-rich fluids (lymph) to the bloodstream. Congenital lymphatic defects lead to accumulation of lymph in peripheral tissues and body cavities, termed primary lymphedema. To date, only a limited number of individual genes have been identified in association with primary lymphedema. However, variability of age of onset and severity of lymphatic abnormalities within some families suggests that multiple mutations or genes may be responsible, thus hampering efforts to identify individual associated genes. METHODS Whole exome sequencing (WES) was performed in 4 members of a large multigeneration family with highly variable lymphedema and followed by Sanger sequencing for identified mutations in 34 additional family members. Genotypes were correlated with clinical and lymphangioscintigraphic phenotypes. RESULTS WES uncovered 2 different mechanotransducer PIEZO1 mutations and one FOXC2 transcription factor mutation in various combinations. Sanger sequencing confirmed the presence/absence of the 3 variants in affected and unaffected family members and co-segregation of one or more variants with disease. Genetic profiles did not clearly correlate with the highly variable severity of lymphatic abnormalities. CONCLUSIONS WES in lymphedema families can uncover unexpected combinations of several lymphedema-associated mutations. These findings provide essential information for genetic counseling and reveal complex gene interactions in lymphatic developmental pathways. These can offer insights into the complex spectrum of clinical and lymphatic lymphedema phenotypes and potential targets for treatment.
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Affiliation(s)
- Debbie J Mustacich
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Li-Wen Lai
- Department of Pathology, University of Arizona College of Medicine, Tucson
| | - Michael J Bernas
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Jazmine A Jones
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Reginald J Myles
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Phillip H Kuo
- Medical Imaging (Nuclear Medicine), University of Arizona College of Medicine, Tucson
| | - Walter H Williams
- Medical Imaging (Nuclear Medicine), University of Arizona College of Medicine, Tucson
| | - Charles L Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Robert P Erickson
- Department of Pediatrics, University of Arizona College of Medicine, Tucson.
| | - Marlys Hearst Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson; Department of Pediatrics, University of Arizona College of Medicine, Tucson.
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Wallis M, Pope-Couston R, Mansour J, Amor DJ, Tang P, Stock-Myer S. Lymphedema distichiasis syndrome may be caused by FOXC2 promoter-enhancer dissociation and disruption of a topological associated domain. Am J Med Genet A 2020; 185:150-156. [PMID: 33107170 DOI: 10.1002/ajmg.a.61935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/20/2020] [Accepted: 10/03/2020] [Indexed: 01/05/2023]
Abstract
Lymphedema distichiasis syndrome (LDS) is a rare autosomal dominant condition characterized by lower limb lymphedema, distichiasis, and variable additional features. LDS is usually caused by heterozygous sequence variants in the FOXC2 gene located at 16q24, but in one previous instance LDS has resulted from a balanced reciprocal translocation with a breakpoint at 16q24, 120 kb distal to the FOXC2 gene suggesting a position effect. Here, we describe a second family with LDS caused by a translocation involving 16q24. The family were ascertained after detection of a paternally inherited balanced reciprocal translocation t(16;22)(q24;q13.1) in a pregnancy complicated by severe fetal hydrops. There was a past history of multiple miscarriages in the father's family, and a personal and family history of lymphedema and distichiasis, consistent with the diagnosis of LDS. Using whole genome amplified DNA from single sperm of the male proband, bead array analysis demonstrated that the FOXC2 gene was intact and the chromosome 16 breakpoint mapped to the same region 120Kb distal to the FOXC2 gene. This case highlights the clinical consequences that can arise from a translocation of genomic material without dosage imbalance, and that it is increasingly feasible to predict and characterize possible effects with improved access to molecular techniques.
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Affiliation(s)
- Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, C/- The Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachel Pope-Couston
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, C/- The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Julia Mansour
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, C/- The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - David J Amor
- Department of Pediatrics, University of Melbourne.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paisu Tang
- Virtus Diagnostics, East Melbourne, Victoria, Australia
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3
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Dempsey E, Homfray T, Simpson JM, Jeffery S, Mansour S, Ostergaard P. Fetal hydrops – a review and a clinical approach to identifying the cause. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1719827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Esther Dempsey
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Tessa Homfray
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steve Jeffery
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Sahar Mansour
- Molecular and Clinical Sciences, St George’s University of London, London, UK
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pia Ostergaard
- Molecular and Clinical Sciences, St George’s University of London, London, UK
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Aldersey JE, Sonstegard TS, Williams JL, Bottema CDK. Understanding the effects of the bovine POLLED variants. Anim Genet 2020; 51:166-176. [PMID: 31999853 DOI: 10.1111/age.12915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 12/31/2022]
Abstract
Horns are paired appendages on the head of bovine species, comprising an inner bony core and outer keratin sheath. The horn bud forms during early fetal development but ossification of the developing horn does not occur until approximately 1 month after birth. Little is known about the genetic pathways that lead to horn growth. Hornless, or polled, animals are found in all domestic bovids. Histological studies of bovine fetuses have shown that the horn bud does not form in polled individuals. There are currently four known genetic variants for polledness in cattle on BTA1. All of the variants are intergenic, but probably affect regulation of nearby genes or long non-coding RNAs. Transcriptomic studies suggest that the expression of two nearby long non-coding RNAs are affected by the Celtic POLLED variant, but further studies are required to confirm these data. Candidate genes located elsewhere in the genome are involved in regulating bone formation and epithelial-to-mesenchymal transition. Expression of one of these candidate genes, RXFP2, appears to be reduced in the fetal horn bud of polled animals carrying the Celtic variant compared with horned individuals. Investigating horn ontogenesis and the genetic pathway by which the POLLED variants prevent horn development has implications for cattle breeding. If the genetic basis of horn bud formation and polledness is better understood, then new targets may be identified for precision genome editing to create polled individuals.
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Affiliation(s)
- J E Aldersey
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
| | | | - J L Williams
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
| | - C D K Bottema
- Davies Research Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Adelaide, SA, 5371, Australia
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Li S, Pradhan L, Ashur S, Joshi A, Nam HJ. Crystal Structure of FOXC2 in Complex with DNA Target. ACS OMEGA 2019; 4:10906-10914. [PMID: 31460188 PMCID: PMC6648891 DOI: 10.1021/acsomega.9b00756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/22/2019] [Indexed: 06/10/2023]
Abstract
Forkhead transcription factor C2 (FOXC2) is a transcription factor regulating vascular and lymphatic development, and its mutations are linked to lymphedema-distichiasis syndrome. FOXC2 is also a crucial regulator of the epithelial-mesenchymal transition processes essential for tumor metastasis. Here, we report the crystal structure of the FOXC2-DNA-binding domain in complex with its cognate DNA. The crystal structure provides the basis of DNA sequence recognition by FOXC2 for the T/CAAAC motif. Helix 3 makes the majority of the DNA-protein interactions and confers the DNA sequence specificity. The computational energy calculation results also validate the structural observations. The FOXC2 and DNA complex structure provides a detailed picture of protein and DNA interactions, which allows us to predict its DNA recognition specificity and impaired functions in mutants identified in human patients.
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Castorena-Gonzalez JA, Zawieja SD, Li M, Srinivasan RS, Simon AM, de Wit C, de la Torre R, Martinez-Lemus LA, Hennig GW, Davis MJ. Mechanisms of Connexin-Related Lymphedema. Circ Res 2018; 123:964-985. [PMID: 30355030 PMCID: PMC6771293 DOI: 10.1161/circresaha.117.312576] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
RATIONALE Mutations in GJC2 and GJA1, encoding Cxs (connexins) 47 and 43, respectively, are linked to lymphedema, but the underlying mechanisms are unknown. Because efficient lymph transport relies on the coordinated contractions of lymphatic muscle cells (LMCs) and their electrical coupling through Cxs, Cx-related lymphedema is proposed to result from dyssynchronous contractions of lymphatic vessels. OBJECTIVE To determine which Cx isoforms in LMCs and lymphatic endothelial cells are required for the entrainment of lymphatic contraction waves and efficient lymph transport. METHODS AND RESULTS We developed novel methods to quantify the spatiotemporal entrainment of lymphatic contraction waves and used optogenetic techniques to analyze calcium signaling within and between the LMC and the lymphatic endothelial cell layers. Genetic deletion of the major lymphatic endothelial cell Cxs (Cx43, Cx47, or Cx37) revealed that none were necessary for the synchronization of the global calcium events that triggered propagating contraction waves. We identified Cx45 in human and mouse LMCs as the critical Cx mediating the conduction of pacemaking signals and entrained contractions. Smooth muscle-specific Cx45 deficiency resulted in 10- to 18-fold reduction in conduction speed, partial-to-severe loss of contractile coordination, and impaired lymph pump function ex vivo and in vivo. Cx45 deficiency resulted in profound inhibition of lymph transport in vivo, but only under an imposed gravitational load. CONCLUSIONS Our results (1) identify Cx45 as the Cx isoform mediating the entrainment of the contraction waves in LMCs; (2) show that major endothelial Cxs are dispensable for the entrainment of contractions; (3) reveal a lack of coupling between lymphatic endothelial cells and LMCs, in contrast to arterioles; (4) point to lymphatic valve defects, rather than contraction dyssynchrony, as the mechanism underlying GJC2- or GJA1-related lymphedema; and (5) show that a gravitational load exacerbates lymphatic contractile defects in the intact mouse hindlimb, which is likely critical for the development of lymphedema in the adult mouse.
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Affiliation(s)
| | - Scott D. Zawieja
- Dept. of Medical Pharmacology and Physiology and University of Missouri School of Medicine
| | - Min Li
- Dept. of Medical Pharmacology and Physiology and University of Missouri School of Medicine
| | - R. Sathish Srinivasan
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City OK
| | | | - Cor de Wit
- Institute of Physiology, University of Luebeck, Luebeck Germany
| | | | - Luis A. Martinez-Lemus
- Dept. of Medical Pharmacology and Physiology and University of Missouri School of Medicine
| | | | - Michael J. Davis
- Dept. of Medical Pharmacology and Physiology and University of Missouri School of Medicine
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Gulati N, Morris RK, Williams D, Kilby MD. Prenatal thoraco-amniotic chest drain insertion to manage a case of fetal hydrops secondary to FOXC2. BMJ Case Rep 2018; 2018:bcr-2017-223902. [PMID: 29866673 DOI: 10.1136/bcr-2017-223902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lymphoedema-distichiasis is an inherited autosomal dominant disorder of the lymphatic system. Rarely, it is associated with fetal hydrops; the risk and severity of which increases with successive generations. The causative gene is a member of the forkhead transcription factor family (FOXC2). We describe a fetus presenting with early-onset, rapidly progressing body wall oedema, bilateral pleural effusions and a pericardial effusion in a mother with known FOXC2 mutation. First trimester chorionic villus sampling confirmed FOXC2 mutation in the fetus when there was only a large nuchal translucency. As the phenotype progressed, the couple consented to in utero ultrasound-guided insertion of sequential bilateral pleuro-amniotic chest drains (at 23 weeks) which successfully drained the pleural effusions. The fetus was delivered at 39 weeks gestation by elective caesarean section in good condition. The shunts were removed postnatally, and the baby was discharged after 7 days. This is the first case described of a fetus with severe early-onset fetal hydrops secondary to FOXC2 mutation successfully treated by the prenatal insertion of bilateral pleuro-amniotic shunts.
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Affiliation(s)
- Nidhi Gulati
- Obstetrics and Gynaecology, Burton Hospitals NHS Foundation Trust, Staffordshire, UK
| | - Rachel Katie Morris
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and System Research, University of Birmingham, Edgbaston, UK
| | - Denise Williams
- West Midlands Genetic Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - Mark David Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and System Research, University of Birmingham, Edgbaston, UK
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Laterre M, Bernard P, Vikkula M, Sznajer Y. Improved diagnosis in nonimmune hydrops fetalis using a standardized algorithm. Prenat Diagn 2018; 38:337-343. [DOI: 10.1002/pd.5243] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Marie Laterre
- Centre for Human Genetics; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Obstetrics Department; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
| | - Pierre Bernard
- Obstetrics Department; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
| | - Miika Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Center for Vascular Anomalies; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
- Walloon Excellence in Life Sciences and Biotechnology (WELBIO); de Duve Institute, UCL.; Brussels Belgium
| | - Yves Sznajer
- Centre for Human Genetics; Cliniques Universitaires St. Luc, UCL; Brussels Belgium
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