1
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Mason G, Aghajani R, Dance B, Othman J, Goodwin L, Stevenson W, Mackinlay N. Chronic myeloproliferative neoplasm in adulthood in CBL syndrome harboring a splice-site CBL variant alongside a novel constitutional CSF3R variant. EJHAEM 2024; 5:397-402. [PMID: 38633130 PMCID: PMC11020124 DOI: 10.1002/jha2.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 04/19/2024]
Abstract
Casitas B-cell lineage (CBL) syndrome is a rare RASopathy known to predispose to CBL-mutated juvenile myelomonocytic leukemia (JMML) in childhood. Adulthood acute myeloid leukemia arising out of a genetic aberrancies consistent with prior CBL-mutated JMML has been twice previously described, but chronic myeloproliferative neoplasia has not. We present a case of progressive myeloproliferative neoplasm in adulthood in the context of CBL syndrome alongside a novel CSF3R variant. We also review pathogenic splice-site mutations in CBL-mutated JMML.
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Affiliation(s)
- George Mason
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Rhian Aghajani
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Brieanna Dance
- Department of Clinical GeneticsChildren's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Jad Othman
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Linda Goodwin
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - William Stevenson
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Naomi Mackinlay
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
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2
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Zenker M. Clinical overview on RASopathies. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:414-424. [PMID: 36428239 DOI: 10.1002/ajmg.c.32015] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
RASopathies comprise a group of clinically overlapping developmental disorders caused by genetic variations affecting components or modulators of the RAS-MAPK signaling cascade, which lead to dysregulation of signal flow through this pathway. Noonan syndrome and the less frequent, clinically related disorders, Costello syndrome, cardiofaciocutaneous syndrome, Noonan syndrome with multiple lentigines, and Noonan syndrome-like disorder with loose anagen hair are part of the RASopathy spectrum and share a recognizable pattern of multisystem involvement. This review describes the "Noonan syndrome-like" phenotype as a common phenotypic signature of generalized developmental RAS pathway dysregulation. Distinctive features of the different entities are revisited against the background of the understanding of underlying genetic alterations and genotype correlations, which has evolved rapidly during the past 20 years, thereby leading to suggestions regarding the nosology of RASopathies.
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Affiliation(s)
- Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
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3
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Genetic Disorders with Predisposition to Paediatric Haematopoietic Malignancies—A Review. Cancers (Basel) 2022; 14:cancers14153569. [PMID: 35892827 PMCID: PMC9329786 DOI: 10.3390/cancers14153569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/26/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
The view of paediatric cancer as a genetic disease arises as genetic research develops. Germline mutations in cancer predisposition genes have been identified in about 10% of children. Paediatric cancers are characterized by heterogeneity in the types of genetic alterations that drive tumourigenesis. Interactions between germline and somatic mutations are a key determinant of cancer development. In 40% of patients, the family history does not predict the presence of inherited cancer predisposition syndromes and many cases go undetected. Paediatricians should be aware of specific symptoms, which highlight the need of evaluation for cancer syndromes. The quickest possible identification of such syndromes is of key importance, due to the possibility of early detection of neoplasms, followed by presymptomatic genetic testing of relatives, implementation of appropriate clinical procedures (e.g., avoiding radiotherapy), prophylactic surgical resection of organs at risk, or searching for donors of hematopoietic stem cells. Targetable driver mutations and corresponding signalling pathways provide a novel precision medicine strategy.Therefore, there is a need for multi-disciplinary cooperation between a paediatrician, an oncologist, a geneticist, and a psychologist during the surveillance of families with an increased cancer risk. This review aimed to emphasize the role of cancer-predisposition gene diagnostics in the genetic surveillance and medical care in paediatric oncology.
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4
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Fardeau C, Alafaleq M, Ferchaud MA, Hié M, Besnard C, Meynier S, Rieux-Laucat F, Roos-Weil D, Cohen F, Meunier I. Casitas B-lineage lymphoma Gene Mutation Ocular Phenotype. Int J Mol Sci 2022; 23:ijms23147868. [PMID: 35887217 PMCID: PMC9318494 DOI: 10.3390/ijms23147868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
This article describes the ocular phenotype associated with the identified Casitas B-lineage lymphoma (CBL) gene mutation and reviews the current literature. This work also includes the longitudinal follow-up of five unrelated cases of unexplained fundus lesions with visual loss associated with a history of hepatosplenomegaly. Wide repeated workup was made to rule out infections, inflammatory diseases, and lysosomal diseases. No variants in genes associated with retinitis pigmentosa, cone–rod dystrophy, and inherited optic neuropathy were found. Molecular analysis was made using next-generation sequencing (NGS) and whole-exome sequencing (WES). The results included two cases sharing ophthalmological signs including chronic macular edema, vascular leakage, visual field narrowing, and electroretinography alteration. Two other cases showed damage to the optic nerve head and a fifth young patient exhibited bilateral complicated vitreoretinal traction and carried a heterozygous mutation in the CBL gene associated with a mutation in the IKAROS gene. Ruxolitinib as a treatment for RASopathy did not improve eye conditions, whereas systemic lesions were resolved in one patient. Mutations in the CBL gene were found in all five cases. In conclusion, a detailed description may pave the way for the CBL mutation ocular phenotype. Genetic analysis using whole-exome sequencing could be useful in the diagnosis of unusual clinical features.
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Affiliation(s)
- Christine Fardeau
- Department of Ophthalmology, Reference Center for Rare Diseases, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (M.A.); (M.-A.F.)
- Correspondence:
| | - Munirah Alafaleq
- Department of Ophthalmology, Reference Center for Rare Diseases, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (M.A.); (M.-A.F.)
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Marie-Adélaïde Ferchaud
- Department of Ophthalmology, Reference Center for Rare Diseases, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (M.A.); (M.-A.F.)
| | - Miguel Hié
- Department of Internal Medicine, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (M.H.); (F.C.)
| | - Caroline Besnard
- Laboratory of Immunogenetics of Autoimmune Diseases in Children, INSERM UMR 1163, Imagine Institute, 24 Boulevard du Montparnasse, 75015 Paris, France; (C.B.); (S.M.); (F.R.-L.)
| | - Sonia Meynier
- Laboratory of Immunogenetics of Autoimmune Diseases in Children, INSERM UMR 1163, Imagine Institute, 24 Boulevard du Montparnasse, 75015 Paris, France; (C.B.); (S.M.); (F.R.-L.)
| | - Frédéric Rieux-Laucat
- Laboratory of Immunogenetics of Autoimmune Diseases in Children, INSERM UMR 1163, Imagine Institute, 24 Boulevard du Montparnasse, 75015 Paris, France; (C.B.); (S.M.); (F.R.-L.)
| | - Damien Roos-Weil
- Hematology Department, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France;
| | - Fleur Cohen
- Department of Internal Medicine, La Pitié-Salpêtrière Hospital, Paris-Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (M.H.); (F.C.)
| | - Isabelle Meunier
- Department of Ophthalmology, Reference Centre for Genetic Sensory Diseases, Hôpital Gui de Chauliac, Montpellier University, 34295 Montpellier, France;
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5
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Byrne AB, Brouillard P, Sutton DL, Kazenwadel J, Montazaribarforoushi S, Secker GA, Oszmiana A, Babic M, Betterman KL, Brautigan PJ, White M, Piltz SG, Thomas PQ, Hahn CN, Rath M, Felbor U, Korenke GC, Smith CL, Wood KH, Sheppard SE, Adams DM, Kariminejad A, Helaers R, Boon LM, Revencu N, Moore L, Barnett C, Haan E, Arts P, Vikkula M, Scott HS, Harvey NL. Pathogenic variants in MDFIC cause recessive central conducting lymphatic anomaly with lymphedema. Sci Transl Med 2022; 14:eabm4869. [PMID: 35235341 DOI: 10.1126/scitranslmed.abm4869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Central conducting lymphatic anomaly (CCLA), characterized by the dysfunction of core collecting lymphatic vessels including the thoracic duct and cisterna chyli, and presenting as chylothorax, pleural effusions, chylous ascites, and lymphedema, is a severe disorder often resulting in fetal or perinatal demise. Although pathogenic variants in RAS/mitogen activated protein kinase (MAPK) signaling pathway components have been documented in some patients with CCLA, the genetic etiology of the disorder remains uncharacterized in most cases. Here, we identified biallelic pathogenic variants in MDFIC, encoding the MyoD family inhibitor domain containing protein, in seven individuals with CCLA from six independent families. Clinical manifestations of affected fetuses and children included nonimmune hydrops fetalis (NIHF), pleural and pericardial effusions, and lymphedema. Generation of a mouse model of human MDFIC truncation variants revealed that homozygous mutant mice died perinatally exhibiting chylothorax. The lymphatic vasculature of homozygous Mdfic mutant mice was profoundly mispatterned and exhibited major defects in lymphatic vessel valve development. Mechanistically, we determined that MDFIC controls collective cell migration, an important early event during the formation of lymphatic vessel valves, by regulating integrin β1 activation and the interaction between lymphatic endothelial cells and their surrounding extracellular matrix. Our work identifies MDFIC variants underlying human lymphatic disease and reveals a crucial, previously unrecognized role for MDFIC in the lymphatic vasculature. Ultimately, understanding the genetic and mechanistic basis of CCLA will facilitate the development and implementation of new therapeutic approaches to effectively treat this complex disease.
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Affiliation(s)
- Alicia B Byrne
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Clinical and Health Sciences, University of South Australia, 5001 Adelaide, Australia
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, 1200 Brussels, Belgium
| | - Drew L Sutton
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Jan Kazenwadel
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | | | - Genevieve A Secker
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Anna Oszmiana
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Milena Babic
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Department of Genetics and Molecular Pathology, SA Pathology, 5000 Adelaide, Australia
| | - Kelly L Betterman
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Peter J Brautigan
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Department of Genetics and Molecular Pathology, SA Pathology, 5000 Adelaide, Australia
| | - Melissa White
- Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Genome Editing Program, South Australian Health and Medical Research Institute, 5000 Adelaide, Australia.,South Australian Genome Editing Facility, University of Adelaide, 5005 Adelaide, Australia
| | - Sandra G Piltz
- Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Genome Editing Program, South Australian Health and Medical Research Institute, 5000 Adelaide, Australia.,South Australian Genome Editing Facility, University of Adelaide, 5005 Adelaide, Australia
| | - Paul Q Thomas
- Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Genome Editing Program, South Australian Health and Medical Research Institute, 5000 Adelaide, Australia.,South Australian Genome Editing Facility, University of Adelaide, 5005 Adelaide, Australia
| | - Christopher N Hahn
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Department of Genetics and Molecular Pathology, SA Pathology, 5000 Adelaide, Australia.,ACRF Cancer Genomics Facility, Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Matthias Rath
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, 17489 Greifswald, Germany
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, 17489 Greifswald, Germany
| | - G Christoph Korenke
- Department of Neuropediatrics, University Children's Hospital, Klinikum Oldenburg, 26133 Oldenburg, Germany
| | - Christopher L Smith
- Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Division of Cardiology, Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathleen H Wood
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarah E Sheppard
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Denise M Adams
- Vascular Anomalies Centre, Division of Haematology/Oncology, Cancer and Blood Disorders Centre, Boston Children's Hospital, Boston, PA 02115, USA
| | | | - Raphael Helaers
- Human Molecular Genetics, de Duve Institute, University of Louvain, 1200 Brussels, Belgium
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, 1200 Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques Universitaires Saint-Luc and University of Louvain, 1200 Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques Universitaires Saint-Luc and University of Louvain, 1200 Brussels, Belgium.,Centre for Human Genetics, Cliniques Universitaires Saint-Luc and University of Louvain, 1200 Brussels, Belgium
| | - Lynette Moore
- Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Anatomical Pathology, SA Pathology, 5000 Adelaide, Australia
| | - Christopher Barnett
- Paediatric and Reproductive Genetics Unit, South Australian Clinical Genetics Service, Women's and Children's Hospital, 5006 Adelaide, South Australia, Australia
| | - Eric Haan
- Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia
| | - Peer Arts
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, 1200 Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques Universitaires Saint-Luc and University of Louvain, 1200 Brussels, Belgium.,Centre for Human Genetics, Cliniques Universitaires Saint-Luc and University of Louvain, 1200 Brussels, Belgium.,Walloon Excellence in Life Sciences and Biotechnology, University of Louvain, 1200 Brussels, Belgium
| | - Hamish S Scott
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia.,Department of Genetics and Molecular Pathology, SA Pathology, 5000 Adelaide, Australia.,ACRF Cancer Genomics Facility, Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia
| | - Natasha L Harvey
- Centre for Cancer Biology, University of South Australia and SA Pathology, 5001 Adelaide, Australia.,Adelaide Medical School, University of Adelaide, 5005 Adelaide, Australia
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6
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Kinota N, Kodama H, Moriyama T, Taniguchi J, Maruyama M, Ogasawara A, Kako Y, Kobayashi K, Takaki H, Shibata A, Minagawa K, Takeshima Y, Yamakado K. Lymphangiography as a Treatment for Refractory Congenital Chylothorax Due to RASopathies: A Report of Two Cases. INTERVENTIONAL RADIOLOGY 2022; 7:17-20. [PMID: 35911871 PMCID: PMC9327383 DOI: 10.22575/interventionalradiology.2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/28/2021] [Indexed: 12/02/2022]
Abstract
In this study, we report two cases in which intranodal lymphangiography helped improve congenital chylothorax due to RASopathies. We performed lymphangiography after conservative treatments failed to improve chylothorax in an 8-year-old girl with cardiofaciocutaneous syndrome and a 2-month-old boy with Noonan syndrome. Inguinal lymph nodes were punctured with 25-gauge needles under ultrasonographic guidance, and 4 and 1 mL of iodized oil were injected, respectively, showing a backflow of iodized oil into the lungs. Chylothorax had improved in both patients after nodal lymphangiography. However, the second child experienced worsening of disease-associated extremity edema and died of sepsis 4 months later.
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Affiliation(s)
- Naoya Kinota
- Department of Radiology, Hyogo College of Medicine
| | | | | | | | | | | | | | | | | | - Akio Shibata
- Department of Pediatrics, Hyogo College of Medicine
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7
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Role of CBL Mutations in Cancer and Non-Malignant Phenotype. Cancers (Basel) 2022; 14:cancers14030839. [PMID: 35159106 PMCID: PMC8833995 DOI: 10.3390/cancers14030839] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022] Open
Abstract
Simple Summary CBL mutations are progressively being described as involved in different clinical manifestations. Somatic CBL mutations can be found in different type of cancer. The clinical spectrum of germline mutations configures the so-called CBL syndrome, a cancer-predisposing condition that includes multisystemic involvement characterized by variable phenotypic expression and expressivity. In this review we provide an up-to-date review of the clinical manifestation of CBL mutations and of the molecular mechanisms in which CBL exerts its pathogenic role. Abstract CBL plays a key role in different cell pathways, mainly related to cancer onset and progression, hematopoietic development and T cell receptor regulation. Somatic CBL mutations have been reported in a variety of malignancies, ranging from acute myeloid leukemia to lung cancer. Growing evidence have defined the clinical spectrum of germline CBL mutations configuring the so-called CBL syndrome; a cancer-predisposing condition that also includes multisystemic involvement characterized by variable phenotypic expression and expressivity. This review provides a comprehensive overview of the molecular mechanisms in which CBL exerts its function and describes the clinical manifestation of CBL mutations in humans.
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8
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Longo JF, Carroll SL. The RASopathies: Biology, genetics and therapeutic options. Adv Cancer Res 2022; 153:305-341. [PMID: 35101235 DOI: 10.1016/bs.acr.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The RASopathies are a group of genetic diseases in which the Ras/MAPK signaling pathway is inappropriately activated as a result of mutations in genes encoding proteins within this pathway. As their causative mutations have been identified, this group of diseases has expanded to include neurofibromatosis type 1 (NF1), Legius syndrome, Noonan syndrome, CBL syndrome, Noonan syndrome-like disorder with loose anagen hair, Noonan syndrome with multiple lentigines, Costello syndrome, cardiofaciocutaneous syndrome, gingival fibromatosis and capillary malformation-arteriovenous malformation syndrome. Many of these genetic disorders share clinical features in common such as abnormal facies, short stature, varying degrees of cognitive impairment, cardiovascular abnormalities, skeletal abnormalities and a predisposition to develop benign and malignant neoplasms. Others are more dissimilar, even though their mutations are in the same gene that is mutated in a different RASopathy. Here, we describe the clinical features of each RASopathy and contrast them with the other RASopathies. We discuss the genetics of these disorders, including the causative mutations for each RASopathy, the impact that these mutations have on the function of an individual protein and how this dysregulates the Ras/MAPK signaling pathway. As several of these individual disorders are genetically heterogeneous, we also consider the different genes that can be mutated to produce disease with the same phenotype. We also discuss how our growing understanding of dysregulated Ras/MAPK signaling had led to the development of new therapeutic agents and what work will be critically important in the future to improve the lives of patients with RASopathies.
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Affiliation(s)
- Jody Fromm Longo
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Steven L Carroll
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States.
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9
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Cardoso L, Galán‐Gómez V, Corral‐Sánchez MD, Pérez‐Martínez A, Riesco S, Isidoro‐García M, Escudero A. Juvenile myelomonocytic leukemia in CBL syndrome associated with germline splice-site mutations: Two case reports and a literature review. Clin Case Rep 2021; 9:e04260. [PMID: 34026204 PMCID: PMC8123759 DOI: 10.1002/ccr3.4260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 11/05/2022] Open
Abstract
The clinical and laboratory criteria for hemophagocytic lymphohistiocytosis should be taken into account during the juvenile myelomonocytic leukemia diagnosis, specifically in CBL syndrome, to reveal the presence of primary rather than secondary associated hemophagocytosis.
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Affiliation(s)
- Leila Cardoso
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell TherapyHospital La Paz Institute for Health Research (INGEMM‐IdiPAZ)MadridSpain
| | - Víctor Galán‐Gómez
- Paediatric Haematology and Oncology ServiceLa Paz University HospitalMadridSpain
| | | | - Antonio Pérez‐Martínez
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell TherapyHospital La Paz Institute for Health Research (INGEMM‐IdiPAZ)MadridSpain
- Paediatric Haematology and Oncology ServiceLa Paz University HospitalMadridSpain
| | - Susana Riesco
- Department of Paediatric OncohaematologyUniversity Hospital of SalamancaSalamancaSpain
| | | | - Adela Escudero
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell TherapyHospital La Paz Institute for Health Research (INGEMM‐IdiPAZ)MadridSpain
- Institute of Medical and Molecular Genetics (INGEMM)La Paz University HospitalMadridSpain
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10
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Wu C, Wang Y, Pan Z, Wu Y, Wang Q, Li Y, An Y, Li H, Wang G, Dai J. Analysis of the etiology and treatment of chylothorax in 119 pediatric patients in a single clinical center. J Pediatr Surg 2019; 54:1293-1297. [PMID: 29884553 DOI: 10.1016/j.jpedsurg.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE To summarize the etiology and treatment of 119 patients with chylothorax in our hospital. METHODS A total of 119 patients with chylothorax, divided into a neonate group, an infant group, and an older-than-1-year group, were included in our study and analyzed from January 2000 to July 2017 in the Children's Hospital of Chongqing Medical University. RESULTS A total of 90 males and 29 females were included in our study. In the neonate group, 21 chylothorax cases were due to idiopathic factors, constituting 72.4% of the cases; 8 were related to cardiothoracic surgery, constituting 27.6%. In the infant group, 15 chylothorax cases were due to cardiothoracic surgery, constituting 55.6% of the cases; 11 were related to idiopathic factors, constituting 40.7%; and 1 was related to lymphoma, constituting 3.8%. In the older-than-1-year group, 33 chylothorax cases were due to idiopathic factors, constituting 52.4% of the cases; 25 were cardiothoracic surgery, constituting 39.7%; 2 were related to another internal medicine disease, constituting 3.2%; 2 were due to injury, constituting 3.2%; and 1 was related to lymphoma, constituting 1.6%. All the patients sequentially underwent thoracic drainage therapy, followed by fasting, thoracic injection of an adhesion-promoting agent, and thoracic duct ligation surgery. Among the neonates, 23 patients (79%) with fasting therapy improved, and 5 patients with fasting + intrapleural injection improved (17%). In the infant group, fasting promoted recovery in 14 patients, accounting for 51%, and fasting + thoracic injection improved the conditions of 10 patients, accounting for 37%. In the older-than-1-year group, fasting was effective in 35 patients, accounting for 55%; fasting + thoracic injection was effective in 22 patients, accounting for 34%; and fasting + thoracic injection + thoracic duct ligation surgery enabled the recovery of 2 patients, accounting for 3.2%. CONCLUSION In our center, the main causes of chylothorax in the neonates group are idiopathic factors but may also include a history of unspecified birth trauma; the proportions of idiopathic factors in the infant and older-than-1-year groups are also higher, but the iatrogenic factors are significantly increased in the latter 2 groups. All the patients underwent thoracic drainage therapy, and fasting promoted the recovery of most children. When fasting was ineffective, subsequent thoracic injections were effective. If the above two methods failed, surgery was a method of choice, but it was not always effective. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective study.
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Affiliation(s)
- Chun Wu
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Pediatric intensive care unit, Children's Hospital, Chongqing Medical University, Chongqing, China.
| | - Zhengxia Pan
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuhao Wu
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Wang
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yong An
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Wang
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangtao Dai
- Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China international Science and Technology Cooperation base of child development and critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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11
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Li D, March ME, Gutierrez-Uzquiza A, Kao C, Seiler C, Pinto E, Matsuoka LS, Battig MR, Bhoj EJ, Wenger TL, Tian L, Robinson N, Wang T, Liu Y, Weinstein BM, Swift M, Jung HM, Kaminski CN, Chiavacci R, Perkins JA, Levine MA, Sleiman PMA, Hicks PJ, Strausbaugh JT, Belasco JB, Dori Y, Hakonarson H. ARAF recurrent mutation causes central conducting lymphatic anomaly treatable with a MEK inhibitor. Nat Med 2019; 25:1116-1122. [DOI: 10.1038/s41591-019-0479-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/06/2019] [Indexed: 12/16/2022]
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12
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Mardy AH, Chetty SP, Norton ME, Sparks TN. A system-based approach to the genetic etiologies of non-immune hydrops fetalis. Prenat Diagn 2019; 39:732-750. [PMID: 31087399 DOI: 10.1002/pd.5479] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Abstract
A wide spectrum of genetic causes may lead to nonimmune hydrops fetalis (NIHF), and a thorough phenotypic and genetic evaluation are essential to determine the underlying etiology, optimally manage these pregnancies, and inform discussions about anticipated prognosis. In this review, we outline the known genetic etiologies of NIHF by fetal organ system affected, and provide a systematic approach to the evaluation of NIHF. Some of the underlying genetic disorders are associated with characteristic phenotypic features that may be seen on prenatal ultrasound, such as hepatomegaly with lysosomal storage disorders, hyperechoic kidneys with congenital nephrosis, or pulmonary valve stenosis with RASopathies. However, this is not always the case, and the approach to evaluation must include prenatal ultrasound findings as well as genetic testing and many other factors. Genetic testing that has been utilized for NIHF ranges from standard chromosomal microarray or karyotype to gene panels and broad approaches such as whole exome sequencing. Family and obstetric history, as well as pathology examination, can yield additional clues that are helpful in establishing a diagnosis. A systematic approach to evaluation can guide a more targeted approach to genetic evaluation, diagnosis, and management of NIHF.
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Affiliation(s)
- Anne H Mardy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Shilpa P Chetty
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Mary E Norton
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
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13
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Stuurman KE, Joosten M, van der Burgt I, Elting M, Yntema HG, Meijers-Heijboer H, Rinne T. Prenatal ultrasound findings of rasopathies in a cohort of 424 fetuses: update on genetic testing in the NGS era. J Med Genet 2019; 56:654-661. [PMID: 31040167 DOI: 10.1136/jmedgenet-2018-105746] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study evaluates 6 years of prenatal rasopathy testing in the Netherlands, updates on previous data and gives recommendations for prenatal rasopathy testing. METHODS 424 fetal samples, sent in for prenatal rasopathy testing in 2011-2016, were collected. Cohort 1 included 231 samples that were sequenced for 1-5 rasopathy genes. Cohort 2 included 193 samples that were analysed with a 14-gene next generation sequencing (NGS) panel. For all mutation-positive samples in both cohorts, the referring physician provided detailed ultrasound findings and postnatal follow-up. For 168 mutation-negative samples in cohort 2, solely clinical information on the requisition form was collected. RESULTS In total, 40 (likely) pathogenic variants were detected (9.4%). All fetuses showed a variable degree of involvement of prenatal findings: increased nuchal translucency (NT)/cystic hygroma, distended jugular lymph sacs (JLS), hydrops fetalis, polyhydramnios, pleural effusion, ascites, cardiac defects and renal anomalies. An increased NT was the most common finding. Eight fetuses showed solely an increased NT/cystic hygroma, which were all larger than 5.5 mm. Ascites and renal anomalies appeared to be poor predictors of pathogenic outcome. CONCLUSION Fetuses with a rasopathy show in general multiple ultrasound findings. The larger the NT and the longer it persists, the more likely it is to find a pathogenic variant. Rasopathy testing is recommended when the fetus shows an isolated increased NT ≥5.0 mm or when NT of ≥3.5 mm and at least one of the following ultrasound anomalies is present: distended JLS, hydrops fetalis, polyhydramnios, pleural effusion, ascites, cardiac defects and renal anomalies.
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Affiliation(s)
- Kyra E Stuurman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ineke van der Burgt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mariet Elting
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Helger G Yntema
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tuula Rinne
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Ji J, Navid F, Hiemenz MC, Kaneko M, Zhou S, Saitta SC, Biegel JA. Embryonal rhabdomyosarcoma in a patient with a germline CBL pathogenic variant. Cancer Genet 2018; 231-232:62-66. [PMID: 30803559 DOI: 10.1016/j.cancergen.2018.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/08/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
Germline pathogenic variants in CBL are associated with an autosomal dominant RASopathy and an increased risk for malignancies, particularly juvenile myelomonocytic leukemia. Herein, we describe a patient with clinical features of a Noonan-spectrum disorder who developed embryonal rhabdomyosarcoma of the bladder at age two years. Tumor analysis using the OncoKids® cancer panel revealed a CBL pathogenic variant: NM_005188.3:c.1100A>C (p.Gln367Pro). Sanger sequencing of peripheral blood DNA confirmed a de novo heterozygous germline variant. This is the first report of embryonal rhabdomyosarcoma in association with a germline CBL pathogenic variant, further broadening the CBL cancer predisposition spectrum.
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Affiliation(s)
- Jianling Ji
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Fariba Navid
- Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mathew C Hiemenz
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maki Kaneko
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Shengmei Zhou
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sulagna C Saitta
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
PURPOSE OF REVIEW To provide information on the scope of cardiac disease in Noonan syndrome. RECENT FINDINGS Noonan syndrome is a common autosomal dominant RASopathy disorder characterized by clinical findings of facial dysmorphism, congenital heart disease, and short stature. The degree of genetic heterogeneity has recently become evident in that Noonan syndrome is now known to be caused by mutations in a large variety of genes which produce dysregulation of the RAS-MAPK (mitogen-activated protein kinase) signaling pathway. The scope of cardiac disease in Noonan syndrome is quite variable depending on the gene mutation, with some mutations usually associated with a high incidence of congenital heart defects (PTPN11, KRAS, and others) while those with predominantly hypertrophic cardiomyopathy (HCM) have higher risk and morbidity profiles (RAF1, RIT1, and those associated with multiple lentigines). SUMMARY Cardiac disease in Noonan syndrome varies according to the type of gene mutation. The most common forms of cardiac disease include pulmonary stenosis, HCM, and atrial septal defect. HCM in general is associated with increased risk, mortality, and morbidity. New concepts for potential treatments are discussed.
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16
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Carrasco Salas P, Gómez-Molina G, Carreto-Alba P, Granell-Escobar R, Vázquez-Rico I, León-Justel A. Noonan syndrome: Severe phenotype and PTPN11 mutations. Med Clin (Barc) 2018; 152:62-64. [PMID: 29703613 DOI: 10.1016/j.medcli.2018.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/19/2018] [Accepted: 03/01/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION AND OBJECTIVE Noonan syndrome (NS) is a genetic disorder characterized by a wide range of distinctive features and health problems. It caused in 50% of cases by missense mutations in PTPN11 gene. It has been postulated that it is possible to predict the disease course based into the impact of mutations on the protein. PATIENTS AND METHODS We report two cases of severe NS phenotype including hydrops fetalis. PTPN11 gene was studied in germinal cells of both patients by sequencing. RESULTS Two different mutations (p.Gly503Arg and p.Met504Val) was detected in PTPN11 gene. DISCUSSION These mutations have been reported previously, and when they were germinal variants, patients presented classic NS, NS with other malignancies and recently, p.Gly503Arg has been also observed in a patient with severe NS and hydrops fetalis, as our cases. Therefore, these observations shade light on that it is not always possibly to determine the genotype-phenotype relation based into the impact of mutations on the protein in NS patients with PTPN11 mutations.
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Affiliation(s)
| | - Gertrudis Gómez-Molina
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - Páxedes Carreto-Alba
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - Reyes Granell-Escobar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Juan Ramón Jiménez Hospital, Huelva, Spain
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Michelini S, Paolacci S, Manara E, Eretta C, Mattassi R, Lee BB, Bertelli M. Genetic tests in lymphatic vascular malformations and lymphedema. J Med Genet 2018; 55:222-232. [PMID: 29440349 DOI: 10.1136/jmedgenet-2017-105064] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/04/2022]
Abstract
Syndromes with lymphatic malformations show phenotypic variability within the same entity, clinical features that overlap between different conditions and allelic as well as locus heterogeneity. The aim of this review is to provide a comprehensive clinical genetic description of lymphatic malformations and the techniques used for their diagnosis, and to propose a flowchart for genetic testing. Literature and database searches were performed to find conditions characterised by lymphatic malformations or the predisposition to lymphedema after surgery, to identify the associated genes and to find the guidelines and genetic tests currently used for the molecular diagnosis of these disorders. This search allowed us to identify several syndromes with lymphatic malformations that are characterised by a great heterogeneity of phenotypes, alleles and loci, and a high frequency of sporadic cases, which may be associated with somatic mutations. For these disorders, we found many diagnostic tests, an absence of harmonic guidelines for molecular diagnosis and well-established clinical guidelines. Targeted sequencing is the preferred method for the molecular diagnosis of lymphatic malformations. These techniques are easy to implement and have a good diagnostic success rates. In addition, they are relatively inexpensive and permit parallel analysis of all known disease-associated genes. The targeted sequencing approach has improved the diagnostic process, giving patients access to better treatment and, potentially, to therapy personalised to their genetic profiles. These new techniques will also facilitate the prenatal and early postnatal diagnosis of congenital lymphatic conditions and the possibility of early intervention.
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Affiliation(s)
- Sandro Michelini
- Department of Vascular Rehabilitation, San Giovanni Battista Hospital, Rome, Italy
| | | | | | | | - Raul Mattassi
- Center for Vascular Malformations, 'Stefan Belov', Clinical Institute Humanitas 'Mater Domini', Castellanza (Varese), Italy
| | - Byung-Boong Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, District of Columbia, USA
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Abstract
In this article we discuss the occurrence of myeloid neoplasms in patients with a range of syndromes that are due to germline defects of the RAS signaling pathway and in patients with trisomy 21. Both RAS mutations and trisomy 21 are common somatic events contributing to leukemogenis. Thus, the increased leukemia risk observed in children affected by these conditions is biologically highly plausible. Children with myeloid neoplasms in the context of these syndromes require different treatments than children with sporadic myeloid neoplasms and provide an opportunity to study the role of trisomy 21 and RAS signaling during leukemogenesis and development.
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Affiliation(s)
- Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany.
| | - Shai Izraeli
- The Genes, Development and Environment Institute for Pediatric Research, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Human Molecular Genetics and Biochemistry, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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19
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Martinelli S, Stellacci E, Pannone L, D'Agostino D, Consoli F, Lissewski C, Silvano M, Cencelli G, Lepri F, Maitz S, Pauli S, Rauch A, Zampino G, Selicorni A, Melançon S, Digilio MC, Gelb BD, De Luca A, Dallapiccola B, Zenker M, Tartaglia M. Molecular Diversity and Associated Phenotypic Spectrum of Germline CBL Mutations. Hum Mutat 2015; 36:787-96. [PMID: 25952305 DOI: 10.1002/humu.22809] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/30/2015] [Indexed: 01/11/2023]
Abstract
Noonan syndrome (NS) is a relatively common developmental disorder with a pleomorphic phenotype. Mutations causing NS alter genes encoding proteins involved in the RAS-MAPK pathway. We and others identified Casitas B-lineage lymphoma proto-oncogene (CBL), which encodes an E3-ubiquitin ligase acting as a tumor suppressor in myeloid malignancies, as a disease gene underlying a condition clinically related to NS. Here, we further explored the spectrum of germline CBL mutations and their associated phenotype. CBL mutation scanning performed on 349 affected subjects with features overlapping NS and no mutation in NS genes allowed the identification of five different variants with pathological significance. Among them, two splice-site changes, one in-frame deletion, and one missense mutation affected the RING domain and/or the adjacent linker region, overlapping cancer-associated defects. A novel nonsense mutation generating a v-Cbl-like protein able to enhance signal flow through RAS was also identified. Genotype-phenotype correlation analysis performed on available records indicated that germline CBL mutations cause a variable phenotype characterized by a relatively high frequency of neurological features, predisposition to juvenile myelomonocytic leukemia, and low prevalence of cardiac defects, reduced growth, and cryptorchidism. Finally, we excluded a major contribution of two additional members of the CBL family, CBLB and CBLC, to NS and related disorders.
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Affiliation(s)
- Simone Martinelli
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
| | - Emilia Stellacci
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
| | - Luca Pannone
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy.,Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Daniela D'Agostino
- Department of Medical Genetics, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Federica Consoli
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy.,Laboratorio Mendel, Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza, Rome, Italy
| | - Christina Lissewski
- Institute of Human Genetics, University Hospital of Magdeburg, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marianna Silvano
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
| | - Giulia Cencelli
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
| | | | - Silvia Maitz
- Dipartimento di Pediatria, Genetica Clinica, Ospedale S. Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Silke Pauli
- Institute of Human Genetics, University of Göttingen, Göttingen, Germany
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, Schlieren-Zurich, Switzerland
| | - Giuseppe Zampino
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Selicorni
- Dipartimento di Pediatria, Genetica Clinica, Ospedale S. Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Serge Melançon
- Department of Medical Genetics, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | - Bruce D Gelb
- Mindich Child Health and Development Institute and Departments of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York
| | - Alessandro De Luca
- Laboratorio Mendel, Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza, Rome, Italy
| | | | - Martin Zenker
- Institute of Human Genetics, University Hospital of Magdeburg, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marco Tartaglia
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
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