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Vanbelleghem E, Van Damme T, Beyens A, Symoens S, Claes K, De Backer J, Meerschaut I, Vanommeslaeghe F, Delanghe SE, van den Ende J, Beyltjens T, Scimone ER, Lindsay ME, Schimmenti LA, Hinze AM, Dunn E, Gomez-Ospina N, Vandernoot I, Delguste T, Coppens S, Cormier-Daire V, Tartaglia M, Garavelli L, Shieh J, Demir Ş, Arslan Ateş E, Zenker M, Rohanizadegan M, Rivera-Cruz G, Douzgou S, Lin AE, Callewaert B. Myhre syndrome in adulthood: clinical variability and emerging genotype-phenotype correlations. Eur J Hum Genet 2024; 32:1086-1094. [PMID: 38997468 PMCID: PMC11369149 DOI: 10.1038/s41431-024-01664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/26/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Myhre syndrome (MS, MIM 139210) is a rare multisystemic disorder caused by recurrent pathogenic missense variants in SMAD4. The clinical features have been mainly documented in childhood and comprise variable neurocognitive development, recognizable craniofacial features, a short stature with a pseudo-muscular build, hearing loss, thickened skin, joint limitations, diverse cardiovascular and airway manifestations, and increased fibrosis often following trauma or surgery. In contrast, adults with MS are underreported obscuring potential clinical variability. Here, we describe 24 adults with MS, including 17 diagnosed after the age of 18 years old, and we review the literature on adults with MS. Overall, our cohort shows a milder phenotype as well as lower mortality rates compared to what has been published in literature. Individuals with a codon 500 variant in SMAD4 present with a more pronounced neurodevelopmental and systemic phenotype. However, in contrast to the literature, we observe cardiovascular abnormalities in individuals with the p.(Arg496Cys) variant. In addition, we describe scoliosis as a new manifestation and we report fertility in two additional males with the p.(Arg496Cys). In conclusion, our study contributes novel insights into the clinical variability of MS and underscores the importance of variant-specific considerations, and we provide recommendations for the management of MS in adulthood.
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Affiliation(s)
- Eva Vanbelleghem
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Tim Van Damme
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Aude Beyens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Sofie Symoens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Kathleen Claes
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Julie De Backer
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Ilse Meerschaut
- Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium
| | | | | | - Jenneke van den Ende
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Tessi Beyltjens
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Eleanor R Scimone
- Department of Pediatrics, Genetics Unit, MassGeneral for Children, Boston, MA, USA
| | - Mark E Lindsay
- Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Cardiology Division, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alicia M Hinze
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Emily Dunn
- Department of Pediatrics, Division of Medical Genetic, Stanford University, Stanford, CA, USA
| | - Natalia Gomez-Ospina
- Department of Pediatrics, Division of Medical Genetic, Stanford University, Stanford, CA, USA
| | - Isabelle Vandernoot
- ULB Center of Human Genetics, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Delguste
- ULB Center of Human Genetics, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandra Coppens
- ULB Center of Human Genetics, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Valérie Cormier-Daire
- Paris Cité University, Centre of Reference for Constitutional Bone Diseases (MOC), Department of Genetics, INSERM UMR 1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Joseph Shieh
- Institute for Human Genetics and Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Şenol Demir
- Department of Medical Genetics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Esra Arslan Ateş
- Department of Medical Genetics, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Mersedeh Rohanizadegan
- Department of Medicine, Division of Translational Medicine & Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Greysha Rivera-Cruz
- Division of Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Stanford, CA, USA
| | - Sofia Douzgou
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Angela E Lin
- Department of Pediatrics, Genetics Unit, MassGeneral for Children, Boston, MA, USA
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.
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2
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Martin-Malpartida P, Torner C, Martinez A, Macias MJ. TPPU_DSF: A Web Application to Calculate Thermodynamic Parameters Using DSF Data. J Mol Biol 2024; 436:168519. [PMID: 39237200 DOI: 10.1016/j.jmb.2024.168519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 09/07/2024]
Abstract
Here we present TPPU_DSF (https://maciasnmr.net/tppu_dsf/). This is a free and open-source web application that opens, converts, fits, and calculates the thermodynamic parameters of protein unfolding from standard differential scanning fluorimetry (DSF) data in an automated manner. The software has several applications. In the context of screening compound libraries for protein binders, obtaining thermodynamic parameters provides a more robust approach to detecting hits than the changes in the melting temperature (Tm) alone, thereby helping to increase the number of positive hits in screening campaigns. Moreover, changes in ΔGuo indicate protein response to binding at lower compound concentrations than those in the Tm, thereby reducing the costs associated with the amounts of protein and compounds required for the assays. Also, by adding thermodynamic information to the Tm comparison, the software can contribute to the optimization of protein constructs and buffer conditions, a common practice before structural and functional projects.
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Affiliation(s)
- Pau Martin-Malpartida
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology (BIST), Baldiri Reixac, 10, Barcelona 08028, Spain
| | - Carles Torner
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology (BIST), Baldiri Reixac, 10, Barcelona 08028, Spain
| | - Aurora Martinez
- Department of Biomedicine, and the Kristian Gerhard Jebsen Center for Translational Research in Parkinson's Disease, University of Bergen, 5020 Bergen, Norway
| | - Maria J Macias
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology (BIST), Baldiri Reixac, 10, Barcelona 08028, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona 08010, Spain.
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3
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Lin AE, Scimone ER, Thom RP, Balaguru D, Kinane TB, Moschovis PP, Cohen MS, Tan W, Hague CD, Dannheim K, Levitsky LL, Lilly E, DiGiacomo DV, Masse KM, Kadzielski SM, Zar-Kessler CA, Ginns LC, Neumeyer AM, Colvin MK, Elder JS, Learn CP, Mou H, Weagle KM, Buch KA, Butler WE, Alhadid K, Musolino PL, Sultana S, Bandyopadhyay D, Rapalino O, Peacock ZS, Chou EL, Heidary G, Dorfman AT, Morris SA, Bergin JD, Rayment JH, Schimmenti LA, Lindsay ME. Emergence of the natural history of Myhre syndrome: 47 patients evaluated in the Massachusetts General Hospital Myhre Syndrome Clinic (2016-2023). Am J Med Genet A 2024:e63638. [PMID: 38779990 DOI: 10.1002/ajmg.a.63638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
Myhre syndrome is an increasingly diagnosed ultrarare condition caused by recurrent germline autosomal dominant de novo variants in SMAD4. Detailed multispecialty evaluations performed at the Massachusetts General Hospital (MGH) Myhre Syndrome Clinic (2016-2023) and by collaborating specialists have facilitated deep phenotyping, genotyping and natural history analysis. Of 47 patients (four previously reported), most (81%) patients returned to MGH at least once. For patients followed for at least 5 years, symptom progression was observed in all. 55% were female and 9% were older than 18 years at diagnosis. Pathogenic variants in SMAD4 involved protein residues p.Ile500Val (49%), p.Ile500Thr (11%), p.Ile500Leu (2%), and p.Arg496Cys (38%). Individuals with the SMAD4 variant p.Arg496Cys were less likely to have hearing loss, growth restriction, and aortic hypoplasia than the other variant groups. Those with the p.Ile500Thr variant had moderate/severe aortic hypoplasia in three patients (60%), however, the small number (n = 5) prevented statistical comparison with the other variants. Two deaths reported in this cohort involved complex cardiovascular disease and airway stenosis, respectively. We provide a foundation for ongoing natural history studies and emphasize the need for evidence-based guidelines in anticipation of disease-specific therapies.
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Affiliation(s)
- Angela E Lin
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor R Scimone
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robyn P Thom
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Duraisamy Balaguru
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - T Bernard Kinane
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter P Moschovis
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Cohen
- Pediatric Otorhinolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Weizhen Tan
- Pediatric Nephrology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cole D Hague
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katelyn Dannheim
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lynne L Levitsky
- Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel V DiGiacomo
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara M Masse
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M Kadzielski
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire A Zar-Kessler
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leo C Ginns
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann M Neumeyer
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jack S Elder
- Division of Pediatric Urology, Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher P Learn
- Division of Cardiology, Department of Medicine, Corrigan Minehan Heart Center, Adult Congenital Heart Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hongmei Mou
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn M Weagle
- Department of Child Life, Pediatric Imaging Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen A Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenda Alhadid
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sadia Sultana
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary S Peacock
- Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Aaron T Dorfman
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James D Bergin
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan H Rayment
- Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Schimmenti
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Lindsay
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Cardiology, Department of Pediatrics, Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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4
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Brunet-Garcia L, Prada Martínez FH, Carretero Bellon JM. Myhre syndrome: expanding its paediatric phenotypic spectrum. Cardiol Young 2023; 33:2408-2410. [PMID: 37325812 DOI: 10.1017/s1047951123001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Myhre syndrome is a rare disease secondary to pathogenic variants in SMAD4 gene. It is a multisystem disease characterised by short stature, deafness, joint stiffness, craniofacial dysmorphism, and potential cardiac manifestations. Herein, we report two new paediatric cases of Myhre syndrome who, additionally, presented with mid-aortic syndrome. This confirms and extends the scarce reports describing the association between these two entities.
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Affiliation(s)
- Laia Brunet-Garcia
- Department of Paediatric Cardiology, Consorci Sanitari del Maresme, Hospital de Mataró, Barcelona, Spain
| | | | - Juan Manuel Carretero Bellon
- Department of Paediatric Cardiology, Hospital Sant Joan de Déu. Barcelona, Spain
- Department of Paediatric Cardiology, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
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5
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Hui PW, Mok YK, Luk HM, Au SLK, Lau EYT, Chung B, Kan ASY. Prenatal diagnosis of Myhre syndrome with a heterozygous pathogenic variant in SMAD4 gene presented with thick nuchal translucency and cardiac abnormalities. Prenat Diagn 2023; 43:1366-1369. [PMID: 37529930 DOI: 10.1002/pd.6414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
Prenatal testing was performed in a 39-year-old Chinese pregnant woman referred for increased nuchal translucency measuring 5.7 mm. Non-invasive prenatal testing and SNP array study on amniotic fluid samples were normal. Whole exome sequencing (WES) was initiated further as the fetus had pericardial effusion of 1.2 mm, thickened myocardium over the right ventricular lateral wall and aberrant right subclavian artery. A detailed fetal echocardiogram also revealed persistent left superior vena cava and dilated coronary sinus at 20 weeks. From whole exome sequencing of the trio, a de novo heterozygous variant NM_005359.5(SMAD4): c.1499T>C (p.Ile500Thr) was detected. This pathogenic variant has been reported in the postnatal case cohort of Myhre syndrome. This condition is characterized by facial dysmorphism, intellectual disability, hearing loss, skeletal abnormalities and potential life threatening respiratory or cardiovascular manifestations. Termination of pregnancy was performed at 23 weeks. Small chins, pre-axial polydactyly, brachydactyly and clinodactyly were noted in the abortus. Ultrasound findings of increased nuchal translucency, thickened myocardium and pericardial effusion prompted further genetic evaluation for the prenatal diagnosis of Myhre syndrome by whole exome sequencing.
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Affiliation(s)
- Pui Wah Hui
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Yin Kwan Mok
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Ho Ming Luk
- Department of Health, Clinical Genetic Service, Hong Kong, Hong Kong
| | | | | | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anita Sik Yau Kan
- Prenatal Diagnostic Laboratory, Tsan Yuk Hospital, Hong Kong, Hong Kong
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6
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Yang K, Wang X, Wang WQ, Han MY, Hu LM, Kang DY, Yang JY, Liu M, Gao X, Yuan YY, Xu JC. A newborn male with Myhre syndrome, hearing loss, and complete syndactyly of fingers 3-4. Mol Genet Genomic Med 2023; 11:e2103. [PMID: 36373990 PMCID: PMC10009913 DOI: 10.1002/mgg3.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Myhre syndrome is a rare multisystem genetic disorder that is caused by de novo heterozygous gain-of-function variants in SMAD4. Patients with Myhre syndrome exhibit several phenotypes at different ages such as small size, autism, developmental delay, left-sided heart defects, and hearing loss and often have a characteristic facial appearance. The early clinical diagnosis of Myhre syndrome remains a major challenge, particularly in the first year of life. METHODS A Chinese male infant with syndactyly of fingers, hypertelorism, short palpebral fissures, and short philtrum was enrolled into the ENT department of the Chinese PLA General Hospital. Whole exome sequencing analysis was used to detect the disease-causing variant. A literature review of Myhre syndrome was also performed. RESULTS A recurrent de novo missense variant c.1498A > G p.I500V(p. Ile500Val) in SMAD4 was detected confirming the clinical diagnosis of Myhre syndrome at the age of 38 days. The infant appears to be the youngest reported case of Myhre syndrome. At 23-month follow-up, the affected infant has dysmorphic facial features, growth retardation, and previously undescribed complete syndactyly. Review the literatures noted several common features in Myhre syndrome patients including hearing loss (72.7%), characteristic facial features (26.0%-54.5%), finger and toe abnormalities (3.9%-48.1%), short stature (45.5%), and respiratory (30.0%) and cardiovascular problems (65.0%). CONCLUSIONS Clinicians should have a low threshold to perform genetic testing on patients with features suggesting Myhre syndrome even in the first year of life. Although some individuals with Myhre syndrome have normal hearing, early onset or progressive hearing loss usually occur in one or both ears in most patients, with remarkable phenotypic heterogeneity. Syndactyly may be minor such as typical 2-3 toe involvement, or more complicated as was observed in our patient.
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Affiliation(s)
- Kun Yang
- Postgraduate Training Base of Jinzhou Medical University (The PLA Rocket Force Characteristic Medical Center), Beijing, P. R. China
| | - Xi Wang
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China
| | - Wei-Qian Wang
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, P. R. China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, P. R. China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, P. R. China
| | - Ming-Yu Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, P. R. China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, P. R. China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, P. R. China
| | - Li-Min Hu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China
| | - Dong-Yang Kang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, P. R. China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, P. R. China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, P. R. China
| | - Jin-Yuan Yang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, P. R. China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, P. R. China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, P. R. China
| | - Min Liu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China
| | - Xue Gao
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China
| | - Yong-Yi Yuan
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, P. R. China.,National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, P. R. China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, P. R. China
| | - Jin-Cao Xu
- Department of Otolaryngology, The PLA Rocket Force Characteristic Medical Center, Beijing, P. R. China
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Abstract
Mid-aortic syndrome (MAS) is an uncommon condition characterized by severe narrowing of the abdominal aorta, usually involving visceral and renal arteries. Most patients are asymptomatic and typically present with incidental hypertension which might evolve into end-organ damage if untreated. Our aim was to review 8 new pediatric MAS cases. A retrospective observational study of all pediatric patients with MAS diagnosis (April 1992-November 2021) was conducted. Patients underwent systematic evaluation (medical and family history; 12-lead electrocardiogram; echocardiogram; angiography and/or computed tomography or magnetic resonance angiography). 8 pediatric patients with MAS were included. Median age at diagnosis was 2.6 [0.2-4.7] years; median follow-up time was 8.6 [6.6-10.0] years. 6/8 patients presented with incidental hypertension, 1/8 with heart murmur, and 1/8 with heart failure symptoms. All patients were on antihypertensive treatment. 1/8 patients underwent surgery and 7/8 an endovascular treatment. At the end of the study period, among the 6 patients that underwent a successful endovascular procedure, 2 achieved good blood pressure (BP) control, 2 acceptable BP control, 1 stage 1 hypertension and, another, stage 2 hypertension. There was 1 death during follow-up. BP monitoring in pediatric patients is crucial for early recognition of MAS. Treatment should be based on the individual clinical characteristics of patients with careful planning of surgical revascularisation, if possible, after adult growth is completed. Our study demonstrates that endovascular treatment might be a good alternative to surgery. Nevertheless, further trials with larger sample size and longer-term follow-up are required to determine the best treatment approach.
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8
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Starr LJ, Lindsay ME, Perry D, Gheewalla G, VanderLaan PA, Majid A, Strange C, Costea GC, Lungu A, Lin AE. Review of the Pathologic Characteristics in Myhre Syndrome: Gain-of-Function Pathogenic Variants in SMAD4 cause a Multisystem Fibroproliferative Response. Pediatr Dev Pathol 2022; 25:611-623. [PMID: 36120950 DOI: 10.1177/10935266221079569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Myhre syndrome, caused by pathogenic variants in SMAD4, is characterized by compact body habitus with short stature, distinctive craniofacial appearance, stiff skin, cardiovascular abnormalities (valve stenosis, coarctation, hypoplasia, or stenosis of aorta), effusions of potential spaces (pericardium, pleura, peritoneum), restricted movement of the joints (including thorax), and hearing loss. Lung and airway disease has been reported, but not always well-defined, to include interstitial lung disease, large airway obstruction, and pulmonary arterial hypertension. Excessive fibroproliferation of tissues especially following trauma or surgical instrumentation has been recognized, although these may also present spontaneously. Method: We report the pathologic features of 1 new patient with progressive choanal stenosis, and 22 literature cases, including the expanded history of 5 patients (3 who died). Results: Examination of patient tissues documents cellular fibroproliferation and deposition of excessive extracellular matrix explaining some of the observed clinical features of Myhre syndrome. Conclusion: Excessive fibrosis is noted in multiple tissues, especially heart, lung, and upper and lower airways. Our research provides the first systematic review to provide a knowledge base of gross and pathologic findings in Myhre syndrome.
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Affiliation(s)
- Lois J Starr
- Department of Pediatrics, Munroe-Meyer Institute, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Mark E Lindsay
- Division of Pediatric Cardiology, Department of Pediatrics, Harvard Medical School, 547756MassGeneral Hospital for Children, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Cardiovascular Research Center, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah Perry
- Department of Pathology, 6217Methodist Hospital, Omaha, NE, USA
| | | | - Paul A VanderLaan
- Department of Pathology, 1859Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Adnan Majid
- Department of Medicine, 1859Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, 2345Medical University of South Carolina, Charleston, SC, USA
| | - George-Claudiu Costea
- Division of Nephrology, Department of Pediatrics, 277067Fundeni Clinical Institute, Bucharest, Romania
| | - Adrian Lungu
- Division of Nephrology, Department of Pediatrics, 277067Fundeni Clinical Institute, Bucharest, Romania
| | - Angela E Lin
- Medical Genetics, Department of Pediatrics, Harvard Medical School, 547756MassGeneral Hospital for Children, Boston, MA, USA
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9
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Yang DD, Rio M, Michot C, Boddaert N, Yacoub W, Garcelon N, Thierry B, Bonnet D, Rondeau S, Herve D, Guey S, Angoulvant F, Cormier-Daire V. Natural history of Myhre syndrome. Orphanet J Rare Dis 2022; 17:304. [PMID: 35907855 PMCID: PMC9338657 DOI: 10.1186/s13023-022-02447-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Myhre syndrome (MS) is a rare genetic disease characterized by skeletal disorders, facial features and joint limitation, caused by a gain of function mutation in SMAD4 gene. The natural history of MS remains incompletely understood.
Methods We recruited in a longitudinal retrospective study patients with molecular confirmed MS from the French reference center for rare skeletal dysplasia. We described natural history by chaining data from medical reports, clinical data warehouse, medical imaging and photographies.
Results We included 12 patients. The median age was 22 years old (y/o). Intrauterine and postnatal growth retardation were consistently reported. In preschool age, neurodevelopment disorders were reported in 80% of children. Specifics facial and skeletal features, thickened skin and joint limitation occured mainly in school age children. The adolescence was marked by the occurrence of pulmonary arterial hypertension (PAH) and vascular stenosis. We reported for the first time recurrent strokes from the age of 26 y/o, caused by a moyamoya syndrome in one patient. Two patients died at late adolescence and in their 20 s respectively from PAH crises and mesenteric ischemia. Conclusion Myhre syndrome is a progressive disease with severe multisystemic impairement and life-threathning complication requiring multidisciplinary monitoring.
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Affiliation(s)
- David Dawei Yang
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Marlene Rio
- Université de Paris, Institut IMAGINE, Developmental Brain Disorders Laboratory, INSERM UMR1163, 75015, Paris, France.,Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Caroline Michot
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France
| | - Wael Yacoub
- Paediatric Radiology Department, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Université de Paris, Institut IMAGINE, Data Science Platform, INSERM UMR1163, 75015, Paris, France
| | - Briac Thierry
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Universitaire Necker - Enfants Malades, 75015, Paris, France.,Université de Paris, Human Immunology, Pathophysiology, Immunotherapy/HIPI/INSERM UMR976, Stem Cell Biotechnologies, 75010, Paris, France
| | - Damien Bonnet
- Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France.,M3C-Paediatric Cardiology, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France
| | - Sophie Rondeau
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France
| | - Dominique Herve
- Department of Neurology, AP-HP Nord, Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), DHU NeuroVasc, INSERM U 1161, 75010, Paris, France
| | - Stephanie Guey
- Department of Neurology, AP-HP, Hôpital Lariboisière, UMR-S1161, 75010, Paris, France
| | - Francois Angoulvant
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Valerie Cormier-Daire
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France. .,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France.
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10
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Lodato V, Parlapiano G, Calì F, Silvetti MS, Adorisio R, Armando M, El Hachem M, Romanzo A, Dionisi-Vici C, Digilio MC, Novelli A, Drago F, Raponi M, Baban A. Cardiomyopathies in Children and Systemic Disorders When Is It Useful to Look beyond the Heart? J Cardiovasc Dev Dis 2022; 9:47. [PMID: 35200700 PMCID: PMC8877723 DOI: 10.3390/jcdd9020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathy (CMP) is a rare disease in the pediatric population, with a high risk of morbidity and mortality. The genetic etiology of CMPs in children is extremely heterogenous. These two factors play a major role in the difficulties of establishing standard diagnostic and therapeutic protocols. Isolated CMP in children is a frequent finding, mainly caused by sarcomeric gene variants with a detection rate that can reach up to 50% of analyzed cohorts. Complex multisystemic forms of pediatric CMP are even more heterogenous. Few studies in literature take into consideration this topic as the main core since it represents a rarity (systemic CMP) within a rarity (pediatric population CMP). Identifying etiology in this cohort is essential for understanding prognosis, risk stratification, eligibility to heart transplantation and/or mechanical-assisted procedures, preventing multiorgan complications, and relatives' recurrence risk calculation. The previous points represent a cornerstone in patients' empowerment and personalized medical care approach. The aim of this work is to propose a new approach for an algorithm in the setting of the diagnostic framework of systemic pediatric CMP. On the other hand, during the literature review, we noticed a relatively common etiologic pattern in some forms of complex/multisystem CMP. In other words, certain syndromes such as Danon, Vici, Alström, Barth, and Myhre syndrome share a common pathway of directly or indirectly defective "autophagy" process, which appears to be a possible initiating/triggering factor for CMPs. This conjoint aspect could be important for possible prognostic/therapeutic implications in this category of patients. However, multicentric studies detailed functional and experimental models are needed prior to deriving conclusions.
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Affiliation(s)
- Valentina Lodato
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Federica Calì
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimo Stefano Silvetti
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Rachele Adorisio
- Heart Failure Clinic-Heart Failure, Heart Transplant, Mechanical Circulatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - May El Hachem
- Dermatology and Genodermatosis Units, Genetics and Rare Disease Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonino Romanzo
- Ophtalmology Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy;
| | - Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
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11
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Cappuccio G, Brunetti-Pierri N, Clift P, Learn C, Dykes JC, Mercer CL, Callewaert B, Meerschaut I, Spinelli AM, Bruno I, Gillespie MJ, Dorfman AT, Grimberg A, Lindsay ME, Lin AE. Expanded cardiovascular phenotype of Myhre syndrome includes tetralogy of Fallot suggesting a role for SMAD4 in human neural crest defects. Am J Med Genet A 2022; 188:1384-1395. [PMID: 35025139 DOI: 10.1002/ajmg.a.62645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 11/08/2022]
Abstract
Tetralogy of Fallot (ToF) can be associated with a wide range of extracardiac anomalies, with an underlying etiology identified in approximately 10% of cases. Individuals affected with Myhre syndrome due to recurrent SMAD4 mutations frequently have cardiovascular anomalies, including congenital heart defects. In addition to two patients in the literature with ToF, we describe five additional individuals with Myhre syndrome and classic ToF, ToF with pulmonary atresia and multiple aorto-pulmonary collaterals, and ToF with absent pulmonary valve. Aorta hypoplasia was documented in one patient and suspected in another two. In half of these individuals, postoperative cardiac dysfunction was thought to be more severe than classic postoperative ToF repair. There may be an increase in right ventricular pressure, and right ventricular dysfunction due to free pulmonic regurgitation. Noncardiac developmental abnormalities in our series and the literature, including corectopia, heterochromia iridis, and congenital miosis suggest an underlying defect of neural crest cell migration in Myhre syndrome. We advise clinicians that Myhre syndrome should be considered in the genetic evaluation of a child with ToF, short stature, unusual facial features, and developmental delay, as these children may be at risk for increased postoperative morbidity. Additional research is needed to investigate the hypothesis that postoperative hemodynamics in these patients may be consistent with restrictive myocardial physiology.
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Affiliation(s)
- Gerarda Cappuccio
- Department of Translational Medicine, Section of Pediatrics, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli (Naples), Italy
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Section of Pediatrics, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli (Naples), Italy
| | - Paul Clift
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
| | - Christopher Learn
- Adult Congenital Heart Disease Program, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John C Dykes
- Departments of Pediatrics, Stanford, California, USA
| | - Catherine L Mercer
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK
| | - Bert Callewaert
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.,Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Ilse Meerschaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Irene Bruno
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aaron T Dorfman
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mark E Lindsay
- Department of Pediatrics, Division of Pediatric Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angela E Lin
- Genetics Unit, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, USA
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12
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Inoue K, Eiro T, Semoto M, Roppongi T, Nomoto M, Takahashi Y, Hishimoto A. First case of Myhre syndrome with schizophrenia. Clin Dysmorphol 2021; 30:207-208. [PMID: 34456243 DOI: 10.1097/mcd.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Keisuke Inoue
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Hokujinkai Foundation, Asahiyama Hospital, Sapporo
| | - Tsuyoshi Eiro
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Department of Physiology, Yokohama City University Graduate School of Medicine
| | - Misato Semoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Seieikai Foundation, Kouhoku Hospital
| | - Tomohide Roppongi
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Psychiatric Center, Yokohama City University Medical Center
| | - Munetaka Nomoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Psychiatric Center, Yokohama City University Medical Center
| | - Yuichi Takahashi
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
- Yokohama East Area Habilitation Center for children, Yokohama, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama
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13
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Jeon MJ, Kim MJ, Kim JH, Park JS, Yim J, Kim M, Kwon SK, Lee S, Ko JM, Chae JH, Suh DI. Multilevel Airway Stenosis Being Bypassed by a Customized Tracheostomy Tube in an Infant with Myhre Syndrome. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:83-87. [PMID: 34143683 DOI: 10.1089/ped.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Myhre syndrome is a rare connective tissue disorder caused by heterozygous pathogenic variants in the SMAD4 gene. Although recognizing Myhre syndrome in early childhood is challenging, it is important to manage airway stenosis in patients with Myhre syndrome. Case Presentation: We report the case of a 2-month-old boy who initially presented with severe multilevel airway stenosis, dysmorphic face, and multiple abnormalities. Lung fibrosis and mild aortic valve stenosis were additionally observed on follow-up examinations. A heterozygous missense variant, c.1499T>C (p.Ile500Thr), in SMAD4 was identified through exome sequencing. Tracheostomy was performed, and the patient has maintained stable respiration through a customized tracheostomy tube with a home ventilator. Conclusions: Patients who have dysmorphic face, airway stenosis, and cardiovascular anomalies that do not fit the diagnosis of common syndromes should be evaluated for rare diseases, including Myhre syndrome. Since respiratory complications can be life threatening, early diagnosis and suitable intervention are necessary.
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Affiliation(s)
- Min Jin Jeon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jisook Yim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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14
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Matalon DR, Stevenson DA, Bhoj EJ, Santani AB, Keena B, Cohen MS, Lin AE, Sheppard SE, Zackai EH. Congenital polyvalvular disease expands the cardiac phenotype of the RASopathies. Am J Med Genet A 2021; 185:1486-1493. [PMID: 33683002 DOI: 10.1002/ajmg.a.62146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 01/13/2023]
Abstract
The RASopathies are a group of similar genetic syndromes with cardiovascular abnormalities, characteristic facial features, short stature, abnormalities of the skin and musculoskeletal system, and variable neurodevelopmental challenges. The most common cardiovascular abnormalities include pulmonary valvular stenosis and hypertrophic cardiomyopathy. Congenital polyvalvular disease (CPVD) refers to congenital dysplasia of two or more cardiac valves. We diagnosed a RASopathy in two individuals with CPVD and noted that CPVD in RASopathies has rarely been reported in the literature. Thus, we performed a retrospective chart review and literature review to investigate the association and characterize the phenotype of CPVD in the RASopathies. CPVD was present in 2.5% (n = 6/243) of individuals in our RASopathy cohort. Involvement of two cardiac valves, commonly the aortic and pulmonic valves, was seen in the majority of individuals (6/8; 75%) in our cohort, but only 27% (3/11) of reported CPVD and RASopathy cases in the literature. CPVD should be considered an associated cardiovascular phenotype of the RASopathies, which has implications for diagnosis and management.
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Affiliation(s)
- Dena R Matalon
- Division of Medical Genetics, Stanford University, Stanford, California, USA
| | - David A Stevenson
- Division of Medical Genetics, Stanford University, Stanford, California, USA
| | - Elizabeth J Bhoj
- Division of Human Genetics and Molecular Biology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Avni B Santani
- Division of Human Genetics and Molecular Biology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beth Keena
- Division of Human Genetics and Molecular Biology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Meryl S Cohen
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Angela E Lin
- Medical Genetics, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Sarah E Sheppard
- Division of Human Genetics and Molecular Biology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaine H Zackai
- Division of Human Genetics and Molecular Biology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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15
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Lin AE, Brunetti-Pierri N, Callewaert B, Cormier-Daire V, Douzgou S, Kinane TB, Lindsay ME, Starr LJ. Lack of resemblance between Myhre syndrome and other "segmental progeroid" syndromes warrants restraint in applying this classification. GeroScience 2021; 43:459-461. [PMID: 33630210 PMCID: PMC8110621 DOI: 10.1007/s11357-021-00337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Angela E Lin
- Medical Genetics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Valérie Cormier-Daire
- Clinical Genetics, Paris Centre University, INSERM UMR 1163, Imagine Institute, Hôpital Necker enfants, Malades, Paris, France
| | - Sofia Douzgou
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.,Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, England.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicines and Health, University of Manchester, Manchester, UK
| | - T Bernard Kinane
- Pediatric Pulmonary, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Mark E Lindsay
- Cardiovascular Genetics Program, Division of Cardiology and Pediatric Cardiology, Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Lois J Starr
- Medical Genetics, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
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16
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Wu H, Wang X, Cui Y, Wang X. Case Report: Improved Height in a Patient With Myhre Syndrome Using a Combination of Growth Hormone and Letrozole. Front Pediatr 2021; 9:675934. [PMID: 34395338 PMCID: PMC8360501 DOI: 10.3389/fped.2021.675934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Myhre syndrome is a rare disorder caused by a heterozygous mutation in the SMAD4 gene. Affected patients may exhibit dysmorphic facial features, intrauterine growth retardation, short stature, obesity, muscle hypertrophy, thickened skin, limited joint movement, hearing impairment, and varying degrees of psychomotor developmental disorder. Serious complications of the cardiovascular and respiratory system may be seen later in life. We report the case of a Chinese boy with Myhre syndrome presenting with a novel symptom of giant testicles where treatment with growth hormone combined with letrozole successfully improved his short stature. This case shows that letrozole combined with growth hormone can improve height in children with Myhre syndrome without adverse effects.
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Affiliation(s)
- Hui Wu
- Department of Pediatrics, Peking University Health Science Center, Peking University Third Hospital, Beijing, China
| | - Xinli Wang
- Department of Pediatrics, Peking University Health Science Center, Peking University Third Hospital, Beijing, China
| | - Yunpu Cui
- Department of Pediatrics, Peking University Health Science Center, Peking University Third Hospital, Beijing, China
| | - Xuemei Wang
- Department of Pediatrics, Peking University Health Science Center, Peking University Third Hospital, Beijing, China
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17
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Jensen B, James R, Hong Y, Omoyinmi E, Pilkington C, Sebire NJ, Howell KJ, Brogan PA, Eleftheriou D. A case of Myhre syndrome mimicking juvenile scleroderma. Pediatr Rheumatol Online J 2020; 18:72. [PMID: 32917212 PMCID: PMC7488857 DOI: 10.1186/s12969-020-00466-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myhre syndrome is a genetic disorder caused by gain of function mutations in the SMAD Family Member 4 (SMAD4) gene, resulting in progressive, proliferative skin and organ fibrosis. Skin thickening and joint contractures are often the main presenting features of the disease and may be mistaken for juvenile scleroderma. CASE PRESENTATION We report a case of a 13 year-old female presenting with widespread skin thickening and joint contractures from infancy. She was diagnosed with diffuse cutaneous systemic sclerosis, and treatment with corticosteroids and subcutaneous methotrexate recommended. There was however disease progression prompting genetic testing. This identified a rare heterozygous pathogenic variant c.1499 T > C (p.Ile500Thr) in the SMAD4 gene, suggesting a diagnosis of Myhre syndrome. Securing a molecular diagnosis in this case allowed the cessation of immunosuppression, thus reducing the burden of unnecessary and potentially harmful treatment, and allowing genetic counselling. CONCLUSION Myhre Syndrome is a rare genetic mimic of scleroderma that should be considered alongside several other monogenic diseases presenting with pathological fibrosis from early in life. We highlight this case to provide an overview of these genetic mimics of scleroderma, and highlight the molecular pathways that can lead to pathological fibrosis. This may provide clues to the pathogenesis of sporadic juvenile scleroderma, and could suggest novel therapeutic targets.
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Affiliation(s)
- Barbara Jensen
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Rebecca James
- grid.240562.7Paediatric Rheumatology Department, Queensland Children’s Hospital, Brisbane, Australia
| | - Ying Hong
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Ebun Omoyinmi
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Clarissa Pilkington
- grid.424537.30000 0004 5902 9895Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil J. Sebire
- grid.424537.30000 0004 5902 9895Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kevin J. Howell
- grid.426108.90000 0004 0417 012XMicrovascular Diagnostics, UCL Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Paul A. Brogan
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK ,grid.424537.30000 0004 5902 9895Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK ,grid.424537.30000 0004 5902 9895Paediatric Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201Centre for Adolescent Rheumatology Versus Arthritis at UCL, London, UK
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18
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Hawley MH, Moschovis PP, Lu M, Kinane TB, Yonker LM. The future is here: Integrating genetics into the pediatric pulmonary clinic. Pediatr Pulmonol 2020; 55:1810-1818. [PMID: 32533912 PMCID: PMC7384239 DOI: 10.1002/ppul.24723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
Recognition of underlying genetic etiologies of disease is increasing at an exponential rate, likely due to greater access to and lower cost of genetic testing. Monogenic causes of disease, or conditions resulting from a mutation or mutations in a single gene, are now well recognized in every subspecialty, including pediatric pulmonary medicine; thus, it is important to consider genetic conditions when evaluating children with respiratory disease. In the pediatric pulmonary clinic, genetic testing should be considered when multiple family members present with similar or related clinical features and when individuals have unusual clinical presentations, such as early-onset disease or complex, syndromic features. This review provides a practical guide for genetic diagnosis in the pediatric pulmonary setting, including a review of genetic concepts, considerations for test selection and results in interpretation, as well as an overview of genetic differential diagnoses for common pediatric pulmonary phenotypes. Genetic conditions that commonly present to the pediatric pulmonary clinic are reviewed in a companion article by Yonker et al.
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Affiliation(s)
- Megan H Hawley
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, Massachusetts
| | - Peter P Moschovis
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mengdi Lu
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - T Bernard Kinane
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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19
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Varenyiova Z, Hrckova G, Ilencikova D, Podracka L. Myhre Syndrome Associated With Dunbar Syndrome and Urinary Tract Abnormalities: A Case Report. Front Pediatr 2020; 8:72. [PMID: 32175297 PMCID: PMC7057230 DOI: 10.3389/fped.2020.00072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
Myhre syndrome is a rare condition caused by a mutation in the SMAD4 gene, which leads to a defective TGF-β/BMP signaling, resulting in the proliferation of abnormal fibrous tissues. Clinically, patients with Myhre syndrome manifest with defects of connective tissue (skin, muscles, joints), and cardiovascular and neurological impairment. In our report, we present a case of a 16-year-old female with skeletal abnormalities, reduced articular mobility, skin, and muscular hypertrophy and cardiovascular defects characteristic of Myhre syndrome. Long-term pulmonary hypertension and arterial hypertension were persistent in spite of antihypertensive treatment. Our patient was also diagnosed with chronic kidney disease and Dunbar syndrome, which is an external compression of the coeliac trunk or coeliac artery by the surrounding tissues. Until now, only a few cases of renal complications in Myhre syndrome have been published. We describe for the first time a female patient with genetically confirmed Myhre syndrome caused by the p.Ile500Val SMAD4 mutation presenting with an unusual occurrence of congenital vesicoureteral reflux, proteinuria with a decreased renal function, and a condition recognized as Dunbar syndrome.
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Affiliation(s)
| | | | | | - Ludmila Podracka
- Department of Paediatrics, Medical School, Comenius University and National Institute of Children′s Diseases, Bratislava, Slovakia
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20
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Lin AE, Alali A, Starr LJ, Shah N, Beavis A, Pereira EM, Lindsay ME, Klugman S. Gain-of-function pathogenic variants in SMAD4 are associated with neoplasia in Myhre syndrome. Am J Med Genet A 2019; 182:328-337. [PMID: 31837202 DOI: 10.1002/ajmg.a.61430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Myhre syndrome is an increasingly diagnosed rare syndrome that is caused by one of two specific heterozygous gain-of-function pathogenic variants in SMAD4. The phenotype includes short stature, characteristic facial appearance, hearing loss, laryngotracheal stenosis, arthritis, skeletal abnormalities, learning and social challenges, distinctive cardiovascular defects, and a striking fibroproliferative response in the ear canals, airways, and serosal cavities (peritoneum, pleura, pericardium). Confirmation of the clinical diagnosis is usually prompted by the characteristic appearance with developmental delay and autistic-like behavior using targeted gene sequencing or by whole exome sequencing. We describe six patients (two not previously reported) with molecularly confirmed Myhre syndrome and neoplasia. Loss-of-function pathogenic variants in SMAD4 cause juvenile polyposis syndrome and we hypothesize that the gain-of-function pathogenic variants observed in Myhre syndrome may contribute to neoplasia in the patients reported herein. The frequency of neoplasia (9.8%, 6/61) in this series (two new, four reported patients) and endometrial cancer (8.8%, 3/34, mean age 40 years) in patients with Myhre syndrome, raises the possibility of cancer susceptibility in these patients. We alert clinicians to the possibility of detecting this syndrome when cancer screening panels are used. We propose that patients with Myhre syndrome are more susceptible to neoplasia, encourage increased awareness, and suggest enhanced clinical monitoring.
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Affiliation(s)
- Angela E Lin
- Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Abdulrazak Alali
- Division of Pediatric Genetics, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Division of Genetics, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Lois J Starr
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nidhi Shah
- Harvard Medical School Genetics Training Program, Boston, Massachusetts
| | - Anna Beavis
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Elaine M Pereira
- Division of Pediatric Genetics, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Mark E Lindsay
- Thoracic Aortic and Cardiovascular Genetics Centers, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan Klugman
- Division of Reproductive and Medical Genetics, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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21
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The first two Chinese Myhre syndrome patients with the recurrent SMAD4 pathogenic variants: Functional consequences and clinical diversity. Clin Chim Acta 2019; 500:128-134. [PMID: 31654632 DOI: 10.1016/j.cca.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022]
Abstract
Myhre syndrome is a rare autosomal dominant multi-organ disorder characterized by growth retardation, skeletal anomalies, muscular hypertrophy, joint stiffness, facial dysmorphism, deafness, cardiovascular disease, and abnormal sexual development. Here we described the first two Chinese Myhre syndrome patients diagnosed by whole-exome sequencing. They both had de novo c.1498A > G (p.Ile500Val) variant in SMAD4 and presented with key characteristics of Myhre syndrome but also revealed uncommon features (polydactyly in the girl and precocious puberty in the boy). We performed functional analysis on four previously reported SMAD4 pathogenic variants in Myhre syndrome patients using dual-luciferase assay. Our results revealed that the pathogenic variants resulted in a variable degree of increased transcription activity of target genes that contain the minimal SMAD binding elements in their promoter regions. The boy responded to the recombinant human growth hormone treatment with improved height but also led to hyperinsulinemia and advanced bone age. Because of his precocious puberty, we subsequently combined the recombinant human growth hormone and gonadotrophin-releasing hormone agonist treatments, which resulted in overall improved height. We reviewed the sexual features of reported Myhre syndrome cases and discussed the possible mechanism of SMAD4 variants in Myhre syndrome that lead to the abnormal hypothalamic-pituitary-gonadal axis.
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22
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23
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Alagia M, Cappuccio G, Pinelli M, Torella A, Brunetti-Pierri R, Simonelli F, Limongelli G, Oppido G, Nigro V, Brunetti-Pierri N. A child with Myhre syndrome presenting with corectopia and tetralogy of Fallot. Am J Med Genet A 2017; 176:426-430. [PMID: 29230941 PMCID: PMC5814867 DOI: 10.1002/ajmg.a.38560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 12/18/2022]
Abstract
Myhre syndrome is a rare autosomal dominant disorder caused by a narrow spectrum of missense mutations in the SMAD4 gene. Typical features of this disorder are distinctive facial appearance, deafness, intellectual disability, cardiovascular abnormalities, short stature, short hands and feet, compact build, joint stiffness, and skeletal anomalies. The clinical features generally appear during childhood and become more evident in older patients. Therefore, the diagnosis of this syndrome in the first years of life is challenging. We report a 2‐year‐old girl diagnosed with Myhre syndrome by whole exome sequencing (WES) that revealed the recurrent p.Ile500Val mutation in the SMAD4 gene. Our patient presented with growth deficiency, dysmorphic features, tetralogy of Fallot, and corectopia (also known as ectopia pupillae). The girl we described is the youngest patient with Myhre syndrome. Moreover, corectopia and tetralogy of Fallot have not been previously reported in this disorder.
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Affiliation(s)
- Marianna Alagia
- Department of Translational Medicine, Federico II University, Naples, Italy
| | - Gerarda Cappuccio
- Department of Translational Medicine, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - Michele Pinelli
- Department of Translational Medicine, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - Annalaura Torella
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy.,Medical Genetics, Department of Biochemistry, Biophysics and General Pathology, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Raffaella Brunetti-Pierri
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giuseppe Limongelli
- Department of Cardiothoracic Science, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Monaldi Hospital, AO Colli, Naples, Italy
| | | | - Vincenzo Nigro
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy.,Medical Genetics, Department of Biochemistry, Biophysics and General Pathology, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
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24
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Lin TW, Tseng CW, Huang CY, Wang KY, Liang KW. Familial clustering of congenital deafness, patent ductus arteriosus, Eisenmenger complex, and differential cyanosis: A case report. Medicine (Baltimore) 2017; 96:e7105. [PMID: 28614229 PMCID: PMC5478314 DOI: 10.1097/md.0000000000007105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Few studies had reported syndromes that include patent ductus arteriosus (PDA) with Eisenmenger syndrome and congenital deafness clustered in male siblings without facial, skeletal, or mental abnormalities. PATIENT CONCERNS Two brothers, who were deaf and had PDA with Eisenmenger complex, were first seen at our Cardiology clinic at the ages of 25 and 41, respectively. They presented with progressive dyspnea on exertion. Upon physical examination, both brothers had clubbing and/or cyanotic toes, normal fingers, and without facial, skeletal, ophthalmological, or mental abnormalities. DIAGNOSES AND INTERVENTIONS Echocardiography and multidetector computed tomography revealed large PDAs in both brothers. Cardiac catheterization showed bidirectional shunting via the PDA. OUTCOMES AND LESSONS Familial clustering of Eisenmenger PDA and congenital deafness is rare. Further studies are warranted to define possible genetic links.
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Affiliation(s)
- Ting-Wei Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, Cardiovascular Research Center, National Yang Ming University, School of Medicine, Taipei
| | - Chih-Wei Tseng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Cishan Hospital, Ministry of Health and Welfare, Kaohsiung
| | - Chi-Yao Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, Cardiovascular Research Center, National Yang Ming University, School of Medicine, Taipei
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, Cardiovascular Research Center, National Yang Ming University, School of Medicine, Taipei
- Department of Medicine, Chung Shan Medical University
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, Cardiovascular Research Center, National Yang Ming University, School of Medicine, Taipei
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25
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Garavelli L, Maini I, Baccilieri F, Ivanovski I, Pollazzon M, Rosato S, Iughetti L, Unger S, Superti-Furga A, Tartaglia M. Natural history and life-threatening complications in Myhre syndrome and review of the literature. Eur J Pediatr 2016; 175:1307-15. [PMID: 27562837 DOI: 10.1007/s00431-016-2761-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED Myhre syndrome (OMIM 139210) is a rare developmental disorder inherited as an autosomal dominant trait and caused by a narrow spectrum of missense mutations in the SMAD4 gene. The condition features characteristic face, short stature, skeletal anomalies, muscle pseudohypertrophy, restricted joint mobility, stiff and thick skin, and variable intellectual disability. While most of the clinical features manifest during childhood, the diagnosis may be challenging during the first years of life. We report on the evolution of the clinical features of Myhre syndrome during childhood in a subject with molecularly confirmed diagnosis. The clinical records of 48 affected patients were retrospectively analysed to identify any early clinical signs characterizing this disorder and to better delineate its natural history. We also note that pericarditis and laryngotracheal involvement represent important life-threatening complications of Myhre syndrome that justify the recommendation for cardiological and ENT follow-up for these patients. CONCLUSION Short length/stature, short palpebral fissures, and brachydactyly with hyperconvex nails represent signs/features that might lead to the correct diagnosis in the first years of life and direct to the proper molecular analysis. We underline the clinical relevance of pericarditis and laryngotracheal stenosis as life-threatening complications of this disorder and the need for careful monitoring, in relation to their severity. WHAT IS KNOWN • The clinical and radiological signs of the disease in children older than 7-8 years. • Pericarditis, sometimes occurring with constrictive pericardium requiring pericardiectomy, has been reported as a recurrent feature but has not been adequately stressed in previous literature. What is New: • Short length/stature, short palpebral fissures, brachydactyly with hyperconvex nails represent clinical signs that might lead to diagnosis in the first years of life. • Review of the literature showed that pericarditis and laryngotracheal complications represent major recurrent issues in patients with Myhre syndrome.
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Affiliation(s)
- Livia Garavelli
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - Ilenia Maini
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Federica Baccilieri
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Ivan Ivanovski
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marzia Pollazzon
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Simonetta Rosato
- Clinical Genetics Unit, Department of Obstetrics and Paediatrics, IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Childhood and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Sheila Unger
- Medical Genetics Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Superti-Furga
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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26
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Lin AE, Michot C, Cormier-Daire V, L'Ecuyer TJ, Matherne GP, Barnes BH, Humberson JB, Edmondson AC, Zackai E, O'Connor MJ, Kaplan JD, Ebeid MR, Krier J, Krieg E, Ghoshhajra B, Lindsay ME. Gain-of-function mutations in SMAD4 cause a distinctive repertoire of cardiovascular phenotypes in patients with Myhre syndrome. Am J Med Genet A 2016; 170:2617-31. [PMID: 27302097 DOI: 10.1002/ajmg.a.37739] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 04/28/2016] [Indexed: 02/03/2023]
Abstract
Myhre syndrome is a rare, distinctive syndrome due to specific gain-of-function mutations in SMAD4. The characteristic phenotype includes short stature, dysmorphic facial features, hearing loss, laryngotracheal anomalies, arthropathy, radiographic defects, intellectual disability, and a more recently appreciated spectrum of cardiovascular defects with a striking fibroproliferative response to surgical intervention. We report four newly described patients with typical features of Myhre syndrome who had (i) a mildly narrow descending aorta and restrictive cardiomyopathy; (ii) recurrent pericardial and pleural effusions; (iii) a large persistent ductus arteriosus with juxtaductal aortic coarctation; and (iv) restrictive pericardial disease requiring pericardiectomy. Additional information is provided about a fifth previously reported patient with fatal pericardial disease. A literature review of the cardiovascular features of Myhre syndrome was performed on 54 total patients, all with a SMAD4 mutation. Seventy percent had a cardiovascular abnormality including congenital heart defects (63%), pericardial disease (17%), restrictive cardiomyopathy (9%), and systemic hypertension (15%). Pericarditis and restrictive cardiomyopathy are associated with high mortality (three patients each among 10 deaths); one patient with restrictive cardiomyopathy also had epicarditis. Cardiomyopathy and pericardial abnormalities distinguish Myhre syndrome from other disorders caused by mutations in the TGF-β signaling cascade (Marfan, Loeys-Dietz, or Shprintzen-Goldberg syndromes). We hypothesize that the expanded spectrum of cardiovascular abnormalities relates to the ability of the SMAD4 protein to integrate diverse signaling pathways, including canonical TGF-β, BMP, and Activin signaling. The co-occurrence of congenital and acquired phenotypes demonstrates that the gene product of SMAD4 is required for both developmental and postnatal cardiovascular homeostasis. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Angela E Lin
- Genetics Unit, Massachusetts General Hospital, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
| | - Caroline Michot
- INSERM UMR1163 Unit, Department of Genetics, Institut Imagine, Paris Descartes University-Sorbonne Paris Cité, Necker Enfants-Malades Hospital, Paris, France
| | - Valerie Cormier-Daire
- INSERM UMR1163 Unit, Department of Genetics, Institut Imagine, Paris Descartes University-Sorbonne Paris Cité, Necker Enfants-Malades Hospital, Paris, France
| | - Thomas J L'Ecuyer
- Division of Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - G Paul Matherne
- Division of Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Barrett H Barnes
- Division of Gastroenterology, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Jennifer B Humberson
- Division of Genetics, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Andrew C Edmondson
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie D Kaplan
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Makram R Ebeid
- Division of Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Joel Krier
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Krieg
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Ghoshhajra
- Thoracic Aortic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark E Lindsay
- Thoracic Aortic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Pediatric Cardiology, Department of Pediatrics, MassGeneral Hospital for Children, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Yu HC, Coughlin CR, Geiger EA, Salvador BJ, Elias ER, Cavanaugh JL, Chatfield KC, Miyamoto SD, Shaikh TH. Discovery of a potentially deleterious variant in TMEM87B in a patient with a hemizygous 2q13 microdeletion suggests a recessive condition characterized by congenital heart disease and restrictive cardiomyopathy. Cold Spring Harb Mol Case Stud 2016; 2:a000844. [PMID: 27148590 PMCID: PMC4853521 DOI: 10.1101/mcs.a000844] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/03/2016] [Indexed: 01/22/2023] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare cause of heart muscle disease with the highest mortality rate among cardiomyopathy types. The etiology of RCM is poorly understood, although genetic causes have been implicated, and syndromic associations have been described. Here, we describe a patient with an atrial septal defect and restrictive cardiomyopathy along with craniofacial anomalies and intellectual disabilities. Initial screening using chromosomal microarray analysis (CMA) identified a maternally inherited 2q13 microdeletion. The patient had many of the features reported in previous cases with the recurrent 2q13 microdeletion syndrome. However, the inheritance of the microdeletion from an unaffected mother combined with the low incidence (10%) and milder forms of cardiac defects in previously reported cases made the clinical significance of the CMA results unclear. Whole-exome sequencing (WES) with trio-based analysis was performed and identified a paternally inherited TMEM87B mutation (c.1366A>G, p.Asn456Asp) in the patient. TMEM87B, a highly conserved, transmembrane protein of currently unknown function, lies within the critical region of the recurrent 2q13 microdeletion syndrome. Furthermore, a recent study had demonstrated that depletion of TMEM87B in zebrafish embryos affected cardiac development and led to cardiac hypoplasia. Thus, by combining CMA and WES, we potentially uncover an autosomal-recessive disorder characterized by a severe cardiac phenotype caused by mutations in TMEM87B. This study expands the spectrum of phenotypes associated with the recurrent 2q13 microdeletion syndrome and also further suggests the role of TMEM87B in its etiology, especially the cardiac pathology.
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Affiliation(s)
- Hung-Chun Yu
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Curtis R Coughlin
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Elizabeth A Geiger
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Blake J Salvador
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Ellen R Elias
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Jean L Cavanaugh
- Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Kathryn C Chatfield
- Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Shelley D Miyamoto
- Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Tamim H Shaikh
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA;; Colorado Intellectual and Developmental Disabilities Research Center (IDDRC), University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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28
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Abstract
Since the identification in 1988 of bone morphogenetic protein 2 (BMP2) as a potent inducer of bone and cartilage formation, BMP superfamily signalling has become one of the most heavily investigated topics in vertebrate skeletal biology. Whereas a large part of this research has focused on the roles of BMP2, BMP4 and BMP7 in the formation and repair of endochondral bone, a large number of BMP superfamily molecules have now been implicated in almost all aspects of bone, cartilage and joint biology. As modulating BMP signalling is currently a major therapeutic target, our rapidly expanding knowledge of how BMP superfamily signalling affects most tissue types of the skeletal system creates enormous potential to translate basic research findings into successful clinical therapies that improve bone mass or quality, ameliorate diseases of skeletal overgrowth, and repair damage to bone and joints. This Review examines the genetic evidence implicating BMP superfamily signalling in vertebrate bone and joint development, discusses a selection of human skeletal disorders associated with altered BMP signalling and summarizes the status of modulating the BMP pathway as a therapeutic target for skeletal trauma and disease.
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Affiliation(s)
- Valerie S Salazar
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Laura W Gamer
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA
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