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Caples M, McCarthy B, Savage E. Hardiness as a Resilience Factor for Adaptation in Families of Children With 22q11.2 Deletion Syndrome: A Mixed Methods Study of Parents' Perspectives. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:738-758. [PMID: 37402159 DOI: 10.1177/17446295231186851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
22q11.2 deletion syndrome is a rare multisystem genetic disorder with over 200 associated characteristics, occurring in various combinations and severity. Extensive biomedical research has been undertaken on 22q11.2 deletion syndrome, however, there is a dearth of research on families' experiences of managing a family member with this condition. The complex and at times serious phenotypical presentation of the syndrome can make the management of the condition difficult for families. The aim of this mixed method explanatory sequential study was to investigate family hardiness as a resilience factor for adaptation in families of children with 22q11.2 deletion syndrome from parents' perspectives. We found that adaptation scores increased by 0.57 points (95% CI: 0.19-0.94) for every one-point increase in family hardiness score. Qualitative results indicated that acceptance of the child's diagnosis and support positively influenced hardiness whereas fears about the future and their experiences of loss negatively influenced hardiness.
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Stanek K, Wang AT, Hseu AF, Clark RE, Meara JG, Nuss RC, Ganske IM, Rogers-Vizena CR. Multidisciplinary Velopharyngeal Dysfunction Evaluation Helps Detect Non-classic Cases of 22q11.2 Deletion. Cleft Palate Craniofac J 2024:10556656241266464. [PMID: 39043360 DOI: 10.1177/10556656241266464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To explore the role of multidisciplinary velopharyngeal dysfunction (VPD) assessment in diagnosing 22q11.2 deletion syndrome (22q) in children. DESIGN Retrospective cohort study. SETTING Multidisciplinary VPD clinic at a tertiary pediatric hospital. PATIENTS, PARTICIPANTS Seventy-five children with genetically confirmed 22q evaluated at the VPD clinic between February 2007 and February 2023, including both previously diagnosed patients and those newly diagnosed as a result of VPD evaluation. INTERVENTIONS Comprehensive review of medical records, utilizing ICD-10 codes and an institutional tool for keyword searches, to identify patients and collect data on clinical variables and outcomes. MAIN OUTCOME MEASURES Characteristics of children with 22q, pathways to diagnosis, and clinical presentations that led to genetic testing for 22q. RESULTS Of the 75 children, 9 were newly diagnosed with 22q following VPD evaluation. Non-cleft VPI was a significant indicator for 22q in children not previously diagnosed, occurring in 100% of newly diagnosed cases compared to 52% of cases with existing 22q diagnosis (P = .008). Additional clinical findings leading to diagnosis included congenital heart disease, craniofacial abnormalities, and developmental delays. CONCLUSIONS VPD evaluations, particularly the presence of non-cleft VPI, play a crucial role in identifying undiagnosed cases of 22q. This underscores the need for clinicians, including plastic surgeons, otolaryngologists, and speech-language pathologists, to maintain a high degree of suspicion for 22q in children presenting with VPI without a clear etiology. Multidisciplinary approaches are essential for early diagnosis and management of this complex condition.
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Affiliation(s)
- Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alice T Wang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Anne F Hseu
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roseanne E Clark
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - John G Meara
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Roger C Nuss
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Almakhari M, Chen Y, Kong ASY, Moradigaravand D, Lai KS, Lim SHE, Loh JY, Maran S. In-silico identification of deleterious non-synonymous SNPs of TBX1 gene: Functional and structural impact towards 22q11.2DS. PLoS One 2024; 19:e0298092. [PMID: 38905172 PMCID: PMC11192383 DOI: 10.1371/journal.pone.0298092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 06/23/2024] Open
Abstract
The TBX1 gene plays a critical role in the development of 22q11.2 deletion syndrome (22q11.2DS), a complex genetic disorder associated with various phenotypic manifestations. In this study, we performed in-silico analysis to identify potentially deleterious non-synonymous single nucleotide polymorphisms (nsSNPs) within the TBX1 gene and evaluate their functional and structural impact on 22q11.2DS. A comprehensive analysis pipeline involving multiple computational tools was employed to predict the pathogenicity of nsSNPs. This study assessed protein stability and explored potential alterations in protein-protein interactions. The results revealed the rs751339103(C>A), rs780800634(G>A), rs1936727304(T>C), rs1223320618(G>A), rs1248532217(T>C), rs1294927055 (C>T), rs1331240435 (A>G, rs1601289406 (A>C), rs1936726164 (G>A), and rs911796187(G>A) with a high-risk potential for affecting protein function and stability. These nsSNPs were further analyzed for their impact on post-translational modifications and structural characteristics, indicating their potential disruption of molecular pathways associated with TBX1 and its interacting partners. These findings provide a foundation for further experimental studies and elucidation of potential therapeutic targets and personalized treatment approaches for individuals affected by 22q11.2DS.
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Affiliation(s)
- Maitha Almakhari
- Oxford Nanopore Department, Omics Centre of Excellence (Biogenix Labs) G42 Healthecare, Abu Dhabi, United Arab Emirates
| | - Yan Chen
- Hainan Key Laboratory for Conservation and Utilization of Tropical Marine Fishery Resources & Key Laboratory of Utilization and Conservation for Tropical Marine Bioresources of Ministry of Education, Hainan, PR China
| | - Amanda Shen-Yee Kong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Danesh Moradigaravand
- Laboratory for Infectious Disease Epidemiology, KAUST Smart-Health Initiative and Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Makkah, Saudi Arabia
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Makkah, Saudi Arabia
| | - Kok-Song Lai
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Swee-Hua Erin Lim
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Jiun-Yan Loh
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
- Tropical Futures Institute, James Cook University Singapore, Singapore, Singapore
| | - Sathiya Maran
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan, Malaysia
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Goldmuntz E, Bassett AS, Boot E, Marino B, Moldenhauer JS, Óskarsdóttir S, Putotto C, Rychik J, Schindewolf E, McDonald-McGinn DM, Blagowidow N. Prenatal cardiac findings and 22q11.2 deletion syndrome: Fetal detection and evaluation. Prenat Diagn 2024; 44:804-814. [PMID: 38593251 DOI: 10.1002/pd.6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Clinical features of 22q11.2 microdeletion syndrome (22q11.2DS) are highly variable between affected individuals and frequently include a subset of conotruncal and aortic arch anomalies. Many are diagnosed with 22q11.2DS when they present as a fetus, newborn or infant with characteristic cardiac findings and subsequently undergo genetic testing. The presence of an aortic arch anomaly with characteristic intracardiac anomalies increases the likelihood that the patient has 22q11.2 DS, but those with an aortic arch anomaly and normal intracardiac anatomy are also at risk. It is particularly important to identify the fetus at risk for 22q11.2DS in order to prepare the expectant parents and plan postnatal care for optimal outcomes. Fetal anatomy scans now readily identify aortic arch anomalies (aberrant right subclavian artery, right sided aortic arch or double aortic arch) in the three-vessel tracheal view. Given the association of 22q11.2DS with aortic arch anomalies with and without intracardiac defects, this review highlights the importance of recognizing the fetus at risk for 22q11.2 deletion syndrome with an aortic arch anomaly and details current methods for genetic testing. To assist in the prenatal diagnosis of 22q11.2DS, this review summarizes the seminal features of 22q11.2DS, its prenatal presentation and current methods for genetic testing.
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Affiliation(s)
- Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Bruno Marino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Roma, Italy
| | - Julie S Moldenhauer
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Obstetrics and Gynecology and Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sólveig Óskarsdóttir
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Immunology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Carolina Putotto
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Roma, Italy
| | - Jack Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Schindewolf
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, 22q and You Center, Clinical Genetics Center, Section of Genetic Counseling, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Human Biology and Medical Genetics, Sapienza University, Rome, Italy
| | - Natalie Blagowidow
- The Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, Maryland, USA
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Malecki SL, Heung T, Wodchis WP, Saskin R, Palma L, Verma AA, Bassett AS. Young adults with a 22q11.2 microdeletion and the cost of aging with complexity in a population-based context. Genet Med 2024; 26:101088. [PMID: 38310401 DOI: 10.1016/j.gim.2024.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE Information about the impact on the adult health care system is limited for complex rare pediatric diseases, despite their increasing collective prevalence that has paralleled advances in clinical care of children. Within a population-based health care context, we examined costs and multimorbidity in adults with an exemplar of contemporary genetic diagnostics. METHODS We estimated direct health care costs over an 18-year period for adults with molecularly confirmed 22q11.2 microdeletion (cases) and matched controls (total 60,459 person-years of data) by linking the case cohort to health administrative data for the Ontario population (∼15 million people). We used linear regression to compare the relative ratio (RR) of costs and to identify baseline predictors of higher costs. RESULTS Total adult (age ≥ 18) health care costs were significantly higher for cases compared with population-based (RR 8.5, 95% CI 6.5-11.1) controls, and involved all health care sectors. At study end, when median age was <30 years, case costs were comparable to population-based individuals aged 72 years, likelihood of being within the top 1st percentile of health care costs for the entire (any age) population was significantly greater for cases than controls (odds ratio [OR], for adults 17.90, 95% CI 7.43-43.14), and just 8 (2.19%) cases had a multimorbidity score of zero (vs 1483 (40.63%) controls). The 22q11.2 microdeletion was a significant predictor of higher overall health care costs after adjustment for baseline variables (RR 6.9, 95% CI 4.6-10.5). CONCLUSION The findings support the possible extension of integrative models of complex care used in pediatrics to adult medicine and the potential value of genetic diagnostics in adult clinical medicine.
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Affiliation(s)
- Sarah L Malecki
- Internal Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada; Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Senior Scientist and Research Chair, Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | | | | | - Amol A Verma
- Li Ka Shing Knowledge Institute and Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Centre for Mental Health & Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Freud LR, Galloway S, Crowley TB, Moldenhauer J, Swillen A, Breckpot J, Borrell A, Vora NL, Cuneo B, Hoffman H, Gilbert L, Nowakowska B, Geremek M, Kutkowska-Kaźmierczak A, Vermeesch JR, Devriendt K, Busa T, Sigaudy S, Vigneswaran T, Simpson JM, Dungan J, Gotteiner N, Gloning KP, Digilio MC, Unolt M, Putotto C, Marino B, Repetto G, Fadic M, Garcia-Minaur S, Achón Buil A, Thomas MA, Fruitman D, Beecroft T, Hui PW, Oskarsdottir S, Bradshaw R, Criebaum A, Norton ME, Lee T, Geiger M, Dunnington L, Isaac J, Wilkins-Haug L, Hunter L, Izzi C, Toscano M, Ghi T, McGlynn J, Romana Grati F, Emanuel BS, Gaiser K, Gaynor JW, Goldmuntz E, McGinn DE, Schindewolf E, Tran O, Zackai EH, Yan Q, Bassett AS, Wapner R, McDonald-McGinn DM. Prenatal vs postnatal diagnosis of 22q11.2 deletion syndrome: cardiac and noncardiac outcomes through 1 year of age. Am J Obstet Gynecol 2024; 230:368.e1-368.e12. [PMID: 37717890 DOI: 10.1016/j.ajog.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The 22q11.2 deletion syndrome is the most common microdeletion syndrome and is frequently associated with congenital heart disease. Prenatal diagnosis of 22q11.2 deletion syndrome is increasingly offered. It is unknown whether there is a clinical benefit to prenatal detection as compared with postnatal diagnosis. OBJECTIVE This study aimed to determine differences in perinatal and infant outcomes between patients with prenatal and postnatal diagnosis of 22q11.2 deletion syndrome. STUDY DESIGN This was a retrospective cohort study across multiple international centers (30 sites, 4 continents) from 2006 to 2019. Participants were fetuses, neonates, or infants with a genetic diagnosis of 22q11.2 deletion syndrome by 1 year of age with or without congenital heart disease; those with prenatal diagnosis or suspicion (suggestive ultrasound findings and/or high-risk cell-free fetal DNA screen for 22q11.2 deletion syndrome with postnatal confirmation) were compared with those with postnatal diagnosis. Perinatal management, cardiac and noncardiac morbidity, and mortality by 1 year were assessed. Outcomes were adjusted for presence of critical congenital heart disease, gestational age at birth, and site. RESULTS A total of 625 fetuses, neonates, or infants with 22q11.2 deletion syndrome (53.4% male) were included: 259 fetuses were prenatally diagnosed (156 [60.2%] were live-born) and 122 neonates were prenatally suspected with postnatal confirmation, whereas 244 infants were postnatally diagnosed. In the live-born cohort (n=522), 1-year mortality was 5.9%, which did not differ between groups but differed by the presence of critical congenital heart disease (hazard ratio, 4.18; 95% confidence interval, 1.56-11.18; P<.001) and gestational age at birth (hazard ratio, 0.78 per week; 95% confidence interval, 0.69-0.89; P<.001). Adjusting for critical congenital heart disease and gestational age at birth, the prenatal cohort was less likely to deliver at a local community hospital (5.1% vs 38.2%; odds ratio, 0.11; 95% confidence interval, 0.06-0.23; P<.001), experience neonatal cardiac decompensation (1.3% vs 5.0%; odds ratio, 0.11; 95% confidence interval, 0.03-0.49; P=.004), or have failure to thrive by 1 year (43.4% vs 50.3%; odds ratio, 0.58; 95% confidence interval, 0.36-0.91; P=.019). CONCLUSION Prenatal detection of 22q11.2 deletion syndrome was associated with improved delivery management and less cardiac and noncardiac morbidity, but not mortality, compared with postnatal detection.
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Affiliation(s)
- Lindsay R Freud
- Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Stephanie Galloway
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | | | - Julie Moldenhauer
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann Swillen
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Antoni Borrell
- Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Neeta L Vora
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bettina Cuneo
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | - Hilary Hoffman
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | - Lisa Gilbert
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | | | | | | | - Joris R Vermeesch
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Koen Devriendt
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Tiffany Busa
- Hôpital de la Timone, Marseille University, Marseille, France
| | - Sabine Sigaudy
- Hôpital de la Timone, Marseille University, Marseille, France
| | - Trisha Vigneswaran
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust and Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - John M Simpson
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust and Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Jeffrey Dungan
- Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nina Gotteiner
- Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Marta Unolt
- Children's Hospital of Philadelphia, Philadelphia, PA; Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | | | - Gabriela Repetto
- Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Magdalena Fadic
- Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | | | - Mary Ann Thomas
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deborah Fruitman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Taylor Beecroft
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Pui Wah Hui
- Queen Mary Hospital, Tsan Yuk Hospital, University of Hong Kong, Hong Kong, China
| | | | - Rachael Bradshaw
- SSM Health Cardinal Glennon St. Louis Fetal Care Institute, Saint Louis University, St. Louis, MO
| | - Amanda Criebaum
- SSM Health Cardinal Glennon St. Louis Fetal Care Institute, Saint Louis University, St. Louis, MO
| | - Mary E Norton
- University of California, San Francisco, San Francisco, CA
| | - Tiffany Lee
- University of California, San Francisco, San Francisco, CA
| | - Miwa Geiger
- Kravis Children's Hospital, Mount Sinai Medical Center, New York City, NY
| | - Leslie Dunnington
- Memorial Hermann-Texas Medical Center, University of Texas Health Science Center at Houston, Houston, TX
| | | | | | - Lindsey Hunter
- Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Claudia Izzi
- Children's Hospital of Philadelphia, Philadelphia, PA; Azienda Socio Sanitaria Territoriale (ASST) degli Spedali Civili di Brescia, Brescia, Italy
| | | | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Beverly S Emanuel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kimberly Gaiser
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J William Gaynor
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Goldmuntz
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel E McGinn
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Schindewolf
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Oanh Tran
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elaine H Zackai
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qi Yan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | - Anne S Bassett
- Centre for Addiction and Mental Health and Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Ronald Wapner
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | - Donna M McDonald-McGinn
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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7
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Courraud J, Russo F, Themudo GE, Laursen SS, Ingason A, Hougaard DM, Cohen AS, Werge T, Ernst M. Metabolic signature of the pathogenic 22q11.2 deletion identifies carriers and provides insight into systemic dysregulation. Transl Psychiatry 2023; 13:391. [PMID: 38097559 PMCID: PMC10721888 DOI: 10.1038/s41398-023-02697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
Large deletions at chromosome 22q11.2 are known to cause severe clinical conditions collectively known as 22q11.2 deletion syndrome. Notwithstanding the pathogenicity of these deletions, affected individuals are typically diagnosed in late childhood or early adolescence, and little is known of the molecular signaling cascades and biological consequences immediately downstream of the deleted genes. Here, we used targeted metabolomics to compare neonatal dried blood spot samples from 203 individuals clinically identified as carriers of a deletion at chromosome 22q11.2 with 203 unaffected individuals. A total of 173 metabolites were successfully identified and used to inform on systemic dysregulation caused by the genomic lesion and to discriminate carriers from non-carriers. We found 84 metabolites to be differentially abundant between carriers and non-carriers of the 22q11.2 deletion. A predictive model based on all 173 metabolites achieved high Accuracy (89%), Area Under the Curve (93%), F1 (88%), Positive Predictive Value (94%), and Negative Predictive Value (84%) with tyrosine and proline having the highest individual contributions to the model as well as the highest interaction strength. Targeted metabolomics provides insight into the molecular consequences possibly contributing to the pathology underlying the clinical manifestations of the 22q11 deletion and is an easily applicable approach to first-pass screening for carrier status of the 22q11 to prompt subsequent verification of the genomic diagnosis.
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Affiliation(s)
- Julie Courraud
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Leof. Vasilissis Sofias 80, Athens, 11528, Greece
| | - Francesco Russo
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Gonçalo Espregueira Themudo
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
- Institute of Biological Psychiatry, Copenhagen University Hospital, Copenhagen Mental Health Services, Kristineberg 3, DK-2100, Copenhagen Ø, Denmark
- CIIMAR, Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Avenida General Norton de Matos, S/N, 4450-208, Matosinhos, Portugal
- Centre for Ecology, Evolution and Environmental Changes (CE3C), Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal
| | - Susan Svane Laursen
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Andrés Ingason
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
- Institute of Biological Psychiatry, Mental Health Center Sankt Hans, DK-4000, Roskilde, Denmark
| | - David M Hougaard
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Arieh S Cohen
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Thomas Werge
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark.
- Institute of Biological Psychiatry, Copenhagen University Hospital, Copenhagen Mental Health Services, Kristineberg 3, DK-2100, Copenhagen Ø, Denmark.
- Department of Clinical Sciences, Faculty of Health, University of Copenhagen, Blegdamsvej 3, DK-2200, København N, Denmark.
- GLOBE Institute, LF Center for GeoGenetics, Faculty of Health, University of Copenhagen, Oester Voldgade 5-7, 1350, Copenhagen K, Denmark.
| | - Madeleine Ernst
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark.
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark.
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8
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Martin K, Norton ME, MacPherson C, Demko Z, Egbert M, Haeri S, Malone F, Wapner RJ, Roman AS, Khalil A, Faro R, Madankumar R, Strong N, Silver R, Vohra N, Hyett J, Kao C, Hakonarson H, Jacobson B, Dar P. Impact of high-risk prenatal screening results for 22q11.2 deletion syndrome on obstetric and neonatal management: Secondary analysis from the SMART study. Prenat Diagn 2023; 43:1574-1580. [PMID: 38066724 DOI: 10.1002/pd.6483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE One goal of prenatal genetic screening is to optimize perinatal care and improve infant outcomes. We sought to determine whether high-risk cfDNA screening for 22q11.2 deletion syndrome (22q11.2DS) affected prenatal or neonatal management. METHODS This was a secondary analysis from the SMART study. Patients with high-risk cfDNA results for 22q11.2DS were compared with the low-risk cohort for pregnancy characteristics and obstetrical management. To assess differences in neonatal care, we compared high-risk neonates without prenatal genetic confirmation with a 1:1 matched low-risk cohort. RESULTS Of 18,020 eligible participants enrolled between 2015 and 2019, 38 (0.21%) were high-risk and 17,982 (99.79%) were low-risk for 22q11.2DS by cfDNA screening. High-risk participants had more prenatal diagnostic testing (55.3%; 21/38 vs. 2.0%; 352/17,982, p < 0.001) and fetal echocardiography (76.9%; 10/13 vs. 19.6%; 10/51, p < 0.001). High-risk newborns without prenatal diagnostic testing had higher rates of neonatal genetic testing (46.2%; 6/13 vs. 0%; 0/51, P < 0.001), echocardiography (30.8%; 4/13 vs. 4.0%; 2/50, p = 0.013), evaluation of calcium levels (46.2%; 6/13 vs. 4.1%; 2/49, P < 0.001) and lymphocyte count (53.8%; 7/13 vs. 15.7%; 8/51, p = 0.008). CONCLUSIONS High-risk screening results for 22q11.2DS were associated with higher rates of prenatal and neonatal diagnostic genetic testing and other 22q11.2DS-specific evaluations. However, these interventions were not universally performed, and >50% of high-risk infants were discharged without genetic testing, representing possible missed opportunities to improve outcomes for affected individuals.
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Affiliation(s)
| | - Mary E Norton
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Cora MacPherson
- The Biostatistics Center, George Washington University, Washington, District of Columbia, USA
| | | | | | | | - Fergal Malone
- Department of Obstetrics and Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, New York, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, New York University Langone, New York, New York, USA
| | - Asma Khalil
- Department of Obstetrics and Gynecology, St. George's Hospital, University of London, London, UK
| | - Revital Faro
- Department of Obstetrics and Gynecology, St. Peter's University Hospital, New Brunswick, New Jersy, USA
| | - Rajeevi Madankumar
- Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Noel Strong
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Nidhi Vohra
- Department of Obstetrics and Gynecology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Jon Hyett
- Department of Obstetrics and Gynecology, Royal Prince Alfred Hospital, University of Sydney, Camperdown, New South Wales, Australia
| | - Charlly Kao
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bo Jacobson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pe'er Dar
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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9
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Bassett AS, Reuter MS, Malecki S, Silversides C, Oechslin E. Clinically Relevant Genetic Considerations for Patients With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:426-439. [PMID: 38161665 PMCID: PMC10755827 DOI: 10.1016/j.cjcpc.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 01/03/2024]
Abstract
Genetic changes affect embryogenesis, cardiac and extracardiac phenotype, development, later onset conditions, and both short- and long-term outcomes and comorbidities in the increasing population of individuals with tetralogy of Fallot (TOF). In this review, we focus on current knowledge about clinically relevant genetics for patients with TOF across the lifespan. The latest findings for TOF genetics that are pertinent to day-to-day practice and lifelong management are highlighted: morbidity/mortality, cardiac/extracardiac features, including neurodevelopmental expression, and recent changes to prenatal screening and diagnostics. Genome-wide microarray is the first-line clinical genetic test for TOF across the lifespan, detecting relevant structural changes including the most common for TOF, the 22q11.2 microdeletion. Accumulating evidence illustrates opportunities for advances in understanding and care that may arise from genetic diagnosis at any age. We also glimpse into the near future when the multigenic nature of TOF will be more fully revealed, further enhancing possibilities for preventive care. Precision medicine is nigh.
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Affiliation(s)
- Anne S. Bassett
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, and Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
| | - Miriam S. Reuter
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Malecki
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Candice Silversides
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erwin Oechslin
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Toronto Adult Congenital Heart Disease Program, Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Vlădăreanu R, Maier C, Tocariu R, Șerban M, Brătilă E. Perinatal Diagnosis and Management of a Case with Interrupted Aortic Arch, Pulmonary Valve Dysplasia and 22q11.2 Deletion: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1838. [PMID: 37893556 PMCID: PMC10608239 DOI: 10.3390/medicina59101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion disorder caused by hemizygous microdeletion of the long arm of chromosome 22. It is now known to have a heterogenous presentation that includes multiple additional congenital anomalies and later-onset conditions, such as gastrointestinal and renal abnormalities, autoimmune disease, variable cognitive delays, behavioral phenotypes and psychiatric illness. The purpose of our paper is to present the case of a fetus diagnosed with a complex association of cardiac anomalies: interrupted aortic arch type B, large malalignment-type ventricular septal defect, pulmonary valve dysplasia, and aberrant right subclavian artery for whom the result of genetic testing revealed 22q11.2 deletion. The pregnancy was regularly followed until delivery which took place in Germany so that neonatal cardiac surgery could be performed in an experienced center for cardiac malformations. The distinctivness of our report resides in the fact that it offers a complete image of a case of 22q11.2 deletion syndrome starting from the prenatal diagnosis (and emphasizing on the most relevant sonographic features) and, with parents not opting for termination of pregnancy, ending with the newborn surviving major cardiac surgery, offering thus the possibility to bring into focus postnatal outcome and future expectations in similar cases.
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Affiliation(s)
- Radu Vlădăreanu
- Department of Obstetrics And Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | - Călina Maier
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Raluca Tocariu
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Marcela Șerban
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Elvira Brătilă
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
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Szczawińska-Popłonyk A, Schwartzmann E, Chmara Z, Głukowska A, Krysa T, Majchrzycki M, Olejnicki M, Ostrowska P, Babik J. Chromosome 22q11.2 Deletion Syndrome: A Comprehensive Review of Molecular Genetics in the Context of Multidisciplinary Clinical Approach. Int J Mol Sci 2023; 24:ijms24098317. [PMID: 37176024 PMCID: PMC10179617 DOI: 10.3390/ijms24098317] [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: 04/14/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
The 22q11.2 deletion syndrome is a multisystemic disorder characterized by a marked variability of phenotypic features, making the diagnosis challenging for clinicians. The wide spectrum of clinical manifestations includes congenital heart defects-most frequently conotruncal cardiac anomalies-thymic hypoplasia and predominating cellular immune deficiency, laryngeal developmental defects, midline anomalies with cleft palate and velar insufficiency, structural airway defects, facial dysmorphism, parathyroid and thyroid gland hormonal dysfunctions, speech delay, developmental delay, and neurocognitive and psychiatric disorders. Significant progress has been made in understanding the complex molecular genetic etiology of 22q11.2 deletion syndrome underpinning the heterogeneity of clinical manifestations. The deletion is caused by chromosomal rearrangements in meiosis and is mediated by non-allelic homologous recombination events between low copy repeats or segmental duplications in the 22q11.2 region. A range of genetic modifiers and environmental factors, as well as the impact of hemizygosity on the remaining allele, contribute to the intricate genotype-phenotype relationships. This comprehensive review has been aimed at highlighting the molecular genetic background of 22q11.2 deletion syndrome in correlation with a clinical multidisciplinary approach.
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Affiliation(s)
- Aleksandra Szczawińska-Popłonyk
- Department of Pediatric Pneumonology, Allergy and Clinical Immunology, Institute of Pediatrics, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Eyal Schwartzmann
- Medical Student Scientific Society, English Division, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Zuzanna Chmara
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Antonina Głukowska
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Tomasz Krysa
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Maksymilian Majchrzycki
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Maurycy Olejnicki
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Paulina Ostrowska
- Medical Student Scientific Society, Karol Marcinkowski University of Medical Sciences, 60-572 Poznań, Poland
| | - Joanna Babik
- Gynecology and Obstetrics with Pregnancy Pathology Unit, Franciszek Raszeja Municipal Hospital, 60-834 Poznań, Poland
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12
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Cancelliere S, Heung T, Fischbach S, Klaiman P, Bassett AS. Adult-onset obstructive sleep apnea and pediatric pharyngoplasty in 22q11.2 deletion syndrome. Sleep Med 2023; 104:49-55. [PMID: 36889031 DOI: 10.1016/j.sleep.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE/BACKGROUND We aimed to evaluate adult-onset obstructive sleep apnea (OSA) and related risk factors, including history of pediatric palatal/pharyngeal surgery to remediate velopharyngeal dysfunction, in 22q11.2 deletion syndrome (22q11.2DS). PATIENTS/METHODS Using a retrospective cohort design and standard sleep study-based criteria, we determined presence of adult-onset OSA (age ≥16 years) and relevant variables through comprehensive chart review in a well-characterized cohort of 387 adults with typical 22q11.2 microdeletions (51.4% female, median age 32.3, interquartile range 25.0-42.5, years). We used multivariate logistic regression to identify independent risk factors for OSA. RESULTS Of the 73 adults with sleep study data, 39 (53.4%) met criteria for OSA at median age 33.6 (interquartile range 24.0-40.7) years, indicating a minimum OSA prevalence of 10.1% in this 22q11.2DS cohort. History of pediatric pharyngoplasty (odds ratio 2.56, 95% confidence interval 1.15-5.70) was a significant independent predictor of adult-onset OSA, while accounting for other significant independent predictors (asthma, higher body mass index, older age), and for male sex. An estimated 65.5% of those prescribed continuous positive airway pressure therapy were reported as adherent. CONCLUSIONS In addition to factors of known importance in the general population, delayed effects of pediatric pharyngoplasty may contribute to risk of adult-onset OSA in individuals with 22q11.2DS. The results support increased index of suspicion for OSA in adults with a 22q11.2 microdeletion. Future research with this and other homogeneous genetic models may help to improve outcomes and to better understand genetic and modifiable risk factors for OSA.
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Affiliation(s)
- Sabrina Cancelliere
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Simone Fischbach
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paula Klaiman
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada; Department of Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
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13
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Blagowidow N, Nowakowska B, Schindewolf E, Grati FR, Putotto C, Breckpot J, Swillen A, Crowley TB, Loo JCY, Lairson LA, Óskarsdóttir S, Boot E, Garcia-Minaur S, Cristina Digilio M, Marino B, Coleman B, Moldenhauer JS, Bassett AS, McDonald-McGinn DM. Prenatal Screening and Diagnostic Considerations for 22q11.2 Microdeletions. Genes (Basel) 2023; 14:160. [PMID: 36672900 PMCID: PMC9858737 DOI: 10.3390/genes14010160] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Diagnosis of a chromosome 22q11.2 microdeletion and its associated deletion syndrome (22q11.2DS) is optimally made early. We reviewed the available literature to provide contemporary guidance and recommendations related to the prenatal period. Indications for prenatal diagnostic testing include a parent or child with the 22q11.2 microdeletion or suggestive prenatal screening results. Definitive diagnosis by genetic testing of chorionic villi or amniocytes using a chromosomal microarray will detect clinically relevant microdeletions. Screening options include noninvasive prenatal screening (NIPS) and imaging. The potential benefits and limitations of each screening method should be clearly conveyed. NIPS, a genetic option available from 10 weeks gestational age, has a 70-83% detection rate and a 40-50% PPV for most associated 22q11.2 microdeletions. Prenatal imaging, usually by ultrasound, can detect several physical features associated with 22q11.2DS. Findings vary, related to detection methods, gestational age, and relative specificity. Conotruncal cardiac anomalies are more strongly associated than skeletal, urinary tract, or other congenital anomalies such as thymic hypoplasia or cavum septi pellucidi dilatation. Among others, intrauterine growth restriction and polyhydramnios are additional associated, prenatally detectable signs. Preconception genetic counselling should be offered to males and females with 22q11.2DS, as there is a 50% risk of transmission in each pregnancy. A previous history of a de novo 22q11.2 microdeletion conveys a low risk of recurrence. Prenatal genetic counselling includes an offer of screening or diagnostic testing and discussion of results. The goal is to facilitate optimal perinatal care.
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Affiliation(s)
- Natalie Blagowidow
- Harvey Institute for Human Genetics, Greater Baltimore Medical Center, Baltimore, MD 21204, USA
| | - Beata Nowakowska
- Cytogenetic Laboratory, Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Erica Schindewolf
- Center for Fetal Diagnosis and Treatment and the 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Francesca Romana Grati
- R&D Department, Menarini Biomarkers Singapore, Via Giuseppe di Vittorio 21/b3, 40013 Castel Maggiore, Italy
| | - Carolina Putotto
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Viale del Policlinico 155, 00161 Roma, Italy
| | - Jeroen Breckpot
- Center for Human Genetics, Herestraat 49, 3000 Leuven, Belgium
| | - Ann Swillen
- Center for Human Genetics, Herestraat 49, 3000 Leuven, Belgium
| | - Terrence Blaine Crowley
- Division of Human Genetics, The 22q and You Center, and Clinical Genetics Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Joanne C. Y. Loo
- The Dalglish Family 22q Clinic, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Lauren A. Lairson
- Division of Human Genetics, The 22q and You Center, and Clinical Genetics Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sólveig Óskarsdóttir
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Paediatrics, Queen Silva Children’s Hospital, 416 50 Gothenburg, Sweden
| | - Erik Boot
- The Dalglish Family 22q Clinic, University Health Network, Toronto, ON M5G 2C4, Canada
- Advisium’s Heeren Loo, Berkenweg 11, 3818 LA Amersfoort, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Sixto Garcia-Minaur
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, 28046 Madrid, Spain
| | | | - Bruno Marino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome (Italy), Viale del Policlinico 155, 00161 Roma, Italy
| | - Beverly Coleman
- Center for Fetal Diagnosis and Treatment and the 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Treatment and the 22q and You Center, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Obstetrics, Gynecology, and Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anne S. Bassett
- The Dalglish Family 22q Clinic, University Health Network, Toronto, ON M5G 2C4, Canada
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON M5S 2S1, Canada
- Division of Cardiology, Department of Medicine, and Centre for Mental Health, and Toronto General Hospital Research Institute, University Health Network, Toronto, ON M5G 2N2, Canada
| | - Donna M. McDonald-McGinn
- Division of Human Genetics, The 22q and You Center, and Clinical Genetics Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Human Biology and Medical Genetics, Sapienza University, 00185 Roma, Italy
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14
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Montemurro N, Ricciardi L, Scerrati A, Ippolito G, Lofrese G, Trungu S, Stoccoro A. The Potential Role of Dysregulated miRNAs in Adolescent Idiopathic Scoliosis and 22q11.2 Deletion Syndrome. J Pers Med 2022; 12:1925. [PMID: 36422101 PMCID: PMC9695868 DOI: 10.3390/jpm12111925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 08/29/2023] Open
Abstract
Background: Adolescent idiopathic scoliosis (AIS), affecting 2-4% of adolescents, is a multifactorial spinal disease. Interactions between genetic and environmental factors can influence disease onset through epigenetic mechanisms, including DNA methylation, histone modifications and miRNA expression. Recent evidence reported that, among all clinical features in individuals with 22q11.2 deletion syndrome (DS), scoliosis can occur with a higher incidence than in the general population. Methods: A PubMed and Ovid Medline search was performed for idiopathic scoliosis in the setting of 22q11.2DS and miRNA according to PRISMA guidelines. Results: Four papers, accounting for 2841 individuals, reported clinical data about scoliosis in individuals with 22q11.2DS, showing that approximately 35.1% of the individuals with 22q11.2DS developed scoliosis. Conclusions: 22q11.2DS could be used as a model for the study of AIS. The DGCR8 gene seems to be essential for microRNA biogenesis, which is why we propose that a possible common pathological mechanism between scoliosis and 22q11.2DS could be the dysregulation of microRNA expression. In the current study, we identified two miRNAs that were altered in both 22q11.2DS and AIS, miR-93 and miR-1306, thus, corroborating the hypothesis that the two diseases share common molecular alterations.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
| | - Luca Ricciardi
- Department of NESMOS, Sapienza University of Rome, 00185 Roma, Italy
| | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgio Ippolito
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), DSBMC Sapienza Università di Roma-Polo Pontino, 04100 Latina, Italy
| | - Giorgio Lofrese
- Division of Neurosurgery, Ospedale Bufalini, 47023 Cesena, Italy
| | - Sokol Trungu
- Department of NESMOS, Sapienza University of Rome, 00185 Roma, Italy
| | - Andrea Stoccoro
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56100 Pisa, Italy
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15
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Reproductive Outcomes in Adults with 22q11.2 Deletion Syndrome. Genes (Basel) 2022; 13:genes13112126. [DOI: 10.3390/genes13112126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
The 22q11.2 microdeletion and its associated conditions could affect reproductive outcomes but there is limited information on this important area. We investigated reproductive outcomes in a sample of 368 adults with typical 22q11.2 deletions (median age 32.8, range 17.9–76.3 years; 195 females), and without moderate-severe intellectual disability, who were followed prospectively. We examined all reproductive outcomes and possible effects of diagnosis as a transmitting parent on these outcomes. We used logistic regression to investigate factors relevant to reproductive fitness (liveborn offspring). There were 63 (17.1%) individuals with 157 pregnancy outcomes, 94 (60.3%) of which involved live births. Amongst the remainder involving a form of loss, were seven (5.77%) stillbirths, significantly greater than population norms (p < 0.0001). For 35 (55.6%) individuals, diagnosis of 22q11.2 deletion syndrome (22q11.2DS) followed diagnosis of an offspring, with disproportionately fewer individuals had major congenital heart disease (CHD) in that transmitting parent subgroup. The regression model indicated that major CHD, in addition to previously identified factors, was a significant independent predictor of reduced reproductive fitness. There was evidence of persisting diagnostic delay and limited prenatal genetic testing. The findings indicate that pregnancy loss is an important health issue for adults with 22q11.2DS. CHD and/or its absence is a factor to consider in reproductive outcome research. Further studies are warranted to better appreciate factors that may contribute to reproductive outcomes, including technological advances. The results suggest the need for ongoing efforts to provide optimal education and supports to individuals with 22q11.2DS, and their clinicians, around reproductive issues and early diagnosis.
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16
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McGinn DE, Crowley TB, Heung T, Tran O, Moss E, Zackai EH, Emanuel BS, Chow EWC, Morrow BE, Swillen A, Bassett AS, McDonald-McGinn DM. Influence of Parent-of-Origin on Intellectual Outcomes in the Chromosome 22q11.2 Deletion Syndrome. Genes (Basel) 2022; 13:genes13101800. [PMID: 36292685 PMCID: PMC9602066 DOI: 10.3390/genes13101800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 01/21/2023] Open
Abstract
Learning and intellectual disabilities are hallmark features of 22q11.2 deletion syndrome. Data are limited, however, regarding influences on full-scale IQ (FSIQ). Here, we investigated possible 22q11.2 deletion parent-of-origin effects. In 535 individuals, we compared FSIQ (≥50), 481 with de novo and 54 with inherited 22q11.2 deletions. In the subsets with data available, we examined parent-of-origin effects on FSIQ. We used linear regression models to account for covariates. Median FSIQ was significantly higher in de novo vs. inherited deletions (77; range 50−116 vs. 67; range 50−96, p < 0.0001). Results remained significant using a regression model accounting for age at IQ testing, sex and cohort site. No significant parent-of-origin differences in FSIQ were observed for de novo deletions (n = 81, 63.0% maternal; p = 0.6882). However, median FSIQ was significantly lower in maternally than in paternally inherited familial deletions (65, range 50−86 vs. 71.5, range 58−96, respectively, p = 0.0350), with the regression model indicating an ~8 point decrement in FSIQ for this variable (p = 0.0061). FSIQ is higher on average in de novo than in inherited 22q11.2 deletions, regardless of parental origin. However, parent-of-origin appears relevant in inherited deletions. The results have potential clinical implications with further research needed to delineate possible actionable mechanisms.
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Affiliation(s)
- Daniel E. McGinn
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - T. Blaine Crowley
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON M5G 2C4, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Oanh Tran
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Edward Moss
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Elaine H. Zackai
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beverly S. Emanuel
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eva W. C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 2C4, Canada
| | | | - Ann Swillen
- The Centre for Human Genetics, University Hospital of Leuven, Department of Human Genetics, University of Leuven (KU Leuven), 3000 Leuven, Belgium
- Correspondence: (A.S.); (A.S.B.); (D.M.M.-M.)
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON M5G 2C4, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 2C4, Canada
- Toronto General Hospital Research Institute, and Campbell Family Mental Health Research Institute, Toronto, ON M5G 2C4, Canada
- Correspondence: (A.S.); (A.S.B.); (D.M.M.-M.)
| | - Donna M. McDonald-McGinn
- The 22q and You Center, Clinical Genetics Center, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: (A.S.); (A.S.B.); (D.M.M.-M.)
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17
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McGregor S, Boroditsky M, Blanchard-Rohner G, Loock C, Jade Hildebrand K. Evaluation of rotavirus vaccine administration among a 22q11.2DS patient population. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:50. [PMID: 35690869 PMCID: PMC9188210 DOI: 10.1186/s13223-022-00693-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Background 22q11.2 Deletion Syndrome (22q11.2DS) can result in array of congenital abnormalities including immune dysfunction. International guidelines recommend immune evaluation of 22q11.2DS patients prior to live vaccine administration. A rotavirus vaccination program for infants aged 2 and 4 months was implemented in British Columbia (BC) in 2012. Adherence to immune workup recommendations prior to 2 months of age in patients with 22q11.2DS and adverse events following immunization is not known. Methods A retrospective chart review of children diagnosed with 22q11.2DS in BC from January 1, 2012 to January 1, 2019 was conducted. Demographic, clinical, laboratory, immunization data and adverse reactions to vaccines were obtained. International guidelines were used as a reference for adherence to immunologic workup recommendations. Results Forty-two children with 22q11.2DS were included. Immunization records were available for 39 children, and 22 (52.3%) received at least one dose of a live rotavirus vaccine. No adverse events following immunization were noted in clinical records. While 25 out of 27 (92.6%) of patients who received an immunological workup had a CD4 + lymphocyte count to qualify for safe administration of a live vaccination, only 12 (44%) received the Rotavirus vaccine. Of 22 infants diagnosed with 22q11.DS prior to 8 weeks of age, only ten (45.5%) received an immune workup before the rotavirus vaccine. Conclusions The majority of our infant cohort did not receive medical care consistent with international 22q11.2DS vaccination and immunological surveillance recommendations. More effective dissemination of 22q11.2DS guidelines and improved immunological assessment for infants with 22q11.2DS in BC is necessary.
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Affiliation(s)
- Sophie McGregor
- Medical Undergraduate Program, University of British Columbia, Kelowna, BC, Canada
| | - Matthew Boroditsky
- Division of Plastic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Geraldine Blanchard-Rohner
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christine Loock
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, 4480 Oak St, Vancouver, BC, Canada
| | - Kyla Jade Hildebrand
- British Columbia Children's Hospital Research Institute, 4480 Oak St, Vancouver, BC, Canada. .,British Columbia Children's Hospital, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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18
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Blagojevic C, Heung T, Malecki S, Ying S, Cancelliere S, Hegele RA, Bassett AS. Hypertriglyceridemia in young adults with a 22q11.2 microdeletion. Eur J Endocrinol 2022; 187:91-99. [PMID: 35521712 DOI: 10.1530/eje-21-1104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mild to moderate hypertriglyceridemia is a condition often associated with obesity and diabetes, with as yet incomplete knowledge of underlying genetic architecture. The 22q11.2 microdeletion is associated with multimorbidity, including increased risk of obesity and diabetes. In this study, we sought to investigate whether the 22q11.2 microdeletion was associated with mild to moderate hypertriglyceridemia (1.7-10 mmol/L). DESIGN This was a cohort study comparing 6793 population-based adults and 267 with a 22q11.2 microdeletion aged 17-69 years, excluding those with diabetes or on statins. METHODS We used binomial logistic regression modeling to identify predictors of hypertriglyceridemia, accounting for the 22q11.2 microdeletion, male sex, BMI, ethnicity, age, and antipsychotic medications. RESULTS The 22q11.2 microdeletion was a significant independent predictor of mild to moderate hypertriglyceridemia (odds ratio (OR): 2.35, 95% CI: 1.70-3.26). All other factors examined were also significant predictors (OR: 1.23-2.10), except for antipsychotic medication use. Within the 22q11.2 microdeletion subgroup, only male sex (OR: 3.10, 95% CI: 1.77-5.44) and BMI (OR: 1.63, 95% CI: 1.14-1.98) were significant predictors of hypertriglyceridemia, evident at mean age 31.2 years. CONCLUSIONS The 22q11.2 microdeletion is associated with hypertriglyceridemia even when accounting for other known risk factors for elevated triglycerides. This effect is seen in young adulthood (76.6% were <40 years), in the absence of diabetes, and irrespective of antipsychotics, suggesting that the 22q11.2 microdeletion may represent an unrecognized genetic risk factor for hypertriglyceridemia, providing novel opportunities for animal and cellular models. Early dyslipidemia screening and management strategies would appear prudent for individuals with 22q11.2 microdeletions.
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Affiliation(s)
- Christina Blagojevic
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sarah Malecki
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Shengjie Ying
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sabrina Cancelliere
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto General Hospital Research Institute, and Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
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19
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Silva IMW, Gil-da-Silva-Lopes VL. An overview of the trajectory of Brazilian individuals with 22q11.2 deletion syndrome until diagnosis. Orphanet J Rare Dis 2022; 17:67. [PMID: 35189940 PMCID: PMC8862281 DOI: 10.1186/s13023-022-02225-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background 22q11.2 deletion syndrome (22q11.2DS) is a rare disease with an important characteristic—clinical heterogeneity. The diversity of organs, regions, and systems of the body that can be affected requires periodic updating of health professionals so that they can recognize these clinical signs as belonging to 22q11.2DS. Updated professionals are equally important for the appropriate and timely clinical management of individuals with a positive diagnosis. In this context, this article aimed to map and analyze the access to healthcare for individuals with 22q11.2DS until the moment of diagnosis. Results We analyzed the clinical data of 111 individuals with 22q11.2DS registered in the Brazilian Database on Craniofacial Anomalies (BDCA) from 2008 to 2020. In this study, individuals were diagnosed at a median age of 9 years (mean = 9.7 years). Before the genetic investigation, they accessed 68.75% of the internationally recommended evaluations available at BDCA. Recurrent 22q11.2DS clinical manifestations such as delayed neuropsychomotor development, lip and/or palate defects, cardiac malformation and/or hematological/immunological alteration co-occurred in at least 72.06% of individuals. Cardiac malformation was the only clinical alteration that lowered the median diagnostic age, corresponding to 6.5 years of age with a cardiac malformation versus 11 years of age without one (p = 0.0006). Conclusions In Brazil, 22q11.2 DS is under-recognized, and early diagnosis and management of affected individuals are still a distant reality. In this sense, 22q11.2 DS suspicion followed by the elimination of obstacles for its diagnosis confirmation is essential to increase life expectancy and improve the quality of life of these individuals in Brazil.
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20
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Grassi MS, Montenegro M, Zanardo EA, Pastorino AC, Dorna MB, Kim C, Jatene M, Miura N, Kulikowski L, Carneiro-Sampaio M. Investigação Citogenômica de Crianças com Doença Cardíaca Congênita: Experiência de um Centro no Brasil. Arq Bras Cardiol 2021; 118:61-67. [PMID: 35195210 PMCID: PMC8959050 DOI: 10.36660/abc.20190894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamento Algumas síndromes têm características específicas e facilmente reconhecíveis, enquanto outras podem ser mais complexas de se identificar e podem apresentar diferentes manifestações fenotípicas, por exemplo. Um diagnóstico etiológico é importante para entender a natureza da doença, para estabelecer o prognóstico e para começar o tratamento, permitindo a inclusão de pacientes na sociedade e reduzindo o custo financeiro dessas doenças. Objetivo A proposta inicial deste estudo foi a triagem citogenética para detectar a síndrome de deleção 22q11.2 (SD22q11.2) em recém-nascidos e crianças com doença cardíaca congênita utilizando a técnica da amplificação multiplex de sondas dependente de ligação (MLPA). Assim, por meio da pesquisa, outras mudanças genômicas foram identificadas nesses pacientes cardíacos. Nosso objetivo se estendeu a investigar essas outras mudanças citogenéticas. Métodos Investigamos 118 recém-nascidos com doenças cardíacas congênitas nascidos consecutivamente durante um ano, utilizando a técnica da MLPA. Resultados A técnica da MLPA permitiu a detecção da SD22q11.2 em 10/118 pacientes (8,5%). Outras alterações genômicas foram identificadas em 6/118 pacientes (5%): 1p36 del, 8p23 del (2 casos), 7q dup, 12 dup e 8q24 dup. Conclusão Este estudo ressalta a relevância da detecção de alterações genômicas que estão presentes em recém-nascidos e crianças com doenças cardíacas congênitas por meio de ferramentas citogenômicas.
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21
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Bevilacqua E, Jani JC, Chaoui R, Suk EA, Palma‐Dias R, Ko T, Warsof S, Stokowski R, Jones KJ, Grati FR, Schmid M. Performance of a targeted cell-free DNA prenatal test for 22q11.2 deletion in a large clinical cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:597-602. [PMID: 34090308 PMCID: PMC8518527 DOI: 10.1002/uog.23699] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE 22q11.2 deletion is more common than trisomies 18 and 13 combined, yet no routine approach to prenatal screening for this microdeletion has been established. This study evaluated the clinical sensitivity and specificity of a targeted cell-free DNA (cfDNA) test to screen for fetal 22q11.2 deletion in a large cohort, using blinded analysis of prospectively enrolled pregnancies and stored clinical samples. METHODS In order to ensure that the analysis included a meaningful number of cases with fetal 22q11.2 deletion, maternal plasma samples were obtained by prospective, multicenter enrolment of pregnancies with a fetal cardiac abnormality and from stored clinical samples from a research sample bank. Fetal genetic status, as evaluated by microarray analysis, karyotyping with fluorescence in-situ hybridization or a comparable test, was available for all cases. Samples were processed as described previously for the Harmony prenatal test, with the addition of DANSR (Digital Analysis of Selected Regions) assays targeting the 3.0-Mb region of 22q11.2 associated with 22q11.2 deletion syndrome. Operators were blinded to fetal genetic status. Sensitivity and specificity of the cfDNA test for 22q11.2 deletion were calculated based on concordance between the cfDNA result and fetal genotype. RESULTS The final study group consisted of 735 clinical samples, including 358 from prospectively enrolled pregnancies and 377 stored clinical samples. Of 46 maternal plasma samples from pregnancies with a 22q11.2 deletion, ranging in size from 1.25 to 3.25 Mb, 32 had a cfDNA result indicating a high probability of 22q11.2 deletion (sensitivity, 69.6% (95% CI, 55.2-80.9%)). All 689 maternal plasma samples without a 22q11.2 deletion were classified correctly by the cfDNA test as having no evidence of a 22q11.2 deletion (specificity, 100% (95% CI, 99.5-100%)). CONCLUSIONS The results of this large-scale prospective clinical evaluation of the sensitivity and specificity of a targeted cfDNA test for fetal 22q11.2 deletion demonstrate that this test can detect the common and smaller, nested 22q11.2 deletions with a low (0-0.5%) false-positive rate. Although the positive predictive value (PPV) observed in this study population was 100%, the expected PPV in the general pregnant population is estimated to be 12.2% at 99.5% specificity and 41.1% at 99.9% specificity. The use of this cfDNA test to screen for 22q11.2 deletion could enhance identification of pregnancies at risk for 22q11.2 deletion syndrome without significantly increasing the likelihood of maternal anxiety and unnecessary invasive procedures related to a false-positive result. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - J. C. Jani
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - R. Chaoui
- Prenatal Diagnosis and Human GeneticsBerlinGermany
| | - E.‐K. A. Suk
- Prenatal Diagnosis and Human GeneticsBerlinGermany
| | - R. Palma‐Dias
- The Royal Women's HospitalUniversity of MelbourneParkvilleVICAustralia
| | - T.‐M. Ko
- Genephile Bioscience Laboratory, Ko's Obstetrics & Gynecology ClinicTaipei CityTaiwan
| | - S. Warsof
- Eastern Virginia Medical SchoolNorfolkVAUSA
| | | | - K. J. Jones
- Roche Sequencing Solutions, Inc.San JoseCAUSA
| | - F. R. Grati
- TOMA Advanced Biomedical Assays S.p.A, Impact Lab.Busto ArsizioItaly
| | - M. Schmid
- Roche Sequencing Solutions, Inc.San JoseCAUSA
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22
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Kemp K. 22q11.2 deletion syndrome: an anaesthetic perspective. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.5.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K Kemp
- Department of Anaesthesia and Postoperative Medicine, Red Cross Children’s War Memorial Hospital, University of Cape Town,
South Africa
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23
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Palmer LD, Heung T, Corral M, Boot E, Brooks SG, Bassett AS. Sexual knowledge and behaviour in 22q11.2 deletion syndrome, a complex care condition. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:966-975. [PMID: 34291536 DOI: 10.1111/jar.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/23/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited information about sexual knowledge and behaviours in adults with complex care needs, including those with 22q11.2 deletion syndrome (22q) which represents a group predisposed to intellectual disabilities. METHODS We conducted sexual health assessments with 67 adults with 22q, examining whether those with knowledge deficits and a history of engaging in sexual activities with others would be more likely to engage in high-risk behaviours. RESULTS The majority (65.7%) of adults with 22q were sexually active with others; most (70.1%) had sexual knowledge deficits. Those with intellectual disabilities were more likely (p = .0012) to have deficits in certain topics. In the sexually active subgroup, most (81.8%) engaged in high-risk sexual behaviours, regardless of intellectual disability or knowledge deficits. CONCLUSION The results suggest a need for increased dialogue, repeated education, genetic counselling and preventive healthcare measures related to sexuality in 22q and potentially in other complex care conditions.
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Affiliation(s)
- Lisa D Palmer
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada
| | - Tracy Heung
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Maria Corral
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Advisium, 's Heeren Loo, Amersfoort, The Netherlands.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Stephanie G Brooks
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, and Division of Cardiology, Department of Medicine and, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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24
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Blagojevic C, Heung T, Theriault M, Tomita-Mitchell A, Chakraborty P, Kernohan K, Bulman DE, Bassett AS. Estimate of the contemporary live-birth prevalence of recurrent 22q11.2 deletions: a cross-sectional analysis from population-based newborn screening. CMAJ Open 2021; 9:E802-E809. [PMID: 34404688 PMCID: PMC8373039 DOI: 10.9778/cmajo.20200294] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although pathogenic 22q11.2 deletions are an important cause of developmental delays and lifelong disease burden, their variable and complex clinical expression contributes to under-recognition, delayed molecular diagnosis and uncertainty about prevalence. We sought to estimate the contemporary live-birth prevalence of typical 22q11.2 deletions using a population-based newborn screening sample and to examine data available for associated clinical features. METHODS Using DNA available from an unbiased sample of about 12% of all dried blood spots collected for newborn screening in Ontario between January 2017 and September 2018, we prospectively screened for 22q11.2 deletions using multiplex quantitative polymerase chain reaction assays and conducted independent confirmatory studies. We used cross-sectional analyses to compare available clinical and T-cell receptor excision circle (TREC, used in newborn screening for severe combined immunodeficiency) data between samples with and without 22q11.2 deletions. RESULTS The estimated minimum prevalence of 22q11.2 deletions was 1 in 2148 (4.7 per 10 000) live births (95% confidence interval [CI] 2.5 to 7.8 per 10 000), based on a total of 30 074 samples screened, with 14 having confirmed 22q11.2 deletions. Of term singletons, samples with 22q11.2 deletions had significantly younger median maternal age (25.5 v. 32.0 yr, difference -6.5 yr, 95% CI -7 to -2 yr), a greater proportion with small birth weight for gestational age (odds ratio 7.00, 95% CI 2.36 to 23.18) and lower median TREC levels (108.9 v. 602.5 copies/3 μL, p < 0.001). INTERPRETATION These results indicate that the 22q11.2 deletion syndrome is one of the most common of rare genetic conditions and may be associated with relatively younger maternal ages and with prenatal growth abnormalities. The findings support the public health importance of early - prenatal and neonatal - diagnosis that would enable prompt screening for and management of well-known actionable features associated with 22q11.2 deletions.
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Affiliation(s)
- Christina Blagojevic
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Tracy Heung
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Mylene Theriault
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Aoy Tomita-Mitchell
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Pranesh Chakraborty
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Kristin Kernohan
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Dennis E Bulman
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc
| | - Anne S Bassett
- Clinical Genetics Research Program (Blagojevic, Heung, Bassett), Centre for Addiction and Mental Health; The Dalglish Family 22q Clinic (Blagojevic, Heung, Bassett), University Health Network; Department of Psychiatry (Bassett), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Theriault, Chakraborty, Kernohan, Bulman), University of Ottawa, Ottawa, Ont.; Division of Pediatric Cardiothoracic Surgery (Tomita-Mitchell), Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisc.
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Gur RE, Roalf DR, Alexander-Bloch A, McDonald-McGinn DM, Gur RC. Pathways to understanding psychosis through rare - 22q11.2DS - and common variants. Curr Opin Genet Dev 2021; 68:35-40. [PMID: 33571729 PMCID: PMC8728946 DOI: 10.1016/j.gde.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 12/17/2022]
Abstract
The 22q11.2 Deletion Syndrome has significant impact on brain and behavior, with about 25% of individuals developing schizophrenia. The condition offers a model for prospective studies on the emergence of psychosis and advancing mechanistic hypotheses on gene-environment interactions, with magnified power for examining genome-phenome association. Here, we highlight findings that build on the International 22q11.2 Brain and Behavior Consortium and relate to several key domains in the study of psychosis-risk and schizophrenia. We examine neurocognition, olfaction and neuroimaging data that indicate similar impairment patterns in this rare syndrome and idiopathic presentation of schizophrenia. We conclude that the converging paradigms, studying psychosis dimensionally in rare and common variants samples, provide complementary approaches that will propel precision medicine in psychiatry.
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Affiliation(s)
- Raquel E Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - David R Roalf
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron Alexander-Bloch
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics and 22q and You Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Zodanu GKE, Oszlánczi M, Havasi K, Kalapos A, Rácz G, Katona M, Ujfalusi A, Nagy O, Széll M, Nagy D. Systemic Screening for 22q11.2 Copy Number Variations in Hungarian Pediatric and Adult Patients With Congenital Heart Diseases Identified Rare Pathogenic Patterns in the Region. Front Genet 2021; 12:635480. [PMID: 33995479 PMCID: PMC8117090 DOI: 10.3389/fgene.2021.635480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
Congenital heart defects (CHD) are the most common developmental abnormalities, affecting approximately 0.9% of livebirths. Genetic factors, including copy number variations (CNVs), play an important role in their development. The most common CNVs are found on chromosome 22q11.2. The genomic instability of this region, caused by the eight low copy repeats (LCR A-H), may result in several recurrent and/or rare microdeletions and duplications, including the most common, ∼3 Mb large LCR A-D deletion (classical 22q.11.2 deletion syndrome). We aimed to screen 22q11.2 CNVs in a large Hungarian pediatric and adult CHD cohort, regardless of the type of their CHDs. All the enrolled participants were cardiologically diagnosed with non-syndromic CHDs. A combination of multiplex ligation-dependent probe amplification (MLPA), chromosomal microarray analysis and droplet digital PCR methods were used to comprehensively assess the detected 22q11.2 CNVs in 212 CHD-patients. Additionally, capillary sequencing was performed to detect variants in the TBX1 gene, a cardinal gene located in 22q11.2. Pathogenic CNVs were detected in 5.2% (11/212), VUS in 0.9% and benign CNVs in 1.8% of the overall CHD cohort. In patients with tetralogy of Fallot the rate of pathogenic CNVs was 17% (5/30). Fifty-four percent of all CNVs were typical proximal deletions (LCR A-D). However, nested (LCR A-B) and central deletions (LCR C-D), proximal (LCR A-D) and distal duplications (LCR D-E, LCR D-H, LCR E-H, LCR F-H) and rare combinations of deletions and duplications were also identified. Segregation analysis detected familial occurrence in 18% (2/11) of the pathogenic variants. Based on in-depth clinical information, a detailed phenotype–genotype comparison was performed. No pathogenic variant was identified in the TBX1 gene. Our findings confirmed the previously described large phenotypic diversity in the 22q11.2 CNVs. MLPA proved to be a highly efficient genetic screening method for our CHD-cohort. Our results highlight the necessity for large-scale genetic screening of CHD-patients and the importance of early genetic diagnosis in their clinical management.
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Affiliation(s)
| | - Mónika Oszlánczi
- Second Department of Internal Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Kálmán Havasi
- Second Department of Internal Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- Second Department of Internal Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gergely Rácz
- Second Department of Internal Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Márta Katona
- Department of Pediatrics, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anikó Ujfalusi
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Nagy
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Márta Széll
- Department of Medical Genetics, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Nagy
- Department of Medical Genetics, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Hui L, Poulton A, Kluckow E, Lindquist A, Hutchinson B, Pertile MD, Bonacquisto L, Gugasyan L, Kulkarni A, Harraway J, Howden A, McCoy R, Costa FDS, Menezes M, Palma-Dias R, Nisbet D, Martin N, Bethune M, Poulakis Z, Halliday J. A minimum estimate of the prevalence of 22q11 deletion syndrome and other chromosome abnormalities in a combined prenatal and postnatal cohort. Hum Reprod 2021; 35:694-704. [PMID: 32207823 DOI: 10.1093/humrep/dez286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 11/10/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the frequency of major chromosome abnormalities in a population-based diagnostic data set of genomic tests performed on miscarriage, fetal and infant samples in a state with >73 000 annual births? SUMMARY ANSWER The overall frequency of major chromosome abnormalities in the entire cohort was 28.2% (2493/8826), with a significant decrease in the detection of major chromosome abnormalities with later developmental stage, from 50.9% to 21.3% to 15.6% of tests in the miscarriage, prenatal and postnatal cohorts, respectively. WHAT IS KNOWN ALREADY Over the past decade, technological advances have revolutionized genomic testing at every stage of reproduction. Chromosomal microarrays (CMAs) are now the gold standard of chromosome assessment in prenatal diagnosis and pediatrics. STUDY DESIGN, SIZE, DURATION A population-based cohort study including all chromosome analysis was performed in the Australian state of Victoria during a 24-month period from January 2015 to December 2016. All samples obtained via invasive prenatal diagnosis and postnatal samples from pregnancy tissue and infants ≤12 months of age were included. PARTICIPANTS/MATERIALS, SETTING, METHODS A research collaboration of screening and diagnostic units in the Australian state of Victoria was formed (the Perinatal Record Linkage collaboration), capturing all instances of prenatal and postnatal chromosome testing performed in the state. Victoria has over 73 000 births per annum and a median maternal age of 31.5 years. We analyzed our population-based diagnostic data set for (i) chromosome assessment of miscarriage, prenatal diagnosis and postnatal samples; (ii) testing indications and diagnostic yields for each of these cohorts; (iii) and the combined prenatal/infant prevalence of 22q11.2 deletion syndrome (DS) as a proportion of all births ≥20 weeks gestation. MAIN RESULTS AND THE ROLE OF CHANCE During the 24-month study period, a total of 8826 chromosomal analyses were performed on prenatal and postnatal specimens in Victoria. The vast majority (91.2%) of all chromosome analyses were performed with CMA.The overall frequency of major chromosome abnormalities in the entire cohort was 28.2% (2493/8826). There was a significant decreasing trend in the percentage of chromosome abnormalities with later developmental stage from 50.9% to 21.3% to 15.6% in the miscarriage, prenatal and postnatal cohorts, respectively (χ2 trend = 790.0, P < 0.0001). The total frequency of abnormalities in the live infant subgroup was 13.4% (244/1816). The frequencies of pathogenic copy number variants (CNVs) detected via CMA for the miscarriage, prenatal and postnatal cohorts were 1.9% (50/2573), 2.2% (82/3661) and 4.9% (127/2592), respectively. There was a significant increasing trend in the frequency of pathogenic CNVs with later developmental stage (χ2 trend = 39.72, P < 0.0001). For the subgroup of live infants, the pathogenic CNV frequency on CMA analysis was 6.0% (109/1816). There were 38 diagnoses of 22q11.2 DS, including 1 miscarriage, 15 prenatal and 22 postnatal cases. After excluding the miscarriage case and accounting for duplicate testing, the estimated prevalence of 22q11 DS was 1 in 4558 Victorian births. LIMITATIONS, REASONS FOR CAUTION Clinical information was missing on 11.6% of postnatal samples, and gestational age was rarely provided on the miscarriage specimens. We were unable to obtain rates of termination of pregnancy and stillbirth in our cohort due to incomplete data provided by clinical referrers. We therefore cannot make conclusions on pregnancy or infant outcome following diagnostic testing. Childhood and adult diagnoses of 22q11 DS were not collected. WIDER IMPLICATIONS OF THE FINDINGS Our study marks a complete transition in genomic testing from the G-banded karyotype era, with CMA now established as the first line investigation for pregnancy losses, fetal diagnosis and newborn/infant assessment in a high-income setting. Integration of prenatal and postnatal diagnostic data sets provides important opportunities for estimating the prevalence of clinically important congenital syndromes, such as 22q11 DS. STUDY FUNDING/COMPETING INTEREST(S) L.H. is funded by a National Health and Medical Research Council Early Career Fellowship (1105603); A.L. was funded by a Mercy Perinatal Research Fellowship; J.H. was funded by a National Health and Medical Research Council Senior Research Fellowship (10121252). The funding bodies had no role in the conduct of the research or the manuscript. Discretionary funding from the Murdoch Children's Research Institute has supported the prenatal diagnosis data collection and reporting over the years.Dr Ricardo Palma-Dias reports a commercial relationship with Roche Diagnostics, personal fees from Philips Ultrasound, outside the submitted work. Debbie Nisbet reports a commercial relationship with Roche Diagnostics, outside the submitted work. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Lisa Hui
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Alice Poulton
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia
| | - Eliza Kluckow
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia
| | - Anthea Lindquist
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Briohny Hutchinson
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Leonard Bonacquisto
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia
| | - Lucy Gugasyan
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton 3168, Victoria, Australia
| | - Abhijit Kulkarni
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton 3168, Victoria, Australia
| | - James Harraway
- Department of Cytogenetics/Molecular Pathology, Sullivan Nicolaides Pathology, Bowen Hills, Queensland 4006, Australia
| | - Amanda Howden
- Cytogenetics, Melbourne Pathology, Collingwood 3066, Victoria, Australia
| | - Richard McCoy
- Molecular Genetics, Australian Clinical Labs, Clayton 3168, Victoria, Australia
| | - Fabricio Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, São Paulo, Brazil.,Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Victoria, Australia
| | - Melody Menezes
- Monash Ultrasound for Women, Richmond 3121, Victoria, Australia
| | - Ricardo Palma-Dias
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.,Women's Ultrasound Melbourne, East Melbourne 3002, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville 3052, Victoria, Australia
| | - Debbie Nisbet
- Women's Ultrasound Melbourne, East Melbourne 3002, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville 3052, Victoria, Australia.,Department of Medicine and Radiology, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Nicole Martin
- Virtus Diagnostics and Pathology Services, Spring Hill 4000, Queensland, Australia
| | - Michael Bethune
- Specialist Women's Ultrasound, Box Hill 3128, Victoria, Australia
| | - Zeffie Poulakis
- Department of Paediatrics, University of Melbourne, Parkville 3052, Victoria, Australia.,Victorian Infant Hearing Screening Program, Centre for Community Child Health, Royal Children's Hospital, Parkville 3052, Victoria, Australia.,Prevention Innovation Group, Population Health, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia
| | - Jane Halliday
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville 3052, Victoria, Australia
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Gil-da-Silva-Lopes VL, Tacla MA, Sgardioli IC, Vieira TP, Monlleó IL. Brazil's Craniofacial Project: Different approaches on orofacial clefts and 22q11.2 deletion syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:912-927. [PMID: 33166033 DOI: 10.1002/ajmg.c.31852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022]
Abstract
This article reports the present situation of Brazilian health care in genetics for Orofacial Cleft (OFC) and 22q11.2 Deletions Syndrome (22q11.2 DS) based on research conducted by Brazil's Craniofacial Project (BCFP). Established in 2003, BCFP is a voluntary and cooperative network aiming to investigate the health care of people with these diseases and other craniofacial anomalies. The initiatives and research results are presented in four sections: (a) a comprehensive report of the Brazilian public health system in craniofacial genetics; (b) multicentric studies developed on OFC and 22q11.2 DS; (c) education strategies focused on addressing these conditions for both population and health-care professionals; and (d) the nosology through the Brazilian Database on Craniofacial Anomalies (BDCA). Since 2006, BDCA uses a standardized method with detailed clinical data collection, which allows for conducting studies on nosology, genotype-phenotype correlations, and natural history; data can also contribute to public policies. Currently, the BDCA stores data on 1,724 individuals, including 1,351 (78.36%) who were primarily admitted due to OFC and 373 (21.63%) with clinical suspicion of 22q11.2 DS. Chromosomal abnormalities/genomic imbalances were represented by 92/213 (43.19%) individuals with syndromic OFC, including 43 with 22q11.2 DS, which indicates the need for chromosomal microarray analysis in this group. The nosologic diversity reinforces that monitoring clinical is the best strategy for etiological investigation. BCFP's methodology has introduced the possibility of increasing scientific knowledge and genetic diagnosis of OFC and 22q11.2 DS to in turn improve health care and policies for this group of diseases.
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Affiliation(s)
- Vera Lúcia Gil-da-Silva-Lopes
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Milena Atique Tacla
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Ilária Cristina Sgardioli
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Társis Paiva Vieira
- Faculty of Medical Sciences, Department of Medical Genetics and Genomic Medicine, University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | - Isabella Lopes Monlleó
- Faculty of Medicine, Clinical Genetics Service, University Hospital, Medical Genetics Sector, Federal University of Alagoas-UFAL, Maceió, Alagoas, Brazil
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29
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Steffensen EH, Hyett J, Petersen OB, Vogel I. Increased prenatal detection of 22q11.2 deletion and 22q11.2 duplication after introduction of nationwide prenatal screening for trisomy 21, trisomy 13, and trisomy 18. Prenat Diagn 2020; 41:218-225. [PMID: 33080663 DOI: 10.1002/pd.5851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate time of diagnosis of 22q11.2 deletion and 22q11.2 duplication as well as trisomies 21, 13, and 18 before and after introduction of a prenatal screening program including combined first-trimester screening (cFTS) for the trisomies in Denmark in 2004. METHOD Cross-sectional, population-based register study employing The Danish Cytogenetic Central Register. Proportions of cases diagnosed 1998-2004 and 2005-2017 were compared before 14+0 and 22+0 weeks and birth (prenatal cases) or up to 1 or 10 years of age (postnatal cases). RESULTS In total, 4562 cases were included. From 1998-2004 to 2005-2017, the proportion of 22q11.2 deletion cases identified prenatally increased from 4.3% (95% CI: 0.9-12.0%) to 27.3% (21.2-34.0%), while for 22q11.2 duplication an increase from 0/6 to 26/87 (prenatal cases/all cases) was observed. Similarly, proportions of trisomies 21, 13, and 18 detected before birth increased. A greater proportion of the studied conditions was identified earlier in pregnancy, but not generally earlier in the postnatal course. CONCLUSION Proportions of 22q11.2 deletion and 22q11.2 duplication identified prenatally increased after introduction of a prenatal screening program not aimed specifically to identify these conditions,. A greater proportion of all cases were detected earlier in pregnancy, but not earlier postnatally, following introduction of screening.
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Affiliation(s)
- Ellen Hollands Steffensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark.,Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jonathan Hyett
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Royal Prince Alfred Hospital, Women and Babies, Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
| | - Olav Bjørn Petersen
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, København Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, København N, Denmark
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark.,Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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30
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Van L, Heung T, Malecki SL, Fenn C, Tyrer A, Sanches M, Chow EW, Boot E, Corral M, Dash S, George SR, Bassett AS. 22q11.2 microdeletion and increased risk for type 2 diabetes. EClinicalMedicine 2020; 26:100528. [PMID: 33089125 PMCID: PMC7565196 DOI: 10.1016/j.eclinm.2020.100528] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The 22q11.2 microdeletion is the pathogenic copy number variation (CNV) associated with 22q11.2 deletion syndrome (22q11.2DS, formerly known as DiGeorge syndrome). Familiar endocrinological manifestations include hypoparathyroidism and hypothyroidism, with recent elucidation of elevated risk for obesity in adults. In this study, we aimed to determine whether adults with 22q11.2DS have an increased risk of developing type 2 diabetes (T2D). METHODS We studied the effect of the 22q11.2 microdeletion on risk for T2D, defined by history and glycosylated hemoglobin (HbA1c), using weighted survey data from the adult Canadian population (based on n = 11,874) and from a clinical cohort of adults with 22q11.2DS (n = 314), aged 17-69 years. Binomial logistic regression models accounted for age, sex, non-European ethnicity, family history of T2D, obesity, and antipsychotic medication use. FINDINGS The 22q11.2 microdeletion was a significant independent risk factor for T2D (OR 2·44, 95% CI 1·39-4·31), accounting for other factors (p < 0·0001). All factors except sex were also significant within 22q11.2DS. The median age at diagnosis of T2D was significantly younger in 22q11.2DS than in the Canadian population sample (32 vs 50 years, p < 0·0001). In adults without T2D, HbA1c was significantly higher in 22q11.2DS than the population (p = 0·042), after accounting for younger age of the 22q11.2DS group. INTERPRETATION The results support the 22q11.2 microdeletion as a novel independent risk factor and potential model for early onset T2D. The findings complement emerging evidence that rare CNVs may contribute to risk for T2D. The results have implications for precision medicine and research into the underlying pathogenesis of T2D.
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Affiliation(s)
- Lily Van
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sarah L. Malecki
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian Fenn
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Tyrer
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcos Sanches
- Biostatistical Consulting Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Eva W.C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erik Boot
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Advisium, ’s Heeren Loo Zorggroep, Amersfoort, the Netherlands
| | - Maria Corral
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Satya Dash
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Banting & Best Diabetes Center, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Susan R. George
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Toronto Congenital Cardiac Centre for Adults, and Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Research Institute and Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
- Corresponding author at: The Dalglish Family 22q Clinic, Toronto General Hospital, 200 Elizabeth Street, 8NU-802 Toronto, ON M4G 2C5, Canada.
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31
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Loo JCY, Boot E, Corral M, Bassett AS. Personalized medical information card for adults with 22q11.2 deletion syndrome: An initiative to improve communication between patients and healthcare providers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1534-1540. [PMID: 32407568 DOI: 10.1111/jar.12747] [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: 09/13/2019] [Revised: 03/02/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many individuals with intellectual disabilities and their caregivers struggle to provide accurate and complete information to healthcare providers. METHOD The present authors provided personal medical information cards (PMICs) containing contact and medical information to 52 Canadian adults with 22q11.2 deletion syndrome, a genetic condition associated with intellectual disability. The authors invited them and/or their caregivers to complete a user satisfaction survey concerning usage of the card. RESULTS Forty-eight (92%) patients or their caregivers completed the survey. Twenty-two (46%) respondents used the PMIC over a median of 8 months during encounters with doctors and other professionals, and a majority of these used it more than once. Users reported finding the PMIC "very helpful" (86%) or "helpful" (14%), providing necessary information, speeding up interactions with professionals and helping avoid repeat storytelling. CONCLUSION Providing a PMIC to individuals with intellectual disabilities and their caregivers could help improve patient safety and assist in advocacy.
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Affiliation(s)
- Joanne C Y Loo
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,'s Heeren Loo Zorggroep, Amersfoort, The Netherlands
| | - Maria Corral
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Division of Cardiology, Toronto Congenital Cardiac Centre for Adults at the Peter Munk Cardiac Centre, Department of Medicine, and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Affiliation(s)
| | - Joann Norma Bodurtha
- Department of Genetic Medicine.,Departments of Pediatrics and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
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33
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Martin-Nalda A, Cueto-González AM, Argudo-Ramírez A, Marin-Soria JL, Martinez-Gallo M, Colobran R, Plaja A, Castells N, Riviere J, Tizzano EF, Soler-Palacin P. Identification of 22q11.2 deletion syndrome via newborn screening for severe combined immunodeficiency. Two years' experience in Catalonia (Spain). Mol Genet Genomic Med 2019; 7:e1016. [PMID: 31663686 PMCID: PMC6900354 DOI: 10.1002/mgg3.1016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/06/2019] [Accepted: 09/25/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The current scenario of newborn screening is changing as DNA studies are being included in the programs of several countries. Severe combined immunodeficiency (SCID) disorders can be detected using quantitative PCR assays to measure T-cell receptor excision circles (TRECs), a byproduct of correct T-cell development. However, in addition to SCID, other T-cell-deficient phenotypes such as 22q11.2 deletion syndrome 22q11.2 duplication syndrome, CHARGE syndrome, and trisomy 21 are detected. METHODS We present our experience with the detection of 22q11.2 deletion syndrome and 22q11.2 duplication syndrome in a series of 103,903 newborns included in the newborn screening program of Catalonia (Spain). RESULTS Thirty newborns tested were positive (low TREC levels) and five were found to have copy number variations at the 22q11 region (4 deletions and 1 duplication) when investigated with array comparative genomic hybridization technology and MLPA. CONCLUSION Newborn screening for SCID enables detection of several conditions, such as 22q syndromes, which should be managed by prompt, proactive approaches with adequate counseling for families by a multidisciplinary team.
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Affiliation(s)
- Andrea Martin-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Department of Pediatrics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Anna M Cueto-González
- Department of Clinical and Molecular Genetics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Ana Argudo-Ramírez
- Newborn screening laboratory, Section of Congenital Errors of Metabolism, Biochemistry and Molecular Genetics Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Jose L Marin-Soria
- Newborn screening laboratory, Section of Congenital Errors of Metabolism, Biochemistry and Molecular Genetics Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | - Roger Colobran
- Department of Clinical and Molecular Genetics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain.,Immunology Division, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Albert Plaja
- Department of Clinical and Molecular Genetics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Neus Castells
- Department of Clinical and Molecular Genetics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Jacques Riviere
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Department of Pediatrics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
| | - Eduardo F Tizzano
- Department of Clinical and Molecular Genetics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain.,CIBERER (Biomedical Research Center Network in Rare Diseases), Barcelona, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Department of Pediatrics, Vall d'Hebron Campus Hospitalari, Barcelona, Catalonia, Spain
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Van L, Heung T, Graffi J, Ng E, Malecki S, Van Mil S, Boot E, Corral M, Chow EWC, Hodgkinson KA, Silversides C, Bassett AS. All-cause mortality and survival in adults with 22q11.2 deletion syndrome. Genet Med 2019; 21:2328-2335. [PMID: 30948858 PMCID: PMC6774995 DOI: 10.1038/s41436-019-0509-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/25/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Given limited data available on long-term outcomes in 22q11.2 deletion syndrome (22q11.2DS), we investigated mortality risk in adults with this microdeletion syndrome. METHODS We studied 309 well-characterized adults (age ≥17 years) with 22q11.2DS and their 1014 unaffected parents and siblings, using a prospective case-control design. We used Cox proportional hazards regression modeling and Kaplan-Meier curves to investigate effects of the 22q11.2 deletion and its associated features on all-cause mortality and survival. RESULTS The 22q11.2 deletion (hazard ratio [HR] 8.86, 95% CI 2.87-27.37) and major congenital heart disease (CHD; HR 5.03, 95% CI 2.27-11.17), but not intellectual disability or psychotic illness, were significant independent predictors of mortality for adults with 22q11.2DS compared with their siblings. Amongst those with 22q11.2DS, there were 31 deaths that occurred at a median age of 46.4 (range 18.1-68.6) years; a substantial minority had outlived both parents. Probability of survival to age 45 years was approximately 72% for those with major CHD, and 95% for those with no major CHD (p < 0.0001). CONCLUSION For adults with 22q11.2DS, the 22q11.2 deletion and more severe forms of CHD both contribute to a lower life expectancy than family-based expectations. The results have implications for genetic counseling and anticipatory care.
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Affiliation(s)
- Lily Van
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Justin Graffi
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Enoch Ng
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Malecki
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Spencer Van Mil
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Erik Boot
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Maria Corral
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Eva W C Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kathleen A Hodgkinson
- Unit of Clinical Epidemiology, Memorial University of Newfoundland, St. Johns, NL, Canada
| | - Candice Silversides
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Toronto Congenital Cardiac Centre for Adults, and Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
- Toronto Congenital Cardiac Centre for Adults, and Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada.
- Toronto General Research Institute and Campbell Family Mental Health Research Institute, Toronto, ON, Canada.
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Sgardioli IC, Paoli Monteiro F, Fanti P, Paiva Vieira T, Gil-da-Silva-Lopes VL. Testing criteria for 22q11.2 deletion syndrome: preliminary results of a low cost strategy for public health. Orphanet J Rare Dis 2019; 14:123. [PMID: 31159889 PMCID: PMC6547599 DOI: 10.1186/s13023-019-1098-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/19/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The clinical heterogeneity of the 22q11.2 Deletion Syndrome (22q11.2DS - OMIM, #188400 and #192430) is a universal challenge leading to diagnostic delay. The aim of this study was to evaluate a low cost strategy for the diagnosis of this condition based upon clinical criteria previously reported. Health professionals, who collected clinical data, from twelve centers were trained in those criteria, which were summed through an online application (CranFlow). RESULTS Clinical and laboratorial data of 347 individuals registered from 2008 to 2017 in the Brazilian Database on Craniofacial Anomalies/22q11.2 Deletion Syndrome, were reviewed. They were divided in two groups: (I) 168 individuals investigated before the definition of the criteria and (II) 179 individuals investigated after the criteria application. All of them were investigated for 22q11.2DS by Fluorescent in situ Hybridization (FISH) and/or Multiplex Ligation Probe-dependent Amplification (MLPA), detecting 98 cases with 22q11.2DS. Among the individuals with 22q11.2DS in Group II, 42/53 (79.25%) fulfilled the proposed criteria against 11/53 (20.75%) who did not fulfill them (p < .0001). The association of congenital heart diseases with high predictive value for 22q11.2DS and hypernasal voice were significantly associated to the presence of 22q11.2DS (p = 0.0172 and p < .0001, respectively). In addition, 22q11.2DS was confirmed 3.82 more times when the individuals fulfilled the proposed criteria. Of the 249 cases negative for the typical deletion in 22q11.2, Chromosomal Microarray Analysis (CMA) was performed in 132 individuals and detected pathogenic alterations at other genomic regions in 19 individuals, and variants of uncertain clinical significance in 31 cases. CONCLUSIONS Therefore, a locus-specific approach could be used to individuals with positive criteria as a cost-effective alternative for 22q11.2DS diagnosis. The authors discuss advantages and suggest ways of implementing this approach to investigate 22q11.2DS in a public health system.
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Affiliation(s)
- Ilária Cristina Sgardioli
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP 13083-887 Brazil
| | - Fabíola Paoli Monteiro
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP 13083-887 Brazil
- Association of Parents and Friends of the Exceptional from Sao Paulo (Associação de Pais e Amigos dos Excepcionais de São Paulo – APAE-SP), Campinas, SP Brazil
| | - Paulo Fanti
- Department of Statistics, Faculty of Medical Science, State University of Campinas (Unicamp), Campinas, SP Brazil
| | - Társis Paiva Vieira
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP 13083-887 Brazil
| | - Vera Lúcia Gil-da-Silva-Lopes
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical Science, State University of Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, SP 13083-887 Brazil
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O’Rourke L, Murphy KC. Recent developments in understanding the relationship between 22q11.2 deletion syndrome and psychosis. Curr Opin Psychiatry 2019; 32:67-72. [PMID: 30394904 PMCID: PMC6419739 DOI: 10.1097/yco.0000000000000466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Individuals with 22q11.2 deletion syndrome have high rates of comorbid mental illness, particularly psychosis and schizophrenia. The purpose of this review is to summarize recent research in the area of 22q11.2 deletion syndrome and psychosis. RECENT FINDINGS Research over the past year has identified negative symptoms, functional impairment, dysphoric mood and a childhood diagnosis of attention deficit hyperactivity disorder as important clinical predictors of psychosis risk in 22q11.2 deletion syndrome. As previously reported in nondeleted schizophrenia, recent studies have implicated neuroinflammation as a possible neurobiological mechanism for psychosis in 22q11.2 deletion syndrome. Recent neuroimaging findings suggest that the cortex is significantly thinner in those with 22q11.2 deletion syndrome and psychosis compared to those without psychosis, replicating similar findings in nondeleted schizophrenia. Further data from the International 22q11.2 Deletion Syndrome Brain and Behavior Consortium have suggested that chromosomal microdeletions are significantly more likely to involve protein-coding genes and several rare copy number variants are associated with the presence of psychosis in deleted individuals. SUMMARY There have been several significant recent advances to further characterize the high rates of psychosis in 22q11.2 deletion syndrome, to identify additional clinical predictors of psychosis and to increase our understanding of the neural substrate and genetic aetiology of psychosis in 22q11.2 deletion syndrome.
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Affiliation(s)
- Linda O’Rourke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland
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Boot E, Bassett AS, Marras C. 22q11.2 Deletion Syndrome-Associated Parkinson's Disease. Mov Disord Clin Pract 2019; 6:11-16. [PMID: 30746410 PMCID: PMC6335527 DOI: 10.1002/mdc3.12687] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is a multisystem condition associated with an increased risk of early-onset Parkinson's disease (PD). METHODS We review the clinical, neuroimaging, and neuropathological observations, as well as diagnostic challenges, of PD in 22q11.2DS. We conducted a search of PubMed up until June 1, 2018 and personal files to identify relevant publications. RESULTS 22q11.2DS-associated PD is responsible for approximately 0.5% of early-onset PD. The hallmark motor symptoms and neuropathology of PD, and typical findings of reduced striatal dopamine transporter binding with molecular imaging, are present in 22q11.2DS-associated PD. Mean age at PD onset in 22q11.2DS is relatively young (∼40 years). Patients with 22q11.2DS-associated PD show a good response to levodopa. CONCLUSIONS Further recognition of 22q11.2DS and study of PD in people with 22q11.2DS could provide insights into the mechanisms that cause PD in the general population. 22q11.2DS may serve as an identifiable PD model to study prodromal PD and disease-modifying treatments.
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Affiliation(s)
- Erik Boot
- The Dalglish Family 22q Clinic for Adults, and Department of PsychiatryUniversity Health NetworkTorontoOntarioCanada
- ‘s Heeren Loo ZorggroepAmersfoortThe Netherlands
- Department of Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Anne S. Bassett
- The Dalglish Family 22q Clinic for Adults, and Department of PsychiatryUniversity Health NetworkTorontoOntarioCanada
- Toronto General Hospital Research Institute and Division of Cardiology, Department of MedicineUniversity Health NetworkTorontoOntarioCanada
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease ResearchToronto Western Hospital and University of TorontoTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
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Abstract
Hypoparathyroidism, a disorder characterized by hypocalcemia ensuing from inadequate parathyroid hormone secretion, is a rather rare disorder caused by multiple etiologies. When not caused by inadvertent damage or removal of the parathyroids during neck surgery, it is usually genetically determined. Epidemiological figures of this disease are still scarce and mainly limited to countries where non-anonymous databases are available and to surgical case series. Both the surgical and non-surgical forms pose diagnostic challenges. For surgical hypoparathyroidism, transient forms have to be ruled out even in the long term, in order to avoid unnecessary chronic replacement therapy with calcium and calcitriol. Regarding non-surgical hypoparathyroidism, once referred to as idiopathic, a systematic clinically and genetically-driven approach to define the precise diagnosis have to be pursued. In the case of syndromic hypoparathyroidism, patients have to be screened for associated abnormalities. Autoimmune, non-genetic hypoparathyroidism is still a diagnosis of exclusion, since no specific autoantibodies are specific for this condition.
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Affiliation(s)
- Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
| | - Gemma Marcucci
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
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Scarborough J, Mueller F, Weber-Stadlbauer U, Richetto J, Meyer U. Dependency of prepulse inhibition deficits on baseline startle reactivity in a mouse model of the human 22q11.2 microdeletion syndrome. GENES BRAIN AND BEHAVIOR 2018; 18:e12523. [PMID: 30267483 DOI: 10.1111/gbb.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
Hemizygous microdeletion at the chromosomal locus 22q11.2 is a copy number variation with strong genetic linkage to schizophrenia and related disorders. This association, along with its phenotypic overlap with the 22q11.2 microdeletion syndrome, has motivated the establishment of Df[h22q11]/+ mice, in which the human 22q11.2 orthologous region is deleted. Previous investigations using this model showed the presence of reduced prepulse inhibition (PPI) of the acoustic startle reflex, a form of sensorimotor gating known to be impaired in a number of psychiatric disorders. Concomitantly to reduced PPI, however, Df[h22q11]/+ mice are also characterized by a robust increase in baseline startle reactivity, which may complicate or confound the interpretation of PPI. Therefore, the present study re-examined the relationship between acoustic startle reactivity and PPI in this mouse model. We found that while PPI is reduced in Df[h22q11]/+ mice when using its relative indexation (ie, % PPI), this deficit is no longer apparent when using the absolute quantification, that is, the direct comparison between pulse-alone and prepulse-plus-pulse conditions with successively increasing prepulse intensities. We further identified marked negative correlations between % PPI and startle reactivity in Df[h22q11]/+ mice. Moreover, when stratifying Df[h22q11]/+ mice into subgroups displaying low- and high-startle reactivity, only the latter subgroup displayed a significant reduction in % PPI. Collectively, our data suggest that alterations in baseline startle reactivity can confound the outcomes and interpretation of PPI in this mouse model of the human 22q11.2 microdeletion syndrome.
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Affiliation(s)
- Joseph Scarborough
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Flavia Mueller
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Ulrike Weber-Stadlbauer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Juliet Richetto
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - Urs Meyer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland.,Neuroscience Centre Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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40
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McDonald-McGinn DM. 22q11.2 deletion syndrome: A tiny piece leading to a big picture. Am J Med Genet A 2018; 176:2055-2057. [PMID: 30380195 PMCID: PMC6472263 DOI: 10.1002/ajmg.a.40653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Donna M. McDonald-McGinn
- 22q and You Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Section of Genetic Counseling, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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