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Vocke CD, Fleming LR, Piskorski AM, Amin A, Phornphutkul C, de la Monte S, Vilboux T, Duncan F, Pellegrino J, Braddock B, Middelton LA, Schmidt LS, Merino MJ, Cowen EW, Introne WJ, Linehan WM, Smith ACM. A diagnosis of Birt-Hogg-Dubé syndrome in individuals with Smith-Magenis syndrome: Recommendation for cancer screening. Am J Med Genet A 2023; 191:490-497. [PMID: 36513625 PMCID: PMC10117402 DOI: 10.1002/ajmg.a.63049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
We report a series of four unrelated adults with Smith-Magenis syndrome (SMS) and concomitant features of Birt-Hogg-Dubé (BHD) syndrome based upon haploinsufficiency for FLCN and characteristic renal cell carcinomas and/or evidence of cutaneous fibrofolliculomas. Three of the cases constitute the first known association of histopathologically verified characteristic BHD-associated renal tumors in adults with SMS; the fourth was identified to have histologically confirmed skin fibrofolliculomas. Molecular analysis documented second-hit FLCN mutations in two of the three cases with confirmed BHD renal pathology. These cases suggest the need to expand management recommendations for SMS to include kidney cancer surveillance starting at 20 years of age, as per the screening recommendations for BHD syndrome.
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Affiliation(s)
- Cathy D. Vocke
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Leah R. Fleming
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Genetics, Saint Luke’s Genetics and Metabolic Clinic, Boise, Idaho, USA
| | - Anna M. Piskorski
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ali Amin
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chanika Phornphutkul
- Division of Human Genetics, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Suzanne de la Monte
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thierry Vilboux
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Folami Duncan
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland, USA
| | - Joan Pellegrino
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Bonnie Braddock
- Medical Genetics, Upstate Medical University, Syracuse, New York, USA
| | - Lindsay A. Middelton
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Laura S. Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Maria J. Merino
- Laboratory of Pathology Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Edward W. Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Wendy J. Introne
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Ann C. M. Smith
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
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Garayzábal E, Hidalgo I, Miranda de Souza ALD, da Silva NC, Giacheti CM, Pinato L. Sleep disturbances and behavior in Smith-Magenis syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104286. [PMID: 35779287 DOI: 10.1016/j.ridd.2022.104286] [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: 02/23/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Smith-Magenis syndrome (SMS) shows a collection of neurodevelopmental problems including mild to moderate intellectual disability, change-related anxiety, impulsivity, speech delay, Attention-Deficit/Hyperactivity Disorder (ADH) and sleep disturbances. Sleep disorders, when present, have been treated in several populations with consecutive improvements in cognitive and behavioral aspects. AIMS To better understand the existing relationships between sleep disturbances and behavioral problems in SMS syndrome this study describes the sleep and behavior problems in the SMS and explores the possible relation between both. METHODS AND PROCEDURES 17 individuals with SMS (50% males; 11.2 ± 4.9 years old) and 12 individuals with typical development (50% male; 11.1 ± 4.4 years old) were investigated using the Sleep Disturbance Scale for Children and the Child Behavior Checklist. RESULTS A high percentage (60%) of individuals with SMS have an indication of sleep disorders, being the most frequent disorders the sleep-wake transition disorders, and disorders of initiating and maintaining sleep with sleep latency higher than acceptable and total sleep time below acceptable. More than 94% of the SMS group presented clinical or borderline scores on the total behavioral problems scale. The most common behavioral problems were Externalizing Problems, Thought and Attention, ADH and Aggressive problems. There was a positive correlation between disorders of initiating and maintaining sleep, sleep-wake transition disorders, disorders of arousal, disorders of excessive somnolence and behavioral problems. CONCLUSIONS AND IMPLICATIONS The worse the sleep disturbances investigated, the more severe the behavioral problems characteristics reinforcing the importance to address the sleep problems in the treatment of SMS individuals.
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Affiliation(s)
- Elena Garayzábal
- Departamento de Lingüística General, Facultad de Filosofía y Letras, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
| | - Irene Hidalgo
- Departamento de Filología Española, Facultad de Filosofía y Letras, Universidad Autónoma de Madrid, 28049 Madrid, Spain; Facultad de Ciencias de la Salud, Universidad de Castilla La Mancha, 45600 Talavera de la Reina, Spain; Centro Universitario de Educación Superior (CUNIMAD), 28040 Madrid, Spain.
| | | | - Nathani Cristina da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
| | - Celia Maria Giacheti
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
| | - Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
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Savatt JM, Shimelis H, Moreno-De-Luca A, Strande NT, Oetjens MT, Ledbetter DH, Martin CL, Myers SM, Finucane BM. Frequency of truncating FLCN variants and Birt-Hogg-Dubé-associated phenotypes in a health care system population. Genet Med 2022; 24:1857-1866. [PMID: 35639097 PMCID: PMC9703446 DOI: 10.1016/j.gim.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Penetrance estimates of Birt-Hogg-Dubé syndrome (BHD)-associated cutaneous, pulmonary, and kidney manifestations are based on clinically ascertained families. In a health care system population, we used a genetics-first approach to estimate the prevalence of pathogenic/likely pathogenic (P/LP) truncating variants in FLCN, which cause BHD, and the penetrance of BHD-related phenotypes. METHODS Exomes from 135,990 patient-participants in Geisinger's MyCode cohort were assessed for P/LP truncating FLCN variants. BHD-related phenotypes were evaluated from electronic health records. Association between P/LP FLCN variants and BHD-related phenotypes was assessed using Firth's logistic regression. RESULTS P/LP truncating FLCN variants were identified in 35 individuals (1 in 3234 unrelated individuals), 68.6% of whom had BHD-related phenotype(s), including cystic lung disease (65.7%), pneumothoraces (17.1%), cutaneous manifestations (8.6%), and kidney cancer (2.9%). A total of 4 (11.4%) individuals had prior clinical BHD diagnoses. CONCLUSION In this health care population, the frequency of P/LP truncating FLCN variants is 60 times higher than the previously reported prevalence. Although most variant-positive individuals had BHD-related phenotypes, a minority were previously clinically diagnosed, likely because cutaneous manifestations, pneumothoraces, and kidney cancer were observed at lower frequencies than in clinical cohorts. Improved clinical recognition of cystic lung disease and education concerning its association with FLCN variants could prompt evaluation for BHD.
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Affiliation(s)
- Juliann M. Savatt
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania,Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Hermela Shimelis
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
| | - Andres Moreno-De-Luca
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania,Genomic Medicine Institute, Geisinger, Danville, Pennsylvania,Department of Radiology, Geisinger, Danville, Pennsylvania
| | - Natasha T. Strande
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania,Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Matthew T. Oetjens
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
| | - David H. Ledbetter
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania,Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Christa Lese Martin
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania,Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Scott M. Myers
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
| | - Brenda M. Finucane
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, Pennsylvania
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Rinaldi B, Villa R, Sironi A, Garavelli L, Finelli P, Bedeschi MF. Smith-Magenis Syndrome—Clinical Review, Biological Background and Related Disorders. Genes (Basel) 2022; 13:genes13020335. [PMID: 35205380 PMCID: PMC8872351 DOI: 10.3390/genes13020335] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
Smith-Magenis syndrome (SMS) is a complex genetic disorder characterized by distinctive physical features, developmental delay, cognitive impairment, and a typical behavioral phenotype. SMS is caused by interstitial 17p11.2 deletions (90%), encompassing multiple genes and including the retinoic acid-induced 1 gene (RAI1), or by pathogenic variants in RAI1 itself (10%). RAI1 is a dosage-sensitive gene expressed in many tissues and acting as transcriptional regulator. The majority of individuals exhibit a mild-to-moderate range of intellectual disability. The behavioral phenotype includes significant sleep disturbance, stereotypes, maladaptive and self-injurious behaviors. In this review, we summarize current clinical knowledge and therapeutic approaches. We further discuss the common biological background shared with other conditions commonly retained in differential diagnosis.
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Affiliation(s)
- Berardo Rinaldi
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
| | - Roberta Villa
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
| | - Alessandra Sironi
- Experimental Research Laboratory of Medical Cytogenetics and Molecular Genetics, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (A.S.); (P.F.)
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Segrate, 20090 Milan, Italy
| | - Livia Garavelli
- Clinical Genetics Unit, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Palma Finelli
- Experimental Research Laboratory of Medical Cytogenetics and Molecular Genetics, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy; (A.S.); (P.F.)
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Segrate, 20090 Milan, Italy
| | - Maria Francesca Bedeschi
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.R.); (R.V.)
- Correspondence:
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Finucane B, Oetjens MT, Johns A, Myers SM, Fisher C, Habegger L, Maxwell EK, Reid JG, Ledbetter DH, Kirchner HL, Martin CL. Medical manifestations and health care utilization among adult MyCode participants with neurodevelopmental psychiatric copy number variants. Genet Med 2021; 24:703-711. [PMID: 34906480 DOI: 10.1016/j.gim.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Recurrent pathogenic copy number variants (pCNVs) have large-effect impacts on brain function and represent important etiologies of neurodevelopmental psychiatric disorders (NPDs), including autism and schizophrenia. Patterns of health care utilization in adults with pCNVs have gone largely unstudied and are likely to differ in significant ways from those of children. METHODS We compared the prevalence of NPDs and electronic health record-based medical conditions in 928 adults with 26 pCNVs to a demographically-matched cohort of pCNV-negative controls from >135,000 patient-participants in Geisinger's MyCode Community Health Initiative. We also evaluated 3 quantitative health care utilization measures (outpatient, inpatient, and emergency department visits) in both groups. RESULTS Adults with pCNVs (24.9%) were more likely than controls (16.0%) to have a documented NPD. They had significantly higher rates of several chronic diseases, including diabetes (29.3% in participants with pCNVs vs 20.4% in participants without pCNVs) and dementia (2.2% in participants with pCNVs vs 1.0% participants without pCNVs), and twice as many annual emergency department visits. CONCLUSION These findings highlight the potential for genetic information-specifically, pCNVs-to inform the study of health care outcomes and utilization in adults. If, as our findings suggest, adults with pCNVs have poorer health and require disproportionate health care resources, early genetic diagnosis paired with patient-centered interventions may help to anticipate problems, improve outcomes, and reduce the associated economic burden.
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Affiliation(s)
- Brenda Finucane
- Geisinger, Autism & Developmental Medicine Institute, Lewisburg, PA.
| | | | - Alicia Johns
- Geisinger, Department of Population Health Sciences, Danville, PA
| | - Scott M Myers
- Geisinger, Autism & Developmental Medicine Institute, Lewisburg, PA
| | - Ciaran Fisher
- Geisinger, Autism & Developmental Medicine Institute, Lewisburg, PA
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Boot E, Linders CC, Tromp SH, van den Boogaard MJ, van Eeghen AM. Possible underreporting of pathogenic variants in RAI1 causing Smith-Magenis syndrome. Am J Med Genet A 2021; 185:3167-3169. [PMID: 34089220 PMCID: PMC8519085 DOI: 10.1002/ajmg.a.62380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Erik Boot
- Advisium, 's Heeren Loo, Amersfoort, The Netherlands.,The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Cathelijne C Linders
- Advisium, 's Heeren Loo, Amersfoort, The Netherlands.,Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sterre H Tromp
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Agnies M van Eeghen
- Advisium, 's Heeren Loo, Amersfoort, The Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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