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Leal-Anaya P, Kimball TN, Yanez-Felix AL, Fiesco-Roa MÓ, García-de Teresa B, Monsiváis A, Juárez-Velázquez R, Lieberman E, Villarroel C, Yokoyama E, Fernández-Hernández L, Rivera-Osorio A, Sosa D, Ortiz Sandoval MM, López-Santiago N, Frías S, del Castillo V, Rodríguez A. Inherited bone marrow failure syndromes: phenotype as a tool for early diagnostic suspicion at a major reference center in Mexico. Front Genet 2024; 14:1293929. [PMID: 38327701 PMCID: PMC10848162 DOI: 10.3389/fgene.2023.1293929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction: The inherited bone marrow failure syndromes (IBMFSs) are a group of rare disorders characterized by bone marrow failure (BMF), physical abnormalities, and an increased risk of neoplasia. The National Institute of Pediatrics (INP) is a major medical institution in Mexico, where patients with BMF receive a complete approach that includes paraclinical tests. Readily recognizable features, such as the hematological and distinctive physical phenotypes, identified by clinical dysmorphologists, remain crucial for the diagnosis and management of these patients, particularly in circumstances where next-generation sequencing (NGS) is not easily available. Here, we describe a group of Mexican patients with a high clinical suspicion of an IBMFS. Methods: We performed a systematic retrospective analysis of the medical records of patients who had a high IBMFS suspicion at our institution from January 2018 to July 2021. An initial assessment included first ruling out acquired causes of BMF by the Hematology Department and referral of the patient to the Department of Human Genetics for physical examination to search for specific phenotypes suggesting an IBMFS. Patients with high suspicion of having an IBMFS were classified into two main groups: 1) specific IBMFS, including dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), Shwachman-Diamond syndrome (SDS), thrombocytopenia with absent radii (TAR), and severe congenital neutropenia (SCN); 2) undefined IBMFS (UI). Results: We established a high suspicion of having an IBMFS in 48 patients. At initial evaluation, the most common hematologic features were bicytopenia (20%) and aplastic anemia (16%); three patients received hematopoietic stem cell transplantation. Among patients with a suspicion of an IBMFS, the most common physical abnormality was minor craniofacial features in 83% of patients and neurodevelopmental disorders in 52%. The specific suspicions that we built were DBA (31%), SDS (18%), DC (14%), TAR (4%), and SCN (4%), whereas 27% of cases remained as undefined IBMFS. SDS, TAR, and SCN were more commonly suspected at an earlier age (<1 year), followed by DBA (2 years) and DC (5 years). Conclusions: Thorough examination of reported clinical data allowed us to highly suspect a specific IBMFS in approximately 70% of patients; however, an important number of patients remained with suspicion of an undefined IBMFS. Implementation of NGS and telomere length measurement are forthcoming measures to improve IBMFS diagnosis in Mexico.
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Affiliation(s)
- Paula Leal-Anaya
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
- Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, México City, Mexico
| | - Tamara N. Kimball
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
| | - Ana Lucia Yanez-Felix
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Moisés Ó. Fiesco-Roa
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Benilde García-de Teresa
- Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Angélica Monsiváis
- Departamento de Hematología, Instituto Nacional de Pediatría, México City, Mexico
| | | | - Esther Lieberman
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Camilo Villarroel
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Emiy Yokoyama
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | | | - Anet Rivera-Osorio
- Laboratorio de Análisis Genéticos Especializados México (LAGEM), México City, Mexico
| | - David Sosa
- Laboratorio de Análisis Genéticos Especializados México (LAGEM), México City, Mexico
| | | | - Norma López-Santiago
- Departamento de Hematología, Instituto Nacional de Pediatría, México City, Mexico
| | - Sara Frías
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | - Victoria del Castillo
- Departamento de Genética Humana, Instituto Nacional de Pediatría, México City, Mexico
| | - Alfredo Rodríguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Falla Medular y Carcinogénesis, Instituto Nacional de Pediatría, México City, Mexico
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Martínez-Hernández A, Martínez-Anaya D, Durán-McKinster C, Del Castillo-Ruiz V, Navarrete-Meneses P, Córdova EJ, Villegas-Torres BE, Ruiz-Herrera A, Juárez-Velázquez R, Yokoyama-Rebollar E, Cervantes-Barragán D, Pedraza-Meléndez A, Orozco L, Pérez-Vera P, Salas-Labadía C. Pigmentary mosaicism as a recurrent clinical manifestation in three new patients with mosaic trisomy 12 diagnosed postnatally: cases report and literature review. BMC Med Genomics 2022; 15:224. [PMCID: PMC9620619 DOI: 10.1186/s12920-022-01382-x] [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: 05/30/2022] [Accepted: 10/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background To date, only twenty-one cases diagnosed postnatally with mosaic trisomy 12 have been reported. The most frequent phenotypic manifestations are developmental delay, dysmorphic facial features, congenital heart defects, digital alterations, and pigmentary disorders. In the present report, detailed clinical and genetic profiles of three unrelated new patients with mosaic trisomy 12 are described and compared with previously reported cases. Case presentation In the present report, we include the clinical, cytogenetic, and molecular description of three Mexican patients diagnosed postnatally with mosaic trisomy 12. At phenotypic level, the three patients present with developmental delay, dysmorphic facial features, congenital heart defects and skin pigmentary anomalies. Particularly, patient 1 showed unique eye alterations as bilateral distichiasis, triple rows of upper lashes, and digital abnormalities. In patient 2 redundant skin, severe hearing loss, and hypotonia were observed, and patient 3 presented with hypertelorism and telecanthus. Hyperpigmentation with disseminated pigmentary anomalies is a common trait in all of them. The cytogenetic study was carried out under the strict criteria of analysis, screening 50–100 metaphases from three different tissues, showing trisomy 12 mosaicism in at least one of the three different tissues analyzed. With SNParray, the presence of low-level mosaic copy number variants not previously detected by cytogenetics, and uniparental disomy of chromosome 12, was excluded. STR markers allowed to confirm the absence of uniparental disomy as well as to know the parental origin of supernumerary chromosome 12. Conclusions The detailed clinical, cytogenetic, and molecular description of these three new patients, contributes with relevant information to delineate more accurately a group of patients that show a heterogeneous phenotype, although sharing the same chromosomal alteration. The possibility of detecting mosaic trisomy 12 is directly associated with the sensitivity of the methodology applied to reveal the low-level chromosomal mosaicism, as well as with the possibility to perform the analysis in a suitable tissue.
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Affiliation(s)
- A. Martínez-Hernández
- grid.452651.10000 0004 0627 7633Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica SS, Ciudad de Mexico, México
| | - D. Martínez-Anaya
- grid.419216.90000 0004 1773 4473Laboratorio de Genética y Cáncer, Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, 04530 México
| | - C. Durán-McKinster
- grid.419216.90000 0004 1773 4473Departamento de Dermatología, Instituto Nacional de Pediatría, Ciudad de Mexico, México
| | - V. Del Castillo-Ruiz
- grid.419216.90000 0004 1773 4473Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, México
| | - P. Navarrete-Meneses
- grid.419216.90000 0004 1773 4473Laboratorio de Genética y Cáncer, Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, 04530 México
| | - E. J. Córdova
- grid.452651.10000 0004 0627 7633Consorcio de Oncogenómica, Instituto Nacional de Medicina Genómica SS, Ciudad de Mexico, México
| | - B. E. Villegas-Torres
- grid.452651.10000 0004 0627 7633Instituto Nacional de Medicina Genómica SS, Ciudad de Mexico, México
| | - A. Ruiz-Herrera
- grid.414465.6Hospital de Especialidades Pediátrico de León, León, Guanajuato, México
| | - R. Juárez-Velázquez
- grid.419216.90000 0004 1773 4473Laboratorio de Genética y Cáncer, Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, 04530 México
| | - E. Yokoyama-Rebollar
- grid.419216.90000 0004 1773 4473Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, México
| | - D. Cervantes-Barragán
- grid.502779.e0000 0004 0633 6373Hospital Central Sur de Alta Especialidad, PEMEX, Ciudad de Mexico, México
| | - A. Pedraza-Meléndez
- grid.9486.30000 0001 2159 0001Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Ciudad de Mexico, México
| | - L. Orozco
- grid.452651.10000 0004 0627 7633Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica SS, Ciudad de Mexico, México
| | - P. Pérez-Vera
- grid.419216.90000 0004 1773 4473Laboratorio de Genética y Cáncer, Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, 04530 México
| | - C. Salas-Labadía
- grid.419216.90000 0004 1773 4473Laboratorio de Genética y Cáncer, Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de Mexico, 04530 México
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Fanconi Anemia Patients from an Indigenous Community in Mexico Carry a New Founder Pathogenic Variant in FANCG. Int J Mol Sci 2022; 23:ijms23042334. [PMID: 35216452 PMCID: PMC8877758 DOI: 10.3390/ijms23042334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 12/15/2022] Open
Abstract
Fanconi anemia (FA) is a rare genetic disorder caused by pathogenic variants (PV) in at least 22 genes, which cooperate in the Fanconi anemia/Breast Cancer (FA/BRCA) pathway to maintain genome stability. PV in FANCA, FANCC, and FANCG account for most cases (~90%). This study evaluated the chromosomal, molecular, and physical phenotypic findings of a novel founder FANCG PV, identified in three patients with FA from the Mixe community of Oaxaca, Mexico. All patients presented chromosomal instability and a homozygous PV, FANCG: c.511-3_511-2delCA, identified by next-generation sequencing analysis. Bioinformatic predictions suggest that this deletion disrupts a splice acceptor site promoting the exon 5 skipping. Analysis of Cytoscan 750 K arrays for haplotyping and global ancestry supported the Mexican origin and founder effect of the variant, reaffirming the high frequency of founder PV in FANCG. The degree of bone marrow failure and physical findings (described through the acronyms VACTERL-H and PHENOS) were used to depict the phenotype of the patients. Despite having a similar frequency of chromosomal aberrations and genetic constitution, the phenotype showed a wide spectrum of severity. The identification of a founder PV could help for a systematic and accurate genetic screening of patients with FA suspicion in this population.
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George M, Solanki A, Mohanty P, Dhangar S, Rajendran A, Mohan S, Vundinti BR. Nitric oxide synthase-2 (NOS2) gene polymorphism c.1832C>T (Ser608Leu) associated with nitrosative stress in Fanconi anaemia. Mol Biol Rep 2021; 48:2519-2525. [PMID: 33778919 DOI: 10.1007/s11033-021-06293-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Fanconi anemia (FA) occurs due to genomic instability with predisposition to bone marrow failure, phenotypic abnormalities and cancers. Though mutations in 22 genes leading to DNA repair defect have been identified, the cellular factor such as oxidative stress has also shown to be associated with FA. Nitrosative Stress (NS) is biochemically correlated to many oxidative stress related disorders and the NS as a pathological hallmark in FA has been so far overlooked. We carried out the study first time in Indian patients with FA with an objective to understand the role of NS in the pathogenesis of FA. The study was carried out in 70 FA subjects. The FA subjects were diagnosed by chromosomal breakage analysis. Molecular study was carried out by Next Generation Sequencing and Sanger sequencing. The 3-nitrotyrosine [3-NT] levels were estimated through enzyme-linked immuno-sorbent assay (ELISA) and the nitric oxide synthase genes- NOS1 (c.-420-34221G>A (rs1879417), c.-420-10205C>T (rs499776), c.4286+720G>C (rs81631)) and NOS2 (c.1823C>T (p. Ser608Leu) (rs2297518)) polymorphism were studied by direct sequencing. Chromosomal breakage analysis revealed a high frequency of chromosomal breaks (Mean chromosomal breakage-4.13 ± 1.5 breaks/metaphase) in 70 FA patients as compared to the control. Molecular studies revealed FANCA (58.34%), FANCG (18.34%) and FANCL (16.6%) complementation groups. The 3-nitrotyrosine [3-NT] levels showed to be significantly (p < 0.05) elevated in FA subjects when compared to the age match controls. Genotyping of the NOS2 gene c.1823C>T (p. Ser608Leu) (rs2297518), showed statistically significant (P < 0.05) association with FA. Elevated level of 3-NT is one of the cause of NS and NOS2 gene polymorphism associated with FA is an important target in the treatment regimen.
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Affiliation(s)
- Merin George
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K. E. M. Hospital Campus, Parel, Mumbai, 400 012, Maharashtra, India
| | - Avani Solanki
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K. E. M. Hospital Campus, Parel, Mumbai, 400 012, Maharashtra, India
| | - Purvi Mohanty
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K. E. M. Hospital Campus, Parel, Mumbai, 400 012, Maharashtra, India
| | - Somprakash Dhangar
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K. E. M. Hospital Campus, Parel, Mumbai, 400 012, Maharashtra, India
| | - Aruna Rajendran
- Department of Paediatric Haematology, Institute of Child Health and Hospital for Children, Chennai, India
| | - Sheila Mohan
- Department of Paediatric Haematology, Oncology, Apollo Speciality Hospital, Chennai, India
| | - Babu Rao Vundinti
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K. E. M. Hospital Campus, Parel, Mumbai, 400 012, Maharashtra, India.
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Chan SH, Ni Y, Li ST, Teo JX, Ishak NDB, Lim WK, Ngeow J. Spectrum of Germline Mutations Within Fanconi Anemia–Associated Genes Across Populations of Varying Ancestry. JNCI Cancer Spectr 2021; 5:6146409. [DOI: 10.1093/jncics/pkaa117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Fanconi anemia (FA) is a rare genetic disorder associated with hematological disorders and solid tumor predisposition. Owing to phenotypic heterogeneity, some patients remain undetected until adulthood, usually following cancer diagnoses. The uneven prevalence of FA cases with different underlying FA gene mutations worldwide suggests variable genetic distribution across populations. Here, we aim to assess the genetic spectrum of FA-associated genes across populations of varying ancestries and explore potential genotype–phenotype associations in cancer.
Methods
Carrier frequency and variant spectrum of potentially pathogenic germline variants in 17 FA genes (excluding BRCA1/FANCS, BRCA2/FANCD1, BRIP1/FANCJ, PALB2/FANCN, RAD51C/FANCO) were evaluated in 3523 Singaporeans and 7 populations encompassing Asian, European, African, and admixed ancestries from the Genome Aggregation Database. Germline and somatic variants of 17 FA genes in 7 cancer cohorts from The Cancer Genome Atlas were assessed to explore genotype–phenotype associations.
Results
Germline variants in FANCA were consistently more frequent in all populations. Similar trends in carrier frequency and variant spectrum were detected in Singaporeans and East Asians, both distinct from other ancestry groups, particularly in the lack of recurrent variants. Our exploration of The Cancer Genome Atlas dataset suggested higher germline and somatic mutation burden between FANCA and FANCC with head and neck and lung squamous cell carcinomas as well as FANCI and SLX4/FANCP with uterine cancer, but the analysis was insufficiently powered to detect any statistical significance.
Conclusion
Our findings highlight the diverse genetic spectrum of FA-associated genes across populations of varying ancestries, emphasizing the need to include all known FA-related genes for accurate molecular diagnosis of FA.
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Affiliation(s)
- Sock Hoai Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore
| | - Ying Ni
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shao-Tzu Li
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore
| | - Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
| | - Nur Diana Binte Ishak
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School Singapore, Singapore
- SingHealth Duke-NUS Genomic Medicine Centre, Singapore
| | - Joanne Ngeow
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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García-de Teresa B, Frias S, Molina B, Villarreal MT, Rodriguez A, Carnevale A, López-Hernández G, Vollbrechtshausen L, Olaya-Vargas A, Torres L. FANCC Dutch founder mutation in a Mennonite family from Tamaulipas, México. Mol Genet Genomic Med 2019; 7:e710. [PMID: 31044565 PMCID: PMC6565560 DOI: 10.1002/mgg3.710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Fanconi anemia (FA) (OMIM #227650) is a rare hereditary disease characterized by genomic instability. The clinical phenotype involves malformations, bone marrow failure, and cancer predisposition. Genetic heterogeneity is a remarkable feature of FA; at least 22 FANC genes are known to cooperate in a unique FA/BRCA repair pathway. A common rule on the mutations found in these genes is allelic heterogeneity, except for mutations known to have arisen from a founder effect like the FANCC c.67delG in the Dutch Mennonite Community. Here, we present an 11‐year‐old male patient, member of the Mennonite Community of Tamaulipas México, with a clinical and cytogenetic diagnosis of FA. Method Chromosome fragility test was performed in all siblings. Genomic DNA was obtained from peripheral blood samples. Sanger sequencing was used to identify the FANCC c.67delG mutation (NC_000009.11(NM_000136.2):c.67delG p.(Asp23IlefsTer23)) and its accompanying haplotype. Results The FANCC c.67delG mutation in 13 members of his family confirmed a FA diagnosis in two of his siblings and identified heterozygous carriers. Haplotype analysis supports that in this family, FA is caused by the founder mutation that initially appeared in Mennonite Dutch and followed this population's migrations through Canada and further to Mexico. Conclusion The identification of the FANCC c.67delG mutation in this family not only allows proper genetic counseling, but it also grants the possibility to raise awareness of FA risk among the Mennonite community living in Mexico.
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Affiliation(s)
| | - Sara Frias
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, México.,Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Bertha Molina
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, México
| | - María Teresa Villarreal
- Laboratorio de Enfermedades Cardiovasculares, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Alfredo Rodriguez
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Alessandra Carnevale
- Laboratorio de Enfermedades Mendelianas, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Gerardo López-Hernández
- Servicio de Trasplante de Células Progenitoras Hematopoyéticas, Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Alberto Olaya-Vargas
- Servicio de Trasplante de Células Progenitoras Hematopoyéticas, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Leda Torres
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, México
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