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Radiographic features of the skeleton in disorders of post-squalene cholesterol biosynthesis. Pediatr Radiol 2015; 45:965-76. [PMID: 25646736 DOI: 10.1007/s00247-014-3257-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/05/2014] [Accepted: 11/26/2014] [Indexed: 01/26/2023]
Abstract
Disorders of post-squalene cholesterol biosynthesis are inborn errors of metabolism characterised by multiple congenital abnormalities, including significant skeletal involvement. The most frequent and best-characterised example is the Smith-Lemli-Opitz syndrome. Nine other disorders are known, namely autosomal-recessive Antley-Bixler syndrome, Greenberg dysplasia, X-linked dominant chondrodysplasia punctata, X-linked recessive male emopamil-binding protein deficiency, CHILD syndrome, CK syndrome, sterol C4 methyloxidase-like deficiency, desmosterolosis and lathosterolosis. This study provides an overview of the radiologic features observed in these diseases. A common pattern of limb abnormalities is recognisable, including polydactyly, which is typically post-axial and rarely interdigital and can involve all four limbs, and syndactyly of the toes. Chondrodysplasia punctata is specifically associated with a subgroup of disorders of cholesterol biosynthesis (Greenberg dysplasia, CHILD syndrome, X-linked dominant chondrodysplasia punctata, male emopamil-binding protein deficiency). The possible occurrence of epiphyseal stippling in the Smith-Lemli-Opitz syndrome, initially reported, does not appear to be confirmed. Stippling is also associated with other congenital disorders such as chromosomal abnormalities, brachytelephalangic chondrodysplasia punctata (X-linked recessive chondrodysplasia punctata, disruptions of vitamin K metabolism, maternal autoimmune diseases), rhizomelic chondrodysplasia punctata (peroxisomal disorders) and lysosomal storage disorders. In the differential diagnosis of epiphyseal stippling, a moth-eaten appearance of bones, asymmetry, or presence of a common pattern of limb abnormalities indicate inborn errors of cholesterol biosynthesis. We highlight the specific differentiating radiologic features of disorders of post-squalene cholesterol biosynthesis.
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Posey JE, Burrage LC, Campeau PM, Lu JT, Eble TN, Kratz L, Schlesinger AE, Gibbs RA, Lee BH, Nagamani SCS. Adult presentation of X-linked Conradi-Hünermann-Happle syndrome. Am J Med Genet A 2015; 167:1309-14. [PMID: 25846959 PMCID: PMC4449285 DOI: 10.1002/ajmg.a.36899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022]
Abstract
Conradi-Hünermann-Happle syndrome, or X-linked dominant chondrodysplasia punctata type 2 (CDPX2), is a genodermatosis caused by mutations in EBP. While typically lethal in males, females with CDPX2 generally manifest by infancy or childhood with variable features including congenital ichthyosiform erythroderma, chondrodysplasia punctata, asymmetric shortening of the long bones, and cataracts. We present a 36-year-old female with short stature, rhizomelic and asymmetric limb shortening, severe scoliosis, a sectorial cataract, and no family history of CDPX2. Whole exome sequencing (WES) revealed a p.Arg63del mutation in EBP, and biochemical studies confirmed a diagnosis of CDPX2. Short stature in combination with ichthyosis or alopecia, cataracts, and limb shortening in an adult should prompt consideration of a diagnosis of CDPX2. As in many genetic syndromes, the hallmark features of CDPX2 in pediatric patients are not readily identifiable in adults. This demonstrates the utility of WES as a diagnostic tool in the evaluation of adults with genetic disorders.
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Affiliation(s)
- Jennifer E. Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Philippe M. Campeau
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - James T. Lu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Structural and Computational Biology & Molecular Physics, Baylor College of Medicine, Houston, TX, USA
| | - Tanya N. Eble
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Lisa Kratz
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alan E. Schlesinger
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Richard A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Brendan H. Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
- Howard Hughes Medical Institute, Houston, TX, USA
| | - Sandesh CS. Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
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Lefebvre M, Dufernez F, Bruel AL, Gonzales M, Aral B, Saint-Onge J, Gigot N, Desir J, Daelemans C, Jossic F, Schmitt S, Mangione R, Pelluard F, Vincent-Delorme C, Labaune JM, Bigi N, D'Olne D, Delezoide AL, Toutain A, Blesson S, Cormier-Daire V, Thevenon J, El Chehadeh S, Masurel-Paulet A, Joyé N, Vibert-Guigue C, Rigonnot L, Rousseau T, Vabres P, Hervé P, Lamazière A, Rivière JB, Faivre L, Laurent N, Thauvin-Robinet C. Severe X-linked chondrodysplasia punctata in nine new female fetuses. Prenat Diagn 2015; 35:675-84. [PMID: 25754886 DOI: 10.1002/pd.4591] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/09/2015] [Accepted: 02/28/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Conradi-Hünermann-Happle [X-linked dominant chondrodysplasia punctata 2 (CDPX2)] syndrome is a rare X-linked dominant skeletal dysplasia usually lethal in men while affected women show wide clinical heterogeneity. Different EBP mutations have been reported. Severe female cases have rarely been reported, with only six antenatal presentations. METHODS To better characterize the phenotype in female fetuses, we included nine antenatally diagnosed cases of women with EBP mutations. All cases were de novo except for two fetuses with an affected mother and one case of germinal mosaicism. RESULTS The mean age at diagnosis was 22 weeks of gestation. The ultrasound features mainly included bone abnormalities: shortening (8/9 cases) and bowing of the long bones (5/9), punctuate epiphysis (7/9) and an irregular aspect of the spine (5/9). Postnatal X-rays and examination showed ichthyosis (8/9) and epiphyseal stippling (9/9), with frequent asymmetric short and bowed long bones. The X-inactivation pattern of the familial case revealed skewed X-inactivation in the mildly symptomatic mother and random X-inactivation in the severe fetal case. Differently affected skin samples of the same fetus revealed different patterns of X-inactivation. CONCLUSION Prenatal detection of asymmetric shortening and bowing of the long bones and cartilage stippling should raise the possibility of CPDX2 in female fetuses, especially because the majority of such cases involve de novo mutations.
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Affiliation(s)
- Mathilde Lefebvre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Service d'Anatomo-Pathologie, Faculté de Médecine de Dijon, Dijon, France
| | - Fabienne Dufernez
- APHP, Hôpital Saint-Antoine, Biochimie B, Laboratoire de Référence pour le Diagnostic Génétique des Maladies Rares, Paris, France
| | - Ange-Line Bruel
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Marie Gonzales
- Service de Génétique et d'Embryologie Médicales, Université Paris VI, Hôpital Trousseau, Paris, France
| | - Bernard Aral
- Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | | | - Nadège Gigot
- Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | - Julie Desir
- Center for Medical Genetics, Hospital Erasme, ULB, Brussels, Belgium
| | - Caroline Daelemans
- Institut de Recherches Interdisciplinaires en Biologie Humaine et Moléculaire, Hôpital Erasme, Université Libre de Bruxelles, Brussel, Belgium
| | | | | | | | - Fanny Pelluard
- Service de pathologie, CHU de Bordeaux, Bordeaux, France
| | | | | | - Nicole Bigi
- Génétique médicale, CHRU Arnaud de Villeneuve, Montpellier, France
| | | | | | - Annick Toutain
- Service de Génétique, Centre Hospitalo-Universitaire Tours, Tours, France
| | - Sophie Blesson
- Service de Génétique, Centre Hospitalo-Universitaire Tours, Tours, France
| | | | - Julien Thevenon
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Salima El Chehadeh
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Alice Masurel-Paulet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France
| | - Nicole Joyé
- Service de Génétique et d'Embryologie Médicales, Université Paris VI, Hôpital Trousseau, Paris, France
| | - Claude Vibert-Guigue
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Rigonnot
- Service de Gynécologie-Obstétrique, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France
| | | | - Pierre Vabres
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Service de dermatologie, Hôpital Le Bocage, Dijon, France
| | - Philippe Hervé
- Service de Gynécologie, Centre Hospitalo-Universitaire Tours, Tours, France
| | - Antonin Lamazière
- Laboratory of Mass Spectrometry-APLIPID, Faculté de Médecine Pierre et Marie Curie, ER7-UPMC, Paris, France
| | - Jean-Baptiste Rivière
- GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France.,Laboratoire de Génétique Moléculaire, CHU Dijon, France
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
| | - Nicole Laurent
- Service d'Anatomo-Pathologie, Faculté de Médecine de Dijon, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, France.,GAD: EA4271 « Génétique des Anomalies du Développement » (GAD), FHU-TRANSLAD, Université de Bourgogne, Dijon, France
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Barkova E, Mohan U, Chitayat D, Keating S, Toi A, Frank J, Frank R, Tomlinson G, Glanc P. Fetal skeletal dysplasias in a tertiary care center: radiology, pathology, and molecular analysis of 112 cases. Clin Genet 2014; 87:330-7. [PMID: 24863959 DOI: 10.1111/cge.12434] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
Fetal skeletal dysplasias are a heterogeneous group of rare genetic disorders, affecting approximately 2.4-4.5 of 10,000 births. We performed a retrospective review of the perinatal autopsies conducted between the years 2002-2011 at our center. The study population consisted of fetuses diagnosed with skeletal dysplasia with subsequent termination, stillbirth and live-born who died shortly after birth. Of the 2002 autopsies performed, 112 (5.6%) were diagnosed with skeletal dysplasia. These 112 cases encompassed 17 of 40 groups of Nosology 2010. The two most common Nosology groups were osteogenesis imperfecta [OI, 27/112 (24%)] and the fibroblast growth factor receptor type 3 (FGFR3) chondrodysplasias [27/112 (24%)]. The most common specific diagnoses were thanatophoric dysplasia (TD) type 1 [20 (17.9%)], and OI type 2 [20 (17.9%)]. The combined radiology, pathology, and genetic investigations and grouping the cases using Nosology 2010 resulted in a specific diagnosis in 96 of 112 cases.
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Affiliation(s)
- E Barkova
- Department of Medical Imaging, South Shore Regional Hospital, Bridgewater, Nova Scotia, Canada
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Cañueto J, Girós M, González-Sarmiento R. The role of the abnormalities in the distal pathway of cholesterol biosynthesis in the Conradi-Hünermann-Happle syndrome. Biochim Biophys Acta Mol Cell Biol Lipids 2013; 1841:336-44. [PMID: 24036494 DOI: 10.1016/j.bbalip.2013.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
Conradi-Hünermann-Happle syndrome (CDPX2, OMIM 302960) is an inherited X-linked dominant variant of chondrodysplasia punctata (CP) caused by mutations in one gene of the distal pathway of cholesterol biosynthesis. It exhibits intense phenotypic variation and primarily affects the skin, bones and eyes. The ichthyosis following Blaschko's lines, chondrodysplasia punctata and cataracts are the typical clinical findings. The cardinal biochemical features are an increase in 8(9)-cholestenol and 8-dehydrocholesterol (8DHC), which suggest a deficiency in 3β-hydroxysteroid-Δ8,Δ7-isomerase, also called emopamil binding protein (EBP). The EBP gene is located on the short arm of the X chromosome (Xp11.22-p11.23) and encodes a 230 amino acid protein with dual function. Explaining the clinical phenotype in CDPX2 implies an understanding of both the genetics and biochemical features of this disease. CDPX2 displays an X-linked dominant pattern of inheritance, which is responsible for the distribution of lesions in some tissues. The clinical phenotype in CDPX2 results directly from impairment in cholesterol biosynthesis, and indirectly from abnormalities in the hedgehog signaling protein pathways. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.
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Affiliation(s)
- Javier Cañueto
- Department of Dermatology, University Hospital of Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain; IBSAL (Instituto de Investigación Biosanitaria de Salamanca), Spain.
| | - Marisa Girós
- Seccio Errors Congenits del Metabolisme, Servei de Bioquímica Clínica i Genética Molecular, Hospital Clinic Barcelona, Barcelona, Spain
| | - Rogelio González-Sarmiento
- IBSAL (Instituto de Investigación Biosanitaria de Salamanca), Spain; Molecular Medicine Unit, Faculty of Medicine, University of Salamanca, Campus Miguel de Unamuno S/N, Salamanca 37007, Spain; Laboratory 14, IBMCC-CSIC, University of Salamanca, Campus Miguel de Unamuno S/N, Salamanca 37007, Spain
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Hello M, David A, Barbarot S. [Conradi-Hünermann-Happle syndrome with unilateral distribution]. Ann Dermatol Venereol 2009; 137:44-7. [PMID: 20110068 DOI: 10.1016/j.annder.2009.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND X-linked dominant chondrodysplasia punctata, also known as Conradi-Hünermann-Happle syndrome or CDPX2, is a rare type of genodermatosis with heterogeneous clinical phenotypes. It is characterized by the association of usually bilateral and symmetrical Blaschko-linear cutaneous lesions, ocular involvement, morphological, and skeletal abnormalities (characteristic punctuate epiphyseal calcifications). CASE REPORT A female newborn was examined for a squamous glazed erythema mainly located on the left half of the body. Standard X-rays of the left wrist showed punctuate epiphyseal calcifications. The diagnosis was confirmed by molecular studies, which revealed a mutation on the gene encoding the 3beta-hydroxy-steroid-Delta(8), Delta(7)-isomerase. DISCUSSION We report the case of a baby girl with mainly unilateral skin lesions of CDPX2, possibly due to mosaicism associated with X-inactivation. A diagnosis of CDPX2 must be considered in the event of a female newborn with ichthyosiform Blaschko-linear cutaneous lesions of atypical topography.
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Affiliation(s)
- M Hello
- Clinique dermatologique, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44035 Nantes cedex 1, France
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