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Nissan E, Katz U, Levy-Shraga Y, Frizinsky S, Carmel E, Gothelf D, Somech R. Clinical Features in a Large Cohort of Patients With 22q11.2 Deletion Syndrome. J Pediatr 2021; 238:215-220.e5. [PMID: 34284033 DOI: 10.1016/j.jpeds.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate various clinical aspects, specifically regarding immune status, in a large cohort of patients with DiGeorge syndrome. STUDY DESIGN Data were collected for 98 patients with DiGeorge syndrome treated at a tertiary medical center. This included general information, laboratory results, and clinical features. RESULTS The median age at diagnosis was 2.0 years (range, 0.0-36.5 years). The most common symptoms that led to diagnosis were congenital heart defect, speech delay, palate anomalies, and developmental delay. Common clinical features included recurrent infections (76 patients), congenital heart diseases (61 patients), and otorhinolaryngology disorders (61 patients). Twenty patients had anemia; the incidence was relatively high among patients aged 6-59 months. Thrombocytopenia was present in 20 patients. Recurrent chest infections were significantly higher in patients with T cell and T cell subset deficiencies. Decreased T cell receptor excision circles were more common with increasing age (P < .001). Of the 27 patients hospitalized due to infection, pneumonia was a leading cause in 13. CONCLUSIONS Awareness of DiGeorge syndrome's typical and uncommon characteristics is important to improve diagnosis, treatment, surveillance, and follow-up.
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Affiliation(s)
- Ella Nissan
- Pediatric Department A and Immunology Service, Edmond and Lily Safra Children's Hospital, Jeffrey Modell Foundation Center, Tel Hashomer, Israel; Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Uriel Katz
- Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Edmond Safra International Congenital Heart Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Yael Levy-Shraga
- Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Endocrinology Unit, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Shirly Frizinsky
- Pediatric Department A and Immunology Service, Edmond and Lily Safra Children's Hospital, Jeffrey Modell Foundation Center, Tel Hashomer, Israel; Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Carmel
- Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Otorhinolaryngology Head and Neck Surgery Department, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Somech
- Pediatric Department A and Immunology Service, Edmond and Lily Safra Children's Hospital, Jeffrey Modell Foundation Center, Tel Hashomer, Israel; Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cárdenas-Nieto D, Forero-Castro M, Esteban-Pérez C, Martínez-Lozano J, Briceño-Balcázar I. The 22q11.2 Microdeletion in Pediatric Patients with Cleft Lip, Palate, or Both and Congenital Heart Disease: A Systematic Review. J Pediatr Genet 2020; 9:1-8. [PMID: 31976137 DOI: 10.1055/s-0039-1698804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is present in approximately 5 to 8% of patients with cleft lip, palate, or both (CL/P) and 75 to 80% of patients with congenital heart disease (CHD). In a literature review, we consider this association of 22q11.2DS in pediatric patients with CL/P and CHD. Early diagnosis of 22q11.2DS in pediatric patients with CL/P and CHD helps to optimize a multidisciplinary treatment approach for 22q11DS. Early diagnosis, thereby, can improve quality of life for these patients and awareness of other potential clinical implications that may require attention throughout the patient's life.
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Affiliation(s)
- Diana Cárdenas-Nieto
- Programa de Maestría en Ciencias Biológicas, Grupo de investigación en Ciencias Biomédicas (GICBUPTC), Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia.,Escuela de Ciencias Biológicas, Grupo de investigación en Ciencias Biomédicas (GICBUPTC), Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Maribel Forero-Castro
- Escuela de Ciencias Biológicas, Grupo de investigación en Ciencias Biomédicas (GICBUPTC), Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Clara Esteban-Pérez
- Escuela de Ciencias Biológicas, Grupo de investigación en Ciencias Biomédicas (GICBUPTC), Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Julio Martínez-Lozano
- Facultad de Medicina, Grupo de investigación en Genética Humana, Universidad de La Sabana, Chía, Colombia
| | - Ignacio Briceño-Balcázar
- Facultad de Medicina, Grupo de investigación en Genética Humana, Universidad de La Sabana, Chía, Colombia
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Cancrini C, Puliafito P, Digilio MC, Soresina A, Martino S, Rondelli R, Consolini R, Ruga EM, Cardinale F, Finocchi A, Romiti ML, Martire B, Bacchetta R, Albano V, Carotti A, Specchia F, Montin D, Cirillo E, Cocchi G, Trizzino A, Bossi G, Milanesi O, Azzari C, Corsello G, Pignata C, Aiuti A, Pietrogrande MC, Marino B, Ugazio AG, Plebani A, Rossi P. Clinical features and follow-up in patients with 22q11.2 deletion syndrome. J Pediatr 2014; 164:1475-80.e2. [PMID: 24657119 DOI: 10.1016/j.jpeds.2014.01.056] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/17/2013] [Accepted: 01/28/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the clinical manifestations at diagnosis and during follow-up in patients with 22q11.2 deletion syndrome to better define the natural history of the disease. STUDY DESIGN A retrospective and prospective multicenter study was conducted with 228 patients in the context of the Italian Network for Primary Immunodeficiencies. Clinical diagnosis was confirmed by cytogenetic or molecular analysis. RESULTS The cohort consisted of 112 males and 116 females; median age at diagnosis was 4 months (range 0 to 36 years 10 months). The diagnosis was made before 2 years of age in 71% of patients, predominantly related to the presence of heart anomalies and neonatal hypocalcemia. In patients diagnosed after 2 years of age, clinical features such as speech and language impairment, developmental delay, minor cardiac defects, recurrent infections, and facial features were the main elements leading to diagnosis. During follow-up (available for 172 patients), the frequency of autoimmune manifestations (P = .015) and speech disorders (P = .002) increased. After a median follow-up of 43 months, the survival probability was 0.92 at 15 years from diagnosis. CONCLUSIONS Our data show a delay in the diagnosis of 22q11.2 deletion syndrome with noncardiac symptoms. This study provides guidelines for pediatricians and specialists for early identification of cases that can be confirmed by genetic testing, which would permit the provision of appropriate clinical management.
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Affiliation(s)
- Caterina Cancrini
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy.
| | - Pamela Puliafito
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy
| | | | - Annarosa Soresina
- Pediatrics Clinic and Institute of Molecular Medicine "A. Nocivelli," University and Spedali Civili, Brescia, Italy
| | | | | | - Rita Consolini
- Department of Pediatrics and Reproductive Medicine, University of Pisa, Pisa, Italy
| | - Ezia Maria Ruga
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Padua, Padua, Italy
| | - Fabio Cardinale
- Department of Allergy and Pulmonology, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | - Andrea Finocchi
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy
| | - Maria Luisa Romiti
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy
| | - Baldassarre Martire
- Department of Pediatrics "Federico Vecchio" and Department of Biomedicine of the Development Age, University of Bari, Bari, Italy
| | - Rosa Bacchetta
- Pediatric Immunology San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Hospital, Milan, Italy
| | | | - Adriano Carotti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Davide Montin
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Emilia Cirillo
- Department of Pediatrics, "Federico II" University of Naples, Naples, Italy
| | - Guido Cocchi
- Department of Pediatrics and Neonatology, University of Bologna, Bologna, Italy
| | - Antonino Trizzino
- Department of Pediatric Oncology and Hematology, G. Di Cristina Children's Hospital, Palermo, Italy
| | - Grazia Bossi
- Department of Pediatrics IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Ornella Milanesi
- Department of Pediatrics, Division of Pediatric Cardiology, University of Padua Medical School, Padua, Italy
| | - Chiara Azzari
- Department of Pediatrics, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Claudio Pignata
- Department of Pediatrics, "Federico II" University of Naples, Naples, Italy
| | - Alessandro Aiuti
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy; Pediatric Immunology San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Hospital, Milan, Italy
| | | | - Bruno Marino
- Department of Pediatrics, "La Sapienza" University, Rome, Italy
| | - Alberto Giovanni Ugazio
- Division of Rheumatology, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Plebani
- Pediatrics Clinic and Institute of Molecular Medicine "A. Nocivelli," University and Spedali Civili, Brescia, Italy
| | - Paolo Rossi
- University Department of Pediatrics, Bambino Gesù Children's Hospital and Tor Vergata University, Rome, Italy
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Abstract
Congenital heart disease is a major cause of morbidity and mortality throughout life. Mutations in numerous transcription factors have been identified in patients and families with some of the most common forms of cardiac malformations and arrhythmias. This review discusses transcription factor pathways known to be important for normal heart development and how abnormalities in these pathways have been linked to morphological and functional forms of congenital heart defects. A comprehensive, current list of known transcription factor mutations associated with congenital heart disease is provided, but the review focuses primarily on three key transcription factors, Nkx2-5, GATA4, and Tbx5, and their known biochemical and genetic partners. By understanding the interaction partners, transcriptional targets, and upstream activators of these core cardiac transcription factors, additional information about normal heart formation and further insight into genes and pathways affected in congenital heart disease should result.
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Affiliation(s)
- David J McCulley
- Cardiovascular Research Institute and Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
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Hacıhamdioğlu B, Berberoğlu M, Şıklar Z, Doğu F, Bilir P, Erdeve ŞS, İkincioğulları A, Öçal G. Case report: two patients with partial DiGeorge syndrome presenting with attention disorder and learning difficulties. J Clin Res Pediatr Endocrinol 2011; 3:95-7. [PMID: 21750639 PMCID: PMC3119448 DOI: 10.4274/jcrpe.v3i2.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/01/2011] [Indexed: 12/01/2022] Open
Abstract
DiGeorge syndrome (DGS) has classically been characterized by the triad of clinical features including congenital cardiac defects, immune deficiencies secondary to aplasia or hypoplasia of the thymus, and hypocalcaemia due to small or absent parathyroid glands. The phenotypic features of these patients are much more variable and extensive than previously recognized. The acknowledgement of similarities and phenotypic overlap of DGS with other disorders associated with genetic defects in 22q11 has led to an expanded description of the phenotypic features of DGS including palatal/speech abnormalities, as well as cognitive, neurological and psychiatric disorders. Here, we report the cases of two DGS patients with dysmorphic facial features who were initially admitted to the Psychiatry Department for attention disorder and learning difficulties.
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Affiliation(s)
- Bülent Hacıhamdioğlu
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey.
| | - Merih Berberoğlu
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Figen Doğu
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Pelin Bilir
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Gönül Öçal
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
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Wozniak A, Wolnik-Brzozowska D, Wisniewska M, Glazar R, Materna-Kiryluk A, Moszura T, Badura-Stronka M, Skolozdrzy J, Krawczynski MR, Zeyland J, Bobkowski W, Slomski R, Latos-Bielenska A, Siwinska A. Frequency of 22q11.2 microdeletion in children with congenital heart defects in western poland. BMC Pediatr 2010; 10:88. [PMID: 21134246 PMCID: PMC3016365 DOI: 10.1186/1471-2431-10-88] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 12/06/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The 22q11.2 microdeletion syndrome (22q11.2 deletion syndrome -22q11.2DS) refers to congenital abnormalities, including primarily heart defects and facial dysmorphy, thymic hypoplasia, cleft palate and hypocalcaemia. Microdeletion within chromosomal region 22q11.2 constitutes the molecular basis of this syndrome. The 22q11.2 microdeletion syndrome occurs in 1/4000 births. The aim of this study was to determine the frequency of 22q11.2 microdeletion in 87 children suffering from a congenital heart defect (conotruncal or non-conotruncal) coexisting with at least one additional 22q11.2DS feature and to carry out 22q11.2 microdeletion testing of the deleted children's parents. We also attempted to identify the most frequent heart defects in both groups and phenotypic traits of patients with microdeletion to determine selection criteria for at risk patients. METHODS The analysis of microdeletions was conducted using fluorescence in situ hybridization (FISH) on metaphase chromosomes and interphase nuclei isolated from venous peripheral blood cultures. A molecular probe (Tuple) specific to the HIRA (TUPLE1, DGCR1) region at 22q11 was used for the hybridisation. RESULTS Microdeletions of 22q11.2 region were detected in 13 children with a congenital heart defect (14.94% of the examined group). Microdeletion of 22q11.2 occurred in 20% and 11.54% of the conotruncal and non-conotruncal groups respectively. Tetralogy of Fallot was the most frequent heart defect in the first group of children with 22q11.2 microdeletion, while ventricular septal defect and atrial septal defect/ventricular septal defect were most frequent in the second group. The microdeletion was also detected in one of the parents of the deleted child (6.25%) without congenital heart defect, but with slight dysmorphism. In the remaining children, 22q11.2 microdeletion originated de novo. CONCLUSIONS Patients with 22q11.2DS exhibit wide spectrum of phenotypic characteristics, ranging from discreet to quite strong. The deletion was inherited by one child. Our study suggests that screening for 22q11.2 microdeletion should be performed in children with conotruncal and non-conotruncal heart defects and with at least one typical feature of 22q11.2DS as well as in the deleted children's parents.
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Affiliation(s)
- Anna Wozniak
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland.
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Van Vooren S, Thienpont B, Menten B, Speleman F, De Moor B, Vermeesch J, Moreau Y. Mapping biomedical concepts onto the human genome by mining literature on chromosomal aberrations. Nucleic Acids Res 2007; 35:2533-43. [PMID: 17403693 PMCID: PMC1885641 DOI: 10.1093/nar/gkm054] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biomedical literature provides a rich but unstructured source of associations between chromosomal regions and biomedical concepts. By mining MEDLINE abstracts, we annotate the human genome at the level of cytogenetic bands. Our method creates a set of chromosomal aberration maps that associate cytogenetic bands to biomedical concepts from a variety of controlled vocabularies, including disease, dysmorphology, anatomy, development and Gene Ontology branches. The association between a band (e.g. 4p16.3) and a concept (e.g. microcephaly) is assessed by the statistical overrepresentation of this concept in the abstracts relating to this band. Our method is validated using existing genome annotation resources and known chromosomal aberration maps and is further illustrated through a case study on heart disease. Our chromosomal aberration maps provide diagnostics support to clinical geneticists, aid cytogeneticists to interpret and report cytogenetic findings and support researchers interested in human gene function. The method is available as a web application, aBandApart, at http://www.esat.kuleuven.be/abandapart/.
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Affiliation(s)
- Steven Van Vooren
- Department of Electrotechnical Engineering, Katholieke Universiteit Leuven, Kasteelpark Arenberg 10, B-3001 Heverlee, Belgium.
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