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Memar Montazerin S, Hassanzadeh S, Najafi H, Shojaei F, Kumanayaka D, Suleiman A. The genetics of spontaneous coronary artery dissection: a scoping review. J Cardiovasc Med (Hagerstown) 2024; 25:569-586. [PMID: 38916232 DOI: 10.2459/jcm.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a multifactorial process that involves predisposing factors and precipitating stressors. Genetic abnormality has been implicated to play a mechanistic role in the development of SCAD. This systematic review aims to summarize the current evidence concerning the link between SCAD and genetic abnormalities. METHODS We reviewed original studies published until May 2023 that reported SCAD patients with a genetic mutation by searching PubMed, Embase Ovid, and Google Scholar. Registries, cohort studies, and case reports were included if a definitive SCAD diagnosis was reported, and the genetic analysis was performed. Exclusion criteria included editorials, reviews, letters or commentaries, animal studies, meeting papers, and studies from which we were unable to extract data. Data were extracted from published reports. RESULTS A total of 595 studies were screened and 55 studies were identified. Among 116 SCAD patients with genetic abnormalities, 20% had mutations in the COL gene, 13.70% TLN1 gene, and 8.42% TSR1 gene. Mutations affecting the genes encoding COL and TLN1 were most frequently reported (20 and 13.7%, respectively). Interestingly, 15 genes of this collection were also reported in patients with thoracic aortic diseases as well. The genetic commonality between fibromuscular dysplasia (FMD) and SCAD was also included. CONCLUSION In this review, the inherited conditions and reported genes of undetermined significance from case reports associated with SCAD are collected. A brief description of the encoded protein and the clinical features associated with pathologic genes is provided. Current data suggested that the diagnostic yield of genetic studies for patients with SCAD would be low and routine genetic screening of such patients with no clinical features indicative of associated disorders remains debatable. This review can be used as a guide for clinicians to recognize inherited syndromic and nonsyndromic disorders associated with SCAD.
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Affiliation(s)
- Sahar Memar Montazerin
- Beth Israel Deaconess Medical Center, Harvard Medical School
- Department of Cardiology, Saint Michael's Medical Center, Newark, New Jersey
| | - Shakiba Hassanzadeh
- Department of Pathology, East Carolina University, Greenville, North Carolina, USA
| | - Homa Najafi
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Dilesha Kumanayaka
- Department of Cardiology, Saint Michael's Medical Center, Newark, New Jersey
| | - Addi Suleiman
- Department of Cardiology, Saint Michael's Medical Center, Newark, New Jersey
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2
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Li X, Fan J, Fu R, Peng M, He J, Chen Q, Wang S, Chen C. Case report: A novel R246L mutation in the LMX1B homeodomain causes isolated nephropathy in a large Chinese family. Medicine (Baltimore) 2024; 103:e37442. [PMID: 38457557 PMCID: PMC10919518 DOI: 10.1097/md.0000000000037442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Genetic factors contribute to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Advances in genetic testing have enabled the identification of hereditary kidney diseases, including those caused by LMX1B mutations. LMX1B mutations can lead to nail-patella syndrome (NPS) or nail-patella-like renal disease (NPLRD) with only renal manifestations. CASE PRESENTATION The proband was a 13-year-old female who was diagnosed with nephrotic syndrome at the age of 6. Then she began intermittent hormone and drug therapy. When she was 13 years old, she was admitted to our hospital due to sudden chest tightness, which progressed to end-stage kidney disease (ESRD), requiring kidney replacement therapy. Whole-Exome Sequencing (WES) results suggest the presence of LMX1B gene mutation, c.737G > T, p.Arg246Leu. Tracing her family history, we found that her father, grandmother, uncle and 2 cousins all had hematuria, or proteinuria. In addition to the grandmother, a total of 9 members of the family performed WES. The members with kidney involved all carry the mutated gene. Healthy members did not have the mutated gene. It is characterized by co-segregation of genotype and phenotype. We followed the family for 9 year, the father developed ESRD at the age of 50 and started hemodialysis treatment. The rest patients had normal renal function. No extra-renal manifestations associated with NPS were found in any member of the family. CONCLUSIONS This study has successfully identified missense mutation, c.737G > T (p.Arg246Leu) in the homeodomain, which appears to be responsible for isolated nephropathy in the studied family. The arginine to leucine change at codon 246 likely disrupts the DNA-binding homeodomain of LMX1B. Previous research has documented 2 types of mutations at codon R246, namely R246Q and R246P, which are known to cause NPLRD. The newly discovered mutation, R246L, is likely to be another novel mutation associated with NPLRD, thus expanding the range of mutations at the crucial renal-critical codon 246 that contribute to the development of NPLRD. Furthermore, our findings suggest that any missense mutation occurring at the 246th amino acid position within the homeodomain of the LMX1B gene has the potential to lead to NPLRD.
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Affiliation(s)
- Xian Li
- Xinxiang Medical Univeisity, Xinxiang, China
- Puyang Oilfield General Hospital, Puyang, China
| | - Jiaojiao Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Fu
- Puyang Oilfield General Hospital, Puyang, China
| | - Ming Peng
- Beijing Chigene Translational Medicine Research Center Co., Ltd, Beijing, China
| | - Jujie He
- Puyang Oilfield General Hospital, Puyang, China
| | | | | | - Chong Chen
- Puyang Oilfield General Hospital, Puyang, China
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3
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Kishio N, Iwama K, Nakanishi S, Shindo R, Yasui M, Nicho N, Takahashi A, Kohara M, Hirata M, Kemmotsu T, Tanoshima M, Ito S. A deletion variant in LMX1B causing nail-patella syndrome in Japanese twins. Hum Genome Var 2024; 11:10. [PMID: 38424113 PMCID: PMC10904864 DOI: 10.1038/s41439-024-00266-z] [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: 11/16/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 03/02/2024] Open
Abstract
Nail-patella syndrome (NPS) is a hereditary disease caused by pathogenic variants in LMX1B and characterized by nail, limb, and renal symptoms. This study revealed a likely pathogenic LMX1B variant, NM_002316.4: c.723_726delinsC (p.Ser242del), in Japanese twins with clubfoot. The patients' mother, who shared this variant, developed proteinuria after delivery. p.Ser242del is located in the homeodomain of the protein, in which variants that cause renal disease tend to cluster. Our findings highlight p.Ser242del as a likely pathogenic variant, expanding our knowledge of NPS.
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Affiliation(s)
- Nozomu Kishio
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan.
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
| | - Kazuhiro Iwama
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan.
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
- Department of Clinical Genetics, Yokohama City University Medical Center, Yokohama, Japan.
| | - Sayuri Nakanishi
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Clinical Genetics, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Clinical Genetics, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaki Yasui
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naoki Nicho
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Takahashi
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mana Kohara
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Michisato Hirata
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takahiro Kemmotsu
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Miki Tanoshima
- Department of Maternal and Perinatal Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Clinical Genetics, Yokohama City University Medical Center, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Morito N, Usui T, Ishibashi S, Yamagata K. Podocyte-specific Transcription Factors: Could MafB Become a Therapeutic Target for Kidney Disease? Intern Med 2023; 62:11-19. [PMID: 35249929 PMCID: PMC9876710 DOI: 10.2169/internalmedicine.9336-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The increasing number of patients with chronic kidney disease (CKD) is being recognized as an emerging global health problem. Recently, it has become clear that injury and loss of glomerular visceral epithelial cells, known as podocytes, is a common early event in many forms of CKD. Podocytes are highly specialized epithelial cells that cover the outer layer of the glomerular basement membrane. They serve as the final barrier to urinary protein loss through the formation and maintenance of specialized foot-processes and an interposed slit-diaphragm. We previously reported that the transcription factor MafB regulates the podocyte slit diaphragm protein production and transcription factor Tcf21. We showed that the forced expression of MafB was able to prevent CKD. In this review, we discuss recent advances and offer an updated overview of the functions of podocyte-specific transcription factors in kidney biology, aiming to present new perspectives on the progression of CKD and respective therapeutic strategies.
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Affiliation(s)
- Naoki Morito
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Toshiaki Usui
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Shun Ishibashi
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
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5
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Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders. Diagnostics (Basel) 2022; 12:diagnostics12082011. [PMID: 36010360 PMCID: PMC9407377 DOI: 10.3390/diagnostics12082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. Aims: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. Conclusions: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.
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6
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Loss of CLDN5 in podocytes deregulates WIF1 to activate WNT signaling and contributes to kidney disease. Nat Commun 2022; 13:1600. [PMID: 35332151 PMCID: PMC8948304 DOI: 10.1038/s41467-022-29277-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
Although mature podocytes lack tight junctions, tight junction integral membrane protein claudin-5 (CLDN5) is predominantly expressed on plasma membranes of podocytes under normal conditions. Using podocyte-specific Cldn5 knockout mice, we identify CLDN5 as a crucial regulator of podocyte function and reveal that Cldn5 deletion exacerbates podocyte injury and proteinuria in a diabetic nephropathy mouse model. Mechanistically, CLDN5 deletion reduces ZO1 expression and induces nuclear translocation of ZONAB, followed by transcriptional downregulation of WNT inhibitory factor-1 (WIF1) expression, which leads to activation of WNT signaling pathway. Podocyte-derived WIF1 also plays paracrine roles in tubular epithelial cells, as evidenced by the finding that animals with podocyte-specific deletion of Cldn5 or Wif1 have worse kidney fibrosis after unilateral ureteral obstruction than littermate controls. Systemic delivery of WIF1 suppresses the progression of diabetic nephropathy and ureteral obstruction-induced renal fibrosis. These findings establish a function for podocyte CLDN5 in restricting WNT signaling in kidney. Claudin-5 is a tight junction integral membrane protein, but it is also expressed in mature podocytes which lack tight junctions. Here the authors report that podocyte claudin-5 regulates WNT signaling activity by modulating WIF1 expression, and its downregulation contributes to kidney disease progression in mice.
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7
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Nail the Diagnosis in This Adult Woman. Int J Womens Dermatol 2021. [DOI: 10.1016/j.ijwd.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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8
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Vakharia RM, Meneses ZA, Ardeljan AD, Roche MW. Robotic-Assisted Lateral Unicompartmental Knee Arthroplasty in a Patient With Nail-Patella Syndrome. Arthroplast Today 2021; 8:171-175. [PMID: 33889699 PMCID: PMC8049876 DOI: 10.1016/j.artd.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
A 59-year-old woman with nail patella syndrome (NPS) presented with progressive and severe right knee pain for the past 3 years. Imaging demonstrated laterally dislocated patella, with asymmetric femoral trochlea, and advanced lateral compartment arthritis. The patient underwent robotic-assisted lateral unicompartmental knee arthroplasty (RAUKA). The patient saw marked improvements in patient-reported outcome measurements from her initial visit to the last follow-up visit. While treatment of knee osteoarthritis in patients with NPS can be difficult, especially with attempts of patellar realignment, we present a case of a patient who underwent RAUKA, with sustained improvements in patient outcomes and range of motion, at the 2-year follow-up visit. This study is the first of its kind to demonstrate the use of a novel technology in a rare condition.
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Affiliation(s)
- Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY
- Corresponding author. 927 49th Street, Brooklyn, NY 11219. Tel.: (678) 232 7451.
| | | | - Andrew D. Ardeljan
- Nova Southeastern University, Osteopathic School of Medicine, Ft. Lauderdale, FL
| | - Martin W. Roche
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, FL
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9
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Millard N. A rare disorder causing chronic joint pain in an adolescent. JAAPA 2021; 34:32-34. [PMID: 33470719 DOI: 10.1097/01.jaa.0000731500.86110.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This article describes a patient with chronic knee pain and deformities of her hands and feet that led to a diagnosis of nail-patella syndrome, a rare autosomal dominant disorder.
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Affiliation(s)
- Nicole Millard
- Nicole Millard practices in family medicine at Wake Forest Baptist Health in Mount Airy, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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10
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Hou L, Du Y, Wu Y, Zeng Y, Zhao C. Case Report: Corneal Leucoma as a Novel Clinical Presentation of Nail-Patella Syndrome in a 5-Year-Old Girl. Front Pediatr 2021; 9:638630. [PMID: 34195159 PMCID: PMC8236592 DOI: 10.3389/fped.2021.638630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
Nail-patella syndrome (NPS) is a rare autosomal-dominant disorder characterized by the classic tetrad of absent or hypoplastic finger and toe nails, absent or hypoplastic patella, skeletal deformities involving the elbow joints, and iliac horns. This disease is caused by heterozygous pathogenic variations in the LMX1B gene, which encodes the LIM homeodomain transcription factor protein (LMX1B). We report a case of corneal leucoma and dysplasia prior to overt steroid-resistant nephrotic syndrome (SRNS) in a patient with NPS. At presentation, the parents of a 5-year-old female patient reported their daughter had corneal leucoma, psychomotor delay and speech defect. We also noted the presence of bilateral edema of the lower extremities, hypertension, nail dystrophy, and the bilateral absence of patella. She developed steroid-resistant nephrotic syndrome. Lowe oculocerebrorenal syndrome and NPS were the conditions considered in differential diagnosis. Trio-based whole genome sequencing indicated a heterozygous de novo likely pathogenic variation in the LMX1B gene (c.805A>C [p.Asn269His]). Patients with NPS often develop nail, ocular, or orthopedic symptoms prior to nephrotic syndrome. Corneal leucoma may be a novel clinical presentation of NPS.
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Affiliation(s)
- Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yubin Wu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Zeng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chengguang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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11
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Heron CE, Flowers RH. Absent fingernails and missing finger skin folds in a 16-month-old boy. Pediatr Dermatol 2020; 37:e83-e84. [PMID: 33283927 DOI: 10.1111/pde.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Courtney E Heron
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - R Hal Flowers
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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12
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Carinelli S, Blanco OA, Perdomo-Ramirez A, Claverie-Martin F. Nail-Patella syndrome with early onset end-stage renal disease in a child with a novel heterozygous missense mutation in the LMX1B homeodomain: A case report. Biomed Rep 2020; 13:49. [PMID: 32963778 PMCID: PMC7490783 DOI: 10.3892/br.2020.1356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/20/2020] [Indexed: 01/18/2023] Open
Abstract
Nail-Patella syndrome (NPS) is an inherited disease characterized by nail and skeletal anomalies, nephropathy and glaucoma. The diagnosis of NPS is based on clinical findings, including hypoplastic or absent patella, dystrophic nails, dysplasia of the elbows and iliac horns. However, the main determinant of NPS prognosis is nephropathy, which may range from asymptomatic proteinuria to end-stage renal disease. NPS is caused by heterozygous loss-of-function mutations in the LMX1B gene, which encodes the LIM homeodomain transcription factor LMX1B. LMX1B serves an essential role in the physiological development of dorsal-ventral limb structures, morphogenesis and function of podocytes, as well as in development of the anterior segments of the eyes, and in certain types of neurons. The present study aimed to identify the disease-causing mutation in a 2-year old girl with nephrotic syndrome that evolved rapidly to end-stage renal disease. The patient showed classical symptoms of NPS including dystrophic nails and an absence of the patellae. DNA sequence analysis identified a novel missense variant in exon 4 of LMX1B (c.709T>C, p.S237P); this substitution affected a conserved serine residue in the homeodomain of LMX1B and was predicted to be pathogenic. In silico modeling of the homeodomain revealed that the p.S237P mutation converted the A236-S237-F238 segment of α-helix 1 into a strand. It was hypothesized that this mutation affected binding of the transcription factor to its target DNA, thus abrogating transcription activation, which would explain the phenotype that manifested in the patient.
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Affiliation(s)
- Soledad Carinelli
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - Olalla Alvarez Blanco
- Nefrologia Infantil, Hospital General Univesitario Gregorio Marañón, 28007 Madrid, Spain
| | - Ana Perdomo-Ramirez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - Felix Claverie-Martin
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
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Gardin MA, Khor CC, Silva L, Krefting EA, Ritch R. Plateau iris syndrome and angle-closure glaucoma in a patient with nail-patella syndrome. Am J Ophthalmol Case Rep 2020; 20:100886. [PMID: 32954044 PMCID: PMC7486444 DOI: 10.1016/j.ajoc.2020.100886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/17/2020] [Accepted: 08/16/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose To describe a case of plateau iris syndrome (PIS) and angle-closure glaucoma (ACG) in a patient with nail-patella syndrome (NPS). Observation A 33 year-old woman of Slovakian ancestry from Norway with a history of NPS presented with angle-closure secondary to plateau iris. At the time of her NPS diagnosis, she had no ocular pathology. Genetic testing revealed a rare de novo mutation in LMX1B [c.668G>C (p.Arg223Pro)]. Two years later, she experienced acute bilateral ocular pain and blurred vision in the setting of one year of reported visual loss. Subsequent ophthalmic examinations revealed closed angles and plateau iris OU with ACG OD and angle-closure OS. Perimetry showed superonasal visual field defects OD and no defects OS. Ocular coherence tomography (OCT) revealed thinning of the inferior pole of the optic nerve OD. Medical management proved ineffective. A laser peripheral iridotomy (LPI) OD was performed, without resolution of the angle-closure, and a diagnosis of plateau iris syndrome (PIS) was made. She was then treated with an argon laser peripheral iridoplasty (ALPI) and clear lens extraction with a posterior chamber intraocular lens (PCIOL) and goniosynechialysis OD, but her IOP remained elevated OU. She was referred to New York Eye and Ear Infirmary of Mount Sinai, where an LPI OS was performed, but angle-closure persisted, consistent with PIS. An ALPI OS with touch-up was performed, and her IOP normalized with dark-room gonioscopy revealing open angles OU. Conclusions And importance NPS has been associated with ocular hypertension (OHTN) and open-angle glaucoma (OAG); however, to our knowledge, no association between NPS and angle-closure has previously been reported. The case described here, of a patient with a rare de novo mutation and ocular findings of PIS with associated ACG, represents a novel genetic and clinical presentation of NPS.
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Affiliation(s)
- Margot A Gardin
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Chiea Chuen Khor
- Division of Human Genetics, Genome Institute of Singapore, 60 Biopolis St, Singapore, 138672, Singapore
| | - Luis Silva
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Einar A Krefting
- Eye Department, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
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Aşkın Ö, Engin B, Gencebay G, Tüzün Y. A multistep approach to the diagnosis of rare genodermatoses. Clin Dermatol 2020; 38:399-407. [PMID: 32972599 DOI: 10.1016/j.clindermatol.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Genodermatoses are heritable skin diseases that can cause significant morbidity and mortality. Most of them show characteristic cutaneous findings. Genodermatoses can be associated with extracutaneous system abnormalities. Diagnosing hereditary skin disorders is still a challenging task due to their rarity and diversity, due to diseases evolving over many years, and the initial manifestations not always being diagnostic; therefore, ongoing evaluation and surveillance is often required to make the accurate diagnosis. The algorithm for the diagnosis depends on a combination of thorough clinical and family history clinical examination, laboratory findings, consultation of multiple medical specialists, and molecular analysis. Diagnostic testing targeted at differentiation of similar genodermatoses may be required. Recognition is crucial for the initiation of the treatment for skin manifestations and detection of other extracutaneous abnormalities, including malignancy. Diagnostic accuracy and molecular diagnosis may help in providing a template for ongoing management, testing, and education and prognostication for families of children with genodermatoses.
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Affiliation(s)
- Özge Aşkın
- Department of Dermatology, Cerrahpasa-Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrahpasa-Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Güllü Gencebay
- Department of Dermatology, Cerrahpasa-Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Altınbas University, Istanbul, Turkey
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15
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Starace M, Di Altobrando A, Alessandrini A, Piraccini BM. A Double Case of Nail-Patella Syndrome in the Same Family: The Importance of Nail Changes as Diagnostic Clues for Renal Involvement. Skin Appendage Disord 2019; 5:405-408. [PMID: 31799274 DOI: 10.1159/000501046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Nail diseases are rarely given significant importance in general consultation and their specific examination is often neglected, while localization to the nails could be an initial sign of a syndrome or a systemic disorder. Although rarely, nail alterations could be a sign of a systemic disorder, in which a prompt observation is crucial for an early diagnosis. We describe the case of an elderly woman with a long history of nail dystrophy, previously labelled as nail fragility. On enquiry, similar nail changes were discovered to have affected the patient's son, who was visited the following week. Diagnosis of the Nail-Patella Syndrome (NPS) was suspected on the basis of nail alterations in both patients and confirmed by complementary radiographic examination. Screening for severe renal complications, which could have negatively affected the prognosis and have led to end-stage renal disease, followed. The prompt diagnosis of NPS and the associated diseases are mandatory for a correct management of these patients.
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Affiliation(s)
- Michela Starace
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Ambra Di Altobrando
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
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16
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Abstract
Cutaneous findings that appear in childhood may be the first sign of a hereditary tumor syndrome. Early detection of genodermatoses allows the patient and at-risk family members to be screened for associated malignancies. This article provides a brief description of the pathogenesis and clinical manifestations of various inherited disorders with skin involvement, along with treatment updates. Advances in molecular-based therapy have spurred development of novel treatment methods for various genodermatoses such as xeroderma pigmentosum (XP) and Gorlin-Goltz syndrome. Further studies are needed to better assess the efficacy of many of these new treatment options.
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Affiliation(s)
- Ramiz N Hamid
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
| | - Zeynep M Akkurt
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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17
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Bülow RD, Boor P. Extracellular Matrix in Kidney Fibrosis: More Than Just a Scaffold. J Histochem Cytochem 2019; 67:643-661. [PMID: 31116062 DOI: 10.1369/0022155419849388] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Kidney fibrosis is the common histological end-point of progressive, chronic kidney diseases (CKDs) regardless of the underlying etiology. The hallmark of renal fibrosis, similar to all other organs, is pathological deposition of extracellular matrix (ECM). Renal ECM is a complex network of collagens, elastin, and several glycoproteins and proteoglycans forming basal membranes and interstitial space. Several ECM functions beyond providing a scaffold and organ stability are being increasingly recognized, for example, in inflammation. ECM composition is determined by the function of each of the histological compartments of the kidney, that is, glomeruli, tubulo-interstitium, and vessels. Renal ECM is a dynamic structure undergoing remodeling, particularly during fibrosis. From a clinical perspective, ECM proteins are directly involved in several rare renal diseases and indirectly in CKD progression during renal fibrosis. ECM proteins could serve as specific non-invasive biomarkers of fibrosis and scaffolds in regenerative medicine. The gold standard and currently only specific means to measure renal fibrosis is renal biopsy, but new diagnostic approaches are appearing. Here, we discuss the localization, function, and remodeling of major renal ECM components in healthy and diseased, fibrotic kidneys and the potential use of ECM in diagnostics of renal fibrosis and in tissue engineering.
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Affiliation(s)
- Roman David Bülow
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
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18
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A novel small deletion of LMX1B in a large Chinese family with nail-patella syndrome. BMC MEDICAL GENETICS 2019; 20:71. [PMID: 31053111 PMCID: PMC6499979 DOI: 10.1186/s12881-019-0801-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/03/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Nail-patella syndrome (NPS) is an autosomal dominant developmental disorder most commonly characterized by dyplasia of nail or patella, the radial head or the humeral head hypoplasia, and, frequently ocular abnormalities and renal disease. It is caused by heterozygous loss-of-function mutations in the LMX1B gene, which encodes LIM homeodomain transcription factor and is essential for regulating the dorsal limb fate. METHODS A five generation pedigree was recruited. Genomic DNA was extracted from the peripheral blood samples. Mutation detection was performed by Sanger sequencing the LMX1B gene. In silico functional annotation of the variant was performed using the in silico predictors SIFT, PolyPhen-2 and Mutation Taster. RESULTS A novel heterozygous small deletion within exon 4 of LMX1B, c.712_714delTTC, was identified in a rare five-generation NPS pedigree. The mutation resulted in a deletion of the conserved amino acid phenylalanine at codon 238 (p.Phe238del), which located in the homeodomain of LMX1B may abolish DNA binding with the molecule. Conformational prediction showed that the variation could transform the helical structure comprising p.Phe234, p.Lys235, p.Ala236, and p.Ser237. CONCLUSION We identified a novel NPS-causing LMX1B mutation and expanded the spectrum of mutations in the LMX1B gene. The c.712_714delTTC mutation may affect the quaternary structure of LMX1B, which is essential for the specification of dorsal limb fate at both zeugopodal and autopodal levels, leading to typical NPS.
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Claverie-Martin F, Trindade A, Garcia-Gonzalez NC, Callejon AC. Novel missense mutation affecting the LIM-A domain of LMX1B in a family with Nail-Patella syndrome. Intractable Rare Dis Res 2019; 8:14-19. [PMID: 30881852 PMCID: PMC6409120 DOI: 10.5582/irdr.2018.01131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Nail-patella syndrome (NPS) is a rare autosomal dominant disease characterized by developmental defects of dorsal limb structures, the kidney, and the eye, that manifest as dysplastic nails, hypoplastic or absent patella, elbow dysplasia, iliac horns, glomerulopathy, and adult-onset glaucoma, respectively. This disorder is inherited in an autosomal dominant mode and is caused by heterozygous loss-of-function mutations in the LMX1B gene, which encodes the LIM homeodomain transcription factor LMX1B. In this study, we report the clinical findings of a Spanish family, from the Canary Islands, with three affected members who displayed varying phenotypes. DNA sequence analysis identified a novel heterozygous missense mutation in LMX1B, c.305A>G, p.(Y102C), that segregated with the disease. The tyrosine residue affected by the mutation is highly conserved in evolution, and is located in the LIM-A domain, next to one of the cysteine residues involved in zinc binding, suggesting that p.(Y102C) affects LMX1B function by disturbing its interactions with other proteins. Our results expand the mutation spectrum of LMX1B and provide insight into the molecular mechanisms of NPS pathology.
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Affiliation(s)
- Felix Claverie-Martin
- Unidad de Investigacion, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Address correspondence to:Dr. Félix Claverie-Martín, Unidad de Investigación, Hospital Nuestra Señora de Candelaria, Carretera del Rosario 145, 38010 Santa Cruz de Tenerife, Spain. E-mail:
| | - Amelia Trindade
- Unidad de Investigacion, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Present address:Departamento de Medicina, Centro de Ciências Biológicas e da Saude (CCBS), Universidade Federal de São Carlos, São Carlos, Brasil
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Toriu N, Ueno T, Mizuno H, Sekine A, Hayami N, Hiramatsu R, Sumida K, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Sawa N, Takaichi K, Fujii T, Hasegawa T, Amizuka N, Yanagita M, Ubara Y. Brown tumor diagnosed three years after parathyroidectomy in a patient with nail-patella syndrome: A case report. Bone Rep 2019; 10:100187. [PMID: 30627596 PMCID: PMC6319327 DOI: 10.1016/j.bonr.2018.100187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 12/04/2022] Open
Abstract
We report a 48-year-old Japanese man with a brown tumor of the right distal tibia. At the age of 25 years, hemodialysis was initiated due to nail-patella syndrome. Severe secondary hyperparathyroidism and osteoporosis progressed over time, so parathyroidectomy was performed at age 45. Spontaneous fracture of the right distal tibia occurred suddenly at age 48. Imaging studies revealed a bone tumor-like lesion and surgery was performed. The resected specimen was a brown mass consisting of multinucleated giant cells on a fibrous tissue background, and these findings were consistent with a diagnosis of brown tumor. Immunohistochemistry revealed that multinucleated giant cells near areas of bone matrix were positive for tartrate-resistant acid phosphatase and cathepsin K, but the majority of the giant cells in the lesion were negative for these markers. Even after parathyroidectomy, brown tumor should be considered in the differential diagnosis of bone tumor-like lesions in patients on long-term dialysis. This case suggests that osteoclast activation may not contribute to development of brown tumors, although these lesions are generally considered to arise from subperiosteal bone resorption related to osteoclast overactivity in patients with hyperparathyroidism.
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Key Words
- BAP, bone alkaline phosphatase
- BMD, bone mineral density
- Brown tumor
- Cathepsin K
- HD, hemodialysis
- HPT, hyperparathyroidism
- Hyperparathyroidism
- Nail-patella syndrome
- PTH, parathyroid hormone
- PTX, parathyroidectomy
- Parathyroidectomy
- RANKL, receptor for activator of nuclear factor-κB ligand
- SD, standard deviation
- STIR, short-tI inversion recovery
- TRAP, tartrate-resistant acid phosphatase
- Tartrate-resistant acid phosphatase
- γ-GTP, γ-glutamyl transpeptidase
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Affiliation(s)
- Naoya Toriu
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Toshiharu Ueno
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Hiroki Mizuno
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Noriko Hayami
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Keiichi Sumida
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Tomoka Hasegawa
- Hard Tissue Developmental Biology Department Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Amizuka
- Hard Tissue Developmental Biology Department Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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21
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Total knee arthroplasty in a patient with nail-patella syndrome (NPS). Knee 2019; 26:273-278. [PMID: 30503662 DOI: 10.1016/j.knee.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
Nail-patella syndrome (NPS) or hereditary onycho-osteodyaplasia is a rare genetic condition involving a mutation in the LMX1B gene affecting nails, elbows, knees, and pelvis. Due to the regulatory functions of the gene in many developmental processes through the body, patients with NPS experience wide-ranging musculoskeletal problems including patellar instability, fingernail anomalies, iliac exostoses/horns, and elbow abnormalities. The patellar changes often involve aplasia, hypoplasia, and chronic dislocation. Due to these musculoskeletal involvement, arthritis of joints can occur in patients with NPS causing severe pain and disability. This is a case report of a patient with NPS who underwent a total knee arthroplasty for symptomatic knee arthritis.
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