1
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Yang L, Wu G, Yin H, Pan M, Zhu Y. Periventricular nodular heterotopias is associated with mutation at the FLNA locus-a case history and a literature review. BMC Pediatr 2023; 23:346. [PMID: 37422633 PMCID: PMC10329368 DOI: 10.1186/s12887-023-04161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Periventricular nodular heterotopia (PNH), associated with FLNA mutations, is a rare clinical condition potentially associated with multiple systemic conditions, including cardiac, pulmonary, skeletal, and cutaneous diseases. However, due to a paucity of information in the literature, accurate prognostic advice cannot be provided to patients with the disease. CASE PRESENTATION We report a 2-year-old female whose PNH was associated with a nonsense mutation in the q28 region of the X chromosome, in exon 31 of FLNA (c.5159dupA). The patient is currently seizure-free and has no congenital heart disease, lung disease or skeletal or joint issues, and her development is normal. CONCLUSIONS FLNA-associated PNH is a genetically-heterogeneous disease, and the FLNA mutation, c.5159dupA (p.Tyr1720*) is a newly identified pathogenic variant. FLNA characterization will help the clinical diagnosis and treatment of PNH and provide individualized genetic counseling for patients.
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Affiliation(s)
- Lin Yang
- Pediatric Department, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou, Zhejiang 310000 China
| | - GuangSheng Wu
- Pediatric Department, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou, Zhejiang 310000 China
| | - HuiMei Yin
- Pediatric Department, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou, Zhejiang 310000 China
| | - MengLan Pan
- Pediatric Department, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou, Zhejiang 310000 China
| | - YaFei Zhu
- Pediatric Department, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Hangzhou, Zhejiang 310000 China
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2
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Heterogenous Disease Course and Long-Term Outcome of Children's Interstitial Lung Disease Related to Filamin A Gene Variants. Ann Am Thorac Soc 2022; 19:2021-2030. [PMID: 35767027 DOI: 10.1513/annalsats.202202-142oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Variable disease course and outcomes have been reported in children's interstitial lung disease associated with FLNA (Filamin A gene) variants. Objectives: To further delineate long-term respiratory outcomes and identify potential contributing factors to severe disease course. Methods: We retrospectively collected longitudinal data from three centers on nine cases (one male) with FLNA variants and early respiratory disease onset (within the first 24 mo of life). Clinical, radiographic, and histopathologic data were analyzed, focusing on cardiorespiratory disease course. Results: All required early respiratory support (three invasive ventilation, three noninvasive ventilation, three supplemental oxygen), and all experienced frequent severe infective respiratory exacerbations. Three died in infancy from refractory respiratory failure and pulmonary hypertension (PH). The six surviving individuals were 3, 10, 11, 15, 18, and 33 years old at time of reporting. The extent of functional respiratory impairment decreased with age; at last follow-up, there were no individuals on home invasive ventilation, one on nocturnal noninvasive ventilation, four on oxygen, and one on no respiratory support. Spirometry consistently demonstrated moderate to severe obstructive defects (forced expiratory volume in 1 s/forced vital capacity [FVC] z-score, -3.76 to -1.77; percent predicted FVC, 31.5% to 92.1%). Seven required PH treatment in early childhood (7/9), and three of the survivors (3/6) still receive treatment. Radiologic and histopathologic findings were consistent among cases. Conclusions: Early mortality was common, but many survivors stabilized even after severe symptoms in infancy. All survivors had persistent obstructive defects on spirometry, and half have persistent or recurrent PH. These typical findings are suggestive of this rare diagnosis and should prompt consideration of genetic testing.
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3
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Burrage LC, Heinle JS, Cerfolio RH, Guillerman RP, Patel KR, Santiago NC, Hoover WC, Mallory GB. Application of lung volume reduction surgery for a child with filamin A (FLNA) mutations. Pediatr Pulmonol 2022; 57:224-230. [PMID: 34882997 DOI: 10.1002/ppul.25681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/23/2021] [Accepted: 09/04/2021] [Indexed: 11/07/2022]
Abstract
Diffuse lung disease in early childhood due to mutations in the filamin A gene has been recently reported. Clinical outcomes vary among individuals indicating variability in phenotype but a substantial proportion of reported cases in early life have ended up in death or lung transplantation. We recently encountered a school-aged child in whom the diagnosis of a filamin A mutation was delayed and the natural history of emphysematous lung disease was altered by serial lung volume reduction surgeries. She eventually underwent a bilateral lung transplant and we report the natural history of her disease and treatments applied herein.
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Affiliation(s)
- Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Robert H Cerfolio
- Department of Cardiovascular Surgery, Division of Thoracic Surgery, New York University Langone, New York, New York, USA
| | | | - Kalyani R Patel
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Nahir C Santiago
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Wynton C Hoover
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - George B Mallory
- Department of Pediatrics, Baylor College of Medicine, Section of Pediatric Pulmonology, Houston, Texas, USA
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4
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Billon C, Adham S, Hernandez Poblete N, Legrand A, Frank M, Chiche L, Zuily S, Benistan K, Savale L, Zaafrane-Khachnaoui K, Brehin AC, Bal L, Busa T, Fradin M, Quelin C, Chesneau B, Wahl D, Fergelot P, Goizet C, Mirault T, Jeunemaitre X, Albuisson J. Cardiovascular and connective tissue disorder features in FLNA-related PVNH patients: progress towards a refined delineation of this syndrome. Orphanet J Rare Dis 2021; 16:504. [PMID: 34863227 PMCID: PMC8642866 DOI: 10.1186/s13023-021-02128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND FLNA Loss-of-Function (LoF) causes periventricular nodular heterotopia type 1 (PVNH1), an acknowledged cause of seizures of various types. Neurological symptoms are inconstant, and cardiovascular (CV) defects or connective tissue disorders (CTD) have regularly been associated. We aimed at refining the description of CV and CTD features in patients with FLNA LoF and depicting the multisystemic nature of this condition. METHODS We retrospectively evaluated FLNA variants and clinical presentations in FLNA LoF patient with at least one CV or CTD feature, from three cohorts: ten patients from the French Reference Center for Rare Vascular Diseases, 23 patients from the national reference diagnostic lab for filaminopathies-A, and 59 patients from literature review. RESULTS Half of patients did not present neurological symptoms. Most patients presented a syndromic association combining CV and CTD features. CV anomalies, mostly aortic aneurysm and/or dilation were present in 75% of patients. CTD features were present in 75%. Variants analysis demonstrated an enrichment of coding variants in the CH1 domain of FLNA protein. CONCLUSION In FLNA LoF patients, the absence of seizures should not be overlooked. When considering a diagnosis of PVNH1, the assessment for CV and CTD anomalies is of major interest as they represent interlinked features. We recommend systematic study of FLNA within CTD genes panels, regardless of the presence of neurological symptoms.
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Affiliation(s)
- Clarisse Billon
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,INSERM, U970 PARCC, Université de Paris, Paris, France.
| | - Salma Adham
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Service de Médecine Vasculaire, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Natalia Hernandez Poblete
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Anne Legrand
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Michael Frank
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Laurent Chiche
- Faculté de médecine, Université de la Sorbonne, Paris, France.,Service de chirurgie vasculaire et endovasculaire, Centre aortique tertiaire, Hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stephane Zuily
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karelle Benistan
- Centre de Référence des Syndromes d'Ehlers-Danlos non Vasculaires, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France.,UMR U1179 INSERM, Université Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Laurent Savale
- Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, Université Paris-Sud, Le Plessis-Robinson, France.,Service de Pneumologie, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | | | - Anne-Claire Brehin
- INSERM U1245 , Normandy center for Genomic and Personalized Medicine, Normandie Univ, CHU Rouen, 76000, Rouen, France
| | - Laurence Bal
- Centre de référence régional Marfan et apparentés, Centre aortique, Hôpital La Timone, AP-HM, Marseille, France
| | - Tiffany Busa
- Département de Génétique Médicale, Hôpital La Timone, CHU de Marseille, Marseille, France
| | - Mélanie Fradin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Chloé Quelin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Bertrand Chesneau
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du Syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Denis Wahl
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Patricia Fergelot
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Cyril Goizet
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Faculté de médecine, Université de la Sorbonne, Paris, France
| | - Tristan Mirault
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Xavier Jeunemaitre
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Juliette Albuisson
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France.,Plateforme de Transfert en Biologie Cancérologique, Centre Georges François Leclerc - UNICANCER- Institut GIMI, Dijon, France
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5
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Franklin AD, Chaudhari BP, Koboldt DC, Machut KZ. Polymerase Gamma Mitochondrial DNA Depletion Syndrome Initially Presenting as Disproportionate Respiratory Distress in a Moderately Premature Neonate: A Case Report. Front Genet 2021; 12:664278. [PMID: 34194468 PMCID: PMC8238196 DOI: 10.3389/fgene.2021.664278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
A 32-week premature infant presented with respiratory failure, later progressing to pulmonary hypertension (PH), liver failure, lactic acidosis, and encephalopathy. Using exome sequencing, this patient was diagnosed with a rare Polymerase Gamma (POLG)-related mitochondrial DNA (mtDNA) depletion syndrome. This case demonstrates that expanding the differential to uncommon diagnoses is important for complex infants, even in premature neonates whose condition may be explained partially by their gestational age (GA). It also shows that patients with complex neonatal diseases with significant family history may benefit from exome sequencing for diagnosis.
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Affiliation(s)
- Andrew D Franklin
- Division of Neonatology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Bimal P Chaudhari
- Division of Genetic and Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, United States.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States.,The Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel C Koboldt
- The Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children's Hospital, Columbus, OH, United States
| | - Kerri Z Machut
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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6
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Shah AS, Black ED, Simon DM, Gambello MJ, Garber KB, Iannucci GJ, Riedesel EL, Kasi AS. Heterogeneous Pulmonary Phenotypes in Filamin A Mutation-Related Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:7-14. [PMID: 33734874 DOI: 10.1089/ped.2020.1280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Interstitial lung disease (ILD) has been recently reported in a few patients with pathogenic variants in the Filamin A (FLNA) gene with variable presentation and prognosis. This study evaluated the respiratory manifestations and clinical features in children with FLNA disease. Methods: We conducted a retrospective review of pediatric patients with variants in FLNA in a tertiary children's hospital. The clinical features, genotype, management, and outcomes were analyzed. Results: We identified 9 patients with variants in FLNA aged 15 months to 24 years, 4 females and 5 males. Six patients had abnormal chest imaging ranging from mild interstitial prominence to atelectasis, interstitial densities, and hyperinflation. Three patients with ILD presented during the neonatal period or early infancy with respiratory distress or respiratory failure requiring supplemental oxygen or assisted ventilation via tracheostomy. We report male twins with the same FLNA variant and lung disease, but different ages and clinical features at presentation eventually culminating in respiratory failure requiring assisted ventilation. All patients had FLNA variants identified by FLNA sequencing, had abnormal echocardiograms, and none of the patients underwent lung biopsy or lung transplantation. The outcomes were variable and could be as severe as chronic respiratory failure. Conclusion: The wide spectrum of respiratory manifestations and abnormal chest imaging in our study highlights the importance of evaluation for lung disease in patients with variants in FLNA. FLNA sequencing in suspected cases with ILD may obviate the need for a lung biopsy, prompt surveillance for progressive lung disease, and evaluation for associated clinical features.
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Affiliation(s)
- Amit S Shah
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Emily D Black
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Dawn M Simon
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | | | - Kathryn B Garber
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA.,EGL Genetics, Tucker, Georgia, USA
| | - Glen J Iannucci
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Erica L Riedesel
- Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Ajay S Kasi
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
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7
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Filamin A Mutations: A New Cause of Unexplained Emphysema in Adults? Chest 2021; 159:e131-e135. [PMID: 33678279 DOI: 10.1016/j.chest.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022] Open
Abstract
Emphysema is a chronic respiratory disorder characterized by destruction of alveoli, usually due to cigarette smoking or exposure to noxious particles or gases. Dysfunction of proteins that are involved in lung development and maintenance, such as alpha-1 antitrypsin, also contributes to emphysema. Filamin A (FLNA) is an actin-binding protein involved in cytoskeleton reorganization. Mutations in the FLNA gene classically lead to abnormal neuronal migration and connective and vascular tissue anomalies. Pulmonary manifestations consist of a wide range of pulmonary disorders that occur during infancy. We report the first familial case of emphysema in non- and very low-smoking adults who carry a loss-of-function mutation of the FLNA gene. The identification of this new risk factor for emphysema encourages (1) screening, prevention and monitoring of pulmonary disorders in patients with FLNA mutation and (2) screening for FLNA mutation in patients with early-onset emphysema that is associated with low-smoking or vascular or connective tissue anomalies.
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8
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Deng X, Li S, Qiu Q, Jin B, Yan M, Hu Y, Wu Y, Zhou H, Zhang G, Zheng X. Where the congenital heart disease meets the pulmonary arterial hypertension, FLNA matters: a case report and literature review. BMC Pediatr 2020; 20:504. [PMID: 33143682 PMCID: PMC7607646 DOI: 10.1186/s12887-020-02393-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Pediatric patients with genetic disorders have a higher incidence of pulmonary arterial hypertension (PAH) regardless of their heart defects. Filamin A (FLNA) mutation is recently recognized to be associated with pediatric pulmonary disorders, however, the clinical courses of PAH related to the mutation were reported in limited cases. Here, we presented a case and pooled data for better understanding of the correlation between FLNA mutation and pediatric PAH. Case presentation The patient was a 8-month-old female with repeated episodes of pneumonia. Physical examination revealed cleft lip, cleft palate and developmental retardation. Imaging examination showed a small atrial septal defect (ASD), central pulmonary artery enlargement, left upper lobe of lung atelectasis, and pulmonary infiltration. Genetic test showed she carried a de novo pathogenic variant of FLNA gene (c.5417-1G > A, p.-). Oral medications didn’t slow the progression of PAH in the patient, and she died two years later. Conclusions FLNA mutation causes rare but progressive PAH in addition to a wide spectrum of congenital heart disease and other comorbidities in pediatric patients. We highly recommend genetic testing for pediatric patients when suspected with PAH. Given the high mortality in this group, lung transplantation may offer a better outcome.
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Affiliation(s)
- Xiaoxian Deng
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Shanshan Li
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Qiu Qiu
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Bowen Jin
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Menghuan Yan
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Yuanpin Hu
- Laboratory of Molecular Cardiology, Wuhan Asia Heart hospital, 753 Jinghan Avn, 430022, Wuhan, China
| | - Yang Wu
- Imaging center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Hongmei Zhou
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Gangcheng Zhang
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China
| | - Xuan Zheng
- Congenital Heart Disease center, Wuhan Asia Heart hospital, 753 Jinghan Ave, 430022, Wuhan, China. .,Laboratory of Molecular Cardiology, Wuhan Asia Heart hospital, 753 Jinghan Avn, 430022, Wuhan, China.
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9
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Walsh R, Batra D, Dixit A, Bhatt JM. Clues beyond the lung: an unusual diagnosis in an infant with chronic lung disease. Breathe (Sheff) 2020; 16:190319. [PMID: 32494305 PMCID: PMC7249791 DOI: 10.1183/20734735.0319-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Kremer TM, Lindsay ME, Kinane TB, Hawley MH, Little BP, Mino-Kenudson M. Case 28-2019: A 22-Year-Old Woman with Dyspnea and Chest Pain. N Engl J Med 2019; 381:1059-1067. [PMID: 31509678 DOI: 10.1056/nejmcpc1904041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ted M Kremer
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Mark E Lindsay
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - T Bernard Kinane
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Megan H Hawley
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Brent P Little
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
| | - Mari Mino-Kenudson
- From the Department of Pediatrics, UMass Memorial Medical Center, and the Department of Pediatrics, University of Massachusetts Medical School, Worcester (T.M.K.), the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Massachusetts General Hospital, and the Departments of Pediatrics (M.E.L., T.B.K.), Radiology (B.P.L.), and Pathology (M.M.-K.), Harvard Medical School, Boston, and the Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge (M.H.H.) - all in Massachusetts
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Pelizzo G, Collura M, Puglisi A, Pappalardo MP, Agolini E, Novelli A, Piccione M, Cacace C, Bussani R, Corsello G, Calcaterra V. Congenital emphysematous lung disease associated with a novel Filamin A mutation. Case report and literature review. BMC Pediatr 2019; 19:86. [PMID: 30922288 PMCID: PMC6440113 DOI: 10.1186/s12887-019-1460-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Progressive lung involvement in Filamin A (FLNA)-related cerebral periventricular nodular heterotopia (PVNH) has been reported in a limited number of cases. CASE PRESENTATION We report a new pathogenic FLNA gene variant (c.7391_7403del; p.Val2464Alafs*5) in a male infant who developed progressive lung disease with emphysematous lesions and interstitial involvement. Following lobar resection, chronic respiratory failure ensued necessitating continuous mechanical ventilation and tracheostomy. Cerebral periventricular nodular heterotopia was also present. CONCLUSIONS We report a novel variant of the FLNA gene, associated with a severe lung disorder and PNVH. The lung disorder led to respiratory failure during infancy and these pulmonary complications may be the first sign of this disorder. Early recognition with thoracic imaging is important to guide genetic testing, neuroimaging and to define optimal timing of potential therapies, such as lung transplant in progressive lung disease.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital "G. di Cristina", ARNAS Civico-Di Cristina-Benfratelli, Via dei Benedettini, 1, 90134, Palermo, Italy.
| | - Mirella Collura
- Cystic Fibrosis and Respiratory Pediatric Center, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Aurora Puglisi
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Maria Pia Pappalardo
- Pediatric Radiology Unit, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Piccione
- Department of Sciences for Health Promotion and Mother and Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| | - Caterina Cacace
- Neonatal Intensive Care Unit, Hospital "Barone Romeo" Patti, ASP Messina, Messina, Italy
| | - Rossana Bussani
- Institute of Pathological Anatomy, Trieste University Hospital, Trieste, Italy
| | - Giovanni Corsello
- Pediatrics and Neonatal Intensive Therapy Unit, Mother and Child Department, University of Palermo, Palermo, Italy
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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12
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Sasaki E, Byrne AT, Phelan E, Cox DW, Reardon W. A review of filamin A mutations and associated interstitial lung disease. Eur J Pediatr 2019; 178:121-129. [PMID: 30547349 DOI: 10.1007/s00431-018-3301-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
The filamin A gene (FLNA) on Xq28 encodes the filamin A protein. Mutation in FLNA causes a wide spectrum of disease including skeletal dysplasia, neuronal migration abnormality, cardiovascular malformation, intellectual disability and intestinal obstruction. Recently, childhood-onset interstitial lung disease associated with a range of FLNA mutations has been recognised and reported. We document our personal experience of this emerging disorder and compile a comprehensive overview of clinical features and molecular changes in all identifiable published cases. Reviewing the emerging dataset, we underline this unanticipated phenotypic consequence of pathogenic FLNA mutation-associated pulmonary disease.Conclusion: From the emerging data, we suggest that while reviewing complex cases with a sustained oxygen requirement against a clincial background of cardiac concerns or intestinal obstruction to have a high index of suspicion for FLNA related pathology and to instigate early MRI brain scan and FLNA mutation analysis. What is Known: • FLNA gene on Xq28 encodes the filamin A protein and mutation therein is associated with variable phenotypes depending on its nature of mutation. • Loss-of-function mutation of filamin A is associated with X-linked inherited form of periventricular nodular heterotopia with or without epilepsy with most individuals affected being female. There is a recently recognised associated respiratory phenotype. What is New: • The respiratory phenotype in the form of childhood interstitial lung disease is a recently recognised clinical consequence of loss-of-function FLNA mutation. • Rare male patients with loss-of-function FLNA mutation-associated lung disease with residual protein function can survive into infancy with a severe form of the phenotype.
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Affiliation(s)
- Erina Sasaki
- Clinical Genetics Department, Our Lady's Children's Hospital, Dublin, Ireland.
| | - Angela T Byrne
- Paediatric Radiology Department, Our Lady's Children's Hospital, Dublin, Ireland
| | - Ethna Phelan
- Paediatric Radiology Department, Our Lady's Children's Hospital, Dublin, Ireland
| | - Desmond W Cox
- Paediatric Respiratory Department, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - William Reardon
- Clinical Genetics Department, Our Lady's Children's Hospital, Dublin, Ireland
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13
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Park H, Park MS, Ki CS, Cho J, Lee J, Kim J, Ahn K. A case of FLNAgene mutation with respiratory insufficiency and periventricular heterotopia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.3.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hwanhee Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Seung Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joongbum Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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14
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Calcaterra V, Avanzini MA, Mantelli M, Agolini E, Croce S, De Silvestri A, Re G, Collura M, Maltese A, Novelli A, Pelizzo G. A case report on filamin A gene mutation and progressive pulmonary disease in an infant: A lung tissued derived mesenchymal stem cell study. Medicine (Baltimore) 2018; 97:e13033. [PMID: 30557962 PMCID: PMC6319781 DOI: 10.1097/md.0000000000013033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mesenchymal stem cells (MSC) play a crucial role in both the maintenance of pulmonary integrity and the pathogenesis of lung disease. Lung involvement has been reported in patients with the filamin A (FLNA) gene mutation. Considering FLNA's role in the intrinsic mechanical properties of MSC, we characterized MSCs isolated from FLNA-defective lung tissue, in order to define their pathogenetic role in pulmonary damage. PATIENT CONCERNS A male infant developed significant lung disease resulting in emphysematous lesions and perivascular and interstitial fibrosis. He also exhibited general muscular hypotonia, bilateral inguinal hernia, and deformities of the lower limbs (pes tortus congenitalis and hip dysplasia). Following lobar resection, chronic respiratory failure occurred. DIAGNOSIS Genetic testing was performed during the course of his clinical care and revealed a new pathogenic variant of the FLNA gene c.7391_7403del; (p.Val2464AlafsTer5). Brain magnetic resonance imaging revealed periventricular nodular heterotopia. INTERVENTIONS AND OUTCOMES Surgical thoracoscopic lung biopsy was performed in order to obtain additional data on the pathological pulmonary features. A small portion of the pulmonary tissue was used for MSC expansion. Morphology, immunophenotype, differentiation capacity, and proliferative growth were evaluated. Bone marrow-derived mesenchymal stem cells (BM-MSC) were employed as a control. MSCs presented the typical MSC morphology and phenotype while exhibiting higher proliferative capacity (P <.001) and lower migration potential (P=.02) compared to control BM-MSC. LESSONS The genetic profile and altered features of the MSCs isolated from FLNA-related pediatric lung tissue could be directly related to defects in cell migration during embryonic lung development and pulmonary damage described in FLNA-defective patients.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Unit, Department of Internal Medicine University of Pavia and Fondazione IRCCS Policlinico San Matteo
| | - Maria Antonietta Avanzini
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S, Matteo, Pavia
| | - Melissa Mantelli
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S, Matteo, Pavia
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome
| | - Stefania Croce
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S, Matteo, Pavia
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Giuseppe Re
- Pediatric Anesthesiology and Intensive Care Unit
| | | | - Alice Maltese
- Immunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S, Matteo, Pavia
| | - Antonio Novelli
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome
| | - Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
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15
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Deloison B, Sonigo P, Millischer-Bellaiche AE, Quibel T, Cavallin M, Benoist G, Quelin C, Jouk PS, Lev D, Alison M, Baumann C, Beldjord C, Razavi F, Bessières B, Boddaert N, Ville Y, Salomon LJ, Bahi-Buisson N. Prenatally diagnosed periventricular nodular heterotopia: Further delineation of the imaging phenotype and outcome. Eur J Med Genet 2018; 61:773-782. [PMID: 30391507 DOI: 10.1016/j.ejmg.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Periventricular nodular heterotopia (PNH) is a malformation of cortical development which presents with heterogeneous imaging, neurological phenotype and outcome. There is a paucity of comprehensive description detailing the prenatal diagnosis of PNH. The aim of this study is to report neuroimaging features and correlated outcomes in order to delineate the spectrum of prenatally diagnosed PNH. METHODS It was a retrospective study over 15 years in five tertiary centers. All fetuses with prenatally diagnosed PNH were collected. Fetal ultrasound and MRI were reviewed and genetic screening collected. Prenatal findings were analyzed in correlation to fetopathological analyses and post-natal follow up. RESULTS Thirty fetuses (22 females and 8 males) with PNH were identified. The two major ultrasound signs were ventriculomegaly associated with dysmorphic frontal horns (60%) and posterior fossa anomalies (73.3%). On MRI, two groups of PNH were identified: the contiguous and diffuse PNH (n = 15, 50%), often associated with megacisterna magna, and the non-diffuse, either anterior, posterior or unilateral PNH. FLNA mutations were found in 6/11 cases with diffuse PNH. Additional cortical malformations were exclusively observed in non diffuse PNH (9/15; 60%). Twenty-four pregnancies (80%) were terminated. Six children aged 6 months to 5 years are alive. Five have normal neurodevelopment (all had diffuse PNH) whereas one case with non diffuse PNH has developmental delay and epilepsy. CONCLUSION PNH is heterogeneous but patients with diffuse PNH are a common subgroup with specific findings on prenatal imaging and implications for prenatal counseling.
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Affiliation(s)
- B Deloison
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - P Sonigo
- Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A E Millischer-Bellaiche
- Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Quibel
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - M Cavallin
- Université Paris Descartes - Sorbonne Paris Cités, France; Institut Imagine-INSERM UMR-1163, Embryology and genetics of congenital malformations, France; Pediatric Neurology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Benoist
- Department of Obstetrics and Gynecology, Caen Hospital, Caen Basse Normandie University, France
| | - C Quelin
- Clinical Genetic Department, Rennes Hospital, France
| | - P S Jouk
- Clinical Genetic Department, Grenoble Hospital, France
| | - D Lev
- Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - M Alison
- Pediatric Radiology, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Baumann
- Clinical Genetics Department, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Beldjord
- Department of Molecular Genetics, Cochin-Port-Royal Université Paris Descartes - Sorbonne Paris Cités, Paris, France
| | - F Razavi
- Fetopathology Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Bessières
- Fetopathology Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Boddaert
- Université Paris Descartes - Sorbonne Paris Cités, France; Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - L J Salomon
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - N Bahi-Buisson
- Université Paris Descartes - Sorbonne Paris Cités, France; Institut Imagine-INSERM UMR-1163, Embryology and genetics of congenital malformations, France; Pediatric Neurology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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16
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Demirel N, Ochoa R, Dishop MK, Holm T, Gershan W, Brottman G. Respiratory distress in a 2-month-old infant: Is the primary cause cardiac, pulmonary or both? Respir Med Case Rep 2018; 25:61-65. [PMID: 30003023 PMCID: PMC6039757 DOI: 10.1016/j.rmcr.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022] Open
Abstract
A 2-month-old female with worsening cough, respiratory distress and an abnormal chest X-ray was referred to our institution for further evaluation of suspected scimitar syndrome. She was found to have normal pulmonary venous drainage with a large patent ductus arteriosus and severe pulmonary arterial hypertension. Chest CT was suggestive of interstitial lung disease. Wedge lung biopsy revealed alveolar simplification and patchy pulmonary interstitial glycogenosis. A definitive diagnosis of Filamin A deficiency was made with genetic studies. The patient is currently showing clinical improvement on systemic glucocorticoid therapy.
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Affiliation(s)
- Nadir Demirel
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roberto Ochoa
- Department of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Megan K Dishop
- Pathology and Laboratory Medicine, Phoenix Children's, Phoenix, AZ, USA
| | - Tara Holm
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - William Gershan
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Gail Brottman
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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17
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Shelmerdine SC, Semple T, Wallis C, Aurora P, Moledina S, Ashworth MT, Owens CM. Filamin A (FLNA) mutation-A newcomer to the childhood interstitial lung disease (ChILD) classification. Pediatr Pulmonol 2017; 52:1306-1315. [PMID: 28898549 DOI: 10.1002/ppul.23695] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/26/2017] [Indexed: 11/11/2022]
Abstract
AIM Interstitial lung disease (ILD) in infants represents a rare and heterogenous group of disorders, distinct from those occurring in adults. In recent years a new entity within this category is being recognized, namely filamin A (FLNA) mutation related lung disease. Our aims are to describe the clinical and radiological course of patients with this disease entity to aid clinicians in the prognostic counseling and management of similar patients they may encounter. METHOD A retrospective case note review was conducted of all patients treated at our institution (a specialist tertiary referral childrens' center) for genetically confirmed FLNA mutation related lung disease. The clinical presentation, evolution, management and radiological features were recorded and a medical literature review of Medline indexed articles was conducted. RESULTS We present a case series of four patients with interstitial lung disease and genetically confirmed abnormalities within the FLNA gene. Their imaging findings all reveal a pattern of predominantly upper lobe overinflation, coarse pulmonary lobular septal thickening and diffuse patchy atelectasis. The clinical outcomes of our patients have been variable ranging from infant death, lobar resection and need for supplemental oxygen and bronchodilators. CONCLUSION The progressive nature of the pulmonary aspect of this disorder and need for early aggressive supportive treatment make identification crucial to patient management and prognostic counseling.
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Affiliation(s)
| | - Thomas Semple
- Department of Clinical Radiology, The Royal Brompton Hospital, London, UK
| | - Colin Wallis
- Department of Respiratory Paediatrics, Great Ormond Street Hospital, London, UK
| | - Paul Aurora
- Department of Respiratory Paediatrics, Great Ormond Street Hospital, London, UK
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital, London, UK
| | | | - Catherine M Owens
- Department of Clinical Radiology, Great Ormond Street Hospital, London, UK
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18
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Burrage LC, Guillerman RP, Das S, Singh S, Schady DA, Morris SA, Walkiewicz M, Schecter MG, Heinle JS, Lotze TE, Lalani SR, Mallory GB. Lung Transplantation for FLNA-Associated Progressive Lung Disease. J Pediatr 2017; 186:118-123.e6. [PMID: 28457522 PMCID: PMC5534178 DOI: 10.1016/j.jpeds.2017.03.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/10/2017] [Accepted: 03/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. STUDY DESIGN We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. RESULTS Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. CONCLUSIONS Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients.
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Affiliation(s)
- Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | | | - Shailendra Das
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
| | - Shipra Singh
- Division of Pulmonology, Department of Pediatrics, State University of New York - Buffalo
| | | | - Shaine A. Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine
| | | | - Marc G. Schecter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati School of Medicine
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine
| | - Timothy E. Lotze
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine
| | - Seema R. Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | - George B. Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
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Spagnolo P, Bush A. Interstitial Lung Disease in Children Younger Than 2 Years. Pediatrics 2016; 137:peds.2015-2725. [PMID: 27245831 DOI: 10.1542/peds.2015-2725] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Childhood interstitial lung disease (chILD) represents a highly heterogeneous group of rare disorders associated with substantial morbidity and mortality. Although our understanding of chILD remains limited, important advances have recently been made, the most important being probably the appreciation that disorders that present in early life are distinct from those occurring in older children and adults, albeit with some overlap. chILD manifests with diffuse pulmonary infiltrates and nonspecific respiratory signs and symptoms, making exclusion of common conditions presenting in a similar fashion an essential preliminary step. Subsequently, a systematic approach to diagnosis includes a careful history and physical examination, computed tomography of the chest, and some or all of bronchoscopy with bronchoalveolar lavage, genetic testing, and if diagnostic uncertainty persists, lung biopsy. This review focuses on chILD presenting in infants younger than 2 years of age and discusses recent advances in the classification, diagnostic approach, and management of chILD in this age range. We describe novel genetic entities, along with initiatives that aim at collecting clinical data and biologic samples from carefully characterized patients in a prospective and standardized fashion. Early referral to expert centers and timely diagnosis may have important implications for patient management and prognosis, but effective therapies are often lacking. Following massive efforts, international collaborations among the key stakeholders are finally starting to be in place. These have allowed the setting up and conducting of the first randomized controlled trial of therapeutic interventions in patients with chILD.
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Affiliation(s)
- Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland, and University of Basel, Liestal, Switzerland;
| | - Andrew Bush
- Royal Brompton Hospital and Harefield NHS Foundation Trust, London, United Kingdom; and National Heart and Lung Institute, Imperial College, London, United Kingdom
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20
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Eltahir S, Ahmad KS, Al-Balawi MM, Bukhamsien H, Al-Mobaireek K, Alotaibi W, Al-Shamrani A. Lung disease associated with filamin A gene mutation: a case report. J Med Case Rep 2016; 10:97. [PMID: 27091362 PMCID: PMC4836084 DOI: 10.1186/s13256-016-0871-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mutations in the gene encoding filamin A (FLNA) lead to diseases with high phenotypic diversity including periventricular nodular heterotopia, skeletal dysplasia, otopalatodigital spectrum disorders, cardiovascular abnormalities, and coagulopathy. FLNA mutations were recently found to be associated with lung disease. In this study, we report a novel FLNA gene associated with significant lung disease and unique angiogenesis. CASE PRESENTATION Here, we describe a 1-year-old Saudi female child with respiratory distress at birth. The child then had recurrent lower respiratory tract infections, bilateral lung emphysema with basal atelectasis, bronchospasm, pulmonary artery hypertension, and oxygen and mechanical ventilation dependency. Molecular testing showed a new pathogenic variant of one copy of c.3153dupC in exon 21 in the FLNA gene. CONCLUSIONS Our data support previous reports in the literature that associate FLNA gene mutation and lung disease.
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Affiliation(s)
- Safa Eltahir
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Khalid S Ahmad
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Mohammed M Al-Balawi
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia.
| | - Hussien Bukhamsien
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Khalid Al-Mobaireek
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Wadha Alotaibi
- King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
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21
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Children’s Interstitial and Diffuse Lung Disease. Progress and Future Horizons. Ann Am Thorac Soc 2015; 12:1451-7. [DOI: 10.1513/annalsats.201508-558ps] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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22
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Connor CJ, Shchelochkov OA, Ciliberto H. Anetoderma in a patient with terminal osseous dysplasia with pigmentary defects. Am J Med Genet A 2015; 167A:2459-62. [DOI: 10.1002/ajmg.a.37176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/10/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Cody J. Connor
- Carver College of Medicine; University of Iowa Hospitals and Clinics
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Parrini E, Mei D, Pisanti MA, Catarzi S, Pucatti D, Bianchini C, Mascalchi M, Bertini E, Morrone A, Cavaliere ML, Guerrini R. Familial periventricular nodular heterotopia, epilepsy and Melnick–Needles Syndrome caused by a singleFLNAmutation with combined gain-of-function and loss-of-function effects. J Med Genet 2015; 52:405-12. [DOI: 10.1136/jmedgenet-2014-102959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/18/2015] [Indexed: 12/12/2022]
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Diffuse Lung Disease. PEDIATRIC CHEST IMAGING 2014. [PMCID: PMC7120093 DOI: 10.1007/174_2014_1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diffuse lung disease (DLD) comprises a diverse group of disorders characterized by widespread pulmonary parenchymal pathology and impaired gas exchange. While many of these disorders are categorized under the rubric of interstitial lung disease (ILD), some of these disorders involve the airspaces or peripheral airways in addition to, or rather than, the interstitium. Some of these disorders are present primarily in infancy or early childhood, while others that are prevalent in adulthood rarely occur in childhood. This chapter will review the classification of pediatric DLD and the characteristic imaging findings of specific disorders to facilitate accurate diagnosis and guide appropriate treatment of children with these disorders.
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Meuwissen MEC, Lequin MH, Bindels-de Heus K, Bruggenwirth HT, Knapen MFCM, Dalinghaus M, de Coo R, van Bever Y, Winkelman BHJ, Mancini GMS. ACTA2 mutation with childhood cardiovascular, autonomic and brain anomalies and severe outcome. Am J Med Genet A 2013; 161A:1376-80. [PMID: 23613326 DOI: 10.1002/ajmg.a.35858] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/20/2012] [Indexed: 01/10/2023]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) are associated with connective tissue disorders like Marfan syndrome and Loeys-Dietz syndrome, caused by mutations in the fibrillin-1, the TGFβ-receptor 1- and -2 genes, the SMAD3 and TGFβ2 genes, but have also been ascribed to ACTA2 gene mutations in adults, spread throughout the gene. We report on a novel de novo c.535C>T in exon 6 leading to p.R179C aminoacid substitution in ACTA2 in a toddler girl with primary pulmonary hypertension, persistent ductus arteriosus, extensive cerebral white matter lesions, fixed dilated pupils, intestinal malrotation, and hypotonic bladder. Recently, de novo ACTA2 R179H substitutions have been associated with a similar phenotype and additional cerebral developmental defects including underdeveloped corpus callosum and vermis hypoplasia in a single patient. The patient here shows previously undescribed abnormal lobulation of the frontal lobes and position of the gyrus cinguli and rostral dysplasis of the corpus callosum; she died at the age of 3 years during surgery due to vascular fragility and rupture of the ductus arteriosus. Altogether these observations support a role of ACTA2 in brain development, especially related to the arginine at position 179. Although all previously reported patients with R179H substitution successfully underwent the same surgery at younger ages, the severe outcome of our patient warns against the devastating effects of the R179C substitution on vasculature.
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Affiliation(s)
- Marije E C Meuwissen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Lee EY. Interstitial lung disease in infants: new classification system, imaging technique, clinical presentation and imaging findings. Pediatr Radiol 2013; 43:3-13; quiz p.128-9. [PMID: 23229343 DOI: 10.1007/s00247-012-2524-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/09/2012] [Accepted: 08/11/2012] [Indexed: 12/13/2022]
Abstract
Interstitial lung disease (ILD) is defined as a rare, heterogeneous group of parenchymal lung conditions that develop primarily because of underlying developmental or genetic disorders. Affected infants typically present with clinical syndromes characterized by dyspnea, tachypnea, crackles and hypoxemia. Until recently, the understanding of ILD in infants has been limited largely owing to a lack of evidence-based information of underlying pathogenesis, natural history, imaging findings and histopathological features. However, ILD in infants is now better understood and managed because of (1) advances in imaging methods that result in rapid and accurate detection, (2) improved thoracoscopic techniques for lung biopsy, (3) a consensus regarding the pathological criteria for these particular lung conditions and (4) a new classification system based on the underlying etiology of ILD. This article reviews the new classification system, imaging technique, clinical presentation and imaging findings of ILD in infants. Specialized knowledge of this new classification system in conjunction with recognition of characteristic imaging findings of ILD in infants has great potential for early and accurate diagnosis, which in turn can lead to optimal patient management.
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Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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Sheen VL. Periventricular Heterotopia: Shuttling of Proteins through Vesicles and Actin in Cortical Development and Disease. SCIENTIFICA 2012; 2012:480129. [PMID: 24278701 PMCID: PMC3820590 DOI: 10.6064/2012/480129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 10/14/2012] [Indexed: 06/02/2023]
Abstract
During cortical development, proliferating neural progenitors exhibit polarized apical and basolateral membranes that are maintained by tightly controlled and membrane-specific vesicular trafficking pathways. Disruption of polarity through impaired delivery of proteins can alter cell fate decisions and consequent expansion of the progenitor pool, as well as impact the integrity of the neuroependymal lining. Loss of neuroependymal integrity disrupts radial glial scaffolding and alters initial neuronal migration from the ventricular zone. Vesicle trafficking is also required for maintenance of lipid and protein cycling within the leading and trailing edge of migratory neurons, as well as dendrites and synapses of mature neurons. Defects in this transport machinery disrupt neuronal identity, migration, and connectivity and give rise to a malformation of cortical development termed as periventricular heterotopia (PH). PH is characterized by a reduction in brain size, ectopic clusters of neurons localized along the lateral ventricle, and epilepsy and dyslexia. These anatomical anomalies correlate with developmental impairments in neural progenitor proliferation and specification, migration from loss of neuroependymal integrity and neuronal motility, and aberrant neuronal process extension. Genes causal for PH regulate vesicle-mediated endocytosis along an actin cytoskeletal network. This paper explores the role of these dynamic processes in cortical development and disease.
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Affiliation(s)
- Volney L. Sheen
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
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Vascular and connective tissue anomalies associated with X-linked periventricular heterotopia due to mutations in Filamin A. Eur J Hum Genet 2012; 21:494-502. [PMID: 23032111 DOI: 10.1038/ejhg.2012.209] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mutations conferring loss of function at the FLNA (encoding filamin A) locus lead to X-linked periventricular nodular heterotopia (XL-PH), with seizures constituting the most common clinical manifestation of this disorder in female heterozygotes. Vascular dilatation (mainly the aorta), joint hypermobility and variable skin findings are also associated anomalies, with some reports suggesting that this might represents a separate syndrome allelic to XL-PH, termed as Ehlers-Danlos syndrome-periventricular heterotopia variant (EDS-PH). Here, we report a cohort of 11 males and females with both hypomorphic and null mutations in FLNA that manifest a wide spectrum of connective tissue and vascular anomalies. The spectrum of cutaneous defects was broader than previously described and is inconsistent with a specific type of EDS. We also extend the range of vascular anomalies associated with XL-PH to included peripheral arterial dilatation and atresia. Based on these observations, we suggest that there is little molecular or clinical justification for considering EDS-PH as a separate entity from XL-PH, but instead propose that there is a spectrum of vascular and connective tissues anomalies associated with this condition for which all individuals with loss-of-function mutations in FLNA should be evaluated. In addition, since some patients with XL-PH can present primarily with a joint hypermobility syndrome, we propose that screening for cardiovascular manifestations should be offered to those patients when there are associated seizures or an X-linked pattern of inheritance.
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Clapham KR, Yu TW, Ganesh VS, Barry B, Chan Y, Mei D, Parrini E, Funalot B, Dupuis L, Nezarati MM, du Souich C, van Karnebeek C, Guerrini R, Walsh CA. FLNA genomic rearrangements cause periventricular nodular heterotopia. Neurology 2012; 78:269-78. [PMID: 22238415 DOI: 10.1212/wnl.0b013e31824365e4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify copy number variant (CNV) causes of periventricular nodular heterotopia (PNH) in patients for whom FLNA sequencing is negative. METHODS Screening of 35 patients from 33 pedigrees on an Affymetrix 6.0 microarray led to the identification of one individual bearing a CNV that disrupted FLNA. FLNA-disrupting CNVs were also isolated in 2 other individuals by multiplex ligation probe amplification. These 3 cases were further characterized by high-resolution oligo array comparative genomic hybridization (CGH), and the precise junctional breakpoints of the rearrangements were identified by PCR amplification and sequencing. RESULTS We report 3 cases of PNH caused by nonrecurrent genomic rearrangements that disrupt one copy of FLNA. The first individual carried a 113-kb deletion that removes all but the first exon of FLNA. A second patient harbored a complex rearrangement including a deletion of the 3' end of FLNA accompanied by a partial duplication event. A third patient bore a 39-kb deletion encompassing all of FLNA and the neighboring gene EMD. High-resolution oligo array CGH of the FLNA locus suggests distinct molecular mechanisms for each of these rearrangements, and implicates nearby low copy repeats in their pathogenesis. CONCLUSIONS These results demonstrate that FLNA is prone to pathogenic rearrangements, and highlight the importance of screening for CNVs in individuals with PNH lacking FLNA point mutations.
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Affiliation(s)
- K R Clapham
- Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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