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López-Cañizares A, Fernandez MP, Al-Khersan H, Carletti P, Arroyo MS, Fernandez-Ruiz MC, Berrocal AM. Coats plus in prematurity. Ophthalmic Genet 2022; 43:543-549. [PMID: 35416114 DOI: 10.1080/13816810.2022.2051193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Coats plus syndrome or cerebroretinal microangiopathy with calcifications and cysts (CMCC) is an exceedingly rare autosomal recessive disorder that predominantly affects the microvasculature in the retina, brain, bones, and gastrointestinal system. Unlike Coats disease, CMCC is bilateral and affects multiple organ systems. MATERIALS AND METHODS Case report. RESULTS We report the case of two brothers with Coats Plus syndrome who presented with variable phenotypic expression. One sibling (Patient 1) was thought to have atypical retinopathy of prematurity and was only diagnosed with Coats plus after his older brother (Patient 2) presented with a seizure and a left upper extremity tremor at 4 years of age. The CTC1 mutation was confirmed in both patients. Aggressive treatment with laser photocoagulation and intravitreal bevacizumab dramatically improved the retinal vascular and exudative changes. CONCLUSION Coats Plus syndrome can have a variable phenotypic presentation, including retinal vascular findings. This rare genetic disease should be in the differential diagnosis in patients who present with atypical retinal pathology, including Retinopathy of Prematurity, Familial Exudative Vitreoretinopathy, or Coats disease associated with non-specific multiorgan abnormalities.
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Karremann M, Neumaier-Probst E, Schlichtenbrede F, Beier F, Brümmendorf TH, Cremer FW, Bader P, Dürken M. Revesz syndrome revisited. Orphanet J Rare Dis 2020; 15:299. [PMID: 33097095 PMCID: PMC7583287 DOI: 10.1186/s13023-020-01553-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background Revesz syndrome (RS) is an extremely rare variant of dyskeratosis congenita (DKC) with only anecdotal reports in the literature. Methods To further characterize the typical features and natural course of the disease, we screened the English literature and summarized the clinical and epidemiological features of previously published RS cases. In addition, we herein describe the first recorded patient in central Europe. Results The literature review included 18 children. Clinical features are summarized, indicating a low prevalence of the classical DKC triad. All patients experienced early bone marrow failure, in most cases within the second year of life (median age 1.5 years; 95% CI 1.4–1.6). Retinopathy occurred typically between 6 and 18 months of age (median age 1.1 years; 95% CI 0.7–1.5). The incidence of seizures was low and was present in an estimated 20% of patients. The onset of seizures was exclusively during early childhood. The Kaplan–Meier estimate of survival was dismal (median survival 6.5 years; 95% CI 3.6–9.4), and none of the patients survived beyond the age of 12 years. Stem cell transplantation (SCT) was performed in eight children, and after a median of 22 months from SCT four of these patients were alive at the last follow up visit. Conclusion RS is a severe variant of DKC with early bone marrow failure and retinopathy in all patients. Survival is dismal, but stem cell transplantation may be performed successfully and might improve prognosis in the future.
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Affiliation(s)
- Michael Karremann
- Department of Pediatrics, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Eva Neumaier-Probst
- Department of Neuroradiology, University Medical Center Mannheim, Mannheim, Germany
| | | | - Fabian Beier
- Department of Hematology and Oncology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology and Oncology, University Hospital of RWTH Aachen, Aachen, Germany
| | | | - Peter Bader
- Department of Pediatrics, Pediatric Stem Cell Transplantation, University Hospital Frankfurt, Frankfurt, Germany
| | - Matthias Dürken
- Department of Pediatrics, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Anesthetic Management of an Unusual Case of Coats' Disease Complex: Use of Dexmedetomidine. J Neurosurg Anesthesiol 2015; 28:427-8. [PMID: 26237668 DOI: 10.1097/ana.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yannuzzi NA, Tzu JH, Ko AC, Hess DJ, Cristian I, Berrocal AM. Ocular Findings and Treatment of a Young Boy With Coats’ Plus. Ophthalmic Surg Lasers Imaging Retina 2014; 45:462-5. [DOI: 10.3928/23258160-20140827-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/17/2014] [Indexed: 11/20/2022]
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Walne AJ, Bhagat T, Kirwan M, Gitiaux C, Desguerre I, Leonard N, Nogales E, Vulliamy T, Dokal IS. Mutations in the telomere capping complex in bone marrow failure and related syndromes. Haematologica 2012; 98:334-8. [PMID: 22899577 DOI: 10.3324/haematol.2012.071068] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dyskeratosis congenita and its variants have overlapping phenotypes with many disorders including Coats plus, and their underlying pathology is thought to be one of defective telomere maintenance. Recently, biallelic CTC1 mutations have been described in patients with syndromes overlapping Coats plus. CTC1, STN1 and TEN1 are part of the telomere-capping complex involved in maintaining telomeric structural integrity. Based on phenotypic overlap we screened 73 genetically uncharacterized patients with dyskeratosis congenita and related bone marrow failure syndromes for mutations in this complex. Biallelic CTC1 mutations were identified in 6 patients but none in either STN1 or TEN1. We have expanded the phenotypic spectrum associated with CTC1 mutations and report that intracranial and retinal abnormalities are not a defining feature, as well as showing that the effect of these mutations on telomere length is variable. The study also demonstrates the lack of disease-causing mutations in other components of the telomere-capping complex.
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Polvi A, Linnankivi T, Kivelä T, Herva R, Keating J, Mäkitie O, Pareyson D, Vainionpää L, Lahtinen J, Hovatta I, Pihko H, Lehesjoki AE. Mutations in CTC1, encoding the CTS telomere maintenance complex component 1, cause cerebroretinal microangiopathy with calcifications and cysts. Am J Hum Genet 2012; 90:540-9. [PMID: 22387016 PMCID: PMC3309194 DOI: 10.1016/j.ajhg.2012.02.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 01/26/2023] Open
Abstract
Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is a rare multisystem disorder characterized by extensive intracranial calcifications and cysts, leukoencephalopathy, and retinal vascular abnormalities. Additional features include poor growth, skeletal and hematological abnormalities, and recurrent gastrointestinal bleedings. Autosomal-recessive inheritance has been postulated. The pathogenesis of CRMCC is unknown, but its phenotype has key similarities with Revesz syndrome, which is caused by mutations in TINF2, a gene encoding a member of the telomere protecting shelterin complex. After a whole-exome sequencing approach in four unrelated individuals with CRMCC, we observed four recessively inherited compound heterozygous mutations in CTC1, which encodes the CTS telomere maintenance complex component 1. Sanger sequencing revealed seven more compound heterozygous mutations in eight more unrelated affected individuals. Two individuals who displayed late-onset cerebral findings, a normal fundus appearance, and no systemic findings did not have CTC1 mutations, implying that systemic findings are an important indication for CTC1 sequencing. Of the 11 mutations identified, four were missense, one was nonsense, two resulted in in-frame amino acid deletions, and four were short frameshift-creating deletions. All but two affected individuals were compound heterozygous for a missense mutation and a frameshift or nonsense mutation. No individuals with two frameshift or nonsense mutations were identified, which implies that severe disturbance of CTC1 function from both alleles might not be compatible with survival. Our preliminary functional experiments did not show evidence of severely affected telomere integrity in the affected individuals. Therefore, determining the underlying pathomechanisms associated with deficient CTC1 function will require further studies.
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Affiliation(s)
- Anne Polvi
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Molecular Medicine Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Neuroscience Center, University of Helsinki, Helsinki 00290, Finland
| | - Tarja Linnankivi
- Department of Pediatric Neurology, Children's Castle, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Tero Kivelä
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Riitta Herva
- Department of Pathology, Oulu University Hospital, Oulu 90029, Finland
| | - James P. Keating
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri 63110, USA
| | - Outi Mäkitie
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Davide Pareyson
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences, Fondazione Instituto di Ricovero e Cura a Carattere Scientifico, C. Besta Neurological Institute, Milan 20133, Italy
| | - Leena Vainionpää
- Department of Pediatrics, Oulu University Hospital, Oulu 90029, Finland
| | - Jenni Lahtinen
- Molecular Neurology Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
| | - Iiris Hovatta
- Molecular Neurology Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Helena Pihko
- Department of Pediatric Neurology, Children's Castle, Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Anna-Elina Lehesjoki
- Folkhälsan Institute of Genetics, Helsinki 00290, Finland
- Molecular Medicine Research Program, Research Programs Unit and Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00290, Finland
- Neuroscience Center, University of Helsinki, Helsinki 00290, Finland
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Toiviainen-Salo S, Linnankivi T, Saarinen A, Mäyränpää MK, Karikoski R, Mäkitie O. Cerebroretinal microangiopathy with calcifications and cysts: characterization of the skeletal phenotype. Am J Med Genet A 2011; 155A:1322-8. [PMID: 21523908 DOI: 10.1002/ajmg.a.33994] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/18/2011] [Indexed: 11/05/2022]
Abstract
Cerebral cysts and calcifications with leukoencephalopathy and retinal vascular abnormalities are diagnostic hallmarks of cerebroretinal microangiopathy with calcifications and cysts (CRMCC). Previous studies have suggested that skeletal involvement is also common, but its characteristics remain unknown. This study aimed to assess the skeletal phenotype in CRMCC. All Finnish patients with features consistent with CRMCC and for whom radiographs were available were included. Clinical information pertinent to the skeletal phenotype was collected from hospital records, and all plain radiographs were reviewed for skeletal features. Bone mineral density (BMD) was measured by DXA. In one patient, bone biopsies were obtained for bone histology and histomorphometric analyses. The LRP5 gene was analyzed for mutations by direct sequencing. Our results show that the skeletal phenotype in CRMCC includes (1) compromised longitudinal growth pre- and postnatally, (2) generalized osteopenia or early onset low turnover osteoporosis with fragility fractures, and (3) metaphyseal abnormalities that may lead to limb deformities such as short femoral neck or genua valga. DXA measurements in three patients showed low BMD, and bone biopsies in the fourth patient with pathological fractures and impaired fracture healing showed low-turnover osteoporosis, with reduced osteoclast and osteoblast activity. Direct sequencing of all LRP5 coding exons and exon-intron boundaries in six patients with CRMCC revealed no putative mutations. We conclude that the CRMCC-associated bone disease is characterized by low BMD and pathological fractures with delayed healing, metaphyseal changes, and short stature pre- and postnatally. LRP5 is not a disease-causing gene in CRMCC.
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Briggs T, Abdel-Salam G, Balicki M, Baxter P, Bertini E, Bishop N, Browne B, Chitayat D, Chong W, Eid M, Halliday W, Hughes I, Klusmann-Koy A, Kurian M, Nischal K, Rice G, Stephenson J, Surtees R, Talbot J, Tehrani N, Tolmie J, Toomes C, van der Knaap M, Crow Y. Cerebroretinal microangiopathy with calcifications and cysts (CRMCC). Am J Med Genet A 2007; 146A:182-90. [DOI: 10.1002/ajmg.a.32080] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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