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Grabala P, Kowalski P, Rudziński MJ, Polis B, Grabala M. The Surgical Management of Severe Scoliosis in Immature Patient with a Very Rare Disease Costello Syndrome-Clinical Example and Brief Literature Review. Life (Basel) 2024; 14:740. [PMID: 38929723 PMCID: PMC11204508 DOI: 10.3390/life14060740] [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: 03/26/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Costello syndrome (CS) is a rare genetic syndrome in which, due to the occurrence of a mutation in the HRAS gene on chromosome 11 that causes the manifestation, a set of features such as a characteristic appearance, many congenital defects, intellectual disability and a genetic predisposition to cancer, friendly personality, and others can be identified. CS is very rare, with an incidence of ~1/300,000, but it belongs to one of the largest groups of congenital syndromes, called RASopathies, occurring with an incidence of 1/1000 people. Scoliosis and kyphosis, as well as other spinal defects, are common, in 63% and 58% of patients, respectively, and a study conducted among adult patients showed the presence of scoliosis in 75% of patients; there may be excessive lordosis of the lumbar section and inverted curvatures of the spine (lordosis in the thoracic section and kyphosis in the lumbar section). The aim of our study is to present a case report of treatment of severe scoliosis of 130 degrees in a 14-year-old patient with Costello syndrome, with coexisting Chiari II syndrome and syrinx in the absence of skeletal maturity. This patient underwent foramen magnum decompression 3 months before planned surgical correction for severe scoliosis. The patient was qualified for surgical treatment using magnetically controlled growing rods (MCGR). After spine surgery using MCGR, we gradually performed MCGR distraction over the next 2 years; we performed the final surgery, conversion to posterior spinal fusion (PSF) with simultaneous multi-level Ponte osteotomy, which gave a very good and satisfactory surgical result. In the perioperative period, two serious complications occurred: pneumothorax caused by central catheter and gastrointestinal bleeding due to previously undiagnosed gastrointestinal varices. This case shows that the treatment of severe and neglected scoliosis is complicated and requires special preparation and a surgical plan with other cooperating specialists. The scoliosis was corrected from 130 degrees to approximately 48 degrees, sagittal balance was significantly improved, and the surgical outcome was very pleasing, significantly improving quality of life and function for the patient.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland;
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Piotr Kowalski
- Department of Neurosurgery, Regional Specialized Hospital, ul. Dekerta 1, 66-400 Gorzow Wielkopolski, Poland;
| | - Marek J. Rudziński
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland;
| | - Bartosz Polis
- Department of Neurosurgery and Neurotraumatology, Polish Mother’s Memorial Hospital Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland;
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24A, 15-276 Bialystok, Poland;
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Crincoli E, Leoni C, Viscogliosi G, Onesimo R, Mattei R, Tartaglia M, Catania F, Rizzo S, Zampino G, Salerni A. Systematic ophthalmologic evaluation in cardio-facio-cutaneous syndrome: A genotype-endophenotype correlation. Am J Med Genet A 2023; 191:2783-2792. [PMID: 37697822 DOI: 10.1002/ajmg.a.63395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
Cardio-facio-cutaneous syndrome (CFCS) is a rare genetic disorder belonging to the RASopathies, a group of developmental syndromes caused by upregulated RAS/MAPK signaling. Pathogenic variants affecting four genes, KRAS, BRAF, MAP2K1 and MAP2K2, encoding core signal transducers of the pathway, underlie the condition. Major clinical features include a distinctive facies, ectodermal and cardiac anomalies, reduced postnatal growth, intellectual disability, and musculoskeletal abnormalities. Similar to other RASopathies, reports of visual impairment, high refractive error, optic nerve pallor, and other ocular abnormalities have been anecdotally reported in the literature. The aim of our study is to report the prevalence of ophthalmologic abnormalities in a large monocentric cohort of individuals affected by CFCS and explore the occurrence of genotype-endophenotype correlations in this series of patients. We observed that BRAF mutations are associated to a higher prevalence of anisometropia >3D (11.8% vs. 0%) and high astigmatism (29.4% vs. 0%; both p < 0.001) while patients with mutations in other genes had a significantly higher prevalence of myopia >6 D (60% vs. 5.9%; p = 0.012). Pale optic disc was associated with higher prevalence of inferior oblique muscle (IO) overaction (33.3% vs. 0%) and lower prevalence of ptosis (0% vs. 11.8%; both p < 0.001). Combined exotropia, IO overaction and nystagmus were frequent in patients with pale optic nerve. Our findings might suggest the need for earlier ophthalmologic referral for CFCS patients due to high risk of amblyopia, especially those expressing BRAF mutations.
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Affiliation(s)
- Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberta Mattei
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Fiammetta Catania
- Department of Ophthalmology, Hopital Fondation Adolphe De Rothschild, Paris, France
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze", Pisa, Italy
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defect, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annabella Salerni
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
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Metivier E, Prasad M, Prasad C. Neonatal hyperinsulinism-broadening the differential diagnosis. Paediatr Child Health 2023; 28:67-68. [PMID: 37151925 PMCID: PMC10156923 DOI: 10.1093/pch/pxac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/04/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Emma Metivier
- Western University Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Madhavi Prasad
- Western University Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Chitra Prasad
- Western University Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
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Kontaridis MI, Roberts AE, Schill L, Schoyer L, Stronach B, Andelfinger G, Aoki Y, Axelrad ME, Bakker A, Bennett AM, Broniscer A, Castel P, Chang CA, Cyganek L, Das TK, den Hertog J, Galperin E, Garg S, Gelb BD, Gordon K, Green T, Gripp KW, Itkin M, Kiuru M, Korf BR, Livingstone JR, López‐Juárez A, Magoulas PL, Mansour S, Milner T, Parker E, Pierpont EI, Plouffe K, Rauen KA, Shankar SP, Smith SB, Stevenson DA, Tartaglia M, Van R, Wagner ME, Ware SM, Zenker M. The seventh international RASopathies symposium: Pathways to a cure-expanding knowledge, enhancing research, and therapeutic discovery. Am J Med Genet A 2022; 188:1915-1927. [PMID: 35266292 PMCID: PMC9117434 DOI: 10.1002/ajmg.a.62716] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 12/15/2022]
Abstract
RASopathies are a group of genetic disorders that are caused by genes that affect the canonical Ras/mitogen-activated protein kinase (MAPK) signaling pathway. Despite tremendous progress in understanding the molecular consequences of these genetic anomalies, little movement has been made in translating these findings to the clinic. This year, the seventh International RASopathies Symposium focused on expanding the research knowledge that we have gained over the years to enhance new discoveries in the field, ones that we hope can lead to effective therapeutic treatments. Indeed, for the first time, research efforts are finally being translated to the clinic, with compassionate use of Ras/MAPK pathway inhibitors for the treatment of RASopathies. This biannual meeting, organized by the RASopathies Network, brought together basic scientists, clinicians, clinician scientists, patients, advocates, and their families, as well as representatives from pharmaceutical companies and the National Institutes of Health. A history of RASopathy gene discovery, identification of new disease genes, and the latest research, both at the bench and in the clinic, were discussed.
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Affiliation(s)
- Maria I. Kontaridis
- Department of Biomedical Research and Translational MedicineMasonic Medical Research InstituteUticaNew YorkUSA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
- Department of Biological Chemistry and Molecular PharmacologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Amy E. Roberts
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
- Division of Genetics, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
| | - Lisa Schill
- RASopathies Network USAAltadenaCaliforniaUSA
| | | | | | - Gregor Andelfinger
- Cardiovascular Genetics, Department of Pediatrics, Centre Hospitalier Universitaire Saint‐Justine Research CentreUniversité de MontréalMontréalCanada
| | - Yoko Aoki
- Department of Medical GeneticsTohoku University School of MedicineSendaiJapan
| | - Marni E. Axelrad
- Section of Psychology, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
| | | | - Anton M. Bennett
- Yale Center for Molecular and Systems MetabolismYale University School of MedicineNew HavenConnecticutUSA
| | - Alberto Broniscer
- Division of Hematology‐OncologyUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Pau Castel
- Department of Biochemistry and Molecular PharmacologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Caitlin A. Chang
- Department of Medical GeneticsBC Women and Children's HospitalVancouverBritish ColumbiaCanada
| | - Lukas Cyganek
- Stem Cell Unit, Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Tirtha K. Das
- Department of Cell, Developmental, and Regenerative BiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jeroen den Hertog
- Hubrecht Institute‐KNAW and University Medical Center UtrechtUtrechtThe Netherlands
- Institute Biology LeidenLeiden UniversityLeidenThe Netherlands
| | - Emilia Galperin
- Department of Molecular and Cellular BiochemistryUniversity of KentuckyLexingtonKentuckyUSA
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences CentreUniversity of Manchester & Child & Adolescent Mental Health ServicesManchesterUK
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and the Departments of Pediatrics and Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kristiana Gordon
- Lymphovascular Medicine, Dermatology DepartmentSt. George's UniversityLondonUK
| | - Tamar Green
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Karen W. Gripp
- Department of GeneticsAI duPont Hospital for ChildrenWilmingtonDelawareUSA
| | - Maxim Itkin
- Center for Lymphatic Disorders, Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Maija Kiuru
- Department of Dermatology, Department of Pathology & Laboratory MedicineUniversity of California DavisSacramentoCaliforniaUSA
| | - Bruce R. Korf
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Alejandro López‐Juárez
- Department of Health and Biomedical SciencesUniversity of Texas Rio Grande ValleyTexasUSA
| | - Pilar L. Magoulas
- Department of Molecular and Human Genetics, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Sahar Mansour
- Molecular and Clinical Sciences InstituteSt George's UniversityLondonUK
- South West Thames Regional Genetics ServiceSt George's NHS Foundation TrustLondonUK
| | | | | | - Elizabeth I. Pierpont
- Division of Clinical Behavioral Neuroscience, Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Katherine A. Rauen
- Department of Pediatrics, Division of Genomic Medicine, MIND InstituteUniversity of California DavisSacramentoCaliforniaUSA
| | - Suma P. Shankar
- Department of Pediatrics, Division of Genomic Medicine, MIND InstituteUniversity of California DavisSacramentoCaliforniaUSA
- Department of Ophthalmology and Vision Science, School of MedicineUniversity of California DavisSacramentoCaliforniaUSA
| | | | - David A. Stevenson
- Department of Pediatrics, Division of Medical GeneticsStanford UniversityStanfordCaliforniaUSA
| | - Marco Tartaglia
- Genetics and Rare Diseases Research DivisionOspedale Pediatrico Bambino Gesù, IRCCSRomeItaly
| | - Richard Van
- Helen Diller Family Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Morgan E. Wagner
- NCI RAS Initiative, Cancer Research Technology ProgramFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | - Stephanie M. Ware
- Department of Pediatrics, Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Martin Zenker
- Institute of Human Genetics, University HospitalOtto‐von‐Guericke UniversityMagdeburgGermany
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Leoni C, Viscogliosi G, Tartaglia M, Aoki Y, Zampino G. Multidisciplinary Management of Costello Syndrome: Current Perspectives. J Multidiscip Healthc 2022; 15:1277-1296. [PMID: 35677617 PMCID: PMC9169840 DOI: 10.2147/jmdh.s291757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/10/2022] [Indexed: 01/09/2023] Open
Abstract
Costello syndrome (CS) is a rare neurodevelopmental disorder caused by germline mutations in HRAS. It belongs among the RASopathies, a group of syndromes characterized by alterations in components of the RAS/MAPK signaling pathway and sharing overlapping phenotypes. Its typical features include a distinctive facial appearance, growth delay, intellectual disability, ectodermal, cardiac, and musculoskeletal abnormalities, and cancer predisposition. Due to the several comorbidities having a strong impact on the quality of life, a multidisciplinary team is essential in the management of such a condition from infancy to adult age, to promptly address any detected issue and to develop appropriate personalized follow-up protocols and treatment strategies. With the present paper we aim to highlight the core and ancillary medical disciplines involved in managing the health challenges characterizing CS from pediatric to adult age, according to literature and to our large clinical experience.
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Affiliation(s)
- Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Correspondence: Chiara Leoni, Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Gemelli 8, Rome, IT-00168, Italy, Tel +39-063381344, Fax +39-063383211, Email
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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