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Damagatla M, Verma A, Pochaboina V, Bhate M, Senthil S. GAPO syndrome: a novel variant in ANTXR1 gene. Ophthalmic Genet 2024:1-6. [PMID: 38691016 DOI: 10.1080/13816810.2024.2345879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND GAPO syndrome is a rare autosomal recessive disorder characterized by the acronym of growth retardation, alopecia, pseudo-anodontia and progressive optic atrophy. While the genetic alteration of the ANTXR1 gene has been known for its cause, the full range of its clinical and genetic manifestations is not well explored due to the syndrome's extreme rarity. MATERIALS/METHODS We report two children born to a non-consanguineous parent in India with classical features of GAPO syndrome. The whole exome sequencing analysis (WES) was performed in both siblings, and the parent's genetic and clinical status was determined. The identified variation was characterized in silico using homology-based protein modelling. RESULTS In WES analysis, a homozygous ANTXR1 gene indel variant c. 151_152 + 2delAAGT (p.Lys51fs) was identified in both siblings. The parents were identified as the carriers of the ANTXR1 variant. Additionally, they also displayed mild GAPO-related facial and glaucomatous features. In silico analysis and homology-based ANTXR1 protein structure illustrate a frameshift and the subsequent premature truncation of the protein. CONCLUSIONS Our reports contribute to the comprehension of GAPO syndrome within the Indian context describing an ANTXR1 novel variant causing premature protein truncation. WES-based genetic testing can significantly aid in expertly diagnosing GAPO syndrome. In the present case scenario, a variable penetrance of ANTXR1 variation was acknowledged as the carrier parents also had a mild degree of GAPO-related features. Future reports that include parental clinical diagnosis can offer further insights in this context.
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Affiliation(s)
| | - Anshuman Verma
- Institute of Rare Eye Diseases and Ocular Genetics, LV Prasad Eye Institute, Hyderabad, India
| | - Venkatesh Pochaboina
- Institute of Rare Eye Diseases and Ocular Genetics, LV Prasad Eye Institute, Hyderabad, India
| | - Manju Bhate
- Strabismus, Paediatric and Neuro-Ophthalmology Services (MB), Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Services, LV Prasad Eye Institute, Hyderabad, India
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Balakrishnan S, Goud I, Teegala ML. Prenatal onset GAPO syndrome with a novel ANTXR1 variant in an Indian child: Expansion of the phenotype & literature review. Eur J Med Genet 2024; 68:104929. [PMID: 38423276 DOI: 10.1016/j.ejmg.2024.104929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/21/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
GAPO syndrome is a rare genetic condition caused by bi-allelic variants in ANTXR1 gene & is an abbreviation for its core features - growth retardation, alopecia, pseudo-anodontia & optic atrophy. Certain additional features involving various other systems have been reported over the years & contribute to the expanding spectrum of this evolving phenotype. We report GAPO syndrome in a 3.75 year old Indian female child, who presented with some unique features such as sagittal craniosynostosis with scaphocephaly & bilateral choroid plexus cysts, alongside the core phenotype. We also report a novel frameshift variant in our patient & offer first evidence for the prenatal onset of some features.
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Falcone MM, Chang YH, Lidov H, Stagner AM, Dagi LR. Two siblings with GAPO syndrome: Ophthalmic presentation and histopathologic findings. Ophthalmic Genet 2023; 44:598-601. [PMID: 36748830 DOI: 10.1080/13816810.2023.2175225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND GAPO syndrome (growth retardation, alopecia, pseudoanodontia, optic atrophy) is a rare, autosomal recessive connective tissue disorder with only 60 reported cases. Ophthalmic manifestations vary and include hypertelorism, optic atrophy, and glaucoma. There have been three reported cases of GAPO syndrome with craniosynostosis. MATERIALS/METHODS We describe two new siblings with GAPO syndrome and craniosynostosis and the first histopathologic analysis of Tenon's capsule and extraocular muscle in this syndrome. RESULTS Both siblings presented with papilledema and V-pattern strabismus in addition to the alopecia, brittle eyelashes, growth retardation, and pseudoanodontia that characterize GAPO syndrome. Cranial vault expansion, though successful, was complicated by lack of distinct periosteal layers, thin dural adherence to bone, and extensive venous bleeding. Tenons encountered during strabismus surgery was inelastic and highly vascular. Histopathological analysis revealed hyalinization of Tenon's and a thickened, homogenized, amorphous appearance, similar to the extracellular matrix abnormalities described in skin and other organs Histopathological analysis of extraocular muscle was, in contrast, unremarkable. CONCLUSIONS GAPO impacts the extracellular matrix of Tenon's resulting in inelasticity and hypervascularity. Ophthalmologists should be mindful of these aberrant characteristics when planning surgery in this population.
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Affiliation(s)
- Michelle M Falcone
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yoon-Hee Chang
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hart Lidov
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Puranik RS, Puranik SR, Hallur N, Venkatesh D. GAPO Syndrome—A Rare Cause of Osteomyelitis of Jaws; Report of 4 Cases With a Brief Review of the Literature. J Oral Maxillofac Surg 2018; 76:1216-1225. [DOI: 10.1016/j.joms.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
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Benetti-Pinto CL, Ferreira V, Andrade L, Yela DA, De Mello MP. GAPO syndrome: a new syndromic cause of premature ovarian insufficiency. Climacteric 2016; 19:594-598. [DOI: 10.1080/13697137.2016.1200551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. L. Benetti-Pinto
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - V. Ferreira
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - L. Andrade
- Department of Pathology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - D. A. Yela
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - M. P. De Mello
- Center of Molecular Biology and Genetic Engineering, University of Campinas, Campinas, SP, Brazil
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Zeydan B, Benbir G, Uluduz D, Ince B, Goksan B, Islak C. Arterial and venous thrombosis of the cerebral vasculature in GAPO syndrome. Am J Med Genet A 2014; 164A:1284-8. [DOI: 10.1002/ajmg.a.36440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/26/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Burcu Zeydan
- Department of Neurology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
| | - Gulcin Benbir
- Department of Neurology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
| | - Derya Uluduz
- Department of Neurology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
| | - Birsen Ince
- Department of Neurology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
| | - Baki Goksan
- Department of Neurology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
| | - Civan Islak
- Department of Radiology; Istanbul University Cerrahpasa Faculty of Medicine; Istanbul Turkey
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Bozkurt B, Yildirim MS, Okka M, Bitirgen G. GAPO syndrome: four new patients with congenital glaucoma and myelinated retinal nerve fiber layer. Am J Med Genet A 2013; 161A:829-34. [PMID: 23494824 DOI: 10.1002/ajmg.a.35734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/01/2012] [Indexed: 11/11/2022]
Abstract
This article reports on the ophthalmological features of four Turkish children with GAPO syndrome, a very rare autosomal recessive condition characterized by growth retardation (G), alopecia (A), pseudoanodontia (P) (failure of tooth eruption), and optic atrophy (O). The children were from two unrelated families born to consanguineous parents. They had the characteristic facial appearance of alopecia, rarefaction of eyebrows and eyelashes, frontal bossing, high forehead, midfacial hypoplasia, hypertelorism, and thickened eyelids and lips. Two children had severe end-stage glaucoma in both eyes and unilateral corneal opacity, whereas other two children had myelinated retinal nerve fiber layer; one with bilateral optic atrophy and the other one with persistent pupillary membrane in the left eye.
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Affiliation(s)
- Banu Bozkurt
- Selcuk University Medical Faculty, Department of Ophthalmology, Konya, Turkey.
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Sinha R, Trikha A, Laha A, Raviraj R, Kumar R. Anesthetic management of a patient with GAPO syndrome for glaucoma surgery. Paediatr Anaesth 2011; 21:910-2. [PMID: 21718384 DOI: 10.1111/j.1460-9592.2011.03550.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nanda A, Al-Ateeqi WA, Al-Khawari MA, Alsaleh QA, Anim JT. GAPO syndrome: a report of two siblings and a review of literature. Pediatr Dermatol 2010; 27:156-61. [PMID: 20537066 DOI: 10.1111/j.1525-1470.2010.01100.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Growth retardation, alopecia, pseudoanodontia, optic atrophy (GAPO) syndrome is a rare autosomal recessive disorder. The molecular nature of the disease is not fully understood and is considered to be one of the ectodermal dysplasia defects. In this report, we describe clinical, histologic, and ultrastructural features in two siblings born to consanguineous parents with a brief review of the literature.
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Affiliation(s)
- Arti Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
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Goloni-Bertollo EM, Ruiz MT, Goloni CBV, Muniz MP, Valério NI, Pavarino-Bertelli EC. GAPO syndrome: three new Brazilian cases, additional osseous manifestations, and review of the literature. Am J Med Genet A 2008; 146A:1523-9. [PMID: 18470892 DOI: 10.1002/ajmg.a.32157] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The GAPO syndrome is an extremely rare autosomal recessive disease that presents as main characteristics evident growth retardation, alopecia, pseudoanodontia, progressive optic atrophy and a typical face. Until now, only 30 patients have been reported in the medical literature (nine of them from Brazil, including the three cases described in the present article). This study describes three siblings with GAPO syndrome, two female and one male, the children of consanguineous parents (first-degree cousins, inbreeding F = 1/16), who are older than the previously described patients, presenting the characteristic phenotype besides serious bone alterations in the lower limbs, which had not yet been observed.
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Affiliation(s)
- Eny Maria Goloni-Bertollo
- Molecular Biology Department, FAMERP-São José do Rio Preto School of Medicine, São José do Rio Preto, SP, Brazil.
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da Silveira HED, Quadros OF, Dalla-Bona RR, da Silveira HLD, Fritscher GG. Dental findings in GAPO syndrome: case report. Braz Dent J 2006; 17:259-62. [PMID: 17262136 DOI: 10.1590/s0103-64402006000300016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 06/14/2006] [Indexed: 11/22/2022] Open
Abstract
This article reports the case of a young female adult with GAPO syndrome who presented as a peculiar dental finding unerupted primary and permanent dentitions, which resembled total anodontia on clinical examination. A cephalometric analysis was performed to investigate the alterations in facial bone development. This is the 9th GAPO syndrome case reported in a Brazilian patient.
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Affiliation(s)
- Heloísa Emília Dias da Silveira
- Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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