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Ehmke N, Cusmano-Ozog K, Koenig R, Holtgrewe M, Nur B, Mihci E, Babcock H, Gonzaga-Jauregui C, Overton JD, Xiao J, Martinez AF, Muenke M, Balzer A, Jochim J, El Choubassi N, Fischer-Zirnsak B, Huber C, Kornak U, Elsea SH, Cormier-Daire V, Ferreira CR. Biallelic variants in KYNU cause a multisystemic syndrome with hand hyperphalangism. Bone 2020; 133:115219. [PMID: 31923704 PMCID: PMC10521254 DOI: 10.1016/j.bone.2019.115219] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 01/17/2023]
Abstract
Catel-Manzke syndrome is characterized by the combination of Pierre Robin sequence and radial deviation, shortening as well as clinodactyly of the index fingers, due to an accessory ossification center. Mutations in TGDS have been identified as one cause of Catel-Manzke syndrome, but cannot be found as causative in every patient with the clinical diagnosis. We performed a chromosome microarray and/or exome sequencing in three patients with hand hyperphalangism, heart defect, short stature, and mild to severe developmental delay, all of whom were initially given a clinical diagnosis of Catel-Manzke syndrome. In one patient, we detected a large deletion of exons 1-8 and the missense variant c.1282C > T (p.Arg428Trp) in KYNU (NM_003937.2), whereas homozygous missense variants in KYNU were found in the other two patients (c.989G > A (p.Arg330Gln) and c.326G > C (p.Trp109Ser)). Plasma and urine metabolomic analysis of two patients indicated a block along the tryptophan catabolic pathway and urine organic acid analysis showed excretion of xanthurenic acid. Biallelic loss-of-function mutations in KYNU were recently described as a cause of NAD deficiency with vertebral, cardiac, renal and limb defects; however, no hand hyperphalangism was described in those patients, and Catel-Manzke syndrome was not discussed as a differential diagnosis. In conclusion, we present unrelated patients identified with biallelic variants in KYNU leading to kynureninase deficiency and xanthurenic aciduria as a very likely cause of their hyperphalangism, heart defect, short stature, and developmental delay. We suggest performance of urine organic acid analysis in patients with suspected Catel-Manzke syndrome, particularly in those with cardiac or vertebral defects or without mutations in TGDS.
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Affiliation(s)
- Nadja Ehmke
- Charité - Universitätsmedizin Berlin, Institute of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, Development and Disease Group, Ihnestr. 63-73, 14195 Berlin, Germany.
| | - Kristina Cusmano-Ozog
- Biochemical Genetics and Metabolism Laboratory, Children's National Hospital, Washington, DC 20010, USA
| | - Rainer Koenig
- Department of Human Genetics, University of Frankfurt, 60590 Frankfurt, Germany
| | - Manuel Holtgrewe
- Core Unit Bioinformatics - CUBI, Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Banu Nur
- Department of Pediatric Genetics, Akdeniz University Medical School, 07059 Antalya, Turkey
| | - Ercan Mihci
- Department of Pediatric Genetics, Akdeniz University Medical School, 07059 Antalya, Turkey
| | - Holly Babcock
- Rare Disease Institute, Children's National Hospital, Washington, DC 20010, USA
| | | | - John D Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc., Tarrytown, NY 10599, USA
| | - Jing Xiao
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ariel F Martinez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Judith Jochim
- Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069 Offenbach am Main, Germany
| | - Naji El Choubassi
- Charité - Universitätsmedizin Berlin, Institute of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, Development and Disease Group, Ihnestr. 63-73, 14195 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353 Berlin, Germany
| | - Björn Fischer-Zirnsak
- Charité - Universitätsmedizin Berlin, Institute of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, Development and Disease Group, Ihnestr. 63-73, 14195 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353 Berlin, Germany
| | - Céline Huber
- Department of Genetics, INSERM UMR 1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, AP-HP, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Uwe Kornak
- Charité - Universitätsmedizin Berlin, Institute of Medical Genetics and Human Genetics, Augustenburger Platz 1, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, Development and Disease Group, Ihnestr. 63-73, 14195 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353 Berlin, Germany
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valérie Cormier-Daire
- Department of Genetics, INSERM UMR 1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, AP-HP, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Carlos R Ferreira
- Department of Pediatric Genetics, Akdeniz University Medical School, 07059 Antalya, Turkey; Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Atik A, Ozyurek S, Meric G, Sargin S, Kose O, Ulusal AE. Congenital Pseudarthrosis of Index Metacarpal Bone Treated with Distraction Osteogenesis Followed by Autologous Grafting. J Hand Microsurg 2015; 7:152-6. [PMID: 26078531 DOI: 10.1007/s12593-014-0128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/17/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Aziz Atik
- Department of Orthopaedics and Traumatology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Selahattin Ozyurek
- Department of Orthopaedics and Traumatology, Aksaz Military Hospital, 48700 Marmaris, Mugla Turkey
| | - Gokhan Meric
- Department of Orthopaedics and Traumatology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Serdar Sargin
- Department of Orthopaedics and Traumatology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ozkan Kose
- Department of Orthopaedics and Traumatology, Antalya Education and Training Hospital, Antalya, Turkey
| | - Ali Engin Ulusal
- Department of Orthopaedics and Traumatology, Balikesir University Medical Faculty, Balikesir, Turkey
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